Does online physiotherapy work?
For some problems, the evidence says yes. A 2024 trial in adults with knee osteoarthritis found video physiotherapy was non-inferior to in-person care for pain and function, and a review of musculoskeletal studies found live video care appears comparable. That does not cover every condition, so we check suitability before you start.
What a major knee trial found
One key piece of evidence is the PEAK trial, published in The Lancet in 2024. It enrolled 394 adults with chronic knee pain consistent with osteoarthritis, recruited from 27 clinics in Australia. About half had in-person consultations and about half had video consultations with a physiotherapist.
Both groups had five consultations over three months, covering strengthening exercise, physical activity and education. The researchers measured knee pain and physical function at three months. They concluded that video physiotherapy was non-inferior to in-person care for both pain and function, which means it did not do meaningfully worse.
The study also looked at safety. Adverse events were similar between the groups, and none were serious.
What the trial does not tell us
PEAK studied adults with knee osteoarthritis, in Australia. It does not tell us that video care works equally well for every condition, every person or every stage of recovery, and we do not claim that it does.
We use it as one good piece of evidence for a common problem, not as proof for everything. PEAK studied knee osteoarthritis, not knee pain in general. If that is your problem, our musculoskeletal physiotherapy service is the closest match to what was tested.
What a wider review found
A 2017 systematic review in Clinical Rehabilitation pulled together 13 studies with 1,520 people in total. It looked at real-time telerehabilitation for musculoskeletal conditions, such as joint and muscle problems, and found it appears effective and comparable to conventional delivery for physical function and pain.
In that review, treatment given only by telerehabilitation was equivalent to face-to-face care for physical function. Pain improvement was comparable between groups.
There is a caveat. The studies were few and varied a lot from one to the next. So the honest summary is that live video care appears comparable for musculoskeletal problems, not that it is proven to be.
What UK professional guidance says
The Chartered Society of Physiotherapy supports a personalised, flexible mix of remote and in-person physiotherapy. It also says a mix works because remote care will not suit everyone, and in-person care is sometimes the better choice.
NHS England's guide to remote consultations in adult musculoskeletal physiotherapy describes remote care as suitable for people who do not need an in-person physical examination, or who have less complex problems. It says that where diagnostic tests might be needed, suitability should be carefully considered.
In other words, the question is not whether online or in-person is better in general. It is which suits you and your problem.
Who online physiotherapy tends to suit
The guidance supports remote care for people who do not need an in-person physical examination or who have less complex problems. In our own approach, that usually means people whose main need is assessment, explanation and a progressive exercise plan, and who can set up a safe space at home to move in. See how online physiotherapy works for what a session involves.
In our sessions you go through the exercises in your own home, with a physiotherapist watching and correcting your technique.
Who may need in-person care instead
Some problems need to be seen and handled in person. That includes red-flag symptoms, suspected fractures, recent serious injury, and problems where hands-on treatment is the main thing needed. Our guide to what online physiotherapy cannot do goes through each of these and what to do instead.
If you are unsure how to read a symptom, the NHS pages for your problem list the signs that need urgent help. For anything that feels like an emergency, call 999 or go to A&E rather than booking an appointment.
How we decide at triage
Before we treat anyone, we ask about your symptoms, your history and your goals, and check whether video care is suitable. In our service, if something suggests you need a different route, we tell you plainly and point you to your GP, urgent care or an in-person clinician instead of keeping you in an online plan that is not the right fit.
That approach matches CSP guidance that safe remote services need good triage and a way to refer people for in-person assessment when they need it. You can see our assessment and pricing before you decide to book, and you can book an appointment when you are ready.
Common questions
Is online physio as good as in person?
For knee osteoarthritis, one large trial found video care non-inferior to in-person care for pain and function. A review of musculoskeletal studies found live video care appears comparable. This does not apply to every condition, so suitability is checked first.
Does online physiotherapy work for back pain or shoulder pain?
The trial we cite was in knee osteoarthritis only. The wider review covered musculoskeletal conditions in general and found video care appears comparable. We assess your individual problem and tell you if video is not suitable.
Is video physiotherapy safe?
In the PEAK trial, adverse events were similar between video and in-person groups, and none were serious. Safe remote care also needs good triage and clear routes to in-person help, which is how we work.
Will I be told if I need to be seen in person?
Yes. If triage or your assessment suggests video is not right for you, we say so plainly and point you towards your GP, urgent care or an in-person clinician.
This information is general and not a substitute for an assessment. Don't start a new exercise programme without advice from a physiotherapist or doctor who knows your condition. If an exercise causes pain that doesn't settle, stop and seek advice.
Sources
- Hinman et al, The Lancet 2024: PEAK telerehabilitation vs in-person trial (Europe PMC)
- Cottrell et al, Clinical Rehabilitation 2017: telerehabilitation for musculoskeletal conditions (Europe PMC)
- CSP: remote consultations guidance for your practice
- NHS England: guide to adopting remote consultations in adult MSK physiotherapy services
Related
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