Tele-Rehabilitation Versus Exercise Booklet for Knee Osteoarthritis: A Randomized Trial on Patient-Reported and Clinically Meaningful Outcomes

Background: Knee osteoarthritis (OA) is a cause of pain and functional limitation. Exercise-based rehabilitation is recommended, yet access to supervised physiotherapy is often limited. This randomized controlled trial compared telerehabilitation with a booklet-based home exercise program and explored explanatory variables of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function. Methods: In this single-centre randomized controlled trial, 118 patients with confirmed knee OA (Kellgren–Lawrence grades 1–3) were randomly allocated to a telerehabilitation group (TG; n = 57) or a booklet-based group (BBG; n = 61). Both groups performed the same exercise program three times per week for 12 weeks and differed only in delivery mode and supervision. The primary outcome was WOMAC physical function. Secondary outcomes included WOMAC pain and stiffness, pain intensity (Numerical Rating Scale - NRS), and knee range of motion. Multiple linear regression analyses identified explanatory variables of WOMAC domains. Results: Both interventions overall improved pain and WOMAC outcomes. Telerehabilitation was associated with greater and clinically meaningful improvement in WOMAC physical function compared with the booklet program. Across both groups, baseline pain intensity showed the strongest association with WOMAC pain, stiffness, and physical function. In the BBG, functional outcomes were pain-driven, whereas in the TG, physical function was less related to pain intensity and more closely associated with body composition. Changes in knee range of motion were not consistently associated with patient-reported outcomes. Conclusions: Both telerehabilitation and booklet-based exercise improve pain and knee-related symptoms in knee OA; however, telerehabilitation provides additional meaningful functional benefits, supporting it as an effective and scalable rehabilitation approach.