Your location shouldn’t affect your ability to participate in a physical therapy program. To address the burden of long travel distances to physical therapy for older adults with knee osteoarthritis living in rural areas, a team of University of Pittsburgh researchers, led by Assistant Professor Allyn Bove, PhD, PT, DPT, conducted a pilot feasibility study of a novel hybrid in-person and telerehabilitation program called the Rural Access to PT for Osteoarthritic Rehabilitation (RAPTOR). This study was found to be safe and feasible, demonstrated promising improvements in physical function, and was well-received by program participants and health practitioners.

Although residents of rural areas experience greater knee osteoarthritis-related disability, there are low rates of physical therapy referrals in rural areas. Addressing this geographic distance is vital to prevent knee osteoarthritis in those living in rural areas from worsening and avoiding any unneeded prescription of opioid medications.

When discussing the importance of the RAPTOR study, Dr. Bove shared, “Although there are some excellent rehabilitation providers and clinics in the [study] area, for some folks they are a 40-minutes or more drive from their homes. Traveling that far to see a physical therapist multiple times a week just isn’t feasible for people who work long hours, have children or other family to take care of, etc.”

Knee osteoarthritis occurs when the natural cushioning and shock-absorbing properties of the cartilage wear away due to use, age, genetics, and other factors. This results in the bones of the knee rubbing together most closely, causing pain, swelling, stiffness, and, in some cases, making it harder to walk.

“I Felt I Was Able to Express Myself Effectively”

Overall, the University of Pittsburgh researchers found that participants reported high satisfaction with telerehabilitation. Participants shared statements such as, “I felt I was able to express myself effectively,” and “I feel comfortable communicating with the clinician using the telehealth system.” On the other hand, participants who had lower satisfaction shared statements such as, “I think the visits provided over the telehealth system are the same as in-person visits.

Of the 20 participants, most (13 of 16) who completed the program demonstrated clinically important improvement in patient-reported function. More than half of the participants demonstrated clinically significant improvement across the performance-based function tests. This pilot study, which was found to be safe and feasible, provides a foundation for future testing in a comparative trial.

This work is described in the publication titled “Rural Access to Physical Therapy for Osteoarthritis Rehabilitation (RAPTOR): A Pilot Feasibility Study”, which was published in October 2025 in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) Open by researchers in the University of Pittsburgh School of Health and Rehabilitation Sciences in the Department of Physical Therapy and Department of Health Informatics along with the University of Pittsburgh Medical Center Rehabilitation Institute.

*Photo:* *Centre for Ageing Better/Unsplash*

A Mixture of In-Person and Online Clinical Care

To increase access to physical therapy in rural areas, the RAPTOR program provided 10 physical therapy visits, two in person and eight via telerehabilitation, to participants with knee osteoarthritis.

The initial visit was in-person and included an assessment with the physical therapist, initial evaluation, and initial teaching of the home exercise program, and instruction on use of the telerehabilitation app. The next eight visits were conducted via telerehabilitation by the physical therapist and focused on tailored therapeutic exercises and education for participants. The 10th visit was in-person and included closing assessments and the sharing of a final home exercise plan for participants.

Taking Next Steps Towards Hybrid Physical Therapy

This pilot feasibility study, a single-arm study in which all participants received the same treatment, provides initial proof of concept and a foundation for the design of more comprehensive studies, such as exploring increased patient numbers, expanded treatment areas, more extensive follow-up, and different health and telehealth platforms.

To increase the use of telerehabilitation physical therapy programs, several important considerations must be addressed, such as reliable internet access and permanent policies that allow reimbursement. For example, in the RAPTOR study, a quarter of participants reported receiving help from a family member to set up or log into telerehabilitation visits. All issues were resolved and did not impact the completion of sessions. To support the potential benefits, in 2024, the American Physical Therapy Association published guidelines for clinical practice.

Dr. Bove shared, “It’s especially important to study this in rural areas, where it’s more likely that patients may have limitations in wireless service and broadband access, so there may be more technological challenges that need to be addressed in order to provide high-quality telerehabilitation services.”

The RAPTOR program and its initial success highlight the benefits of telerehabilitation, which include convenience, no transportation barriers, and reduced time commitment due to lack of commute. Additionally, this hybrid approach maintains the associated benefits of in-person rehabilitation, such as strong patient-provider therapeutic relationships, the ability to perform hands-on assessments and interventions, and the use of equipment not found at home.

The UPitt authors' next steps include undertaking a comparative trial of RAPTOR versus usual medical care and/or usual in-person PT among rural adults with osteoarthritis. Overall, centering this work on older adults with knee osteoarthritis to ensure safety and providing the same level of care is a top priority for physical therapists.

References:

Bove, A. M., Zavacky, E. N., Zeleznik, H., Bise, C. G., Patterson, C. G., Parmanto, B., & Fitzgerald, G. K. (2025). Rural Access to Physical Therapy for Osteoarthritis Rehabilitation (RAPTOR): A Pilot Feasibility Study. Journal of Orthopaedic & Sports Physical Therapy, Advance publication, 1-19. https://www.jospt.org/doi/10.2519/josptopen.2025.0167

Khoja, S. S., Almeida, G. J., & Freburger, J. K. (2020). Recommendation Rates for Physical Therapy, Lifestyle Counseling, and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings: A Cross-Sectional Analysis of the National Ambulatory Care Survey (2007-2015). Arthritis care & research, 72(2), 184-192. https://doi.org/10.1002/acr.24064

Khoja, S. S., Stevans, J. M., Almeida, G. J., Smith, C., & Freburger, J. K. (2025). Physician Referral Patterns to Physical Therapists for Managing Knee Osteoarthritis: A Retrospective Analysis of Electronic Health Records from an Integrated Health System. Arthritis care & research. 10.1002/acr.25630. Advance online publication. https://doi.org/10.1002/acr.25630

Lee, A. C., Deutsch, J. E., Holdsworth, L., Kaplan, S. L., Kosakowski, H., Latz, R., Lennox McNeary, L., O’Neil, J., Ronzio, O., Sanders, K., Sigmund-Gaines, M., Wiley, M., & Russell, T. (2024). Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association. Physical therapy. 104(5), pzae045. https://pubmed.ncbi.nlm.nih.gov/38513257/. Erratum in: Phys Ther. 2024 Jun 4;104(6):pzae077. doi: 10.1093/ptj/pzae077. PMID: 38513257; PMCID: PMC11140266.

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