What motivated you to investigate not just the effectiveness of telerehabilitation but what people with knee pain actually value in these consultations? 

When designing an optimal health intervention, knowing the cost-effectiveness is important. 

Equally important is knowing what people value. An earlier study found that the use of telerehabilitation was non-inferior to in-person consultations and cost-effective. 

It was therefore important to understand the type of telerehabilitation service people value because it helps determine what service they are more likely to use and what they would be willing to pay for it. 

A service that is cost-effective but does not account for patient needs is likely to have a low uptake rate. 

Your study showed that patients were generally willing to pay more for in-person physiotherapy. What do you think drives this preference? 

Patients preferring in-person physiotherapy is not a surprising finding. 

A personal connection to the healthcare provider has generally been found to be important for most patients. 

Studies on preferences for telehealth more broadly or on the use of AI in healthcare have shown that there is a general preference to have human doctors directly involved in a patient’s care. 

This could be in the form of an initial in-person consultation with the healthcare practitioner before a move to telehealth or a mix of both types of services. 

In the case of physiotherapy, there could be an underlying assumption that an in-person consultation will enable any physical manipulation required even when this is not necessarily needed. 

Around 40 per cent of participants said they would choose telerehabilitation if it offered shorter travel and waiting times, more communication or a lower fee. What does this tell us about how services should be designed? 

Telerehabilitation services are likely to be useful in areas where access to a physiotherapist for an in-person consultation is limited. 

This includes remote to very remote areas with a scarcity of physiotherapists. 

This does not mean, however, that such services will not be useful in urban areas. 

In any location where travel to a physiotherapist is a time-consuming activity, having recourse to telerehabilitation can be very beneficial. 

Waiting times are also quite important in determining access to healthcare. 

This is especially true for parents and workers with limited time availability. 

It is not surprising that costs are an important determinant of telerehabilitation adoption by patients. 

Given the general underlying preference for in-person consultations, offering telerehabilitation at the same price as an in-person consultation without gains in other areas such as travel or waiting time will not lead to an uptake of such services. 

We found that telerehabilitation uptake rates were roughly 32 per cent when both services were offered at the same price. 

When telerehabilitation was offered at half the price of inperson services, the uptake rate increased to about 50 per cent. 

Younger people, women, those not working and people confident with videoconferencing were more likely to prefer telerehabilitation. How should this shape the way services are targeted? 

There is likely to be an interaction between these factors. 

Young people have been exposed to various forms of digital communication from an early age and are therefore more likely to be confident in using telerehabilitation services. Younger women may also be less likely to be working full-time. 

Looking ahead, how can insights from willingness-topay studies like this guide the rollout and funding of telerehabilitation in Australia and internationally? 

Embedding discrete choice experiments and other forms of willingness-to-pay studies within clinical trials and other economic evaluations will help indicate which services patients are likely to use. 

This in turn assists us to incorporate patient perspectives and preferences when designing telerehabilitation programs and to identify prices at which uptake is likely to be high. 

>>Dr Maame Esi Woode is a senior research fellow at the Centre for Health Economics, Monash University. Her research focuses on factors that shape individual preferences for healthcare and the economic evaluation of healthcare interventions. She has a particular interest in digital health and the integration of artificial intelligence within healthcare. 

>>Dr Belinda J Lawford is a musculoskeletal researcher, Dame Kate Campbell Fellow and CR Roper Fellow at the Centre for Health, Exercise and Sports Medicine, University of Melbourne. Her research focuses on treatment strategies for people with osteoarthritis, particularly telehealth-delivered care, exercise and weight loss. 

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