Table 2.

Patient barriers associated with implementation of, and engagement with, virtual care for knee osteoarthritis and potential solutions

Barrier	Potential solutions
Reduced sense of rapport with clinician	Prioritise videoconferencing over telephone for synchronous consultations to enable visual as well as verbal contact Consider asynchronous clinician check-in/follow-up with patients who have been recommended self-directed web- or app-based self-management programs Consider a blended approach to care (e.g. combining in-person and virtual care, synchronous clinician telehealth consultations with web-/app-based self-directed programs), where necessary
Perception that intervention is not individualised	Consider a blended approach to care — for example, an in-person visit first for thorough assessment — before implementing virtual intervention strategies Consider use of electronic patient-reported outcome measures and functional performance-based measures (synchronous or asynchronous via video recording) which can be administered/observed remotely Combine generic/less individualised online programs with individualised/more personal advice for home-based self-management
Technological difficulties/failures	Ensure clinician has optimal software and hardware for virtual consultations to minimise disruptions at the clinician end Educate patients how to optimise their internet speed/connection at home and set up their environment for optimal audio/video during consultations Provide clear instructions to the patient on how to set up and use the chosen virtual platform/application Clinician should be familiar with trouble-shooting solutions to assist the patient during synchronous virtual consultations
Mismatch between expectations and actual intervention	Educate patients about what specific virtual tools can and cannot offer them Ensure patient has choice in their treatment plans and provide adequate information about the advantages and disadvantages about all in-person and virtual treatment options so that they can make an informed decision
Reduced digital literacy	Determine patient confidence and competence with using the selected virtual tool prior to recommending it Encourage family member/carer support/assistance where feasible Follow-up with the patient to monitor engagement/use of recommended virtual tools and adjust treatment plans when necessary
Privacy and data security concerns	Ensure all patient and clinician devices used for virtual care have up-to-date and high-quality anti-virus protection and use firewalls Ensure Wi-Fi networks used for virtual care are secure and password-protected using strong passwords Only use/recommend mobile apps that are developed from credible organisations and that are available from reputable app stores (e.g. Google play, Apple’s App Store)
Concerns about trustworthiness of online information	Recommend and encourage use of high-quality websites, preferably those with Health on the Net code (HONcode) certification and from academic/non-profit sources