Rising demand for physiotherapy services suggests the need for strategies which delegate greater responsibility to patients for their own care. The transfer of self-treatment knowledge and skills by face-to-face instruction or in writing have both practical and theoretical disadvantages when compared with instructional videotapes for use by patients at home. Advice and exercise instruction on videotape has not been formally evaluated in clinical practice. The present study compared the effectiveness of videotape with face-to-face instruction for two common musculoskeletal conditions. Primary care patients referred to physiotherapy were randomly assigned to one of three types of instruction. Two of the groups were provided with instructional videotapes -- one featuring the treating physiotherapist, the other an anonymous physiotherapist; the third group was instructed using traditional face-to-face methods. Outcomes were assessed at 4 to 6 weeks using a range of measures. Patients in the videotape groups were prescribed more exercises and were more skilled in performing them than were the face-to-face group. However, in terms of clinical progress, instruction by videotape was no more effective than face-to-face. Videotaped instruction proved popular and appeared to help motivate patients to continue self-treatment but produced no detectable saving in physiotherapist time in consultation.

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