Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

Abstract

BackgroundIn addition to traditional physiotherapy, studies based on telerehabilitation programs have published the results of effectiveness, validity, noninferiority, and important advantages in some neurological, cognitive, and musculoskeletal disorders, providing an opportunity to define new social policies and interventions.ObjectivesThe aim of this systematic review is to investigate the effects of telerehabilitation after surgical procedures on orthopedic conditions as well as to describe how interventions are designed and to determine whether telerehabilitation is comparable with conventional methods of delivery. This systematic review summarizes the levels of evidence and grades of recommendation regarding telerehabilitation intervention (synchronous or asynchronous provided via the telerehabilitation medium, either in conjunction with, or in isolation of, other treatment interventions) after surgical procedures on orthopedic conditions.MethodsStudy quality was assessed using the Physiotherapy Evidence Database (PEDro) scores and grade of recommendation following the recommendation of the Oxford Centre for Evidence-Based Medicine.ResultsWe found 3 studies with PEDro scores between 6 and 8, which is considered as level 1 evidence (good; 20% [3/15]), 4 studies with a score of 5, which is considered as level 2 evidence (acceptable; 27% [4/15]), and the remaining 8 studies had scores of 4 or less, which is considered (poor; 53% [8/15]). A total of 1316 participants received telerehabilitation intervention in the selected studies, where knee and hip replacement were 75% of all the studies. Strong and moderate grades of evidence (grade of recommendation A–B) were found in knee and hip replacement interventions. Studies on the upper limb were 25% of the studies, but only 1 study presented a moderate grade of evidence (grade of recommendation B) and the rest were of poor methodological quality with weak evidence (grade of recommendation C).ConclusionsConclusive evidence on the efficacy of telerehabilitation for treatment after an orthopedic surgery, regardless of pathology, was not obtained. We found strong evidence in favor of telerehabilitation in patients following total knee and hip arthroplasty and limited evidence in the upper limb interventions (moderate and weak evidence). Future research needs to be more extensive and conclusive. To the best of the authors’ knowledge, this is the first attempt at evaluating the quality of telerehabilitation intervention research after surgical procedures on orthopedic conditions in a systematic review. Clinical messages and future research recommendations are included in the review.

Planning for a Safe Discharge: More Than a Capacity Evaluation

“…Enhanced patient and family education at the time of discharge via video, pictorials, or pharmacist visits is also effective in improving patient satisfaction and knowledge . There is emerging evidence that telehealth may enhance access to care and improve the patient experience . Nurse‐led postdischarge telephone calls have also been shown to improve patient satisfaction and follow‐up appointment attendance .…”

Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders

“…Other studies have looked at telehealth in follow‐up after joint arthroplasty and following fractures and found that overall home telehealth is at least as effective as usual care . A systematic review of telehealth for physiotherapy after orthopedic surgery found “strong evidence in favor of telehealth in patients following total knee and hip arthroplasty.”…”

“…One such limitation is the lack of ability to blind both study subjects and providers to the intervention. In addition, it has been suggested that there may be bias in the telehealth groups due to more frequent contact with the therapists and team in comparison with usual care . Despite these challenges, future outcome studies should focus on access, quality of care, cost, prevention of readmission and morbidity/mortality, functional outcomes with standardized measures, and satisfaction of the patient and the provider.…”

Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial (Preprint)

“…Orthopaedic surgeries are experiencing some of the greatest growth rates in developed nations across the world [4]. Decentralising orthopaedic outpatient consultations is of special interest, when a large number of patients live in remote areas, many of whom are not able to use public transport, or they need assistance by accompanying persons.…”

“…It has been reported that teleorthopaedics in an outpatient setting is safe and without serious adverse events [13], that it has increased patient satisfaction [14,15] reduced travels and saved time for the patients [16,17] and reduced costs [18]. Teleorthopaedics can also improve the effectiveness of rehabilitation after orthopaedic surgery [4]. A study of paediatric orthopaedic patients found that even greater benefit can be obtained from telemedicine consultation for patients with a disability where the cost and inconvenience of patient transport is considerably increased [19].…”