Expanding Role of Technology in Rehabilitation After Lower-Extremity Joint Replacement

Abstract

Background:The effectiveness of telehealth programs in the administration of rehabilitation and the monitoring of postoperative progress after joint replacement is not well studied. The purpose of the present study was to systematically review the currently available evidence on the use of smart-device technology and telehealth programs to guide and monitor postoperative rehabilitation following total joint arthroplasty and to assess their impact on outcomes following surgery.Methods:A literature search of the MEDLINE database was performed using keywords “mobile,” “app,” “telehealth,” “virtual,” “arthroplasty,” “outcomes,” “joint replacement,” “web based,” “telemedicine,” “TKA,” “THA,” “activity tracker,” “fitness tracker,” “monitor,” “rehab,” “online,” and “stepcounter” in all possible combinations. All English studies with a level of evidence of I to III that were published from January 1, 2010, to December 19, 2020 were considered for inclusion. Quantitative and qualitative analysis was performed on the data collected.Results:A total of 28 articles meeting the inclusion criteria were identified and reviewed. With regard to objective functional outcome measures, such as strength, range of motion, or results of the Timed Up and Go (TUG) test, the virtual physical therapy group had equivalent or slightly superior outcomes compared with in-person physical therapy. There was similar improvement overall in patient-reported outcome measures (PROMs) and patient satisfaction between virtual and in-person physical therapy. Virtual physical therapy resulted in cost savings ranging from $206 to $4,100 per patient compared with in-person physical therapy.Conclusions:Telerehabilitation following lower-extremity joint replacement is less expensive compared with in-person physical therapy, with equivalent outcomes and patient satisfaction. Telerehabilitation and electronic health adjuncts can be used to substitute for traditional rehabilitation and augment postoperative care following total joint arthroplasty, respectively. Telerehabilitation that provides outcomes equivalent to in-person physical therapy not only increases convenience for patients but also decreases the cost burden on the health-care system.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Self-Reported Outcomes in Early Postoperative Management After Shoulder Surgery Using a Home-Based Strengthening and Stabilization System With Telehealth

“…Telerehabilitation in physical therapy has been shown to be effective for both nonorthopaedic conditions and orthopaedic conditions, such as osteoarthritis, low back pain, and total joint replacement. 19,20,23 High rates of patient satisfaction were seen with the use of SSS with VCS in the current study, with 98% of patients responding positively to the impact of telehealth on the experience with SSS. Given a less than 100% rate in patient satisfaction, it stands to reason that SSS is not the optimal early postoperative rehabilitation modality for every patient.…”

“…3 Moreover, patient satisfaction rates and functional outcomes have been shown to be similar with telerehabilitation when compared with traditional inperson rehabilitation. 8,19,20 Benefits of telemedicine in physical therapy rehabilitation include decreased patient travel, lower coronavirus exposure risk, less wait time burden, and greater patient convenience, 14 all of which may lead to higher adherence rates. The majority of patients continued to use SSS during rehabilitation at 6 weeks postoperatively, indicating that the SSS device and protocols were tolerated by patients during the early postoperative period.…”

Gender and outcomes in total joint arthroplasty: a systematic review on healthcare disparities in the United States

“…This search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement 6. The authors used the same methodology employed in previous studies of technology utilization in joint replacement7 and outcomes by gender in joint replacement 8. All possible combinations of the following keywords were used for the search: “healthcare disparities,” “hip arthroplasty,” “knee arthroplasty,” “hip replacement,” “knee replacement,” “total joint arthroplasty,” “joint replacement,” “THA,” “TKA,” “outcomes,” “social determinants,” “gender,” “inequities,” “inequality,” “bias,” “utilization rate,” “demographic factors,” and “sex.” The literature search was limited to studies published in the last 20 yr from February 14, 2001, to February 14, 2021.…”

“…(6) Were potential confounding variables and risk factors identified and examined using acceptable statistical techniques? (7) Was the duration of follow-up reasonable for investigated outcomes? (8) Was the population included in the study described adequately?…”

Early Virtual-Reality-Based Home Rehabilitation after Total Hip Arthroplasty: A Randomized Controlled Trial

“…Over the years, parallel to the institutions, many organizations from different countries have tested various types of telemedicine services, producing a base of scientific literature on the efficiency and effectiveness of the implementation of e-health services, such as telerehabilitation [ 9 ]. In the field of orthopedic rehabilitation, various systematic reviews [ 10 ] and meta-analyses [ 11 , 12 , 13 , 14 ] have shown similar clinical outcomes after face-to-face rehabilitation as compared to telerehabilitation. In Italy and worldwide, the number of joint replacement surgeries is increasing sharply; of these, hip arthroplasty is the most widely practiced, and it has been shown to be effective in ameliorating the health-related quality of life of subjects diagnosed with end-stage osteoarthritis [ 15 , 16 ].…”