Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty

LeBrun, Drake G.; Martino, Brooks; Biehl, Elizabeth; Fisher, Charles; Valle, Alejandro González Della; Ast, Michael P.

doi:10.1007/s00167-022-06931-6

Cited by 15 publications

(18 citation statements)

References 17 publications

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“…The results of our study demonstrated a significant improvement in the Oxford Knee Score, all KOOS sub-scores, and the KSS satisfaction sub-score at 6 months post-surgery. The significant improvements were similar to those previously reported after in-person interventions in Belgium and The Netherlands [32][33][34], and the population studied was representative of the registry in terms of demographics [35]. The absence of direct comparison with standard protocols in our study limits further conclusions, but the results of our study confirmed previous reports in the literature.…”

Section: Discussionsupporting

confidence: 89%

Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study

Lebleu¹,

Pauwels²,

Anract

et al. 2023

JPM

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Rehabilitation for total knee replacement (TKA) often involves in-person therapy sessions, which can be time consuming and costly. Digital rehabilitation has the potential to address these limitations, but most of these systems offer standardized protocols without considering the patient’s pain, participation, and speed of recovery. Furthermore, most digital systems lack human support in case of need. The aim of this study was to investigate the engagement, safety, and clinical effectiveness of a personalized and adaptative app-based human-supported digital monitoring and rehabilitation program. In this prospective multi-center longitudinal cohort study, 127 patients were included. Undesired events were managed through a smart alert system. Doctors were triggered when there was a suspicion of problems. The drop-out rate, complications and readmissions, PROMS, and satisfaction were collected through the app. There was only 2% readmission. Doctor actions through the platform potentially avoided 57 consultations (85% of alerts). The adherence to the program was 77%, and 89% of the patients would recommend the use of the program. Personalized human-backed-up digital solutions can help to improve the rehabilitation journey of patients after TKA, lower healthcare-related costs by lowering the complication and readmission rate, and improve patient reported outcomes.

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Section: Discussionsupporting

confidence: 89%

Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study

Lebleu¹,

Pauwels²,

Anract

et al. 2023

JPM

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“…When all mean outcomes are compared to established norms, all are above the PASS and documented norms for those timeframes [9]. This study is also consistent with other findings in the literature in which TelePT has shown to provide comparable PROM scores to in-person PT for THA and TKA patients [8,11]. This indicates that regardless of hospital LOS, TelePT provided clinically meaningful outcomes.…”

Section: Discussionsupporting

confidence: 85%

“…The program grew from 1400 TelePT visits in 2019 to over 7000 in 2020 and over 6000 in both 2021 and 2022. The literature has similarly demonstrated continued growth of TelePT along with positive outcomes of being clinically effective, cost effective, safe, and satisfactory to patients [11,14].…”

Section: Introductionmentioning

confidence: 99%

Scaled TelePhysical Therapy Program a Promising Option for Post-acute Care of Lower-Extremity Arthroplasty Patients

Fisher,

Wysin,

Moeller

et al. 2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Post-acute care for orthopedic surgery patients continues to evolve with the reduction in hospital length of stay (LOS), shift to ambulatory surgery, increased number of surgeries, and focus on value-based care. Purpose: We sought to examine outcomes of a cohort of lower-extremity arthroplasty patients receiving telephysical therapy (TelePT) according to hospital LOS, as a means of exploring the viability of TelePT as a value-based discharge option. Methods: A retrospective review was conducted of patients who participated in our institution’s HSS@Home TelePT program after undergoing primary unilateral hip or knee arthroplasty, unicondylar knee replacement, or hip resurfacing. Demographic data and outcomes such as hospital LOS, number of days between discharge and TelePT evaluation, number of TelePT visits, number of re-admissions, Hip dysfunction and Osteoarthritis Outcome (HOOS Jr.) or Knee injury and Osteoarthritis Outcome (KOOS Jr.) scores, and patient satisfaction scores were collected. Patients were divided into categories based on hospital LOS to help determine the versatility of program. Results: In the 2814 patients included, we observed an average of 4.1 TelePT visits; 1% of patients were readmitted within 90 days, and 97% of patients were satisfied or highly satisfied. There was no difference in HOOS or KOOS Jr. scores at each follow-up time point, except for the 6-month HOOS Jr. scores. Conclusion: This retrospective study suggests that TelePT may be a viable option for care of lower-extremity arthroplasty patients in the post-acute setting, regardless of hospital LOS. As a discharge option, it may meet the needs of select patients to fill a gap in providing value-based care.

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“…Therefore, use of technology such telerehabilitation may play a role. Telerehabilitation has shown similar results compared with traditional physical therapy in patients undergoing lower limb arthroplasties . Therefore, careful consideration of all the above is needed to aid decision making on the method of intervention delivery in future trials.…”

Section: Discussionmentioning

confidence: 99%

Prehabilitation for Patients Undergoing Orthopedic Surgery

et al. 2023

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ImportancePrehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results.ObjectiveTo evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery.Data SourcesBibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022.Study SelectionRandomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included.Data Extraction and SynthesisTwo independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresPain, function, muscle strength, and health-related quality of life (HRQOL).ResultsForty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], −0.70 [95% CI, −1.08 to −0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, –8.20 [95% CI, −8.85 to −7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, −0.51 [95% CI, −0.85 to −0.17]) and at 6 months in those undergoing lumbar surgery (SMD, −2.35 [95% CI, −3.92 to −0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence.Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.

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Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty

Cited by 15 publications

References 17 publications

Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study

Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study

Scaled TelePhysical Therapy Program a Promising Option for Post-acute Care of Lower-Extremity Arthroplasty Patients

Prehabilitation for Patients Undergoing Orthopedic Surgery

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