The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis

Abstract

Introduction The objective of this study was to assess the efficacy of telerehabilitation for patients after total knee arthroplasty (TKA) compared with face-to-face rehabilitation. Methods Medline, SCOPUS, Google Scholar, EMBASE, Springer, Science Direct, and Cochrane databases were searched electronically. Relevant journals and references of studies included were hand-searched for randomized controlled trials (RCTs) regarding the efficacy of telerehabilitation on functional recovery in patients after TKA. Two reviewers independently performed data extraction and quality assessment. Data were analysed using RevMan 5.3 software and Stata 12.0 software. Results Four RCTs involving 442 patients were included in the meta-analysis. Overall, compared with face-to-face rehabilitation, telerehabilitation could achieve comparable pain relief (mean difference = 0.52; 95% confidence interval (CI) = -0.20 to 1.24; p = 0.16) and better Western Ontario and McMaster Universities Osteoarthritis Index improvement (mean difference = 1.13; 95% CI = 0.23 to 2.02; p = 0.014). In addition, telerehabilitation treatment resulted in a significantly higher extension range ( p < 0.00001) and quadriceps strength ( p = 0.0002) than face-to-face rehabilitation. Discussion Telerehabilitation should be recommended for patients after TKA because of its comparable pain control and better improvement of functional recovery as compared to face-to-face rehabilitation.

Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer?

“…Several systematic reviews and meta-analysis have assessed the efficacy of telerehabilitation following total arthroplasty (eg, shoulder, knee, hip) and upper limb interventions (eg, proximal humerus fractures, carpal tunnel release surgery, rotator cuff tear). [11][12][13][14][15] Within this context, findings are promising as outcomes commonly considered in postsurgical physical therapy (eg, reduction in pain intensity and improvements in range of motion, muscle strength, functional activities, and disability) are similar or even superior in comparison with face-to-face usual care. [11][12][13][14][15] Moreover, the effects of telerehabilitation, when associated with usual care or as a stand-alone intervention, has been investigated also in chronic nonmalignant MSK pain (eg, low back pain, lumbar stenosis, neck pain, osteoarthritis, fibromyalgia, arthritis).…”

“…[11][12][13][14][15] Within this context, findings are promising as outcomes commonly considered in postsurgical physical therapy (eg, reduction in pain intensity and improvements in range of motion, muscle strength, functional activities, and disability) are similar or even superior in comparison with face-to-face usual care. [11][12][13][14][15] Moreover, the effects of telerehabilitation, when associated with usual care or as a stand-alone intervention, has been investigated also in chronic nonmalignant MSK pain (eg, low back pain, lumbar stenosis, neck pain, osteoarthritis, fibromyalgia, arthritis). [16][17][18] Thus, preliminary evidence has suggested adopting telerehabilitation in substitution of face-to-face interventions for reducing pain and improving physical function, daily life activities, and quality of life in patients affected by these disorders.…”

“…[16][17][18] Caution should be applied, however, to avoid overestimation of findings given the several methodological weaknesses in available studies, such as small sample size (n < 100), short follow-up (<12 months), missed evaluation of barriers/facilitators, and lack of blinding of participants, caregivers, and outcomes assessors. 11,14,16 Feasibility and Acceptability of Telerehabilitation Systematic reviews have also reported that telerehabilitation-based consultation for MSK pain is feasible in terms of concurrent validity and intrarater and interrater…”

Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders

“…58 Telehealth has also been investigated by means of a pilot study for physical therapy for partial rotator cuff injury. 64 Other studies have looked at telehealth in follow-up after joint arthroplasty and following fractures [65][66][67][68][69][70][71] and found that overall home telehealth is at least as effective as usual care. 69 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."…”

“…64 Other studies have looked at telehealth in follow-up after joint arthroplasty and following fractures [65][66][67][68][69][70][71] and found that overall home telehealth is at least as effective as usual care. 69 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." 72 While the practice of musculoskeletal care by means of telehealth is still in the early stages of development, there are some promising outcomes associated with diagnostic assessments, focal musculoskeletal assessments, as well as treatment with physical therapy.…”