Transition to Telehealth Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement: A Pilot Study With Retrospective Matched-Cohort Analysis

Abstract

Background: Telehealth use has increased significantly of late. However, outside of total hip and knee arthroplasty, there is minimal evidence regarding its efficacy in orthopaedics and postoperative rehabilitation. Purpose: To determine the efficacy and cost-effectiveness of a transition to postoperative telehealth physical therapy in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients undergoing postoperative physical therapy after hip arthroscopy for FAI. The intervention group consisted of patients undergoing initial in-person visits followed by a transition to telehealth physical therapy for 3 months postoperatively (group 1; n = 17). Comparison groups included patients undergoing in-person physical therapy with the same physical therapy team as the telehealth group (group 2; n = 17) and patients undergoing in-person therapy with a different therapy team at the same facility (group 3; n = 17). All groups were matched 1-to-1 by patient age and sex. All patients completed the short version of the International Hip Outcome Tool (iHOT-12) both preoperatively and at 3 months postoperatively. At 3 months postoperatively, it was determined whether patients met the minimally clinically important difference (MCID; ≥13 points) or substantial clinical benefit (SCB; ≥28 points) or whether they reached a Patient Acceptable Symptomatic State (PASS; ≥64 points). Billed charges were recorded as a measure of cost. Results: The overall mean age of the study patients ranged from 33 to 34 years. Among the 3 groups, there was no significant difference in the preoperative, postoperative, or pre- to postoperative change in iHOT-12 scores or in the percentage of patients meeting MCID, SCB, or PASS at 3 months. Group 1 had significantly lower mean costs ($1015.67) compared with group 2 ($1555.62; P = .011) or group 3 ($1896.38; P < .001). Conclusion: In this pilot study, telehealth physical therapy after hip arthroscopy was found to lead to similar short-term outcomes and was cost-effective compared with in-person physical therapy.

The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review

“…Six studies presented health economic analyses accompanying an RCT (Bettger et al, 2020;Fatoye et al, 2020;Hollinghurst et al, 2013;Kloek et al, 2018;Tousignant et al, 2015) and of these, three published cost analyses separately (Hollinghurst et al, 2013;Kloek et al, 2018; Pastora-Bernal, . The remaining studies consisted of health economic analyses accompanying a prospective audit (Beard et al, 2017), a retrospective audit (Cottrell et al, 2019), a retrospective cohort (Zachwieja et al, 2020), a prospective cohort (Mallett et al, 2014) and a matched cohort study (Horton et al, 2021). A variety of health economic analyses, conditions and settings were presented, which precluded meta-analysis.…”

“…A variety of health economic analyses, conditions and settings were presented, which precluded meta-analysis. A variety of musculoskeletal conditions appeared; five presented post-operative patients (knee arthroplasty (Bettger et al, 2020;Tousignant et al, 2015;Zachwieja et al, 2020), hip arthroscopy (Horton et al, 2021), shoulder subacromial decompression (Pastora-Bernal, , two back pain (Beard et al, 2017;Fatoye et al, 2020), three mixed MSD (Cottrell et al, 2019;Hollinghurst et al, 2013;Mallett et al, 2014) and one hip/knee osteoarthritis (Kloek et al, 2018).…”

“…Eight studies were conducted from the public hospital outpatient settings (Beard et al, 2017;Cottrell et al, 2019;Fatoye et al, 2020;Hollinghurst et al, 2013;Kloek et al, 2018;Mallett et al, 2014;Tousignant et al, 2015). Three studies were conducted from private (non-public) healthcare settings, of which two were private hospital outpatients (Horton et al, 2021;Zachwieja et al, 2020) and one in private medical centres and independent private clinics although cost analysis in this study was based on public rates (Bettger et al, 2020). In all but one study the usual in-person physiotherapy care arm of the study was based within the settings listed above.…”

Telehealth Physical Therapy for Sports Medicine Rehabilitation: What Is Its Role in the Postpandemic Era?

“… 18 However, patients were also motivated by cost, 19 and in certain settings (ie, postoperative rehabilitation), telehealth PT has been shown to be more cost-efficient due to reduced travel costs. 9 …”

“…18 However, patients were also motivated by cost, 19 and in certain settings (ie, postoperative rehabilitation), telehealth PT has been shown to be more cost-efficient due to reduced travel costs. 9 The future role of telehealth in PT remains unclear. For sports rehabilitation in particular, telehealth PT has shown promise as a platform for nonoperative and postoperative rehabilitation in specific impairments, 5,10,29 but little is known about patient preference for telehealth PT in the postpandemic era.…”