Web-Based Self-Directed Exercise Program Is Cost-Effective Compared to Formal Physical Therapy After Primary Total Knee Arthroplasty

Zachwieja, Erik; Theosmy, Edwin; Yacovelli, Steven; Beatty, Evan W.; McGrath, Mikayla; Lonner, Jess H.

doi:10.1016/j.arth.2020.04.061

Cited by 17 publications

(22 citation statements)

References 29 publications

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“…care costs among the virtual PT group with similar effectiveness [6]. In addition, there are 2 retrospective studies, with similar findings to our own, but our own study is strengthened by a larger sample size and multisurgeon cohort [7,8].…”

Section: Referencessupporting

confidence: 81%

Response to Letter to the Editor on “Formal Physical Therapy Following Total Hip and Knee Arthroplasty Incurs Additional Cost Without Improving Outcomes”

Yayac

Moltz

Pivec

et al. 2020

The Journal of Arthroplasty

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Section: Referencessupporting

confidence: 81%

Response to Letter to the Editor on “Formal Physical Therapy Following Total Hip and Knee Arthroplasty Incurs Additional Cost Without Improving Outcomes”

Yayac

Moltz

Pivec

et al. 2020

The Journal of Arthroplasty

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supporting

confidence: 80%

Letter to the Editor on “Diagnostic Utility of Platelet Count/Lymphocyte Count Ratio and Platelet Count/Mean Platelet Volume Ratio in Periprosthetic Joint Infection After Total Knee Arthroplasty”

Beyan

2020

The Journal of Arthroplasty

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care costs among the virtual PT group with similar effectiveness [6]. In addition, there are 2 retrospective studies, with similar findings to our own, but our own study is strengthened by a larger sample size and multisurgeon cohort [7,8].We agree with the comments that formal PT may still be of benefit in a subset of patients after THA and TKA. Regarding our study, we would like to first clarify that the control group was defined as patients who did not receive formal postoperative PT, not no PT at all. Patients not prescribed formal PT sessions are provided instructions and resources for a home exercise program to rehabilitate their joints. This particular distinction has an important role in the overall conclusion that can be drawn from our study. We do not aim to imply that rehabilitation is not required after TJA, but with consideration of prior studies demonstrating that selfdirected exercise programs may be appropriate for many patients, we provide evidence that opting for such a program in the appropriate patient can be an effective cost-saving measure.We do contend with the comments that costs would be, by default, higher among patients receiving PT. Although PT costs are certainly higher, we analyzed total EOC costs in our study meaning that if PT had a substantial positive impact on shortterm outcomes, then it is possible direct PT costs may be negated by savings in other postacute care resources. Although we did not demonstrate this for the entire cohort in our study, it likely may exist that this holds true for a select subset of patients, and further study is needed. We do not infer into which patients define this select subset within our own study, but several recent studies have provided guidance on that particular topic [3,4].We agree with the authors that there exist several limitations to our study because of its retrospective design. A selection bias exists in who is prescribed formal PT based on surgeon preference and patient baseline. We controlled for the significant differences in groups through multivariate analysis, but as the authors state, there are likely several confounding factors that were not collected and would further explain the differences observed. We agree that an RCT would be both ethical and ideal in assessing this topic but may not be practical. EOC costs can vary substantially, and so a large sample size may be required to achieve adequate power [9e11]. Large RCTs are both time and resource intensive. Initially investigating a clinical question through retrospective observational study can aid one in determining whether that question is worth being explored through a high-quality RCT.Our study is a valuable contribution to the literature as it builds on the recent evidence regarding the utility of formal PT after THA and TKA. In addition, it has an impact on clinical practice as it may incentivize arthroplasty surgeons to implement postsurgical protocol changes. Finally, our study encourages readers to further explore this topic in greater depth, ideally through the hig...

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“…There were 4 studies that compared the costs of telerehabilitation and in-person physical therapy. All 4 studies found that telerehabilitation was significantly less costly compared with in-person physical therapy, with cost savings ranging from $206 to $4,100 per person 14,17,19,29 . These results are summarized in Figure 7.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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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.

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Web-Based Self-Directed Exercise Program Is Cost-Effective Compared to Formal Physical Therapy After Primary Total Knee Arthroplasty

Cited by 17 publications

References 29 publications

Response to Letter to the Editor on “Formal Physical Therapy Following Total Hip and Knee Arthroplasty Incurs Additional Cost Without Improving Outcomes”

Response to Letter to the Editor on “Formal Physical Therapy Following Total Hip and Knee Arthroplasty Incurs Additional Cost Without Improving Outcomes”

Letter to the Editor on “Diagnostic Utility of Platelet Count/Lymphocyte Count Ratio and Platelet Count/Mean Platelet Volume Ratio in Periprosthetic Joint Infection After Total Knee Arthroplasty”

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

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