Background The COVID-19 pandemic has transformed the practice of physical therapy (PT), from a model based on in-person delivery to one that includes telehealth. However, research is needed to assess value, patient satisfaction, and clinical outcomes in the delivery of telehealth PT. Purposes We sought to compare patient satisfaction with in-person and telehealth PT and to determine the factors—such as age, gender, or insurance payer—that contributed to patient satisfaction scores. Methods Patients between the ages of 18 and 90 years who received outpatient PT at our institution were texted a patient satisfaction survey. Surveys were sent to patients who received in-person PT from January 1 to May 8, 2020, and to patients who received telehealth PT from April 21 to May 8, 2020. Patients' age, gender, insurance payer, and written comments were also collected. Kruskal-Wallis tests were used to compare survey scores between groups. χ-squared tests were used to compare categorical patient characteristics between groups. Results In total, 12,345 surveys were sent out. We included completed surveys from 1147 patients in the analysis. Of these, 33% identified as male and 67% as female, mean age was 60.3 years, 58% had commercial insurance, 36% had Medicare, 3% had Medicaid, 2% had no-fault/worker's compensation, and 1% had international insurance. The question of satisfaction was answered by 1074 patients. No statistical difference in satisfaction was seen in age or gender groups. Satisfaction differed by insurance type, but when analysis excluded patients with international insurance, there was no difference between groups. In-person PT patients reported higher satisfaction in achieving treatment goals, as rated on a 1-to-5 scale (4.7 ± 0.6), than telehealth PT patients (4.6 ± 0.6), although it is unclear if this result is clinically meaningful. There was no significant difference in the remaining follow-up questions. Conclusion We found no overall difference in patient satisfaction between those receiving in-person PT and those receiving telehealth PT. This was true for initial and follow-up visits, with the exception of two categories: the “ability of scheduling an appointment” and “progress towards attaining your treatment goals.” However, the clinical significance of these two exceptions is questionable. Ongoing research is indicated to evaluate the efficacy of telehealth PT while identifying the best patients and conditions for use during non-crisis times. Future studies should determine the effect of telehealth PT on patient-reported outcome measures, function, and value.

Background Post-operative rehabilitation after posterior-approach total hip arthroplasty (P-THA) includes the use of standard hip precautions, defined as no hip flexion beyond 90°, hip adduction, or hip internal rotation for 6 to 12 weeks after surgery (sometimes for life). Since they were first implemented in the 1970s, subsequent advances may have made standard hip precautions no longer necessary, although little evidence supports that hypothesis. A modified set of precautions, a “pose avoidance protocol,” could be effective in enhancing recovery, but its effectiveness on early dislocation and post-surgical outcomes is not known. Questions/Purposes We sought to determine the functional recovery of patients on a pose avoidance protocol after P-THA according to levels of pain and patient satisfaction, rates of dislocation, the use of assistive devices, and a return to driving. Methods We conducted a retrospective, descriptive study of data from a consecutive case series of 164 patients treated by a single surgeon between January 2014 and December 2015. Patients who had undergone a primary uncemented P-THA were prescribed a pose avoidance protocol and followed for a minimum of 6 weeks. Exclusion criteria were patients with congenital hip dysplasia, revision THA, femoral neck fracture, rheumatoid arthritis, or neuromuscular disease. Changes to the rehabilitation protocol included elimination of the requirements to use elevated chairs, raised toilet seats, and abduction pillows for sleeping. Patients could resume driving at 2 and 3 weeks for left and right P-THA, respectively. The only motion restriction was avoiding the combination of hip flexion past 90°, hip adduction, and hip internal rotation. Patients could perform all other movements and to bear weight and stop using walking aids as tolerated. Patients completed a biweekly questionnaire to assess their functional recovery, opioid use, and pain levels. Results At 2 weeks after surgery, 80% of patients reported no pain, 86% did not require walking aids, and 92% were satisfied with their recovery. At 6 weeks after surgery, 89% of patients reported no pain. Patients returned to driving at a mean of 2.7 weeks after surgery. No patients had experienced a dislocation at 6 weeks of follow-up. Conclusion A pose avoidance rehabilitation protocol in this P-THA population was found to be safe and was associated with accelerated functional recovery and high patient satisfaction without increased risk of early post-operative dislocation.

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Research Objectives To present the results from a patient satisfaction survey and compare patient satisfaction with in-person to telehealth delivery of pediatric physical and occupational therapy. Design Retrospective cohort study. Setting Outpatient pediatric rehabilitation services from a specialized New York City hospital. Participants All pediatric patients, 1 month to 21 years old, receiving outpatient rehabilitation services from this hospital were sent a Q-Review survey to rate level of satisfaction with the care received. Pediatric patients, 1 month to 21 years old, who received outpatient physical and/or occupational therapy and completed the survey were included. 173 survey responses were included. Interventions During COVID-19 pediatric rehabilitation rapidly shifted from in-person to telehealth sessions. Main Outcome Measures A retrospective review of survey data from April 2 to December 16, 2019 for 2 types of visits: in-person initial evaluation, in-person follow up and from April 2 to December 16, 2020 for 2 types of visits: telehealth initial evaluation, and telehealth follow up. Items were scored on a Likert scale 1-5. A score of 5 indicates "most satisfied" and 1 indicates "least satisfied." One exception was the net promoter score question, "How likely are you to refer this hospital to your friends and family?" was graded on a 10 point scale. Responders comments were collected and reviewed. Since this was a pediatric population, the parent often responded to the survey. Results A total sample of 173 survey responses for pediatric physical and occupational therapy were included. Survey collection was as follows: 46 in-person evaluation surveys, 17 telehealth evaluation surveys, 29 in-person follow up surveys, and 81 telehealth follow-up surveys. 139 surveys were for physical therapy and 34 for occupational therapy. Mean responses for in-person evaluations ranged from 4.3 - 4.8 and 4.6 - 5.0 for telehealth evaluations, indicating a trend in higher satisfaction levels with telehealth evaluations. For in-person follow ups, the mean responses ranged from 4.9 - 5.0 and 4.9 - 5.0 for telehealth follow ups showing comparable satisfaction levels. Conclusions Telehealth can be effective to provide pediatric physical and occupational therapy while maintaining a high level of patient and parent satisfaction. Author(s) Disclosures None.