Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

No abstract

We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery (total knee arthroplasty, TKA). Forty-eight patients (mean age 66 years) who received TKA were recruited prior to discharge from hospital after surgery and were randomly assigned to telerehabilitation or usual care. Telerehabilitation sessions (16 per participant over two months) were conducted by trained physiotherapists using videoconferencing to the patient's home via an Internet connection (512 kbit/s upload speed). Disability and function were measured using standardized outcome measures in face-to-face evaluations at three times (prior to and at the end of treatment, and four months after the end of treatment). Clinical outcomes improved significantly for all subjects in both groups between endpoints. Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group. Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.

BackgroundRehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation.ObjectiveThe objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits.MethodsThe economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student’s t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs).ResultsThe mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient’s home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $90<$152, P<.001).ConclusionsTo our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient’s home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient’s home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic.Trial RegistrationInternational Standard Registered Clinical Study Number (ISRCTN): 66285945; ...

OBJECTIVE -The objective of the present study was to compare postural mechanisms identified by using dual force platform in healthy elderly community-dwelling subjects and diabetic sensory neuropathy (DSN) patients under different visual conditions. RESEARCH DESIGN AND METHODS -The presence and the severity of the sensory neuropathy was evaluated with a clinical scale. Postural mechanisms and motor strategies of the ankle and hip joints were quantified by testing subjects in quiet stance on a dual force platform under two visual conditions (eyes open and eyes closed). Root mean square (RMS) values of the center of pressure (COP) time-varying signals and normalized cross-correlation function were used to estimate the contribution and the interdependence of postural control mechanisms.RESULTS -DSN patients show larger RMS values of the COP net displacement in both anteroposterior and mediolateral (ML) directions. Motor strategies at the ankle joints are altered in DSN patients compared with healthy elderly subjects particularly in the ML direction.CONCLUSIONS -This experiment is the first to highlight that even with vision, postural mechanisms at the ankle joints are impaired in DSN patients during quiet standing. Our results point out the importance of focusing on postural control instability in ML of DSN patients. Diabetes Care 27:173-178, 2004T he postural control system is a complex organization that controls the orientation and the equilibrium of the body during an upright stance (1,2). Past research provides many insights that the postural control system involves sensory afferences integration instead of eliciting reflex responses. Sources of sensory afferences that are viewed to contribute to postural control are 1) vestibular, 2) visual, and 3) proprioceptive. Postural instability in diabetic sensory neuropathy (DSN) patients is usually attributed to the lack of accurate proprioceptive feedback (sensory ataxia) from the lower limbs (3-5). The prevalence of sensory ataxia in diabetic patients ranges from 10 to 90% depending on screening protocol and criteria to define neuropathy (6). Compared with non-neuropathic diabetic patients, DSN patients self-reported 15 times more injuries during gait and reported feeling less safe during unusual situations (7). Peripheral neuropathy has been significantly associated with falling and repetitive falls (8). Evaluation of postural steadiness is usually based on the interpretation of center of pressure (COP) measures using a force platform (9). Only few studies have addressed the problem of postural instability during quiet standing in DSN (3-5,10). High correlations were found between the severity of the neuropathy and the COP measures (5,10,11) but not with diabetes per se (3).Past reports on postural steadiness of DSN patients only quantify the net COP changes in anteroposterior (AP) and mediolateral (ML) directions. During feet side-side configuration, postural mechanisms have been reported (12) to be under ankle mechanism in AP direction, whereas hip abductors/addu...