A randomized controlled trial of home telerehabilitation for post-knee arthroplasty

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.

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…Data were available at one or more time points for five studies with 437 patients. 520,592,594,595,602 As shown in Table 96 and Figure 52, there was no suggestion of a difference in functional outcome between home and outpatient provision at 3-4, 6 or 12 months. For example, at 3-4 months, the average SMD was -0.03 (95% CI -0.25 to 0.19; p = 0.80).…”

“…No heterogeneity was apparent and consideration of higher-quality studies only marginally affected the outcome at 3-4 months in two studies (average SMD -0.15, 95%CI -0.43 to 0.13; p = 0.29), in favour of home-based rehabilitation. 520,595,602 As shown in Table 96 and Figure 53, there was no difference in pain outcome between patients randomised to home-based or outpatient physiotherapy exercise (average SMD -0.00, 95% CI -0.25 to 0.25; p = 0.98). One study 595 followed up 85 and 92 patients at 6 and 12 months and showed no benefit for reduced pain at either follow-up.…”

“…514,588,[591][592][593][594] Two further studies were judged to be of reasonable quality with overall losses to follow-up of between 10% and 20%. 600,602 There was no suggestion of risk of bias in nine studies. 520,589,590,[595][596][597][598][599]601 There was no clear evidence of publication bias from inspection of funnel plots.…”

“…The focus of the intervention was movement and exercise, 591,596,601 exercises aimed at managing kinesiophobia, 598 functional 588,597 or strengthening exercise 514 compared with minimal physiotherapy exercise as discussed in seven studies; home compared with outpatient provision as discussed in six studies; 520,592,594,595,602 physiotherapy with additional balance 589,600 or cycling components 593 compared with standard physiotherapy as discussed in three studies; and pool-based compared with gym-based provision as discussed in one study. …”

“…520,592,594,595,599,602 Patient-reported physical function Physical function was measured using WOMAC, KOOS and OKS measures. Data were available at one or more time points for five studies with 437 patients.…”