Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls

Abstract

Background Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales “function in sport and recreational activities” and “hip-related quality of life” of HOOS, and on the subscale “physical role limitations” of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes. Conclusions Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. Trial Registration ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo

Remote Assessment of Functional Mobility and Strength in Older Cancer Survivors: Protocol for a Validity and Reliability Study

“…Additionally, few if any of these studies have been tested in rural areas, which often have less reliable high-speed internet necessary for quality video transmission. Similarly, home-based rehabilitation interventions delivered via technology typically have involved an in-person assessment of physical performance, either through home visits by a member of the study team [ 37 , 38 ] or by requiring participants to travel to the research center for data collection [ 39 , 40 ].…”

Comparing an eHealth Program (My Hip Journey) With Standard Care for Total Hip Arthroplasty: Randomized Controlled Trial

“…eHealth programs can provide individualized patient care at the preoperative, perioperative, and postoperative stages and have the potential to improve patient engagement, self-care, and outcomes across the surgical pathway [ 1 , 2 ]. The implementation of eHealth has many benefits, including enabling a single source of information that can be regularly and easily updated within a rapidly changing environment and enabling equitable access to all patients regardless of geographical location.…”

“…The incorporation of eHealth programs in the delivery of education has shown some potential to further enhance the educational experience and outcomes for postsurgical rehabilitation for orthopedic patients, including those undergoing THA [ 13 ]. Most studies have focused on the use of telerehabilitation in either the pre- or postsurgical periods [ 1 , 13 - 15 ]. A systematic review conducted on the evidence of the benefit of telerehabilitation after orthopedic surgery has shown strong to moderate grades of evidence for hip replacement interventions; the review recommends that high-methodological quality studies are needed [ 13 ].…”

Leveraging Digital Technology to Overcome Barriers in the Prosthetic and Orthotic Industry: Evaluation of its Applicability and Use During the COVID-19 Pandemic

“…Prosthetic and orthotic patient treatment during the current pandemic with digital technology has opened up the possibility for virtual measurements, fitting, and home-based rehabilitation [ 32 - 36 ]. Bringing care to the patient rather than the patient to care provides a safer environment for patients.…”

“…The use of a mobile phone that includes inertial sensors and gyroscopes has the potential to overcome the physical assessment and contact usually associated with a consultation. The apps developed for mobile phones have shown use in measuring steps, balance, range of motion (ROM), education, and the provision of exercise programs [ 32 , 34 , 37 ] but are rarely used for assessment of patients requiring prostheses or orthoses [ 38 , 39 ].…”