Is an in-home telerehabilitation program for people with proximal humerus fracture as effective as a conventional face-to face rehabilitation program? A study protocol for a noninferiority randomized clinical trial

Abstract

BackgroundProximal humerus fractures can be treated surgically (eg: pinning, plate and screws) or conservatively by wearing a splint or a cast. Following both of these approaches, rehabilitation has proven effective to prevent functional limitations and to re-establish normal shoulder function. However, access to these rehabilitation services and compliance tends to be limited in elderly patients due to travelling difficulties caused by their precarious health status and, in some cases, social and marital status. Since the majority of patients with a proximal humerus fracture are elderly, it becomes relevant to find a new way to offer quick, simple and suitable rehabilitation service. Thus, the use of promising alternative approaches, as in-home telerehabilitation, can enhance access to rehabilitation services for such population. The main objective of the study is to compare the clinical effects of the innovative telerehabilitation approach (TELE group) compared to face-to-face visits to a clinic (CLINIC group) for patients treated for a proximal humerus fracture.Methods/DesignIn this randomized controlled trial, individuals who have had a proximal humerus fracture treated conservatively at the Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l’Estrie CHUS), and who are returning home will be included. Participants will be recruited during their visit to the emergency ward or outpatient clinic by the medical or research team and will then sign the informed consent form if they are interested to participate in the study. We expect to recruit 52 participants (26 per group). Randomization will be done by a random number generator with sealed envelopes. Each patient will be evaluated before the beginning of the rehabilitation (T1), and immediately after the 2-month intervention (T2). The following outcomes will be measured: 1) upper extremity function (Constant Shoulder Score and Disability of the Arm, Shoulder and Hand questionnaire [DASH]); 2) range of motion (conventional goniometer); 3) user satisfaction (Health Care Satisfaction questionnaire); and 4) cost of services to the public healthcare system.The difference between the two groups will be compared using a t-test or a chi-squared test, and through a cost-effectiveness economic analysis.DiscussionWe hypothesize that in-home telerehabilitation will provide a good alternative to conventional rehabilitation, in terms of its efficacy, simplicity, patient satisfaction, and low associated costs.Trial registrationClinicalTrials.gov: NCT02425267. April 22nd, 2015.

Virtual Reality, Augmented Reality, Gamification, and Telerehabilitation: Psychological Impact on Orthopedic Patients’ Rehabilitation

“…Orthopedic remote rehabilitation leads to reduced costs for the national health system. As already proven in other medical fields [34], decreased costs are related to the reduction of transports, hospitalizations, and readmissions [6,17,[22][23][24]27,30,33,38]. It is assumed that for patients living more than 30 km away from the rehabilitation center, savings are around 230 dollars [34].…”

Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review

“…All 56 articles describe HETs that can help patients with musculoskeletal shoulder disorders when exercising at home ( Table 1 ). Of these, 18 articles refer to a specific target group for their use [ 20 , 23 , 26 , 36 , 37 , 45 , 47 - 50 , 52 , 54 , 58 , 62 , 68 , 71 , 73 , 77 ]. In 11 articles, the HET is recommended for several target groups [ 19 , 30 , 31 , 42 , 53 , 55 , 60 , 75 , 76 , 81 , 83 ].…”

“…In total, 47 articles report instructions given by HETs, whereas 3 articles report guidance by therapists alone [ 26 , 29 , 51 ]. In 6 articles, HETs and therapists instruct exercises together [ 19 , 23 , 24 , 43 , 53 , 59 ].…”

“…The degree of detail in monitoring ranges from simply recording the information that training took place on a certain day [ 58 ] to indicating how many repetitions of an exercise were completed [ 56 ] to storing aggregated data on ROM and the recognition of compensatory movements [ 31 ]. In addition, 34 HETs monitor exercises directly, whereas 6 use indirect monitoring ( Table 2 ); 2 articles report indirect monitoring solely by physiotherapists during videoconferencing [ 26 , 28 ]; 4 articles report on therapists who monitor exercises using HETs, and 10 report on both HETs and therapists who monitor the exercises. This is done, for example, by physicians and therapists evaluating recorded videos [ 20 ].…”

Low Cost Device for ”At Home” Rehabilitation After a Stroke Event

“…The rehabilitation of a person implies the existence of a concordance between person and environment in which they live. Telerehabilitation, a branch of telemedicine, is providing medical services and remote medical recovery including assessment, treatment and care coordination [3], [4]. In our days, the use of virtual reality environments allow patients to perform tasks that mimic real life in rehabilitation clinics [5], but it tends increasingly more in the future these tasks can be done at home, sending data and receiving feedback from doctors from hundreds of miles distant.…”