An Internet-based rehabilitation program worked as well as conventional therapy for aiding the recovery of patients following total knee arthroplasty, researchers found.
In a noninferiority trial, telerehabilitation fared at least as well as conventional therapy on all study outcomes after six weeks, including the primary outcome -- the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) -- according to Trevor Russell, PhD, of the University of Queensland in Brisbane, Australia, and colleagues.
In fact, telerehabilitation resulted in greater improvement on the WOMAC stiffness subscale and the Patient-Specific Functional Scale, a secondary endpoint (
P<0.05 for both), the researchers reported in the Jan. 19 issue of the
Journal of Bone & Joint Surgery.
Action Points
- Explain that an Internet-based rehabilitation program worked as well as conventional therapy for aiding the recovery of patients following total knee arthroplasty.
- Note that limitations of the study included the short follow-up period and that the telerehabilitation intervention was delivered in the hospital, which might not reflect conditions when the intervention is delivered to patients in the home.
"This trial provides evidence for the efficacy of low-bandwidth telerehabilitation in producing clinically relevant physical and functional results six weeks after patients have had a total knee replacement," they wrote.
Rehabilitation is an important adjunct to total knee arthroplasty, but access to high-quality rehabilitation services is not always possible, particularly for people living in remote areas, according to the researchers.
So they performed a randomized study comparing an Internet-based rehabilitation program with conventional outpatient physical therapy.
The researchers enrolled 65 adults (mean age 68) who underwent surgery at Queen Elizabeth II Jubilee Hospital in Brisbane, and assigned 34 to conventional therapy and 31 to telerehabilitation. Patients in both groups started the six-week rehabilitation program about one week after discharge.
The patients in the telerehabilitation group were still required to come to the hospital, but they completed the weekly 45-minute session over the Internet in an isolated room set up to resemble a home environment.
All patients were encouraged to perform a comprehensive home exercise program twice a day.
The primary outcome -- WOMAC -- has been used extensively in total knee replacement and osteoarthritis clinical trials.
Secondary outcomes included the Patient-Specific Functional Scale, the Spitzer Quality-of-Life Uniscale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, girth measurements at the knee, and an assessment of gait.
Patients in both groups had clinically and statistically significant improvement on all measures through six weeks (P<0.01 for all).
Improvement on the WOMAC was 52.7% in the control group and 67.6% in the telerehabilitation group, a nonsignificant difference.
Compliance with the home exercise program -- assessed using exercise diaries -- was similar in the two groups.
Patients assigned to telerehabilitation expressed a high level of satisfaction with the intervention, giving a score greater than 9 out of 10 (most satisfied) for nearly all of the items on a survey about the program.
According to Russell and his colleagues, multiple factors may have facilitated rehabilitation in the Internet-based intervention.
"The nature of the telerehabilitation intervention, which relied more on the education of patients in the self-application of mobilization techniques and had a greater emphasis on exercise, may have provided participants with a heightened opportunity for self-treatment outside the formal physical therapy treatment session," the researchers wrote.
Also, "a higher reliance on education in the telerehabilitation group may have assisted in producing a higher technical proficiency in the home exercise program."
The authors acknowledged some limitations of the study, including the short follow-up period and the fact that the telerehabilitation intervention was delivered in the hospital, which might not reflect conditions when the intervention is delivered to patients in the home.
"For these reasons, this investigation should be considered as a proof-of-principle study, and future research should be conducted in the communities and homes of isolated patients to explore the impact of these factors," they wrote.
Economic analyses are also needed, they added.
The study did not receive any outside funding or grants.
The researchers reported that they had no conflicts of interest.
Orthopedics
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