Internet-based rehab a viable treatment option following knee surgery

Telerehabilitation – a postoperative rehabilitation program that can be conducted from a patient’s home – can offer the same results as traditional postoperative rehabilitation, according to a study published in the Journal of Bone and Joint Surgery.

The option of telerehabilitation is becoming popular for patients who live in remote areas and have no access to traditional rehabilitation centers.

“The concept for telerehabilitation is a decade old; however, well-conducted research studies demonstrating its benefits and potential are rare,” study author Trevor Russell, PhD, stated in an American Academy of Orthopaedic Surgeons press release. “This study offers measurable evidence that such technology can be used to provide effective rehabilitation services for knee replacement patients.”

The telerehabilitation process

In the study, 65 patients who underwent total knee arthroplasty (TKA) were randomized to receive 6 weeks of either traditional outpatient rehabilitation services or Internet-based outpatient rehabilitation. Patients in the telerehabilitation group performed their therapy in a hospital room designed and furnished to replicate a typical home environment.

Telerehabilitation patients received their rehabilitation through real-time interaction with a physical therapist via an Internet-based system providing live audio and video. Therapy sessions were limited to 45 minutes and consisted of self-applied techniques under the guidance of the remote therapist, along with exercises and education in the postoperative management of the affected knee.

Specially-designed equipment – including a computer, an echo-cancelling microphone, a web camera, custom software and an Internet connection – was used during the study, but the authors noted that in the future the telerehabilitation process should be available to patients with a home computer and other readily available components.

“The components are packaged in a robust case for transportation,” Russell stated in the release. “It is feasible that in the future patients could use their own home computer with downloaded software, provided they had a webcam and microphone of suitable quality and a broadband Internet connection.”

“Comparable” results

The study found that after the 6-week program, participants in the Internet-based rehabilitation group achieved outcomes “comparable” to those of the conventional rehabilitation group – even faring better in some areas, such as reduction in joint stiffness. Furthermore, the authors reported, patients in the telerehabilitation group showed significant improvement in specific functional areas designed to mimic their actual daily activities.

Functionality was not the only measure of patient improvement: those in the telerehabilitation group reported a higher level of contentment with their program than those in traditional rehabilitation, noting they would do it again and recommend it to friends. These patients were also more compliant, completing an average of 2.2 exercise sessions per day compared with 1.7 in the traditional rehabilitation group.

“Managing the rehabilitation needs of a growing number of total knee replacement patients presents a major challenge to physicians, physical therapists and health-policy decision-makers,” Russell stated in the release. “Alternate service-delivery models need to be considered to address these demands, improve access to services and control medical costs. Our results indicate telerehabilitation can be used to successfully achieve results comparable to traditional rehabilitation, while eliminating the obstacles faces by many patients in rural or remote areas.”

Reference:

Russell TG, et al. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: A randomized controlled trial. J Bone Joint Surgery (American). 2011;93:113-120. doi:10.2106/JBJS.I.01375

Disclosure: The authors have reported no financial disclosures.

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