Lower health care costs found with virtual vs usual physical therapy for TKA
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Patients who underwent total knee arthroplasty and were assigned to receive virtual physical therapy had significantly lower 3-month health care costs compared to those who had the usual physical therapy care, according to study results. However, the treatments had similar effectiveness and safety.
During the Virtual Exercise Rehabilitation In-Home Therapy: A Randomized Study, researchers randomly assigned 287 patients who underwent TKA to undergo virtual physical therapy with The Virtual Exercise Rehabilitation Assistant (VERA; Reflexion Health) in-home 3D biometrics and telerehabilitation with remote clinician oversight by a physical therapist system (n=143) or traditional physical therapy in the home or outpatient clinic (n=144). According to the study, the virtual physical therapy program used 3D tracking technology that quantified pose and motion and an avatar that demonstrated activity. It provided visual and audible instructions and feedback on the quality of the exercise and offered a virtual video connection for telehealth visits with an intervention telehealth physical therapist.
The total health care cost for the 12-week post-hospital period was the primary outcome. Among the other outcomes were 6- and 12-week KOOS, 6-week knee extension, knee flexion, gait speed and 12-week safety measures. A modified intent-to-treat basis was used to analyze all outcome.
Results showed that at 12 weeks after discharge, the virtual physical therapy had a median cost of $1,050 compared with $2,805 for the usual care. Investigators noted patients in the virtual therapy group had a $2,745 lower mean cost. Fewer rehospitalizations were seen in virtual physical therapy patients compared with the usual care patients (12 patients vs. 30 patients). At 6 and 12 weeks, virtual physical therapy was noninferior to usual physical therapy with regard to the KOOS. Virtual physical therapy compared with usual care was noninferior at 6 weeks with regard to knee extension, knee flexion, gait speed, pain and hospital readmissions at 12 weeks. Overall, 19.4% of patients treated with virtual physical therapy reported falls compared to 14.6% of patients who received usual care. – by Monica Jaramillo
Disclosure: The study was funded by Reflexion Health.
Perspective
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Lynn Snyder-Mackler, PT, ScD, FAPTA
This study provides an interesting perspective on how technology may improve surveillance and adherence to postoperative rehabilitation after TKA. Unfortunately, the cost benefit (the primary outcome for his randomized control trial) is not so straightforward. First, and most significantly, differences in inpatient rehabilitation and skilled nursing facility admissions post TKA vs. discharge to home favoring the intervention group, which occurred prior to intervention, and the inexplicable (and unexplored) tremendous difference in rehospitalizations, render the cost and number of outpatient physical therapy encounters (seven vs. 10) not significantly different. Second, the costs of technology used by the patients and therapists, equipment home installation and removal were not included. When value-based health care decisions are made, we need to ensure that the cost of each intervention is accurately portrayed.
The importance of this work is in the demonstration of outcomes. Even if the cost benefit disappears, the evidence of non-inferiority of the has tremendous implications for the future of delivery of rehabilitation services and remote surveillance of patients after TKA. The main cost savings appears to be in the ability to avoid the cost of home health care visits with the surveillance and virtual treatment program, which will have to be weighed against the cost of the technology.
Department of physical therapy
STAR University of Delaware
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