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Henry JP, Tamer P, Scuderi GR. Internet-Based Patient Portals Increase Patient Connectivity Following Total Knee Arthroplasty. J Knee Surg 2025; 38:386-392. [PMID: 40169134 DOI: 10.1055/a-2542-7427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
Many healthcare-related processes have undergone substantial transformation by the internet since the turn of the century. This technological revolution has fostered a fundamental shift from medical paternalism to patient autonomy and empowerment via a "patient-centric approach." Patient portals, or internet-enabled access to an electronic medical record, permit patients to access, manage, and share their health-related information. Patient connectivity following total knee arthroplasty (TKA) has the potential to positively influence overall outcomes, patient experience, and satisfaction. To understand current trends in patient portal usage, modalities of connectivity, and the implications following TKA. A systematic literature review was performed by searching PubMed and Google Scholar. Articles specific to portal usage and connectivity after TKA or total joint arthroplasty were subsequently identified for further review. Patient portals and internet-based digital connectivity platforms enable physicians, team members, and patients to communicate in the perioperative period both directly and indirectly. Communication can be through web-based patient portals, messaging services/apps, preprogrammed alerts (e.g., mobile applications or wearable devices), audio mediums, or videoconferencing. The spectrum and utilization of available patient engagement platforms continues to expand as the importance and implications of patient engagement and connectivity continue to be elucidated. Connectivity through patient portals or other mediums will continue to have an expanding role in all aspects of orthopedic surgery, patient care, and engagement. This includes preoperative education, postoperative rehabilitation, patient care, and, perhaps most importantly, collection of outcome measures. The level of evidence is V (expert opinion).
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Affiliation(s)
- James P Henry
- Department of Orthopaedic Surgery, Huntington Hospital, Northwell Health, Huntington, New York
| | - Pierre Tamer
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
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Stampa S, Podar MD, Thienel C, Freţian AM, Razum O, Dockweiler C. [Status and implementation conditions of digitally supported services in medical rehabilitation]. DIE REHABILITATION 2025; 64:85-91. [PMID: 40032250 PMCID: PMC12043377 DOI: 10.1055/a-2505-5175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
The COVID-19 pandemic forced rehabilitation centres to adapt their daily care routine and their organisational processes to the corresponding circumstances. In this context, digitally supported services were expanded and further developed. This study aims to systematically take stock of digitally supported rehabilitation services in Germany, including factors hindering or facilitating their implementation.The nationwide explorative quantitative online survey explores a so-far understudied topic. Using a self-developed questionnaire based on the Consolidated Framework for Implementation Research constructs, we surveyed the uptake and type of digitally supported rehabilitation services in medical rehabilitation departments, including implementation hindrances and facilitators.A total of 452 departments participated in the study and about half reported using digitally supported services in medical rehabilitation, with digital training and telerehabilitation aftercare being the most common. The primarily reported implementation hindrances were technology-related work interruptions and cost coverage/reimbursements uncertainties. Managerial support and the usefulness of the digitally supported services were perceived as particularly conducive for the implementation process, as was the staff involvement.The study provides a first overview of digitally supported services used in medical rehabilitation in Germany, and a better understanding of the factors hindering or facilitating their implementation.
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Affiliation(s)
- Susanne Stampa
- Professur für Digital Public Health, Lebenswissenschaftliche Fakultät,
Universität Siegen
| | - Monica-Diana Podar
- AG3 Epidemiologie & International Public Health, Fakultät für
Gesundheitswissenschaften, Universität Bielefeld
| | - Christine Thienel
- AG3 Epidemiologie & International Public Health, Fakultät für
Gesundheitswissenschaften, Universität Bielefeld
| | - Alexandra Maria Freţian
- AG3 Epidemiologie & International Public Health, Fakultät für
Gesundheitswissenschaften, Universität Bielefeld
| | - Oliver Razum
- AG3 Epidemiologie & International Public Health, Fakultät für
Gesundheitswissenschaften, Universität Bielefeld
| | - Christoph Dockweiler
- Professur für Digital Public Health, Lebenswissenschaftliche Fakultät,
Universität Siegen
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Rozenberg D, Logan S, Sohrabipour S, Bourgeois N, Cote A, Deliva R, De Souza A, de Vries R, Donald M, Ferreira M, Hart D, Ibrahim Masthan M, Jaundis-Ferreira T, Juillard S, Khoury M, Lallani A, Mager D, Mucsi I, Orchanian-Cheff A, Reed JL, Tandon P, Tennankore K, Yong E, Wickerson L, Mathur S. Establishment of emerging practices and research priorities for telerehabilitation in solid organ transplantation: meeting report and narrative literature review. FRONTIERS IN REHABILITATION SCIENCES 2025; 6:1535138. [PMID: 40226125 PMCID: PMC11985446 DOI: 10.3389/fresc.2025.1535138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/17/2025] [Indexed: 04/15/2025]
Abstract
Solid organ transplantation (SOT) is a life-saving procedure for those with end-stage organ dysfunction. The main goals of SOT are to improve quality of life and daily function, which are supported by pre- and post-transplant rehabilitation. In-person rehabilitation programs have traditionally been the standard-of-care for delivering rehabilitation for SOT patients. Many programs have adopted a virtual delivery model [telerehabilitation (TR)], an approach that has become increasingly used given restrictions to in-person delivery during the COVID-19 pandemic. Presently, TR programs are being used both clinically and in research with variable practices. A 2-day virtual meeting held in February 2023 brought together over 30 Canadian adult and pediatric researchers, clinicians, and patient and family partners across SOT. The meeting objectives were: (1) To facilitate knowledge exchange and dialogue in TR between patient partners, healthcare professionals, researchers, and key stakeholders, and (2) Identify gaps in clinical practice and research in TR. The discussion focused on delivery methods of TR, digital tools, facilitators and barriers of TR, and the effects of TR on physical and mental health in both adult and pediatric populations. This meeting report incorporates a narrative literature review of SOT and rehabilitation articles in the last 20 years. Future directions in TR are highlighted leading to the development of key research priorities targeted towards improved delivery of TR in SOT patients.
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Affiliation(s)
- Dmitry Rozenberg
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Division of Respirology, University of Toronto, Toronto, ON, Canada
| | - Sherrie Logan
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, AB, Canada
| | - Sahar Sohrabipour
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas Bourgeois
- Lung Transplant Program, Centre Hospitalier de L’Université de Montréal, Montreal, QC, Canada
| | - Anita Cote
- School of Human Kinetics, Trinity Western University, Langley, BC, Canada
- Department of Pediatrics, British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Robin Deliva
- Department of Rehabilitation Services, Hospital for Sick Children, Toronto, ON, Canada
| | - Astrid De Souza
- Department of Pediatrics, British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Rienk de Vries
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, AB, Canada
| | - Maoliosa Donald
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Manoela Ferreira
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, AB, Canada
| | - Donna Hart
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, AB, Canada
| | | | | | - Sandrine Juillard
- Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology, CHUM Research Center (CRCHUM), Montreal, QC, Canada
| | - Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Afsana Lallani
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, AB, Canada
| | - Diana Mager
- Department of Agricultural, Food and Nutritional Sciences, Dept of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Istvan Mucsi
- Ajmera Transplant Centre, and Division of Nephrology, University Health Network, Toronto, ON, Canada
- Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Jennifer L. Reed
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Puneeta Tandon
- Department of Medicine, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, AB, Canada
| | - Karthik Tennankore
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | - Elaine Yong
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, AB, Canada
| | - Lisa Wickerson
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto and Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Wang L, Zhang L, He C. Research Progress and Hot Topics in Telerehabilitation for Hip or Knee Arthroplasty. Orthop Surg 2025; 17:677-693. [PMID: 39757734 PMCID: PMC11872367 DOI: 10.1111/os.14347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 12/10/2024] [Accepted: 12/14/2024] [Indexed: 01/07/2025] Open
Abstract
OBJECTIVE Many publications on telerehabilitation for hip or knee arthroplasty have been published in recent years. However, no specific studies have attempted to characterize research hotspots, global research collaborations, or trends related to telerehabilitation after hip or knee arthroplasty. Therefore, the aim of this bibliometric analysis was to provide an overview of the current status of research and map the research landscape on telerehabilitation for joint replacement to understand current trends, identify research gaps, and guide future research directions. METHODS The Web of Science Core Collection and PubMed were comprehensively searched to identify all relevant English-language documents published from 2003 to June 7, 2024. Data from these published studies were then cleaned and structured. CiteSpace and VOSviewer were used to conduct the bibliometric visualization and comparative analysis of countries, institutions, journals, authors, references, and keywords. Then, the map illustrating the research hotspots and knowledge structure was plotted based on the analysis results. RESULTS A total of 229 records were obtained, and the number of articles published has increased steadily over the investigated period. The largest increase was observed in 2022. With the highest number of publications and centrality, the United States was the most influential country. The University of Sherbrooke was the most productive institution. Author Boissy P. ranked first in terms of the number of publications, while Tousignant M. ranked highest in cited authors, with 7 publications and 65 citations. The Journal of Arthroplasty published the greatest number of articles, with 29 publications. The most popular keywords from 2018 to 2023 were "home telerehabilitation," "older adults," and "physical therapy". In terms of the strongest citation burst, the top five keywords were associated with "total knee arthroplasty," "in home tele rehabilitation," "physical activity," "motion," and "range." The frontier keywords were "patient satisfaction," "mobile application," "self-efficacy," "fear avoidance model," "home assessment tool," and "cost benefit analysis." CONCLUSIONS The current status and trends in telerehabilitation for hip or knee arthroplasty are presented. A major concern at present is physical therapy for home telerehabilitation in the elderly. In the future, mobile app-based telerehabilitation programs for arthroplasty will continue to be encouraged, and some outcomes, such as "patient satisfaction," "self-efficacy," and "cost benefit analysis," are expected to receive more attention. Our work will serve as a valuable resource, providing fundamental references and a directional guide for future research.
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Affiliation(s)
- Liqiong Wang
- Rehabilitation Medicine Center, West China HospitalSichuan UniversityChengduChina
- Rehabilitation Key Laboratory of Sichuan Province, West China HospitalSichuan UniversityChengduChina
| | - Liming Zhang
- Rehabilitation Medicine Center, West China HospitalSichuan UniversityChengduChina
- Rehabilitation Key Laboratory of Sichuan Province, West China HospitalSichuan UniversityChengduChina
| | - Chengqi He
- Rehabilitation Medicine Center, West China HospitalSichuan UniversityChengduChina
- Rehabilitation Key Laboratory of Sichuan Province, West China HospitalSichuan UniversityChengduChina
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Missmann M, Fischer MJ. Effect of baseline values on inpatient rehabilitation outcomes after total knee arthroplasty: a retrospective observational study. J Rehabil Med 2025; 57:jrm40443. [PMID: 39849999 PMCID: PMC11780670 DOI: 10.2340/jrm.v57.40443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 12/18/2024] [Indexed: 01/25/2025] Open
Abstract
OBJECTIVE To compare inpatient rehabilitation outcomes after total knee arthroplasty (TKA) between groups with different baseline scores. DESIGN A retrospective observational study. SUBJECTS Patients with knee osteoarthritis who have previously undergone unilateral TKA. METHODS Patients participated in 3-week inpatient rehabilitation following TKA and were assessed for patient-reported outcome measures (PROMs), which included the Numeric Pain Rating Scale (NPRS), the Health Assessment Questionnaire (HAQ), the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Furthermore, mobility scores for the range of motion (ROM) and the Timed Up and Go (TUG) test were recorded at the beginning and the end of rehabilitation. Patients were divided into quartile groups based on their initial examination scores. RESULTS 329 patients were enrolled in the study. The study population consisted mostly of female patients (63.8% vs 36.2%) with a mean age of 68.25 (SD 9.24) years. The personalized 21-day in rehabilitation programme was safe for all patients and had no dropouts. Patients with better PROMs scores at T1 did not have the same potential for improvement in PROMs but showed effective improvement in mobility (η² = 0.103 for changes in the WOMAC vs η²=0.502 for changes in the TUG test). CONCLUSION Regardless of the baseline scores, all patients presented significant improvements in both subjective and objective measures. Age and baseline PROMs or mobility scores did not have a significant effect on score development.
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Affiliation(s)
- Martin Missmann
- Austrian Workers' Compensation Board AUVA, Ingenieur-Etzel-Str. 17, 6020 Innsbruck, Austria.
| | - Michael J Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria; Vamed Rehabilitation Center Kitzbühel, Kitzbühel, Austria; Hannover Medical School MHH, Clinic for Rehabilitation Medicine, Hannover, Germany
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Liu X, Yang G, Xie W, Lu W, Liu G, Xiao W, Li Y. Efficacy of telerehabilitation for total knee arthroplasty: a meta-analysis based on randomized controlled trials combined with a bibliometric study. J Orthop Surg Res 2024; 19:874. [PMID: 39726029 DOI: 10.1186/s13018-024-05381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/17/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Physical therapy (PT) is widely employed in osteoarthritis (OA). This study aimed to explore the research development of PT for OA and to identify the emerging treatment, and verify its efficacy. MATERIALS AND METHODS The Web of Science Core Collection was used to conduct the bibliometric analysis. Furthermore, a meta-analysis based on randomized controlled trials (RCTs) was performed to evaluate the identified treatment's efficacy. RESULTS A total of 3,142 articles were retrieved from the Web of Science Core Collection, and the annual publication volume shows an exponential growth trend (R2 = 0.9515). Keyword analysis demonstrated that telerehabilitation (TELE) in total knee arthroplasty (TKA) has become a hotspot since 2020. To assess the effectiveness of TELE, we conducted a meta-analysis of 25 RCTs including 4402 patients. In the total analysis, the TELE group exhibited superior outcomes compared to the traditional face-to-face (FTF) rehabilitation group in terms of pain (standardized mean differences [SMD]: - 0.15, 95% CI - 0.27 to - 0.04, P = 0.01), passive flexion (MD: 2.60, 95% CI 0.77 to 4.44, P = 0.005), quadriceps muscle strength (SMD: 0.32, 95% CI 0.04 to 0.61, P = 0.03), and cost (SMD: - 0.50, 95% CI - 0.88 to - 0.12, P = 0.009). The subgroup analysis also demonstrated that the fixed equipment-assisted telerehabilitation (FEAT) group and the mobile device-assisted telerehabilitation (MDAT) group were superior to the FTF group. Moreover, patients in the FEAT group exhibited better prognoses than those in the MDAT group. No significant differences in the other measured outcome were observed. CONCLUSION Telerehabilitation proved to be more effective than traditional FTF rehabilitation in patients who underwent TKA. Further research is warranted to compare the different TELE interventions to establish the best protocols and timing for interventions.
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Affiliation(s)
- Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Guang Yang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wenqing Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Gaoming Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Paris Ferrer T, Masaracchio M, Kirker K, Madi Dewan B, Manthripragada M, Ojha H. Outcomes of direct access telehealth physical therapy for patients with musculoskeletal pain: a single cohort observational retrospective study. Physiother Theory Pract 2024; 40:2233-2240. [PMID: 37585711 DOI: 10.1080/09593985.2023.2245032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Telehealth direct access physical therapy is becoming more prevalent in the management of outpatient musculoskeletal pain. This innovative model affords more opportunity to reach potential patients who otherwise would not be able to access services due to geographical isolation, travel barriers, and timely access to quality care. OBJECTIVE The purpose of the study was to investigate if pain, function, and ability to perform jobs improved after direct access telehealth physical therapy in patients with musculoskeletal pain. METHODS A single cohort retrospective design was implemented to offer telehealth physical therapy to patients with musculoskeletal pain from March to November 2021. Eligible patients were at least 18 years old, located in California, and had a history of peripartum pelvic dysfunction, muscle pain, joint pain, or neural symptoms. Paired-samples t-tests and the Wilcoxon signed-rank test were used to analyze normally distributed and non-parametric data (α = 0.05), respectively, to compare pretest and post scores. RESULTS Based on 89 participants, paired-samples t-tests showed statistically significant differences in function [t(87) = 20.71, p < .0001] and pain [t(82) = -8.15, p < .0001]. Wilcoxon's signed-rank test showed statistically significant differences in ability to perform job (Z = -7.345, p < .0001). CONCLUSION This study demonstrated that in a cohort of individuals with multiregional musculoskeletal pain, there was a decrease in pain and improvements in function and ability to perform job after direct access telehealth physical therapy.
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Affiliation(s)
- Tiffany Paris Ferrer
- Department of Physical Therapy, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | | | - Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | | | - Heidi Ojha
- Department of Physical Therapy, Aware Health, Lafayette, CA, USA
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Wang HN, Luo P, Liu S, Liu Y, Zhang X, Li J. Effectiveness of Internet-Based Telehealth Programs in Patients With Hip or Knee Osteoarthritis: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e55576. [PMID: 39348685 PMCID: PMC11474128 DOI: 10.2196/55576] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/10/2024] [Accepted: 09/04/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a chronic musculoskeletal disease that causes pain, functional disability, and an economic burden. Nonpharmacological treatments are at the core of OA management. However, limited access to these services due to uneven regional local availability has been highlighted. Internet-based telehealth (IBTH) programs, providing digital access to abundant health care resources, offer advantages, such as convenience and cost-effectiveness. These characteristics make them promising strategies for the management of patients with OA. OBJECTIVE This study aimed to evaluate the effectiveness of IBTH programs in the management of patients with hip or knee OA. METHODS We systematically searched 6 electronic databases to identify trials comparing IBTH programs with conventional interventions for hip and knee OA. Studies were selected based on inclusion and exclusion criteria, focusing on outcomes related to function, pain, and self-efficacy. Standardized mean differences (SMDs) with 95% CIs were calculated to compare outcome measures. Heterogeneity was assessed using I² and χ² tests. The methodological quality of the selected studies and the quality of evidence were also evaluated. RESULTS A total of 21 studies with low-to-high risk of bias were included in this meta-analysis. The pooled results showed that IBTH has a superior effect on increasing function (SMD 0.30, 95% CI 0.23-0.37, P<.001), relieving pain (SMD -0.27, 95% CI -0.34 to -0.19, P<.001), and improving self-efficacy for pain (SMD 0.21, 95% CI 0.08-0.34, P<.001) compared to the conventional intervention group. Subgroup analysis revealed that IBTH with exercise can significantly alleviate pain and improve function and self-efficacy, but IBTH with cognitive-behavioral therapy only had the effect of reducing pain. CONCLUSIONS The meta-analysis provides moderate-quality evidence that IBTH programs have a beneficial effect on improving function, relieving pain, and improving self-efficacy compared to conventional interventions in patients with hip or knee OA. Limited evidence suggests that the inclusion of exercise regimens in IBTH programs is recommended. TRIAL REGISTRATION PROSPERO CRD42024541111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=541111.
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Affiliation(s)
- Hao-Nan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Pei Luo
- School of Sport Science, Beijing Sport University, Beijing, China
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing, China
| | - Shuyue Liu
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Yunyi Liu
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Xiao Zhang
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Farrokhi N, Sarzaeem MM, Feizi D. Feasibility and acceptability of a telerehabilitation intervention on patients undergoing total knee arthroplasty in Iran: randomised controlled trial protocol. BMJ Open 2024; 14:e083784. [PMID: 38858143 PMCID: PMC11168134 DOI: 10.1136/bmjopen-2023-083784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/23/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Telerehabilitation is a promising avenue to enhance post-total knee arthroplasty (TKA) rehabilitation by improving accessibility, convenience and cost-effectiveness. Despite its potential benefits, its application in the context of TKA in Iran is in its early stages, lacking comprehensive studies on feasibility, acceptance and programme adherence. This article outlines a protocol for an open-label, parallel-group, randomised controlled trial investigating the impact of a 4 week telerehabilitation programme alongside usual care. METHODS Thirty patients (aged 50-90) undergoing TKA for severe Knee Osteoarthritis at Atiyeh Hospital in Tehran, Iran, will be recruited using block randomisation. Participants will be assigned to either the intervention group, receiving telerehabilitation or the control group without telerehabilitation. The intervention will include virtual physiotherapy sessions thrice weekly, lasting 30-45 min each, over 4 weeks. The primary objective is to assess the feasibility and acceptability of telerehabilitation, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction using appropriate questionnaire and adherence to the intervention. Secondary outcomes encompass four Knee Injury and Osteoarthritis Outcome Score questionnaire subscales (function in Activities of Daily Living, Pain, Symptoms, Quality of Life). Patient global assessment will use a standardised question. An online survey will evaluate walking assistant device usage, exercise adherence and adverse events. The number of individuals receiving in-person rehabilitation will be documented after the first postoperative surgeon visit. Assessments occur at baseline and 4 weeks postsurgery. ANALYSIS Statistical analysis, including independent samples t-test, paired samples t-test, χ2 test, Fisher's exact test, analysis of covariance and multiple linear regression, will use SPSS software version 16, with significance set at p<0.05. ETHICS AND DISSEMINATION Approved by AJA University of Medical Sciences Ethics Committee (IR.AJAUMS.REC.1402.126), trial results will be presented to relevant groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER TCTR20231020004.
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Affiliation(s)
- Navvab Farrokhi
- Department of Physiotherapy, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Davood Feizi
- Department of Orthopedic Surgery, Aja University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Langevin P, Frémont P, Fait P, Dubé MO, Roy JS. Moving from the clinic to telehealth during the COVID-19 pandemic - a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury. Disabil Rehabil 2024; 46:2880-2889. [PMID: 37466379 DOI: 10.1080/09638288.2023.2236016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS). MATERIALS AND METHODS DESIGN In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic (n = 30) or telerehabilitation (n = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used. RESULTS For the PCSS, there was a group-by-time interaction (p = 0.05) with significant between-group differences at week 6, 12, and 26 (p < 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache (p < 0.05) for the in-clinic group. CONCLUSION The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. ClinicalTrials.gov Identifier: NCT03677661.IMPLICATION FOR REHABILITATIONThe telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format.The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement.Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area.
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Affiliation(s)
- Pierre Langevin
- Clinique Cortex and Physio Interactive, Québec, Canada
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Philippe Fait
- Clinique Cortex and Physio Interactive, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
- Department of Human Kinetics, University of Quebec at Trois-Rivières, Trois-Rivières, Canada
- Research Center in Neuropsychology and Cognition (CERNEC), Montréal, Canada'
| | - Marc-Olivier Dubé
- Clinique Cortex and Physio Interactive, Québec, Canada
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
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11
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Vasconcelos JM, Viana YG, Duarte NP, Polese JC. Translation and cross-cultural adaptation into Portuguese-Brazil of NuHISS, Enlight, and uMARS. J Bodyw Mov Ther 2024; 38:437-448. [PMID: 38763590 DOI: 10.1016/j.jbmt.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/21/2023] [Accepted: 01/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Easy access to the Internet enables the creation of many online applications. In this sense, questionnaires were developed to evaluate the usability of health area online applications: the National Usability-Focused Health Information System Scale (NuHISS), the Enlight, and the User Version of the Mobile Application Rating Scale (uMARS). Those scales do not have a Portuguese (Brazil) version which is adequate to Brazil's culture. As a consequence, they can not be properly used in Brazil. OBJECTIVE To translate and cross-cultural adapt the NuHISS, Enlight, and uMARS to Portuguese (Brazil). METHODS A methodological study involving the translation and cross-cultural adaptation of the questionnaires NuHISS, Enlight, and uMARS was conducted following international guidelines recommendations. The questionnaires pass trough an initial translation, translation synthesis, back translation, expert committee, and a pre-final version test. RESULTS Thirdy-two health professionals analyzed NuHiss, Enlight, and uMARS translated and cross-cultural adapted Portuguese (Brazil) version. There was conceptual equivalence between the translated and original versions, and no significant adaptations were needed during the translation process. 93.8% of professionals assume that the language is cohesive and 96.9% of them consider that the content is cohesive. CONCLUSION The NuHISS, Enlight, and uMARS were successfully translated and cross-culturally adapted to Portuguese (Brazil) and can be properly applied in Brazil. Brazilian health professionals should use the questionnaires NuHISS, Enlight, and uMARS to evaluate health area applications usability.
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Affiliation(s)
- Júlia Mafra Vasconcelos
- Faculdade Ciências Médicas de Minas Gerais, Physiotherapy Department, Belo Horizonte, Minas Gerais, Brazil
| | - Yasmine Guimarães Viana
- Faculdade Ciências Médicas de Minas Gerais, Physiotherapy Department, Belo Horizonte, Minas Gerais, Brazil
| | - Natalia Pereira Duarte
- Universidade Federal de São Carlos, Physiotherapy Department, São Carlos, São Paulo, Brazil
| | - Janaíne Cunha Polese
- Universidade Federal de Minas Gerais, Physiotherapy Department, Belo Horizonte, Minas Gerais, Brazil.
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12
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Hinman RS, Campbell PK, Kimp AJ, Russell T, Foster NE, Kasza J, Harris A, Bennell KL. Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial. Lancet 2024; 403:1267-1278. [PMID: 38461844 DOI: 10.1016/s0140-6736(23)02630-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Telerehabilitation is perceived as less effective than in-person care for musculoskeletal problems. We aimed to determine if physiotherapy video conferencing consultations were non-inferior to in-person consultations for chronic knee pain. METHODS In this non-inferiority randomised controlled trial, we recruited primary care physiotherapists from 27 Australian clinics. Using computer-generated blocks, participants with chronic knee pain consistent with osteoarthritis were randomly assigned (1:1, stratified by physiotherapist and clinic) in-person or telerehabilitation (ie, video conferencing) physiotherapist consultations. Participants and physiotherapists were unmasked to group assignment. Both groups had five consultations over 3 months for strengthening, physical activity, and education. Primary outcomes were knee pain (on a numerical rating scale of 0-10) and physical function (using the Western Ontario and McMaster Universities osteoarthritis index of 0-68) at 3 months after randomisation. Primary analysis was by modified intention-to-treat using all available data. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12619001240134. FINDINGS Between Dec 10, 2019, and June 17, 2022, 394 adults were enrolled, with 204 allocated to in-person care and 190 to telerehabilitation. 15 primary care physiotherapists were recruited. At 3 months, 383 (97%) participants provided information for primary outcomes and both groups reported improved pain (mean change 2·98, SD 2·23 for in-person care and 3·14, 1·87 for telerehabilitation) and function (10·20, 11·63 and 10·75, 9·62, respectively). Telerehabilitation was non-inferior for pain (mean difference 0·16, 95% CI -0·26 to 0·57) and function (1·65, -0·23 to 3·53). The number of participants reporting adverse events was similar between groups (40 [21%] for in-person care and 35 [19%] for telerehabilitation) and none were serious. INTERPRETATION Telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain. FUNDING National Health and Medical Research Council.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
| | - Penny K Campbell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexander J Kimp
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, University of Queensland, Brisbane, QLD, Australia; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, University of Queensland and Metro North Health, Brisbane, QLD, Australia
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, University of Queensland and Metro North Health, Brisbane, QLD, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Boldo M, Di Marco R, Martini E, Nardon M, Bertucco M, Bombieri N. On the reliability of single-camera markerless systems for overground gait monitoring. Comput Biol Med 2024; 171:108101. [PMID: 38340440 DOI: 10.1016/j.compbiomed.2024.108101] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Motion analysis is crucial for effective and timely rehabilitative interventions on people with motor disorders. Conventional marker-based (MB) gait analysis is highly time-consuming and calls for expensive equipment, dedicated facilities and personnel. Markerless (ML) systems may pave the way to less demanding gait monitoring, also in unsupervised environments (i.e., in telemedicine). However,scepticism on clinical usability of relevant outcome measures has hampered its use. ML is normally used to analyse treadmill walking, which is significantly different from the more physiological overground walking. This study aims to provide end-users with instructions on using a single-camera markerless system to obtain reliable motion data from overground walking, while clinicians will be instructed on the reliability of obtained quantities. METHODS The study compares kinematics obtained from ML systems to those concurrently obtained from marker-based systems, considering different stride counts and subject positioning within the capture volume. RESULTS The findings suggest that five straight walking trials are sufficient for collecting reliable kinematics with ML systems. Precision on joint kinematics decreased at the boundary of the capture volume. Excellent correlation was found between ML and MB systems for hip and knee angles (0.92 CONCLUSION Single-camera markerless motion capture systems have great potential in assessing human joint kinematics during overground walking. Clinicians can confidently rely on estimated joint kinematics while walking, enabling personalized interventions and improving accessibility to remote evaluation and rehabilitation services, as long as: (i) the camera is positioned to capture someone walking back and forth at least five times with good visibility of the entire body silhouette; (ii) the walking path is at least 2 m long; and (iii) images captured at the boundaries of the camera image plane should be discarded.
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Affiliation(s)
- Michele Boldo
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, Verona, 37134, Italy.
| | - Roberto Di Marco
- Department of Engineering for Innovation Medicine, University of Verona, Strada Le Grazie, 15, Verona, 37134, Italy.
| | - Enrico Martini
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, Verona, 37134, Italy.
| | - Mauro Nardon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati, 43, Verona, 37131, Italy.
| | - Matteo Bertucco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati, 43, Verona, 37131, Italy.
| | - Nicola Bombieri
- Department of Engineering for Innovation Medicine, University of Verona, Strada Le Grazie, 15, Verona, 37134, Italy.
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Molina-Garcia P, Mora-Traverso M, Prieto-Moreno R, Díaz-Vásquez A, Antony B, Ariza-Vega P. Effectiveness and cost-effectiveness of telerehabilitation for musculoskeletal disorders: A systematic review and meta-analysis. Ann Phys Rehabil Med 2024; 67:101791. [PMID: 38128150 DOI: 10.1016/j.rehab.2023.101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Internet-based telerehabilitation could be a valuable option for the treatment of musculoskeletal disorders, with the advantage of providing rehabilitation from anywhere. However, there is no solid and updated evidence demonstrating its effectiveness on relevant clinical and cost outcomes. OBJECTIVE This systematic review aims to determine the clinical and cost-effectiveness of internet-based telerehabilitation during the recovery of musculoskeletal disorders. METHODS Medline, Web of Science, Scopus and Cochrane databases were systematically searched from inception to June 2023. Trials investigating the effects of internet-based telerehabilitation in any musculoskeletal disorder were selected. Nonoriginal articles and grey literature were excluded. Two independent reviewers conducted the study selection and data extraction. Random effect meta-analyses (standardized mean difference) and further sensitivity analyses were performed. RESULTS We selected 37 clinical trials (33 randomized and 4 non-randomized) and 5 health economics studies, which included a total of 4,288 participants. Telerehabilitation was more favourable than control treatments in improving all studied clinical outcomes, although the effectiveness varied depending on the type of musculoskeletal disorder. The standard mean differences (SMD) ranged from 0.24 to 0.91. For physical function, the primary outcome, superior effectiveness was found only in people with hip fractures (SMD, 0.87; 95 % CI, 0.34 to 1.41). The effects for joint replacement, osteoarthritis, and spine pain were similar to those of control treatments. However, the favourable outcomes for telerehabilitation became insignificant when compared specifically to face-to-face rehabilitation. Some results displayed publication bias and a lack of robustness, necessitating cautious interpretation. In terms of health economics studies, telerehabilitation was 89.55$ (95 % CI 4.6 to 174.5) cheaper per individual than conventional treatments. CONCLUSIONS Telerehabilitation should be considered in the recovery process of musculoskeletal disorders when optimal face-to-face rehabilitation is not feasible. Moreover, telerehabilitation reduces costs and time. PROSPERO NUMBER CRD42022322425.
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Affiliation(s)
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain; Biomedical Research Unit, Torrecárdenas University Hospital, 04009 Almería, Spain; Department of Education, Faculty of Education Sciences, SPORT Research Group (CTS-1024) and CERNEP Research Center, University of Almería, Almería, Spain
| | | | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania 7000, Australia
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria ibs.GRANDA, Granada, Spain; PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain; Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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Vaksvik T, Støme LN, Føllesdal J, Tvedte KA, Melum L, Wilhelmsen CR, Kværner KJ. Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness. J Hand Ther 2024; 37:3-11. [PMID: 37778875 DOI: 10.1016/j.jht.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Video consultation was implemented as a new service in a hospital hand therapy setting. PURPOSE To describe the first year's practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. STUDY DESIGN Iterative design including economic evaluation. METHODS Using the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients' municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. RESULTS Of 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. CONCLUSIONS The results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.
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Affiliation(s)
- Tone Vaksvik
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | | | - Jorunn Føllesdal
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Linn Melum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kari J Kværner
- Centre for Connected Care (C3), Oslo University Hospital, Oslo, Norway; BI Norwegian Business School, Oslo, Norway
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Das L, Sharma PK, Singh G, Goyal T. Telerehabilitation is as effective as outpatient visits in the management of early osteoarthritis knee and mechanical low backache. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:405-413. [PMID: 37566137 DOI: 10.1007/s00590-023-03673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Teleconsultation services can be used to overcome the barriers imposed by the Covid-19 pandemic in providing basic orthopaedic rehabilitation services. Aim of the study is to compare the effectiveness of rehabilitation provided via outpatient and teleconsultation in patients with mechanical low backache (LBA) and early osteoarthritis (OA) of the knee joint utilizing Patient-Reported Outcome Measures. The satisfaction level of patients receiving teleconsultation will also be assessed. METHODOLOGY This study was a hospital-based prospective observational study. The study's participants were divided into two groups (Outpatient and Teleconsultation, respectively), and each group was further divided into two subgroups of 100 participants each (Knee-pain subgroup 1; LBA subgroup 2). SF-12 questionnaire, visual analogue scale (VAS) score for pain, and functional outcome scores (KOOS score for knee pain and the modified Oswestry Disability Index-MODI for LBA) were assessed at initial presentation and 6 months follow-up. Participants' satisfaction for teleconsultation service was assessed at final follow-up by 5 points Likert scale (5, very satisfied; 1, very dissatisfied). RESULTS Mean consultation time was significantly longer in the outpatient group (p < 0.001). No statistically significant difference in the VAS score, KOOS score (58.0 ± 7.6 vs. 57.8 ± 9.2; p = 0.893), and MODI Score (24.7 ± 13.3 vs. 27.4 ± 12.4; p = 0.128) between the corresponding subgroups of the two groups at final follow-up. Eighty-seven percentage of the participants were satisfied (Likert score ≥ 4) with the teleconsultation services. CONCLUSION Teleconsultation is equally effective to that as face-to-face outpatient consultation in the rehabilitation of patients with early OA knee and mechanical LBA. LEVEL OF STUDY Level 2, Prospective comparative study.
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Affiliation(s)
- Lakshmana Das
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India
| | - Pankaj Kumar Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India
| | - Gaganpreet Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India.
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Chuang HY, Ho SYC, Chou W, Tsai CL. Exploring the top-cited literature in telerehabilitation for joint replacement using the descriptive, diagnostic, predictive, and prescriptive analytics model: A thematic and bibliometric analysis. Medicine (Baltimore) 2023; 102:e36475. [PMID: 38050200 PMCID: PMC10695623 DOI: 10.1097/md.0000000000036475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Telerehabilitation offers a novel approach supplementing or replacing traditional physical rehabilitation. While research on telerehabilitation for joint replacement (TJR) has expanded, no study has investigated the top 100 cited articles (T100TJR) using the descriptive, diagnostic, predictive, and prescriptive analytics (DDPP) model. This study aims to examine the features of T100TJR in TJR through the DDPP approaches. METHODS A comprehensive search of the Web of Science Core Collection was conducted to locate all pertinent English-language documents from the database's inception until August 2, 2023. The T100TJR articles were then identified based on citation counts. The DDPP analytics model, along with 7 visualization techniques, was used to analyze metadata elements such as countries, institutions, journals, authors, references, and keywords. An impact timeline view was employed to highlight 2 particularly noteworthy articles. RESULTS We analyzed 712 articles and observed a consistent upward trend in publications, culminating in a noticeable peak in 2022. The United States stood out as the primary contributor. A detailed examination of the top 100 articles (T100TJR) revealed the following leading contributors since 2010: the United States (by country), University of Sherbrooke, Canada (by institutions), 2017 (by publication year), and Dr Hawker from Canada (by authors). We delineated 4 major themes within these articles. The theme "replacement" dominated, featuring in 89% of them. There was a strong correlation between the citations an article garnered and its keyword prominence (F = 3030.37; P < .0001). Additionally, 2 particularly high-impact articles were underscored for recommendation. CONCLUSIONS Telerehabilitation for TJR has seen rising interest, with the U.S. leading contributions. The study highlighted dominant themes, especially "replacement," in top-cited articles. The significant correlation between article citations and keyword importance indicates the criticality of keyword selection. The research underscores the importance of 2 pivotal articles, recommending them for deeper insights.
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Affiliation(s)
- Hua-Ying Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, Chung Hwa University, Tainan, Taiwan
| | - Sam Yu-Chieh Ho
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chiali Chi-Mei Hospital, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung San Medical University Hospital, Taichung, Taiwan
| | - Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan, Taiwan
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18
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Wicks M, Dennett AM, Peiris CL. Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis. Age Ageing 2023; 52:afad207. [PMID: 37979183 PMCID: PMC10657214 DOI: 10.1093/ageing/afad207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults. OBJECTIVE This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs. METHODS Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed. CONCLUSION Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
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Affiliation(s)
- Matoula Wicks
- Community Health Program, Eastern Health, Box Hill, VIC 3128, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC 3128, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
- Allied Health, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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Valle C, Schmitt-Sody M. [Digitalization in rehabilitation]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:869-875. [PMID: 37318535 DOI: 10.1007/s00132-023-04402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The term digitalization is in trend. In addition to modernizing existing structures and converting analogue to digital processes, there are now a large number of digital applications available in the medical field. This is also increasingly influencing prehabilitation and rehabilitation. OBJECTIVE The aim of this article is to provide an overview of digitalization options in the field of rehabilitation, taking the current literature into account. MATERIAL AND METHODS A systematic literature search was carried out on the topic of digitalization in rehabilitation, especially in relation to interventions and diseases of the knee joint, using among others PubMed and PEDro. RESULTS AND CONCLUSION Having arrived in "Rehabilitation 4.0", the networking of all infrastructures as well as the increasing use of artificial intelligence, the individualization of offers for healthcare companies and patients are playing an increasing role and are experiencing a real hype due to the supposedly infinite possibilities; however, the data situation on various digital offers in rehabilitation is inconsistent. The digital transformation provides many opportunities and challenges for rehabilitation, but despite all the euphoria it has to be critically questioned.
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Affiliation(s)
- Christina Valle
- Medical Park Chiemsee, Birkenallee 41, 83233, Bernau am Chiemsee, Deutschland.
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, München, Deutschland.
| | - Markus Schmitt-Sody
- Medical Park Chiemsee, Birkenallee 41, 83233, Bernau am Chiemsee, Deutschland.
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20
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Choudhury AK, Bansal S, Jain A, Raja BS, Niraula BB, Kalia RB. Conventional rehabilitation post-TKA achieves better knee flexion with higher resource utilization compared to application-based rehabilitation - a systematic review and meta-analysis. J Orthop 2023; 44:77-85. [PMID: 37720916 PMCID: PMC10500420 DOI: 10.1016/j.jor.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023] Open
Abstract
Background Post-operative physiotherapy is a major component of the effectiveness of knee replacement. Adequate rehabilitation protocols are required for better functional outcomes. With the advent of smartphones and smartwatches, the use of telerehabilitation has increased recently. This study aims to compare tele rehabilitation using various mobile-based applications to conventional rehabilitation protocols. Methods From Jan 2000 to Jun 2022, all the RCTs from SCOPUS, EMBASE and PUBMED comparing patient-related outcome measures between the smartphone-based app and conventional rehabilitation protocols were scanned and seven studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The quantitative analysis compared outcomes using the knee injury and osteoarthritis outcome score (KOOS), the knee society function score (KSFS), the active range of motion (AROM), Euro-Qol-5D-5L, and MUA. The qualitative analysis compared VAS, NRS, and Time up and go (TUG). Results The study shows statistically significant improvement in traditional rehabilitation over app based on KSFS score (M.D.: 6.05, p = 0.05) and AROM on long-term follow-up (12 months) (M.D.: 2.46, p = 0.02). AROM was insignificant on 3 months or less follow-up. NRS and VAS were found to be statistically better in app-based groups. No statistically significant results were seen on KOOS, Euro-Qol-5D-5L, MUA and TUG. 90 days of readmission and a number of physiotherapy visits were more in conventional groups. No difference was seen in single-leg stance and satisfaction rates. Conclusions The present review highlights improved early pain scores and comparable patient-reported outcome analysis at a short-term follow-up period among patients receiving mobile app-based rehabilitation. However, knee range of motion and KSFS score achieved after surgery is analysed to be better with traditional rehabilitation at the one-year end follow-up period.
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Affiliation(s)
| | - Shivam Bansal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Akash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Balgovind S. Raja
- Department of Orthopedics, All India Institute of Medical Sciences, Patna, India
| | - Bishwa Bandhu Niraula
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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21
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Venosa M, Romanini E, Ciminello E, Cerciello S, Angelozzi M, Calvisi V. Telerehabilitation Is a Valid Option for Total Knee Arthroplasty Patients: A Retrospective Pilot Study Based on Our Experience during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:2489. [PMID: 37761686 PMCID: PMC10530780 DOI: 10.3390/healthcare11182489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Total knee arthroplasty is an effective operation. Post-surgery rehabilitation, based on early and intensive progressive exercise programs, plays a substantial role and telerehabilitation can be an effective safe option. This retrospective study aimed to compare traditional in-presence rehabilitation and telerehabilitation for total knee arthroplasty, based on our experience during the Italian COVID-19 lockdown. MATERIALS AND METHODS We retrospectively analyzed 164 patients (94 females and 70 males) enrolled in 2020 within 2 weeks after total knee replacement to perform post-operative outpatient rehabilitation. The clinical results of 82 patients (mean age 66.8 ± 10.2 years) performing telerehabilitation with those obtained from a similar cohort of 82 patients (mean age 65.4 ± 11.8 years) performing traditional in-presence outpatient rehabilitation were compared. Clinical outcomes were examined by comparing the gait speed (Time Up and Go-TUG test), the range of motion, the pain intensity (VAS), the functional status (Oxford Knee Score-OKS and Knee injury and Osteoarthritis Outcome Score-KOOS) and the overall satisfaction (Self-administered patient satisfaction scale) 12 weeks after the beginning of the physiotherapeutic protocol. RESULTS Telerehabilitation was non-inferior to traditional in-presence rehabilitation in all of the investigated areas and no statistical difference in terms of effectiveness was detected at 12 weeks, as confirmed by the respective patient-reported outcome scores such as TUG test (reduced from 20 ± 2 s to 12 ± 1.5 s for the telerehab cohort and from 18 ± 1.5 s to 13.1 ± 2 s for the in-presence rehabilitation one), pain VAS, OKS (improved from 22 ± 1.3 to 36 ± 2.7 for the telerehab cohort and from 23 ± 2.1 to 35.1 ± 4.2 for the in-presence group), KOOS (improved from 46.2 ± 10.2 to 67.4 ± 3.8 for the telerehabilitation cohort and from 48.4 ± 8.4 to 68.3 ± 6.6 for the other group), and the Self-administered patient satisfaction scale (more than two-thirds of patients globally satisfied with the results of their surgery in both groups). CONCLUSION The telerehabilitation program was effective after total knee replacement and yielded clinical outcomes that were not inferior to conventional outpatient protocols.
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Affiliation(s)
- Michele Venosa
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio, Coppito 2, 67100 L’Aquila, Italy; (M.A.); (V.C.)
- RomaPro, Polo Sanitario San Feliciano, Via Mattia Battistini 44, 00167 Rome, Italy;
| | - Emilio Romanini
- RomaPro, Polo Sanitario San Feliciano, Via Mattia Battistini 44, 00167 Rome, Italy;
- GLOBE, Italian Working Group on Evidence-Based Orthopaedics, Via Nicola Martelli 3, 00197 Rome, Italy
| | - Enrico Ciminello
- Italian Implantable Prostheses Registry (RIPI), Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Simone Cerciello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy;
- Orthopaedic Department, Casa di Cura Villa Betania, Via Pio IV 42, 00165 Rome, Italy
| | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio, Coppito 2, 67100 L’Aquila, Italy; (M.A.); (V.C.)
| | - Vittorio Calvisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio, Coppito 2, 67100 L’Aquila, Italy; (M.A.); (V.C.)
- UOSD, Department of Mini-Invasive and Computer-Assisting Orthopedic Surgery, San Salvatore Hospital, Via L. Natali 1, 67100 L’Aquila, Italy
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22
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Maltby A, Underhill A, Woodbridge S. The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review. HAND THERAPY 2023; 28:89-102. [PMID: 37904901 PMCID: PMC10581535 DOI: 10.1177/17589983231191867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 11/01/2023]
Abstract
Introduction In 2020, the COVID-19 pandemic caused a rapid uptake of virtual consultations (VCs) to minimise disease transmission and for this reason, research into telerehabilitation has been expanding. This review aimed to map and synthesize evidence on the use of VCs in upper limb musculoskeletal rehabilitation, describe key characteristics, and identify gaps in the research. Methods This scoping review investigated synchronous rehabilitation consultations performed over VC. All asynchronous, wearable or pre-recorded technology was excluded. CINAHL Complete, Medline, PEDro, Google Scholar and grey literature sources were searched. Screening and data extraction were done by a single researcher. Frequency counts were used to analyse the data. Results Nineteen studies were identified, with patients with shoulder injury/pain most frequently studied. Most sources (n = 9) used bespoke video programmes. Range of motion (ROM) was the most common assessment (n = 10) and exercise prescription (n = 7) was the most common treatment. Benefits included time and cost savings, maintaining therapeutic relationships and increasing patient independence. Most diagnostic assessments, except joint and nerve tension tests, were found to be reliable and valid. Studies noted increased function in activities, decreased pain and increased ROM after VCs. Limitations included restricted 'hands-on' treatment, resource and training concerns and limiting patient factors. Conclusions This review mapped available evidence and identified several gaps in the literature. Further robust research into VCs for hand/wrist disorders, ROM assessment and cost-effectiveness is needed.
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Affiliation(s)
- Amy Maltby
- School of Allied Health and Social Care, University of Derby, Derby, UK
- Hand Therapy Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Ann Underhill
- School of Allied Health and Social Care, University of Derby, Derby, UK
| | - Sarah Woodbridge
- School of Allied Health and Social Care, University of Derby, Derby, UK
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Li KY, Chan PK, Yeung SS, Cheung A, Chan WKV, Luk MH, Cheung MH, Fu H, Chiu KY. The role of telemedicine in joint replacement surgery? An updated review. ARTHROPLASTY 2023; 5:39. [PMID: 37537634 PMCID: PMC10401824 DOI: 10.1186/s42836-023-00196-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 08/05/2023] Open
Abstract
The usage of telemedicine and telehealth services has grown tremendously and has become increasingly relevant and essential. Technological advancements in current telehealth services have supported its use as a viable alternative tool to conduct visits for consultations, follow-up, and rehabilitation in total joint arthroplasty. Such technology has been widely implemented, particularly during the coronavirus 2019 (COVID-19) pandemic, to deliver postoperative rehabilitation among patients receiving total joint arthroplasty (TJA), further demonstrating its feasibility with a lower cost yet comparable clinical outcomes when compared with traditional care. There remains ample potential to utilize telemedicine for prehabilitation to optimize the preoperative status and postoperative outcomes of patients with osteoarthritis. In this review, various implementations of telemedicine within total joint arthroplasty and future application of telemedicine to deliver tele-prehabilitation in TJA are discussed.
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Affiliation(s)
- Ka Yau Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Shun Shing Yeung
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong SAR, China
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Wai Kwan Vincent Chan
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Michelle Hilda Luk
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Man Hong Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
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Liao WJ, Lee KT, Chiang LY, Liang CH, Chen CP. Postoperative Rehabilitation after Anterior Cruciate Ligament Reconstruction through Telerehabilitation with Artificial Intelligence Brace during COVID-19 Pandemic. J Clin Med 2023; 12:4865. [PMID: 37510980 PMCID: PMC10381141 DOI: 10.3390/jcm12144865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Due to the rapid spread of the coronavirus disease-19 (COVID-19), most of the patients expressed a reluctance to undergo postoperative rehabilitation at a rehabilitation clinic. Therefore, in this scenario it was necessary to reshape the crucial role of postoperative rehabilitation of these patients. We conducted a telerehabilitation program based on an artificial intelligence brace (AI brace) which can monitor the progress of rehabilitation through an app and an internet server. Our hypothesis was that home-based telerehabilitation might provide clinical outcomes comparable to face-to-face, hospital-based rehabilitation programs in terms of effectiveness. METHODS A retrospective cohort study enrolled patients who received anterior cruciate ligament reconstruction (ACLR) between January and September 2020. Patients were divided into two groups: the tele-AI group received telerehabilitation with an AI brace while the FTF group had face-to-face, hospital-based rehabilitation. Clinical knee functional scores and Tegner Activity Scale (TAS) were assessed and analyzed until 12 months after the operation. RESULTS The tele-AI group had higher IKDC scores at 3 months (p = 0.0443) and 6 months (p = 0.0052) after surgery and higher KOOS scores at 1 month (p = 0.0365) and 6 months (p = 0.0375) after surgery. However, no significant difference between the two groups was detected at the end of the follow-up. The tele-AI group had higher TAS than FTF group after 1 year. CONCLUSIONS Telerehabilitation after ACLR seems to provide a superior short-term outcome compared to hospital-based rehabilitation during the COVID-19 pandemic.
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Affiliation(s)
- Wei-Jen Liao
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Kun-Tsan Lee
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung 402202, Taiwan
| | - Liang-Yu Chiang
- Department of Orthopaedic Surgery, Taichung Armed Forces General Hospital, Taichung 41152, Taiwan
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Che-Han Liang
- Department of Orthopaedics, Tungs' Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
| | - Chao-Ping Chen
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
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Lebleu J, Pauwels A, Anract P, Parratte S, Van Overschelde P, Van Onsem S. Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study. J Pers Med 2023; 13:jpm13050824. [PMID: 37240994 DOI: 10.3390/jpm13050824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Rehabilitation for total knee replacement (TKA) often involves in-person therapy sessions, which can be time consuming and costly. Digital rehabilitation has the potential to address these limitations, but most of these systems offer standardized protocols without considering the patient's pain, participation, and speed of recovery. Furthermore, most digital systems lack human support in case of need. The aim of this study was to investigate the engagement, safety, and clinical effectiveness of a personalized and adaptative app-based human-supported digital monitoring and rehabilitation program. In this prospective multi-center longitudinal cohort study, 127 patients were included. Undesired events were managed through a smart alert system. Doctors were triggered when there was a suspicion of problems. The drop-out rate, complications and readmissions, PROMS, and satisfaction were collected through the app. There was only 2% readmission. Doctor actions through the platform potentially avoided 57 consultations (85% of alerts). The adherence to the program was 77%, and 89% of the patients would recommend the use of the program. Personalized human-backed-up digital solutions can help to improve the rehabilitation journey of patients after TKA, lower healthcare-related costs by lowering the complication and readmission rate, and improve patient reported outcomes.
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Affiliation(s)
| | | | - Philippe Anract
- Service de Chirurgie Orthopédique, Hopital Cochin, 75679 Paris, France
| | - Sébastien Parratte
- International Knee and Joint Centre, Abu Dhabi 46705, United Arab Emirates
- Locomotion Institute, Aix Marseille University, 13009 Marseille, France
| | | | - Stefaan Van Onsem
- Orthopaedics Department, AZ Alma Eeklo, Ringlaan 15, 9900 Eeklo, Belgium
- Department of Human Structure and Repair, Ghent University, 9000 Gent, Belgium
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26
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Lee ACW. Clinician's Commentary on O'Neil. et al. 1. Physiother Can 2023; 75:132-133. [PMID: 37736374 PMCID: PMC10510556 DOI: 10.3138/ptc-2021-0040-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Alan Chong W Lee
- Doctor of Physical Therapy Program, Mount Saint Mary's University, Los Angeles, California, USA;
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27
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Bok SK, Song Y, Lim A, Jin S, Kim N, Ko G. High-Tech Home-Based Rehabilitation after Stroke: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072668. [PMID: 37048751 PMCID: PMC10095213 DOI: 10.3390/jcm12072668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: To improve existing rehabilitation technologies, we conducted a systematic review and meta-analysis to identify the effect size of home-based rehabilitation using robotic, virtual reality, and game devices on physical function for stroke survivors. (2) Methods: Embase, PubMed, Cochrane Library, ProQuest, and CINAHL were used to search the randomized controlled trials that applied technologies via home-based rehabilitation, such as virtual reality, robot-assisted devices, and games. The effect size (Hedges's g) of technology type and affected limb on physical function were calculated. (3) Results: Ten studies were included. The effect size of home-based rehabilitation in virtual reality had the greatest value (Hedges's g, 0.850; 95% CI, 0.314-1.385), followed by robot-assisted devices (Hedges's g, 0.120; 95% CI, 0.003-0.017) and games (Hedges's g, -0.162; 95% CI, -0.036 to -0.534). The effect size was larger in the upper limbs (Hedges's g, 0.287; 95% CI, 0.128-0.447) than in the lower limbs (Hedges's g, -0.113; 95% CI, -0.547 to 0.321). (4) Conclusions: Virtual reality home rehabilitation was highly effective for physical function compared to other rehabilitation technologies. Interventions that consisted of a pre-structured and tailored program applied to the upper limbs were effective for physical function and psychological outcomes.
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Affiliation(s)
- Soo-Kyung Bok
- Department of Rehabilitation, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Youngshin Song
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Ancho Lim
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Sohyun Jin
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Nagyeong Kim
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Geumbo Ko
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
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Alexander JS, Redfern RE, Duwelius PJ, Berend KR, Lombardi AV, Crawford DA. Use of a Smartphone-Based Care Platform After Primary Partial and Total Knee Arthroplasty: 1-Year Follow-Up of a Prospective Randomized Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00213-9. [PMID: 36889524 DOI: 10.1016/j.arth.2023.02.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The rise in demand of knee arthroplasty has led the industry to develop methods to decrease costs of care, such as novel methods of delivering physiotherapy, including smartphone-based exercise educational platforms. The purpose of this study was to determine the noninferiority of one such system after primary knee arthroplasty as compared to traditional in-person physiotherapy. METHODS A prospective, multicenter randomized clinical trial was conducted comparing standard of care rehabilitation to a smartphone-based care platform after primary knee arthroplasty from January 2019 to February 2020. One-year patient outcomes, satisfaction scores, and utilizations of health care resources were analyzed. A total of 401 patients was available for analysis-241 in the control and 160 in the treatment group. RESULTS There were 194 (94.6%) patients in the control group who required 1 or more physiotherapy visits compared to only 97 (60.6%) patients in the treatment group (P < .001). Emergency department visits within 1 year occurred in 13 (5.4%) patients and 2 (1.3%) patients in the control and treatment groups, respectively (P = .03). The change in mean Knee Injury and Osteoarthritis Outcome Score for joint replacement scores at 1 year was similar between both the groups (32.1 ± 1 6.8 versus 30.1 ± 18.1, P = .32). CONCLUSION Implementation of this smartphone/smart watch care platform showed similar outcomes to traditional care models at 1 year postoperative. Traditional physiotherapy and emergency department visits occurred at much lower rates in this cohort, which could alleviate the need for health care dollars spent by reducing postoperative costs and enhancing communication across the health care system.
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de Rezende DRB, Neto IA, Iunes DH, Carvalho LC. Analysis of the effectiveness of remote intervention of patients affected by chronic diseases: A systematic review and meta-analysis. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231197316. [PMID: 37781504 PMCID: PMC10540568 DOI: 10.1177/27550834231197316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
Objectives The aim of the study was to verify the effectiveness of telemedicine in randomized controlled trials (RCTs) in terms of its influence on physical conditioning, quality of life, and health conditions in adults/elderly people affected by chronic diseases. Design This was a systematic review and meta-analysis. Methods The search covered RCTs published from 2011 to 2021 and was conducted using the PubMed, Embase, PEDro, Lilacs, and Cochrane Library databases, on volunteers of both sexes, that were rehabilitated, and/or monitored, and/or evaluated, specifically, via remote care. The extraction, quality of studies, and risk of bias were assessed using the RoB2 (risk of bias) tool, for analysis of the strength of evidence, the GRADE (Grading of Recommendations Assessment, Developing, and Evaluation) method was used, and for the preparation of meta-analysis was used at RevMan 5.4 (Review Manager) was used. Results The database search identified 3949 potential articles for screening, 13 of which were eligible for the present systematic review, involving 1469 participants with chronic diseases (chronic obstructive pulmonary disease (COPD), asthma, heart failure, diabetes mellitus, and fibromyalgia). Through the meta-analysis, an advantage was identified for the remote intervention on physical conditioning (p = 0.001), with an estimated effect of 0.29 (0.11, 0.46) and on health conditions (p = 0.0004), -0.30 (-0.47, -0.14), while for quality of life, no significant difference was identified (p = 0.90), 0.01 (-0.13, 0.14). Conclusion Telemedicine has clinical effectiveness for the outcome of physical conditioning and general health conditions in adults with chronic diseases when compared to usual care without face-to-face intervention.
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Affiliation(s)
| | | | - Denise Hollanda Iunes
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Leonardo César Carvalho
- Department of Postgraduate Program in Applied Health Biosciences, Federal University of Alfenas, Alfenas, Brazil
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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30
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Marks D, Kitcher S, Attrazic E, Hing W, Cottrell M. The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review. Int J Telerehabil 2022. [DOI: 10.5195/ijt.2022.6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods: Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting; intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy; and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results: Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion: Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
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Marks D, Kitcher S, Attrazic E, Hing W, Cottrell M. The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review. Int J Telerehabil 2022; 14:e6524. [PMID: 38026565 PMCID: PMC10681044 DOI: 10.5195/ijt.2023.6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Introduction While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting; intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy; and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
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Affiliation(s)
- Darryn Marks
- Bond University, School of Physiotherapy, Gold Coast, Australia
- Gold Coast University Hospital, Gold Coast, Australia
| | - Sarah Kitcher
- Bond University, School of Physiotherapy, Gold Coast, Australia
| | - Elodie Attrazic
- Bond University, School of Physiotherapy, Gold Coast, Australia
| | - Wayne Hing
- Bond University, School of Physiotherapy, Gold Coast, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Women's and Brisbane Hospital, Australia
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Grigorovich A, Xi M, Lam N, Pakosh M, Chan BCF. A systematic review of economic analyses of home-based telerehabilitation. Disabil Rehabil 2022; 44:8188-8200. [PMID: 34965827 DOI: 10.1080/09638288.2021.2019327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions. MATERIALS AND METHODS Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist. RESULTS Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear. CONCLUSIONS More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.
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Affiliation(s)
- Alisa Grigorovich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Min Xi
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Natascha Lam
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Brian C F Chan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:4098-4103. [PMID: 35347376 DOI: 10.1007/s00167-022-06931-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Telehealth rehabilitation (telerehab) is an increasingly popular cost-saving alternative to traditional rehabilitation after total joint arthroplasty. We compared the safety and efficacy of an institutional telerehab program to conventional "face-to-face" rehabilitation in a sample of patients undergoing total knee arthroplasty (TKA). METHODS A retrospective matched cohort study was performed. Medicare patients who utilized telerehab following unilateral TKA were matched in a 1:3 ratio to those utilizing conventional rehabilitation. Patients were matched on sex, body mass index (BMI, ± 5 kg/m2), preoperative extension (± 10 degrees), preoperative flexion (± 10 degrees), and Risk Assessment and Prediction Tool (RAPT) score (± 2 points). Ninety-day unplanned healthcare encounters, 120-day manipulations under anesthesia (MUAs), and 6-week and 3-month changes in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), pain visual analog scale (VAS), Veterans RAND 12 (VR-12), and Lower-Extremity Activity Scale (LEAS) were compared between groups. RESULTS Eighty-two telerehab patients and 244 conventional rehab patients were included. After matching, there were no differences in 90-day unplanned healthcare encounters or 120-day MUA rates between groups. There were no differences in 6-week or 3-month changes in KOOS-JR, VAS pain, or VR-12 mental or physical sub-scores between groups. Telerehab patients had a greater improvement in LEAS score at 3 months compared to the conventional group (mean difference 1.9, P = 0.03). CONCLUSION In a matched cohort study of 326 TKA patients, telerehab patients had similar rates of unplanned healthcare encounters and MUAs and similar patient-reported outcomes compared to conventional PT patients, suggesting that telerehab can be an equally effective alternative to conventional PT following TKA. LEVEL OF EVIDENCE III.
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Coulibaly LP, Poder TG, Tousignant M. Attributes Underlying Patient Choice for Telerehabilitation Treatment: A Mixed-Methods Systematic Review to Support a Discrete Choice Experiment Study Design. Int J Health Policy Manag 2022; 11:1991-2002. [PMID: 34861762 PMCID: PMC9808290 DOI: 10.34172/ijhpm.2021.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Across most healthcare systems, patients are the primary focus. Patient involvements enhance their adherence to treatment, which in return, influences their health. The objective of this study was to determine the characteristics (ie, attributes) and associated levels (ie, values of the characteristics) that are the most important for patients regarding telerehabilitation (TR) healthcare to support a future discrete choice experiment (DCE) study design. METHODS A mixed-methods systematic review was conducted from January 2005 to the end of July 2020 and the search strategy was applied to five different databases. The initial selection of articles that met the eligibility criteria was independently made by one researcher, two researchers verified the accuracy of the extracted data, and all researchers discussed about relevant variables to include. Reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the study. A qualitative synthesis was used to summarize findings. RESULTS From a total of 928 articles, 11 (qualitative [n = 5], quantitative [n = 3] and mixed-methods [n = 3] design) were included, and 25 attributes were identified and grouped into 13 categories: Accessibility, Distance, Interaction, Technology experience, Treatment mode, Treatment location, Physician contact mode, Physician contact frequency, Cost, Confidence, Ease of use, Feeling safer, and Training session. The attributes levels varied from two to five. The DCE studies identified showed the main stages to undertake these types of studies. CONCLUSION This study could guide the development of interview grid for individual interviews and focus groups to support a DCE study design in the TR field. By understanding the characteristics that enhance patients' preferences, healthcare providers can create or improve TR programs that provide high-quality and accessible care. Future research via a DCE is needed to determine the relative importance of the attributes.
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Affiliation(s)
- Lucien P. Coulibaly
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada
| | - Thomas G. Poder
- Département de Gestion, Évaluation et Politique de Santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| | - Michel Tousignant
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada
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Jirasakulsuk N, Saengpromma P, Khruakhorn S. Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis. JMIR Rehabil Assist Technol 2022; 9:e36028. [PMID: 36048520 PMCID: PMC9478822 DOI: 10.2196/36028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers. OBJECTIVE We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness. METHODS A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane's risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR's effectiveness based on different treatments, controls, and outcome measures. RESULTS The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI -0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment. CONCLUSIONS We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. TRIAL REGISTRATION PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289.
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Affiliation(s)
- Nathaphon Jirasakulsuk
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Pattaridaporn Saengpromma
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
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Dennett AM, Taylor NF, Williams K, Lewis AK, Brann P, Hope JD, Wilton AM, Harding KE. Consumer perspectives of telehealth in ambulatory care in an Australian health network. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1903-1912. [PMID: 34558144 DOI: 10.1111/hsc.13569] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n = 379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face-to-face care and 29% reported they would choose to use telehealth over face-to-face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations.
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Affiliation(s)
- Amy M Dennett
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
| | - Nicholas F Taylor
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
| | | | - Annie K Lewis
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
| | - Peter Brann
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Clinical Sciences, Monash University, Clayton, Vic., Australia
| | - Judith D Hope
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- Eastern Health Clinical School, Monash University, Clayton, Vic., Australia
| | - Anita M Wilton
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
| | - Katherine E Harding
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
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Dennett AM, Harding KE, Peiris CL, Shields N, Barton C, Lynch L, Parente P, Lim D, Taylor NF. Efficacy of Group Exercise-Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38553. [PMID: 35849441 PMCID: PMC9345024 DOI: 10.2196/38553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise-based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. OBJECTIVE We aimed to evaluate the efficacy of a group exercise-based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. RESULTS The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38553.
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Affiliation(s)
- Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Christian Barton
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lauren Lynch
- Community Health, Eastern Health, Healesville, Australia
| | - Phillip Parente
- Department of Cancer Services, Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Monash University, Clayton, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Rennie K, Taylor C, Corriero AC, Chong C, Sewell E, Hadley J, Ardani S. The Current Accuracy, Cost-Effectiveness, and Uses of Musculoskeletal Telehealth and Telerehabilitation Services. Curr Sports Med Rep 2022; 21:247-260. [PMID: 35801726 DOI: 10.1249/jsr.0000000000000974] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Musculoskeletal conditions are a major contributor to global morbidity. During the COVID-19 pandemic, clinicians needed to rapidly meet the evolving requirements of their patients, which resulted in an increased adoption of telehealth services. This area needs more research, as there is currently a paucity of studies, and telehealth practices are continuing to advance and evolve. This study subsequently aims to evaluate the ethics, health economics, and accuracy of current musculoskeletal telehealth services. This article combines three original studies; a telehealth accuracy systematic review; a cost-effectiveness scoping review; and a biopsychosocial narrative review. These studies were combined into one article. This article concludes that telehealth services achieve an average agreement with in-person assessments of 62% for the knee and 31% for the shoulder and that telerehabilitation services incur average cost savings per patient of £38.57 but that these savings are primarily a result of a reduced need to travel.
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Affiliation(s)
| | | | | | | | | | | | - Shina Ardani
- Department of Clinical Research, Sina Medical Technology, Manchester, UNITED KINGDOM
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Zheng J, Hou M, Liu L, Wang X. Knowledge Structure and Emerging Trends of Telerehabilitation in Recent 20 Years: A Bibliometric Analysis via CiteSpace. Front Public Health 2022; 10:904855. [PMID: 35795695 PMCID: PMC9251196 DOI: 10.3389/fpubh.2022.904855] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Telerehabilitation, as an effective means of treatment, is not inferior to traditional rehabilitation, and solves the problem of many patients who do not have access to hospital-based training due to costs and distance. So far, the knowledge structure of the global use of telerehabilitation has not been formed. This study aimed to demonstrate the state of emerging trends and frontiers concerning the studies of telerehabilitation through bibliometric software. Methods Literature about telerehabilitation from 2000 to 2021 was retrieved from the Web of Science Core Collection. We used CiteSpace 5.8.R3 to analyze the publication years, journals/cited journals, countries, institutions, authors/cited authors, references, and keywords. Based on the analysis results, we plotted the co-citation map to more intuitively observe the research hotspots and knowledge structure. Results A total of 1,986 records were obtained. The number of annual publications gradually increased over the investigated period. The largest increase occurred between 2019 and 2020. J TELEMED TELECARE was the most prolific and the most cited journal. The United States was the most influential country, with the highest number of publications and centrality. The University of Queensland was the most productive institution. The author Tousignant M ranked the highest in the number of publications and Russell TG ranked the first in the cited authors. Respectively, the articles published by Cottrell MA and Russell TG ranked the first in the frequency and centrality of cited references. The four hot topics in telerehabilitation were “care”,“stroke”, “telemedicine” and “exercise”. The keyword “stroke” showed the strongest citation burst. The two frontier keywords were “physical therapy” and “participation”. The keywords were clustered to form 21 labels. Conclusion This study uses visualization software CiteSpace to provide the current status and trends in clinical research of telerehabilitation over the past 20 years, which may help researchers identify new perspectives concerning potential collaborators and cooperative institutions, hot topics, and research frontiers in the research field. Bibliometric analysis of telerehabilitation supplements and improves the knowledge field of telemedicine from the concept of rehabilitation medicine and provides new insights into therapists during the COVID-19 pandemic.
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Affiliation(s)
- Jiaqi Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Meijin Hou
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China
| | - Lu Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiangbin Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- *Correspondence: Xiangbin Wang
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de Brito SAF, Scianni AA, Peniche PDC, Faria CDCDM. Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol. PLoS One 2022; 17:e0265841. [PMID: 35312708 PMCID: PMC8936471 DOI: 10.1371/journal.pone.0265841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Völter C, Stöckmann C, Klein H, Dazert S, Thomas JP. [Teletherapy after cochlear implantation during the COVID-19 pandemic]. HNO 2022; 70:214-223. [PMID: 34825919 PMCID: PMC8620318 DOI: 10.1007/s00106-021-01124-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to the COVID-19 pandemic, digitalization in healthcare grew rapidly. Auditory training after cochlear implantation usually takes place face-to-face but social distancing interferes with this therapeutic approach. MATERIALS AND METHODS In follow-up treatment, 42 adult cochlear implant (CI) users aged 53.8 (±15.6) years received video therapy 1 x/week for 5 weeks on a certified platform. After each therapy session, the technical process and therapeutic content were assessed. At the end of the study, usability and the relationship between therapist and patient were evaluated by patients and therapists using the System Usability Scale (SUS), a final questionnaire and by the Skala Therapeutische Allianz - Revised (STA-R). Furthermore, a cost-benefit analysis was done. RESULTS Usability for both users was high (87.97 versus 93.0). Despite the lack of personal contact, therapeutic alliance was highly appreciated by patients and therapists (87.8% versus 84.8%). The main advantages for the patients were reductions in time and costs. In contrast, the rehabilitation center faced higher costs initially due to the longer time therapists needed to prepare the lessons. Technical problems had to be solved in > 75% of the first sessions but did not bother training thereafter. In total, 47.6% of the patients believe that teletherapy can completely fulfill their therapeutic needs. CONCLUSION Video therapy has been judged as a useful tool by all users and the majority wants to continue. However, it remains questionable whether the therapist-patient relationship can be sufficiently maintained over a longer period and whether online therapy is as effective as face-to-face therapy.
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Affiliation(s)
- Christiane Völter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bleichstraße 15, 44787, Bochum, Deutschland.
| | - Carolin Stöckmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bleichstraße 15, 44787, Bochum, Deutschland
| | - Hannah Klein
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bleichstraße 15, 44787, Bochum, Deutschland
| | - Stefan Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bleichstraße 15, 44787, Bochum, Deutschland
| | - Jan Peter Thomas
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Kath. St. Paulus Gesellschaft, St. Johannes Hospital Dortmund, Johannesstr. 9-17, 44137, Dortmund, Deutschland
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Moore MR, Galetta MS, Schwarzkopf R, Slover JD. Patient Satisfaction and Interest in Telemedicine Visits Following Total Knee and Hip Replacement Surgery. Telemed J E Health 2022; 28:1309-1316. [PMID: 35119315 DOI: 10.1089/tmj.2021.0439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: Telemedicine is the practice of caring for patients remotely when the patient and provider are not physically present at the same location. Within orthopedic surgery, telemedicine offers care without the typical obstacles of an in-person appointment such as difficulty ambulating following surgery and patient wait times. In this study, we evaluated patient interest and satisfaction in postoperative telemedicine visits following hip or knee arthroplasty surgery. Materials and Methods: Patients were offered either a traditional in-person or a remote telemedicine postoperative visit following surgery. Patients were asked to complete a satisfaction survey following their postoperative visit regarding their experience. Patient-survey responses as well as patient-reported outcome metrics were captured using a mobile and web-based electronic patient rehabilitation application. Results: A total of 766 patients were included in this study with 360 offered postoperative telemedicine visits and 402 offered traditional in-person visits. Two hundred fifty-nine patients reported satisfaction levels with their telemedicine visit, with 58.3% of patients characterizing their feelings with the visit as "extremely satisfied," 32.0% as "satisfied," 8.9% as "neutral," 0.3% as "dissatisfied," and 0.3% as "extremely dissatisfied." A total of 713 patients reported how the COVID-19 pandemic effected their feelings toward telemedicine with 12.9% of patients characterizing the affect as "extremely positively," 33.1% of patients as "positively," 48.9% of patients as "neutral," 3.6% of patients as "negatively," and 1.4% of patients as "extremely negatively." There were no significant differences in the change between preoperative Hip disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Score Joint Replacement, or Veterans RAND 12 Physical and Mental components and these values at 12 weeks follow-up and 1-year follow-up, respectively, in patients who had telemedicine visits versus those who had traditional in-person visits. Discussion: The results of this study demonstrate that the patients who decided to have a telemedicine visit during their postoperative visit were satisfied with their experience. Overall, COVID-19 had a positive influence on patient's feelings toward telemedicine visits.
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Affiliation(s)
- Michael R Moore
- Department of Orthopedic Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York, USA
| | - Matthew S Galetta
- Department of Orthopedic Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York, USA
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York, USA
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Amorese AJ, Ryan AS. Home-Based Tele-Exercise in Musculoskeletal Conditions and Chronic Disease: A Literature Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:811465. [PMID: 36188988 PMCID: PMC9397976 DOI: 10.3389/fresc.2022.811465] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 01/28/2023]
Abstract
Exercise training is an essential component in the treatment or rehabilitation of various diseases and conditions. However, barriers to exercise such as the burdens of travel or time may hinder individuals' ability to participate in such training programs. Advancements in technology have allowed for remote, home-based exercise training to be utilized as a supplement or replacement to conventional exercise training programs. Individuals in these home-based exercise programs are able to do so under varying levels of supervision from trained professionals, with some programs having direct supervision, and others having little to no supervision at all. The purpose of this review is to examine the use of home-based, tele-exercise training programs for the treatment of different disease states and conditions, and how these programs compare to conventional clinic-based exercise training programs.
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Affiliation(s)
- Adam J Amorese
- Baltimore Veterans Affairs (VA) Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States
| | - Alice S Ryan
- Baltimore Veterans Affairs (VA) Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States.,VA Research Service, Baltimore GRECC, Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Gazendam A, Zhu M, Chang Y, Phillips S, Bhandari M. Virtual reality rehabilitation following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2022; 30:2548-2555. [PMID: 35182172 PMCID: PMC8857886 DOI: 10.1007/s00167-022-06910-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA). The objective of this systematic review and meta-analysis was to compare patient-reported outcomes and cost analyses from randomized controlled trials (RCT) utilizing VR-based rehabilitation in patients following TKA. METHODS MEDLINE, EMBASE, and Cochrane databases were searched for RCTs involving VR-based rehabilitation following TKA. Quantitative synthesis was conducted for pain scores and functional outcomes. Narrative outcomes were reported for results not amenable to quantitative synthesis. RESULTS A total of 9 RCTs with 835 patients were included with follow-up ranging from 10 days to 6 months postoperatively. No differences in pain scores were demonstrated between VR-based and traditional rehabilitation at 2 weeks and 3 months postoperatively. VR-based rehabilitation demonstrated improved functional outcomes at 12 weeks (n = 353) postoperatively [mean difference (MD) - 3.32, 95% confidence interval (CI) - 5.20 to - 1.45, moderate certainty evidence] and 6 months (n = 66) postoperatively [MD - 4.75, 95% CI - 6.69 to - 2.81, low certainty evidence], compared to traditional rehabilitation. One trial demonstrated significant cost savings with the use of VR-based rehabilitation. CONCLUSIONS VR-based rehabilitation for patients undergoing TKA represents an evolving field that may have advantages over traditional therapy for some patients. The current review is limited by the low quality of evidence in the literature. This is a rapidly evolving field with more trials needed to determine the impact of VR-based rehabilitation on patients undergoing TKA. LEVEL OF EVIDENCE Level I; meta-analysis of randomized controlled trials.
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Affiliation(s)
- Aaron Gazendam
- OrthoEvidence, Burlington, ON, Canada. .,Division of Orthopaedics, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Meng Zhu
- OrthoEvidence, Burlington, ON Canada
| | | | | | - Mohit Bhandari
- OrthoEvidence, Burlington, ON Canada ,Division of Orthopaedics, Department of Surgery, McMaster University, St. Joseph’s Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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Nizeyimana E, Joseph C, Louw QA. A scoping review of feasibility, cost-effectiveness, access to quality rehabilitation services and impact of telerehabilitation: A review protocol. Digit Health 2022; 8:20552076211066708. [PMID: 35223074 PMCID: PMC8874157 DOI: 10.1177/20552076211066708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Telerehabilitation is an emerging segment of telehealth and telemedicine that has a potential to deliver quality, accessible, cost-effective and efficient rehabilitation services where geographical distance is a critical factor. The objectives of this review are: to describe the feasibility and cost-effectiveness of telerehabilitation, to scope to what extent telerehabilitation has the potential impact on access to quality of rehabilitation services with specific references to low to middle income countries, and to understand key process factors including barriers and facilitators relevant to the implementation of telerehabilitation. Methods A scoping review of the literature will be conducted. An electronic search literature will be conducted in PubMed, Scopus, Cochrane library, Africa-wide information, CINAHL, MEDLINE, ProQuest, Web of science and reference lists. The review team will develop a data charting form and pilot it on four randomly-selected studies. The form will be refined based on the results of the piloted articles. Studies identified will be screened at the title and abstract levels by the first reviewer, followed by an independent verification for the accuracy and eligibility by two more reviewers prior to obtaining the full texts. Studies to be included must report on feasibility, cost-effectiveness, access to rehabilitation services, implementation process factors including barriers and facilitators of telerehabilitation. The analysis will include both descriptive summary and inductive thematic analysis. Conclusion Telerehabilitation has ability to change the current standard of care and allow for improved access and health outcomes in cost-effective ways, while addressing the scarce and unequal distribution of limited number of healthcare providers especially in low to middle income country settings. Thus, the research findings could be used by different stakeholders including: researchers, clinicians, policy makers, and implementation teams as they determine the appropriate setup for new telerehabilitation programs.
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Affiliation(s)
- Eugene Nizeyimana
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
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Nizeyimana E, Joseph C, Plastow N, Dawood G, Louw QA. A scoping review of feasibility, cost, access to rehabilitation services and implementation of telerehabilitation: Implications for low- and middle-income countries. Digit Health 2022; 8:20552076221131670. [PMID: 36249480 PMCID: PMC9557862 DOI: 10.1177/20552076221131670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Objective To scope all published information reporting on the feasibility, cost, access to rehabilitation services, implementation processes including barriers and facilitators of telerehabilitation (TR) in low- and middle-income countries (LMICs) and high-income countries (HICs). Methods A comprehensive electronic search of PubMed, Scopus, PEDro, Cochrane library, EBSCOhost (Academic search premier, Africa-wide information, CINAHL, Eric, MEDLINE, Health sources - Nursing/Academic edition), Africa online, as well as ProQuest databases were conducted. To maximise the coverage of the literature, the reference lists of included articles identified through the search were also screened. The analysis included both descriptive summary and inductive thematic analysis. Results Twenty-nine studies were included. TR was reported to be feasible, cost-saving and improved access to rehabilitation services in both HICs and LMICs settings. Asynchronous methods using different mobile apps (Skype, WhatsApp, Google meet, Facebook messenger, Viber, Face time and Emails) were the most common mode of TR delivery. Barriers to the implementation were identified and categorised in terms of human, organisational, technical and clinical practice related factors. Facilitators for health professionals and patients/caregivers' dyads were also identified. Conclusion TR could be considered a feasible service delivery mode in both HICs and LMICs. However, the mitigation of barriers such as lack of knowledge and technical skills among TR providers and service users, lack of secure platform dedicated for TR, lack of resources and connectivity issues which are particularly prevalent in LMICs will be important to optimise the benefits of TR.
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Affiliation(s)
- Eugene Nizeyimana
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Nicola Plastow
- Division of Occupational Therapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Gouwa Dawood
- Division of Speech, Language and Hearing Therapy, Department of
Health and Rehabilitation Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
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Alexandre DJA, Ramalho GS, Civile VT, Carvas Junior N, Cury Fernandes MB, Cacione DG, Trevisani VFM. Telerehabilitation versus conventional face-to-face land-based exercises following hip or knee arthroplasty. Hippokratia 2021. [DOI: 10.1002/14651858.cd014931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dângelo JA Alexandre
- Physical Therapy Department; National Institute of Traumatology and Orthopaedics (INTO / Ministry of Health - Brazil); Rio de Janeiro Brazil
| | | | - Vinicius T Civile
- Evidence-Based Health Post-Graduation Program, Universidade Federal de São Paulo; Cochrane Brazil; Department of Physiotherapy, Universidade Paulista; Sao Paulo Brazil
| | | | - Marco Bernardo Cury Fernandes
- The Centre for Hip Surgery; National Institute of Traumatology and Orthopaedics (INTO / Ministry of Health - Brazil); Rio de Janeiro Brazil
| | - Daniel G Cacione
- Division of Vascular and Endovascular Surgery, Department of Surgery; UNIFESP - Escola Paulista de Medicina; São Paulo Brazil
| | - Virginia FM Trevisani
- Medicina de Urgência and Rheumatology; Escola Paulista de Medicina, Universidade Federal de São Paulo and Universidade de Santo Amaro; São Paulo Brazil
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Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910135. [PMID: 34639436 PMCID: PMC8508342 DOI: 10.3390/ijerph181910135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
The importance of telemedicine technologies around the world has been growing for many years, and it turned out to be a particularly important issue for conducting some medical procedures during the SARS-CoV-2 pandemic. It is necessary to create interdisciplinary teams to design and implement improved procedures using telemedicine tools. The aim of the article is to develop original, improved posthospital patient care process after total hip arthroplasty (THA) with the use of telemedicine technologies. In the study, a literature review and empirical research were used. The conducted research resulted in the designing an original posthospital patient care process after THA that uses telematics technologies. Due to the use of analyzed telemedicine technologies, the designed patient care process brings a possibility to increase the patient's safety by monitoring life parameters, allowing for regular, remote contact with specialists and to be supervised remotely. All this may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs. The designed model is ready for further clinical research with the participation of medical staff, patients after THA and patient caregivers.
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McKeon JF, Alvarez PM, Vajapey AS, Sarac N, Spitzer AI, Vajapey SP. Expanding Role of Technology in Rehabilitation After Lower-Extremity Joint Replacement: A Systematic Review. JBJS Rev 2021; 9:01874474-202109000-00010. [PMID: 34516463 DOI: 10.2106/jbjs.rvw.21.00016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The effectiveness of telehealth programs in the administration of rehabilitation and the monitoring of postoperative progress after joint replacement is not well studied. The purpose of the present study was to systematically review the currently available evidence on the use of smart-device technology and telehealth programs to guide and monitor postoperative rehabilitation following total joint arthroplasty and to assess their impact on outcomes following surgery. METHODS A literature search of the MEDLINE database was performed using keywords "mobile," "app," "telehealth," "virtual," "arthroplasty," "outcomes," "joint replacement," "web based," "telemedicine," "TKA," "THA," "activity tracker," "fitness tracker," "monitor," "rehab," "online," and "stepcounter" in all possible combinations. All English studies with a level of evidence of I to III that were published from January 1, 2010, to December 19, 2020 were considered for inclusion. Quantitative and qualitative analysis was performed on the data collected. RESULTS A total of 28 articles meeting the inclusion criteria were identified and reviewed. With regard to objective functional outcome measures, such as strength, range of motion, or results of the Timed Up and Go (TUG) test, the virtual physical therapy group had equivalent or slightly superior outcomes compared with in-person physical therapy. There was similar improvement overall in patient-reported outcome measures (PROMs) and patient satisfaction between virtual and in-person physical therapy. Virtual physical therapy resulted in cost savings ranging from $206 to $4,100 per patient compared with in-person physical therapy. CONCLUSIONS Telerehabilitation following lower-extremity joint replacement is less expensive compared with in-person physical therapy, with equivalent outcomes and patient satisfaction. Telerehabilitation and electronic health adjuncts can be used to substitute for traditional rehabilitation and augment postoperative care following total joint arthroplasty, respectively. Telerehabilitation that provides outcomes equivalent to in-person physical therapy not only increases convenience for patients but also decreases the cost burden on the health-care system. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John F McKeon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul M Alvarez
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anuhya S Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Nikolas Sarac
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew I Spitzer
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Shah N, Costello K, Mehta A, Kumar D. Applications of Digital Health Technologies in Knee Osteoarthritis: A Narrative Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e33489. [PMID: 35675102 PMCID: PMC9218886 DOI: 10.2196/33489] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 05/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR). Objective This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR. Methods In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included. Results Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively. Conclusions For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes.
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Affiliation(s)
- Nirali Shah
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
| | - Kerry Costello
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
| | - Akshat Mehta
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
| | - Deepak Kumar
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
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