Telerehab Proven Effective After Total Knee Replacement
Posted Feb 01 2011 12:00am
One of the challenges of telemedicine for the past several decades has been the tendency for its supporters to align it with some health services without a natural fit. This is to say, those requiring one-on-one, live physician and nurse interactions. I have now come across one type of service, post-operative physical therapy, that seems to be a natural for telemedicine. A recent article discusses an example of a successful telerehab program (see: Telerehab Works After Knee Surgery )
In a noninferiority trial , telerehabilitation fared at least as well as conventional therapy on all study outcomes after six weeks, including the primary outcome...according [a reesearcher in the field]. In fact, telerehabilitation resulted in greater improvement on the WOMAC stiffness subscale and the Patient-Specific Functional Scale, a secondary endpoint... the researchers reported....Rehabilitation is an important adjunct to total knee arthroplasty, but access to high-quality rehabilitation services is not always possible, particularly for people living in remote areas, according to the researchers. So they performed a randomized study comparing an Internet-based rehabilitation program with conventional outpatient physical therapy....The patients in the telerehabilitation group were still required to come to the hospital, but they completed the weekly 45-minute session over the Internet in an isolated room set up to resemble a home environment. All patients were encouraged to perform a comprehensive home exercise program twice a day. The primary outcome -- WOMAC -- has been used extensively in total knee replacement and osteoarthritis clinical trials....Improvement on the WOMAC was 52.7% in the control group and 67.6% in the telerehabilitation group, a nonsignificant difference. Compliance with the home exercise program -- assessed using exercise diaries -- was similar in the two groups. "The nature of the telerehabilitation intervention, which relied more on the education of patients in the self-application of mobilization techniques and had a greater emphasis on exercise, may have provided participants with a heightened opportunity for self-treatment outside the formal physical therapy treatment session," the researchers wrote.
One of my pet theories is that we can lower healthcare costs and improve health outcomes by encouraging patients to take an active role in their own care and encouraging them to "own" many of the healthcare delivery processes. One important facet of this approach is providing them with ready access to their own health records (see: Should Patients Be "Allowed" to Read Their Medical Records? ; Providing Patients Easy Access to Physician Notes in Their EMRs ). Another of my ideas is that we should provide patients with web-based training/teaching videos that can supplement or replace various types of live hospital/physician office interactions.
It's not clear from the above description of "weekly 45-minute session over the Internet in an isolated room" involved live broadcasting, interactive sessions via webcam, or web-based videos. However, these differences would be somewhat irrelevant in the context of this study. Also and as noted above, all patients were encouraged to perform a comprehensive home exercise program twice a day. This new approach to improving knee function post-op fared as well as conventional therapy. That's the key point. Obviously, telerehab is far more cost-effective than conventional therapy and provides access to such services in rural areas where they may be difficult to obtain. I would not claim for a minute that telerehab is right for every patient. My sense is that prerequisites would be younger, highly-motivated patients who are generally comfortable with technology and self-education. Nevertheless, I think that an opportunity to choose telerehab needs to be made widely available across the country.
One of the challenges of telemedicine for the past several decades has been the tendency for its supporters to align it with some health services without a natural fit. This is to say, those requiring one-on-one, live physician and nurse interactions. I have now come across one type of service, post-operative physical therapy, that seems to be a natural for telemedicine. A recent article discusses an example of a successful telerehab program (see: Telerehab Works After Knee Surgery )
In a noninferiority trial , telerehabilitation fared at least as well as conventional therapy on all study outcomes after six weeks, including the primary outcome...according [a reesearcher in the field]. In fact, telerehabilitation resulted in greater improvement on the WOMAC stiffness subscale and the Patient-Specific Functional Scale, a secondary endpoint... the researchers reported....Rehabilitation is an important adjunct to total knee arthroplasty, but access to high-quality rehabilitation services is not always possible, particularly for people living in remote areas, according to the researchers. So they performed a randomized study comparing an Internet-based rehabilitation program with conventional outpatient physical therapy....The patients in the telerehabilitation group were still required to come to the hospital, but they completed the weekly 45-minute session over the Internet in an isolated room set up to resemble a home environment. All patients were encouraged to perform a comprehensive home exercise program twice a day. The primary outcome -- WOMAC -- has been used extensively in total knee replacement and osteoarthritis clinical trials....Improvement on the WOMAC was 52.7% in the control group and 67.6% in the telerehabilitation group, a nonsignificant difference. Compliance with the home exercise program -- assessed using exercise diaries -- was similar in the two groups. "The nature of the telerehabilitation intervention, which relied more on the education of patients in the self-application of mobilization techniques and had a greater emphasis on exercise, may have provided participants with a heightened opportunity for self-treatment outside the formal physical therapy treatment session," the researchers wrote.One of my pet theories is that we can lower healthcare costs and improve health outcomes by encouraging patients to take an active role in their own care and encouraging them to "own" many of the healthcare delivery processes. One important facet of this approach is providing them with ready access to their own health records (see: Should Patients Be "Allowed" to Read Their Medical Records? ; Providing Patients Easy Access to Physician Notes in Their EMRs ). Another of my ideas is that we should provide patients with web-based training/teaching videos that can supplement or replace various types of live hospital/physician office interactions.
It's not clear from the above description of "weekly 45-minute session over the Internet in an isolated room" involved live broadcasting, interactive sessions via webcam, or web-based videos. However, these differences would be somewhat irrelevant in the context of this study. Also and as noted above, all patients were encouraged to perform a comprehensive home exercise program twice a day. This new approach to improving knee function post-op fared as well as conventional therapy. That's the key point. Obviously, telerehab is far more cost-effective than conventional therapy and provides access to such services in rural areas where they may be difficult to obtain. I would not claim for a minute that telerehab is right for every patient. My sense is that prerequisites would be younger, highly-motivated patients who are generally comfortable with technology and self-education. Nevertheless, I think that an opportunity to choose telerehab needs to be made widely available across the country.
Telerehab Works After Knee Surgery