Total knee replacement (TKA) is a surgery which has been increasing in frequency in recent years. In addition, hospital stays have shortened and people are heading home sooner than in the past. This means that the role of rehabilitation has become more important for these folks, and therapists who travel for in home treatments tend to have a lot of these people on their caseload. In home physical therapy can be time consuming and expensive in rural or urban areas and it there is recent interest in seeing if tele rehabilitation (instruction via video link through the internet) is a viable and quality option. This is the first large study to try and determine if tele rehabilitation is equally effective as face-to-face home therapy after a total knee replacement.
This study included two groups, one who had in home physical therapy for the first two months following their TKA, and another who had tele rehabilitation for the first two months following TKA. There were about one hundred people in each group, and each group had approximately sixteen sessions of therapy. Progress was evaluated with two well known questionnaires, range of motion, a six minute walk test and a timed stair test based four months after discharge from the hospital.
The treatments were provided by trained physical therapists and were the same for each group. They included evaluation, supervised exercises, instruction in exercises to complete on days without a session, advice about pain control, use of walking aids and return to activities. The intensity and difficulty was based on each individual patients progress.
The results are very promising for tele rehabilitation. This study found that at the last follow up, four months after discharge from the hospital, the mean differences between the groups was basically zero for all the measures. Tele rehabilitation can improve accessibility to rehabilitation services in remote or rural communities, or even in urban areas where volume can be a challenge for in home therapists. And knowing that the outcomes are similar means that as communication technologies become more available, reliable, and affordable, this is a very good alternative for health professionals and patients trying to maximize results from TKA.