Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty.

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.

HSS@Home, Physical Therapist-Led Telehealth Care Navigation for Arthroplasty Patients: A Retrospective Case Series.

BACKGROUND: As the rate of total joint arthroplasties performed in the USA continues to increase, so does the push for more value-based care. Bundled payments have encouraged organizations to be creative in limiting care overuse. Telehealth is one option for caring for arthroplasty patients post-surgery while limiting costs and improving communication with the surgical team. QUESTIONS/PURPOSES: We sought to determine the effects of the implementation of HSS@Home, a telehealth rehabilitation program that uses patients' existing technology, in patients after they had undergone total knee or total hip arthroplasty. METHODS: In this retrospective case series, of 32 patients referred, 19 patients (nine men and ten women; average age, 69 years) were enrolled in HSS@Home after undergoing a pre- and post-operative screening process. Telehealth video visits were conducted, wherein a physical therapy navigator assisted patients in following exercise and mobility programs, addressing patients' concerns while transitioning to outpatient therapy. Patients were seen within 24 h of hospital discharge, 3 times a week for 3 weeks, for an average of 11 sessions. Episodes of care were recorded in the patient's electronic medical record. RESULTS: There were no readmissions among the 19 patients. Nurse practitioners were consulted for all patients, predominantly for non-emergent reasons. Feedback from patients and physicians was positive, and no overutilization of care was found. CONCLUSION: HSS@Home was a promising alternative to live, in-home physical therapy that was effective in monitoring this series of patients after hip or knee arthroplasty. This preliminary data sets the stage for further research into the use of telehealth technology to provide rehabilitative care to arthroplasty patients.