Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Weill Cornell Medical College, 1300 York Ave, New York, NY, 10021, USA.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4098-4103. doi: 10.1007/s00167-022-06931-6. Epub 2022 Mar 26.
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).
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.
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).
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.
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远程康复（telerehab）是一种越来越受欢迎的、节省成本的全膝关节置换术后传统康复替代方法。我们比较了机构远程康复计划与传统“面对面”康复在接受单侧全膝关节置换术（TKA）的患者中的安全性和疗效。
进行了回顾性匹配队列研究。利用 TKA 后远程康复的医疗保险患者按 1:3 的比例与利用传统康复的患者相匹配。患者按性别、体重指数（BMI，±5kg/m2）、术前伸展（±10 度）、术前屈曲（±10 度）和风险评估和预测工具（RAPT）评分（±2 分）进行匹配。比较了两组之间 90 天非计划性医疗保健就诊、120 天麻醉下操作（MUA）以及 6 周和 3 个月时膝关节损伤和骨关节炎结果评分-关节置换（KOOS-JR）、疼痛视觉模拟量表（VAS）、退伍军人 RAND 12（VR-12）和下肢活动量表（LEAS）的变化。
纳入 82 名远程康复患者和 244 名常规康复患者。匹配后，两组 90 天非计划性医疗保健就诊或 120 天 MUA 率无差异。两组在 6 周和 3 个月时 KOOS-JR、VAS 疼痛或 VR-12 心理或身体子评分的变化均无差异。与常规组相比，远程康复组在 3 个月时 LEAS 评分的改善更大（平均差异 1.9，P=0.03）。
在一项 326 例 TKA 患者的匹配队列研究中，与常规 PT 患者相比，远程康复患者的非计划性医疗保健就诊和 MUA 发生率相似，患者报告的结果也相似，这表明远程康复是 TKA 后替代常规 PT 的有效方法。
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