Hospital for Special Surgery Florida, West Palm Beach, Florida.
Orthopaedic Associates of Reading, Reading, Pennsylvania.
J Arthroplasty. 2024 Aug;39(8S1):S137-S142. doi: 10.1016/j.arth.2024.02.040. Epub 2024 Feb 22.
The costs and benefits of different rehabilitation protocols following total knee arthroplasty are unclear. The emergence of telerehabilitation has introduced the potential for enhanced patient convenience and cost reduction. The purpose of this study was to assess the cost difference between standard physical therapy (SPT) and a telerehabilitation home-based clinician-controlled therapy system (HCTS).
A prospectively enrolled, consecutive series of 109 Medicare patients who received SPT were compared to 101 Medicare patients who were treated with a HCTS. The analysis focused on total rehabilitation costs and the assessment of outcome measures: knee range of motion, visual analog scale pain levels, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement.
The HCTS group demonstrated not only statistically significantly lower average costs but also faster and sustained knee range of motion improvements. Furthermore, in comparison to SPT, the HCTS group exhibited superior visual analog scale pain scores and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement functional scores at all assessment points postoperatively, which were statistically significant (all P < .001) and surpassed the minimal clinically important difference thresholds.
The HCTS used in this study exhibited a remarkable cost-saving advantage of $2,460 per patient compared to standard therapy. As approximately 500,000 primary total knee arthroplasties in the United States are covered by Medicare annually, a switch to HCTS could yield total cost savings of more than $1.23 billion per year for our taxpayer-funded health care system. Furthermore, the HCTS cohort demonstrated superior functional outcomes and improved pain scores across all assessment time points, exceeding the minimal clinically important difference.
全膝关节置换术后不同康复方案的成本效益尚不清楚。远程康复的出现为提高患者便利性和降低成本带来了可能。本研究旨在评估标准物理治疗（SPT）与远程康复家庭临床医生控制治疗系统（HCTS）之间的成本差异。
前瞻性纳入了 109 名接受 SPT 的医疗保险患者和 101 名接受 HCTS 治疗的医疗保险患者，对他们进行了连续系列研究。分析重点是总康复成本以及对膝关节活动度、视觉模拟评分疼痛水平和膝关节损伤和骨关节炎结果评分（膝关节置换）的评估。
HCTS 组不仅显示出统计学上显著更低的平均成本，而且在膝关节活动度改善方面更快且更持久。此外，与 SPT 相比，HCTS 组在术后所有评估点的视觉模拟评分疼痛和膝关节损伤和骨关节炎结果评分（膝关节置换）功能评分均表现出更好的结果，且具有统计学意义（均 P <.001），且超过了最小临床重要差异阈值。
与标准治疗相比，本研究中使用的 HCTS 表现出显著的每例节省 2460 美元的成本优势。由于美国每年约有 50 万例初次全膝关节置换术由医疗保险覆盖，如果改用 HCTS，我们的纳税人资助的医疗保健系统每年可节省超过 12.3 亿美元的总费用。此外，HCTS 组在所有评估时间点均表现出更好的功能结果和疼痛评分改善，超过了最小临床重要差异。
