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Computer- and Telephone-Delivered Interventions on Patient Outcomes and Resource Utilization in Patients With Orthopaedic Conditions: A Systematic Review and Narrative Synthesis
Abstract
Background:
As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend.
Purpose:
The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions.
Methods:
The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice.
Results:
A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs.
Conclusion:
Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.
... Although the virtual hospital initiative in Finland has already started to develop digital care pathways for citizens, HCPs, and patients in digital health conditions [15], there is a complete lack of targeted and tailored solutions covering the whole KOA pathway from admission to discharge and beyond, which is especially important for people with chronic and long-term conditions such as KOA [16,17]. In addition, there is a lack of knowledge on how to create value for patients themselves [13] whereas improvements in early diagnostics and clinical decision-making have improved performance (e.g., outcomes) and accountability (e.g., costs) in primary and secondary care management of symptomatic OA [18,19]. ...
... This qualitative descriptive study is part of a Co-innovation project that co-designs [5,18,19] and evaluates [16,17,20] the effects of new eHealth solutions, together with customers, companies, and academia. The aim of the present study is to identify patients' eHealth needs to improve the quality of counselling in a primary care management of symptomatic KOA. ...
... Our results pinpoint cost-related access barriers to health care, whereas digital care pathways could enable more cost-efficient, tailored, and targeted health information delivery in various formats to build patient-centric care. Although eHealth solutions have the potential to improve health outcomes, performance, and accountability [16,17] they can also exacerbate existing health disparities [27,28,29]. For that reason, health technology assessments must include consideration of equity to demonstrate value [30]. ...
Digital counselling may improve patients’ health outcomes, when eHealth solutions are accessible and tailored to the patients’ needs, which is especially important for people with chronic and long-term conditions such as knee osteoarthritis. This study aims to identify patients’ eHealth needs to improve the quality of digital counselling in a primary care management of symptomatic knee osteoarthritis. A qualitative study was used to collect patients’ eHealth needs through semi-structured interviews in a single outpatient clinic in Finland between August 2020 and November 2020. The data was analyzed using both deductive and inductive content analysis approaches. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist to improve the transparency of the study. Analysis of the data revealed five main categories to be considered when implementing digital counselling in patients with symptomatic knee osteoarthritis: background factors (functional impairments, health literacy, digital literacy, cost-related access barriers), resources (digital methods and materials), sufficiency (knee osteoarthritis-related knowledge and skills), implementation (simplicity, trust, patient-centeredness), and benefits (self-care capabilities, confidence). According to our findings, both health and digital literacy seems to be important contributors to the adoption of digital counselling in a primary care management of symptomatic knee osteoarthritis. New eHealth solutions should not replace the first visit in the outpatient clinic. Instead, the use of eHealth solutions should be based on the first visit, during which a trusting relationship between patients and healthcare providers is established. In future, the level of health and digital literacy in patients with symptomatic knee osteoarthritis should be taken account.
... Systematic literature reviews [17,18] were conducted in January 2019 and February 2020 to describe functional requirements that increase transparency, foster patient adherence, and improve patient-provider communication pre-, intra-and post-surgery. Studies were identified from four multidisciplinary databases (Medline Ovid, Scopus, Ebsco Databases, Web of Science). ...
End-users’ involvement is crucial to develop human-centered solutions; patient acceptance and endorsement by clinicians will be achieved when the features of digital solutions align with their needs and expectations. The aim of the study was to develop the overall concept of digital solution to increase transparency, foster patient adherence, and improve patient-provider communication across the entire total hip and knee arthroplasty journey from admission to discharge, and beyond. Two-stage iterative co-design process was used. Systematic literature reviews and qualitative interviews were conducted to understand the problem. In addition, co-creation sessions were used develop the solution for a reference implementation. As a result, a total of 19 technical and functional requirements were identified. In addition, ten additional functional requirements were identified for future design. The results demonstrate the overall concept of a digital solution for the reference implementation. The uniqueness of the solution lies in the vision of wider integrated systems, which could offer a clinical platform for clinicians to provide patient-focused care remotely, while monitoring patients’ progress closely.
... Although there were no significant differences between groups, telerehabilitation was inferior to face-toface physiotherapy in terms of pain and did not reduce pain more than no intervention. This review adds to previous findings that telerehabilitation is acceptable to [32] and can be as effective as face-to-face physiotherapy [33][34][35] by demonstrating non-inferiority and cost savings in a broader range of conditions in an at-risk older adult population. ...
Background
Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults.
Objective
This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs.
Methods
Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria.
Results
Eleven studies (10 randomised) with 1,400 participants (mean age 65–74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed.
Conclusion
Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
... For instance, many patients believe that their osteoarthritis is "bone on bone" and will progressively worsen over time and that physical activity is harmful to their joints [13]. Uncertainty and long waiting times result in many people seeking out digital resources, such as websites, social media, and smartphone apps, to assist them with managing their symptoms [14]. Although the use of the internet to educate patients shows promising potential because of its low cost and broad reach, there is a risk that patients may access information that is both unreliable and irrelevant [15]. ...
Alexander Tacey, Jack Behne, Rhiannon K Patten, Minh Truc Ngo, Rees Thomas, Jessica Ancilleri, Chelsea Bone, Angela Paredes Castro, Helen McCarthy, Katherine Harkin, Julia FM Gilmartin-Thomas, Amir Takla,
Calum Downie, Jane Mulcahy, Michelle Ball, Jenny Sharples, Sarah Dash, Amy Lawton, Breanna Wright, Peter Sleeth, Tina Kostecki, Christopher Sonn, Michael J McKenna, Vasso Apostolopoulos, Rebecca Lane, Catherine M Said, Mary De Gori, Andrew McAinch, Phong Tran, Itamar Levinger, Alexandra Parker, Mary N Woessner, Michaela Pascoe. Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopaedic Specialist Care: A Co-design study. JMIR Formative Research (accepted 2023)
... For instance, many patients believe that their osteoarthritis is "bone on bone" and will progressively worsen over time and that physical activity is harmful to their joints [13]. Uncertainty and long waiting times result in many people seeking out digital resources, such as websites, social media, and smartphone apps, to assist them with managing their symptoms [14]. Although the use of the internet to educate patients shows promising potential because of its low cost and broad reach, there is a risk that patients may access information that is both unreliable and irrelevant [15]. ...
Background
The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care.
Objective
This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage.
Methods
The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility.
Results
Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category.
Conclusions
Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.
... Previous studies, however, have produced conflicting results and only moderate-to low-quality evidence due to lack of experimental designs, validated instruments, and standardized content [15]. In addition, none of previous solutions have covered the entire THA/TKA journey from admission to discharge, and beyond, thus hampering information sharing and care coordination [16]. ...
Mobile health solutions for patient support have been proposed as promising and safe alternatives to usual care in adults undergoing primary total hip and knee arthroplasty. Studies of such applications, however, have produced conflicting results and only moderate- to low-quality evidence. This study aims to evaluate the short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in patients undergoing total hip and knee arthroplasty using a pragmatic randomized controlled trial design. Randomly allocated patients in the control arm (n = 35, 64 ± 9 years) received usual care, while patients in the intervention arm (n = 34, 62 ± 11 years) received the digital patient journey solution in addition to usual care. The primary outcome was health-related quality of life as measured by the EuroQol EQ-5D-5L scale. Secondary outcomes included functional recovery, pain, self-efficacy, patient experience, adherence to fast-track protocol, and health care utilization. Participants were followed from a preoperative surgical visit until a postoperative follow-up visit at 6–12 weeks. The health-related quality of life, functional recovery, pain, patient experience, adherence to the fast-track protocol, and health care utilization did not differ between the arms. During the study, however, the self-efficacy to use digital health services (p=0.027) increased in the intervention arm. The use of the digital patient journey solution was not superior to usual care in terms of patient-reported outcomes and health care utilization. However, the solution improved the self-efficacy of patients to use digital health services, which may lead to greater demand for similar digital offerings as patient become more familiar with mobile health solutions.
Background
Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear.
Objective
We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders.
Methods
We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively.
Results
Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed “telerehabilitation” (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, “physical function”) were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits.
Conclusions
Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs.
Trial Registration
PROSPERO CRD42022347366; https://osf.io/pxedm/
Objectives
In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice.
Methods
We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and qualitative review.
Results
Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review.
Conclusion
Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
Exercise-based interventions applied before and after total hip and knee arthroplasty (THA and TKA, respectively) have been investigated for a number of years, based on the assumption that they will enhance post-operative recovery. Although recent studies suggest that high-volume, pre-operative exercise may enhance post-operative recovery after TKA, studies of post-operative exercise-based interventions, have not found superiority of one exercise regime over another. It seems, however, that post-operative, exercise-based, rehabilitation is superior to no or minimal rehabilitation after THA and TKA.
The goal of this commentary is to summarize recent evidence for the efficacy of different peri-operative exercise-based interventions to enhance recovery after THA and TKA, and to propose new strategies to further enhance post-operative recovery.
There is a major need to improve functional recovery after THA and TKA. We propose a strategy of “enriched” trials where specific rehabilitation interventions are applied to different patients based on, for example, their expectations for post-operative recovery, willingness to undertake exercise and physical activity, and pre-operative functional performance.
Background:
Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists.
Objective:
The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education.
Methods:
CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial.
Results:
A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients' knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes.
Conclusions:
Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients' knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only.
Background and purpose — Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement.
Patients and methods — We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery.
Results — Length of stay was reduced from 2.1 days (95% CI: 2.0–2.3) to 1.1 day (CI: 0.9–1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group.
Interpretation — Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement.
Background
The well-being of breast cancer patients and reporting of adverse events require close monitoring. Mobile apps allow continuous recording of disease- and medication-related symptoms in patients undergoing chemotherapy.
Objective
The aim of the study was to evaluate the effects of a mobile app on patient-reported daily functional activity in a supervised and unsupervised setting.
Methods
We conducted a randomized controlled study of 139 breast cancer patients undergoing chemotherapy. Patient status was self-measured using Eastern Cooperative Oncology Group scoring and Common Terminology Criteria for Adverse Events. Participants were randomly assigned to a control group, an unsupervised group that used a mobile app to record data, or a supervised group that used the app and reviewed data with a physician. Primary outcome variables were change in daily functional activity and symptoms over three outpatient visits.
Results
Functional activity scores declined in all groups from the first to second visit. However, from the second to third visit, only the supervised group improved, whereas the others continued to decline. Overall, the supervised group showed no significant difference from the first (median 90.85, IQR 30.67) to third visit (median 84.76, IQR 18.29, P=.72). Both app-using groups reported more distinct adverse events in the app than in the questionnaire (supervised: n=1033 vs n=656; unsupervised: n=852 vs n=823), although the unsupervised group reported more symptoms overall (n=4808) in the app than the supervised group (n=4463).
Conclusions
The mobile app was associated with stabilized daily functional activity when used under collaborative review. App-using participants could more frequently report adverse events, and those under supervision made fewer and more precise entries than unsupervised participants. Our findings suggest that patient well-being and awareness of chemotherapy adverse effects can be improved by using a mobile app in collaboration with the treating physician.
ClinicalTrial
ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 (Archived by WebCite at http://www.webcitation.org/6k68FZHo2)
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Background:
Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation.
Objective:
The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits.
Methods:
The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student's t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs).
Results:
The mean cost of a single session was Can 35.70) and 26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -382 to -81<90<$152, P<.001).
Conclusions:
To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient's home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient's home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic.
Trial registration:
International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4).
Objective:
Follow-up intervention boosters are supposed to promote exercise maintenance beyond initial treatment. The current quasi-experimental study investigated the benefits of adding telephone-delivered intervention boosters to a self-management exercise intervention for rehabilitants. Psycho-social mechanisms by which the intervention boosters promote exercise maintenance were examined.
Research design:
Between 2009 and 2011, individuals in cardiac and orthopedic rehabilitation (N = 1,166) were allocated to either a self-management exercise intervention or a control group (i.e., questionnaire only). In addition to standard rehabilitation, participants in the intervention group were offered a series of telephone-delivered intervention boosters after 6 weeks and again after 6 months. Self-efficacy, action planning, and satisfaction with previous exercise outcomes were reassessed 12 months after discharge. Habit strength and exercise were measured 18 months after rehabilitation.
Results:
The intervention with boosters promoted the maintenance of planning, self-efficacy, satisfaction, exercise, and habit strength. Changes in exercise were simultaneously mediated by changes in planning, self-efficacy, and satisfaction. Changes in habit strength were sequentially mediated by planning and exercise.
Conclusions:
Interventions with boosters that focus on action planning, self-efficacy, and satisfaction help to maintain self-directed postrehabilitation exercise. Frequent exercise performance, in turn, can strengthen exercise habits.
The e-patient revolution increasingly enables patients to self diagnose and self educate, influencing decisions affecting their health. This poses a challenge for both patients and health care professionals due to the highly variable and often poor quality information available on the internet.
This study aims to measure the current internet usage in patients attending outpatient clinics, in both a public and private setting. All patients were recruited whilst consulting orthopaedic surgeons.
We developed a 29 question survey which asked questions related to patient demographics, general internet usage and internet usage related to the patient's orthopaedic condition. Patients were recruited for the public cohort during Western Health outpatient clinics and for the private cohort during private surgical consults in the waiting rooms of eight surgeons' clinics.
A total of 400 surveys were completed; 200 in both the private and public cohorts of the study. Of all surveyed participants, 79% (n = 316) had access to the internet. Of people who had access to the internet 65.2% (n = 206) used the internet to investigate their orthopaedic condition. 29.6% (n = 61) of participants asked their surgeon questions related to information they had read on the internet. Of patients that had access to the internet 36.1% (n = 114) used the internet to research their surgeon.
Patients are commonly using the internet as an information resource, in spite of the highly variable quality of this information. This highlights the need for patient information websites which reflect the current standards of clinical practice.
Web-based and mobile health interventions (also called "Internet interventions" or "ehealth/mhealth interventions") are tools or treatments, typically behaviorally based, that are operationalized and transformed for delivery via the Internet or mobile platforms. These include electronic tools for patients, informal caregivers, healthy consumers, and health care providers. The "Consolidated Standards of Reporting Trials" (CONSORT) was developed to improve the suboptimal reporting of randomized controlled trials (RCTs). While broadly the CONSORT statement can be applied to provide guidance on how ehealth and mhealth trials should be reported, RCTs of web-based interventions pose very specific issues and challenges, in particular related to reporting sufficient details of the intervention to allow replication and theory-building.
To develop a checklist, dubbed CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth), as an extension of the CONSORT statement that provides guidance for authors of ehealth and mhealth interventions.
A literature review was conducted, followed by a survey among ehealth experts and a workshop.
An instrument and checklist was constructed as an extension of the CONSORT statement. The instrument has been adopted by the Journal of Medical Internet Research (JMIR) and authors of ehealth RCTs are required to submit an electronic checklist explaining how they addressed each subitem.
CONSORT-EHEALTH has the potential to improve reporting and provides a basis for evaluating the validity and applicability of ehealth trials. Subitems describing how the intervention should be reported can also be used for non-RCT evaluation reports. As part of the development process, an evaluation component is essential, therefore feedback from authors will be solicited, and a before-after study will evaluate whether reporting has been improved.
We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery (total knee arthroplasty, TKA). Forty-eight patients (mean age 66 years) who received TKA were recruited prior to discharge from hospital after surgery and were randomly assigned to telerehabilitation or usual care. Telerehabilitation sessions (16 per participant over two months) were conducted by trained physiotherapists using videoconferencing to the patient's home via an Internet connection (512 kbit/s upload speed). Disability and function were measured using standardized outcome measures in face-to-face evaluations at three times (prior to and at the end of treatment, and four months after the end of treatment). Clinical outcomes improved significantly for all subjects in both groups between endpoints. Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group. Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.
Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these. We distributed a self-designed questionnaire to patients attending elective spinal outpatient clinics. Data including demographics, history of surgery, number of visits, level of satisfaction with previous consultations, access to the internet, possession of health insurance, and details regarding use of the internet to research one's spinal complaint were collected. 213 patients completed the questionnaire. 159 (75%) had access to the internet. Of this group 48 (23%) used the internet to research their spinal condition. Increasing age, higher education level, and possession of health insurance were all significantly associated with access to the internet (p < 0.05). A higher education level predicted greater internet use while possession of insurance weakly predicted non-use (p < 0.05). In our practice, internet access is consistent with national statistics and use is comparable to previous reports. Approximately, one quarter of outpatients will use the internet to research their spinal condition. Should we use this medium to disseminate information we need to be aware some groups may not have access.
Purpose:
The purpose of this study was to assess the impact of a phone assistance nursing program as an adjunct to conventional physiotherapy to increase adherence to a home exercise program on functional outcomes of patients who underwent shoulder instability surgery.
Methods:
A randomized controlled study of 70 patients allocated to a phone assistance program (study group, n = 36 patients) or conventional postoperative management (control group, n = 34 patients) was conducted. All patients in both groups received conventional rehabilitation at the outpatient clinic after surgery. In addition, patients in the study group received phone calls from a nurse (who had access to a physiotherapist) 3 days per week. During the calls these patients received a coaching session about self-care and support with the home exercise program. Evaluations were performed during a follow-up of 12 months for range of motion (ROM), pain (visual analog scale [VAS] score), Disability of the Arm, Shoulder, and Hand (DASH) score, Oxford Shoulder Instability Score (OSIS), and Rowe score.
Results:
All scores significantly improved from preoperative to the final follow-up in both groups (p = .001). At the final follow-up, there were no significant differences between groups in VAS, DASH, or Rowe scores. However, those in the study group had significantly better OSIS (p = .013) and ROM (p = .001), particularly for anterior forward motion (p = .001). Likewise, the study group achieved full motion and function significantly faster than the control group (p = .002). The amount of rehabilitation sessions at the outpatient clinic was 1.7 times higher in the control group (p = .004) than in the study group.
Conclusion:
The phone assistance nursing program was an effective procedure to significantly improve the outcomes of conventional physiotherapy in patients who have undergone an operation for shoulder instability.
Objective:
To conduct systematic review to better define how medical mobile applications (apps) have been utilized in environments relevant to Physical Medicine and Rehabilitation.
Data sources:
PUBMED, IEEE, ACM Digital Library, SCOPUS, INSPEC, and EMBASE STUDY SELECTION: A 10-year date limit was utilized, spanning publication dates from June 1, 2006 to June 30, 2016. Terms related to Physical Medicine and Rehabilitation as well as mobile apps were used in ten individual search strategies.
Data extraction:
Two investigators screened abstracts and applied inclusion and exclusion criteria. Full-length articles were retrieved. Duplicate articles were removed. If a study met all criteria, the manuscript was reviewed in full.
Data synthesis:
Specific variables of interest were extracted and added to summary tables. Summary tables were used to categorize studies according themes, and a list of app features was generated.
Conclusions:
The search yielded abstracts from 8,116 studies, and 102 studies were included in the systematic review. Approximately one-third of the studies evaluated apps as interventions while the remaining two-third of the studies assessed functioning of the app or participant interaction with the app. Some apps may have positive benefits when used to deliver exercise or gait training interventions, as self-management systems, or as measurement tools.
Registration:
The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) network (no. CRD42016046672).
Background:
Chronic low back pain (CLBP) is highly prevalent in older adults, leading to functional decline.
Objective:
The objective of this study was to evaluate physical activity (PA) only and PA plus cognitive-behavioral therapy for pain (CBT-P) among older adult veterans with CLBP.
Design:
This study was a pilot randomized trial comparing a 12-week telephone-supported PA-only intervention group (PA group) or PA plus CBT-P intervention group (PA + CBT-P group) and a wait-list control group (WL group).
Setting:
The study setting was the Durham Veterans Affairs Health Care System.
Participants:
The study participants were 60 older adults with CLBP.
Interventions:
The PA intervention included stretching, strengthening, and aerobic activities; CBT-P covered activity pacing, relaxation techniques, and cognitive restructuring.
Measurements:
Feasibility measures included enrollment and completion metrics; acceptability was measured by completed phone calls. Primary outcomes included the Timed "Up & Go" Test and the PROMIS Health Assessment Questionnaire. Generalized linear mixed models were used to estimate changes within and between groups. Effect sizes were calculated with the Cohen d. Adverse effects were measured by self-report.
Results:
The mean participant age was 70.3 years; 53% were not white, and 93% were men. Eighty-three percent of participants completed the study, and the mean number of completed phone calls was 10 (of 13). Compared with the results for the WL group, small to medium treatment effects were found for the intervention groups in the Timed "Up & Go" Test (PA group: -2.94 [95% CI = -6.24 to 0.35], effect size = -0.28; PA + CBT-P group: -3.26 [95% CI = -6.69 to 0.18], effect size = -0.31) and the PROMIS Health Assessment Questionnaire (PA group: -6.11 [95% CI = -12.85 to 0.64], effect size = -0.64; PA + CBT-P group: -4.10 [95% CI = -11.69 to 3.48], effect size = -0.43). Small treatment effects favored PA over PA + CBT-P. No adverse effects were noted.
Limitations:
This was a pilot study, and a larger study is needed to verify the results.
Conclusions:
This pilot trial demonstrated that home-based telephone-supported PA interventions were feasible, acceptable, and safe for older adult veterans. The results provide support for a larger trial investigating these interventions.
Background
Subacromial impingement syndrome poses a substantial socioeconomic burden, leading to significant consumption of healthcare. Health systems are calling for greater evidence of economic impacts of particular healthcare services. Telerehabilitation programmes have the potential to reduce costs and improve patient access as an alternative to traditional care. Cost analysis has been traditionally included in study protocols and results, although the reliability and research methodology have frequently been under debate. The aim of this study was to compare costs related to a telerehabilitation programme versus conventional physiotherapy following subacromial decompression surgery (ASD).
Methods
The study was embedded in a randomised controlled trial. The economic analysis was based on the perspective of the health sector and the human capital method. Only the costs associated with the provision of physiotherapy services were taken into account. Costs were measured during the intervention period between baseline and 12 weeks for both groups. Student’s t-test was used to compare independent variables between the two groups, with a 95% confidence interval for the estimates and real costs.
Results
The estimated total cost analysis shows a preliminary cost differential in favour of the telerehabilitation group, meaning that for each participant’s total intervention, telerehabilitation saves 29.8% of the costs. Real cost analysis, only for received treatments, shows a cost differential in favour of telerehabilitation, meaning that for each participant’s total intervention, telerehabilitation saves 22.15% of the costs incurred for conventional rehabilitation.
Conclusions
Our study provides direct and meaningful information about telerehabilitation opportunities and can be an essential component in further cost evaluations for different strategies after surgical procedures. This study demonstrates that there was a trend towards lower healthcare costs after ASD. Managers now have the responsibility to decide whether to implement telerehabilitation based on clinical and economic data.
Purpose:
The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder.
Design and methods:
A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not.
Findings:
The intervention group had higher compliance with shoulder exercises than did the comparison group (t = 2.263, p = .03) and had significant improvements in shoulder forward flexion (F = 12.067, p = .001), external rotation (F = 13.61, p = .001), and internal rotation (F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention.
Conclusions:
The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion.
Clinical relevance:
Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises.
Background
Telerehabilitation promises to improve quality, increase patient access and reduce costs in health care. Physiotherapy with exercises is generally recommended to restore function after surgery in patients with chronic subacromial syndrome. Relatively few studies have investigated the feasibility of telerehabilitation interventions in musculoskeletal and orthopaedic disorders. The aim of this study was to evaluate the feasibility and effectiveness of a customizable telerehabilitation intervention and compare with traditional care.
Methods
This research includes 18 consecutive patients with subacromial impingement who underwent arthroscopic subacromial decompression in a controlled clinical prospective study. Patients were randomized to either a 12-week telerehabilitation programme or the usual face-to-face physical therapy for immediate postoperative rehabilitation. We have developed a telerehabilitation system to provide services to patients who have undergone shoulder arthroscopy. An independent blinded observer performed postoperative follow-up after 4, 8, and 12 weeks.
Results
The preliminary efficacy of this telerehabilitation programme in terms of both physical and functional objective outcome measures was assessed on eight patients. Using the Constant–Murley score to evaluate functional outcome, patients in the telerehabilitation group were shown to have improved from a mean 43.50 ± 3.21 points to a mean 68.50 ± 0.86 points after 12 weeks. The physical and functional improvements in the telerehabilitation group were similar to those in the control group ( p = 0.213). There was a non-significant trend for greater improvements in the telerehabilitation group for most outcome measurements.
Conclusion
The results of this study provide evidence for the efficacy of telerehabilitation after shoulder arthroscopy in shoulder impingement syndrome. A telerehabilitation programme with range of motion, strengthening of the rotator cuff and scapula stabilizers exercises seems to be similar and not inferior to traditional face-to-face physiotherapy after subacromial arthroscopic decompression. Through this study, we are developing our preliminary dataset to evaluate the efficacy of telerehabilitation programmes following surgical procedures in musculoskeletal injuries and for comparison with more traditional interventions.
Purpose: The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research.
Materials and methods: We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research.
Results: Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes.
Conclusions: More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field.
• Implications for Rehabilitation
• Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial.
• Type, intensity, and duration of interventions do not appear consistently associated with outcomes.
• Monitoring a patient’s recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip and knee replacement and more work is required to clarify these aspects.
• The burden of comorbidities appears to better predict outcomes regardless of rehabilitation approach.
Introduction:
Successful post-operative telerehabilitation following total knee replacement (TKR) has been documented using synchronous (real-time) video. Bandwidth and the need for expensive hardware are cited as barriers to implementation. Web-based asynchronous visual platforms promise to address these problems but have not been evaluated.We performed a randomized control study comparing an asynchronous video-based software platform to in-person outpatient physical therapy visits following TKR.
Materials and methods:
Fifty-one patients were randomized to either the intervention group, using an asynchronous video application on a mobile device, or the traditional group undergoing outpatient physical therapy. Outcome data were collected using validated instruments prior to surgery and at a minimum three-month follow-up.
Results:
Twenty-nine patients completed the study. There were no statistically significant differences in any clinical outcome between groups. The satisfaction with care was equivalent between groups. Overall utilization of hospital-based resources was 60% less than for the traditional group.
Discussion:
We report that clinical outcomes following asynchronous telerehabilitation administered over the web and through a hand-held device were not inferior to those achieved with traditional care. Outpatient resource utilization was lower. Patient satisfaction was high for both groups. The results suggest that asynchronous telerehabilitation may be a more practical alternative to real-time video visits and are clinically equivalent to the in-person care model.
Background:
Patient satisfaction and effective management of postoperative complaints are important factors in determining the success of outpatient surgery programs.
Methods:
In September 2013, a 24-hour postdischarge telephone follow-up (TFU) call was initiated by surgical day care nurses at the Royal Jubilee Hospital in Victoria, BC. The study group was contacted to evaluate the effectiveness of the TFU in identifying and addressing postoperative complaints and determining the level of satisfaction with discharge instructions and care.
Results:
A total of 854 patients were contacted. Overall, 313 (36.7%) received TFU and 541 (63.3%) did not; these served as our control group. Independent sample t-tests revealed that patients who received TFU had significantly fewer postoperative complaints compared with the controls (.19 vs .28, respectively).
Conclusions:
Day surgery patients receiving TFU reported fewer postoperative concerns. Results of this study suggest that a TFU call results in increased patient satisfaction with discharge care and is an appropriate tool to address patients' postoperative complaints and improve patient-reported outcomes.
Terveydenhuollon tietojärjestelmät ovat maassamme kattavasti käytössä. Potilastiedon alueellinen käyttö on entisestään lisääntynyt ja monimuotoistunut, ja suoraan kansalaisille tarkoitetut sähköisen terveydenhuollon palvelut ovat yleistyneet. Tämä raportti kuvaa tieto- ja viestintäteknologian käyttöä Suomen terveydenhuollossa vaiheessa, jossa Kanta-palveluiden sähköinen resepti oli otettu käyttöön julkisessa terveydenhuollossa ja Potilastiedon arkiston käyttöönotto oli aloitettu. Sairaanhoitopiireissä, terveyskeskuksissa, ja yksityisten terveyspalvelujen tuottajien toiminnassa tapahtuneita muutoksia verrataan neljään aiempaan selvitykseen vuosilta 2003, 2005, 2007 ja 2011. Tuloksia tarkastellaan myös Sote-tieto hyötykäyttöön 2020 -strategian valossa. Tieto- ja viestintäteknologian käytön lisäksi selvitettiin toimijoiden osallistumista kansalliseen kehitystyöhön. Nämä tulokset ovat vertailtavissa vuoden 2011 tietoihin. Selvitys on tehty sosiaali- ja terveysministeriön pyynnöstä Oulun yliopiston FinnTelemedicumin ja THL:n yhteishankkeena. Raportista on hyötyä sosiaali- ja terveydenhuollon palvelujärjestelmän kehittäjille ja muille terveydenhuollon toiminnan digitalisaation kanssa työskenteleville sekä terveydenhuollon tietojärjestelmien kehittäjille.
The availability of less resource-intensive alternatives to home visits for rehabilitation following orthopaedic surgeries is important, given the increasing need for home care services and the shortage of health resources. The goal of this trial was to determine whether an in-home telerehabilitation program is not clinically inferior to a face-to-face home visit approach (standard care) after hospital discharge of patients following a total knee arthroplasty.
Two hundred and five patients who had a total knee arthroplasty were randomized before hospital discharge to the telerehabilitation group or the face-to-face home visit group. Both groups received the same rehabilitation intervention for two months after hospital discharge. Patients were evaluated at baseline (before total knee arthroplasty), immediately after the rehabilitation intervention (two months after discharge), and two months later (four months after discharge). The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the last follow-up evaluation. Secondary outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, functional and strength tests, and knee range of motion. The noninferiority margin was set at 9% for the WOMAC.
The demographic and clinical characteristics of the two groups of patients were similar at baseline. At the last follow-up evaluation, the mean differences between the groups with regard to the WOMAC gains, adjusted for baseline values, were near zero (for 182 patients in the per-protocol analysis): -1.6% (95% confidence interval [CI]: -5.6%, 2.3%) for the total score, -1.6% (95% CI: -5.9%, 2.8%) for pain, -0.7% (95% CI: -6.8%, 5.4%) for stiffness, and -1.8% (95% CI: -5.9%, 2.3%) for function. The confidence intervals were all within the predetermined zone of noninferiority. The secondary outcomes had similar results, as did the intention-to-treat analysis, which was conducted afterward for 198 patients.
Our results demonstrated the noninferiority of in-home telerehabilitation and support its use as an effective alternative to face-to-face service delivery after hospital discharge of patients following a total knee arthroplasty.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
To evaluate the effectiveness of a follow-up telephone call to reduce the number of issues after hospital discharge.
The postdischarge period is often a time of uncertainty and risk. The decreasing length of hospital stays has increased the need for specific instructions about the postdischarge period. A telephone follow-up could be a valuable tool to fill this information gap.
Double-blind, randomised controlled trial.
The participants included medium or low-intensity orthopaedic patients. We implemented a structured telephone follow-up call conducted by a senior orthopaedic nurse to provide educational support to the intervention group (n = 110), while the control group (n = 109) received routine care after being discharged. Data were collected between September 2011-January 2012. Statistical differences between the two groups were tested using chi-square test or Wilcoxon rank sum test, as appropriate. A linear regression model was performed to investigate factors involved into postdischarge outcomes.
The intervention group had a statistically significant reduction in all postdischarge problems except for pain and mobilisation; the group also had a lower chance of experiencing frequent or severe problems. The educational intervention and prior poor health had a strong correlation with problems after discharge. Patients who received a telephone follow-up call believed the information provided was valuable.
This nurse-led follow-up intervention significantly contributed to solving or reducing postdischarge health problems and contributed to reduce unnecessary burden on the community health system.
A nurse-led telephone follow-up is a simple, feasible and low-cost tool to improve patients' outcomes after discharge.
© 2015 John Wiley & Sons Ltd.
Objectives:
To compare patient satisfaction between telemedicine and in-person follow-up appointments for orthopedic trauma.
Design:
Prospective randomized controlled trial (pilot study).
Setting:
Level I trauma center.
Patients/participants:
Twenty-four patients were enrolled and randomized into 2 groups. Eight patients who had telemedicine follow-up appointments and 9 who had in-person follow-up visits were included in a per-protocol analysis. In the telemedicine group, 2 patients left the study because of nonadherence, 1 patient withdrew because of a weak Internet connection, and 1 patient sustained an open fracture. Three control patients left the study because of nonadherence.
Intervention:
The patients had 4 follow-up appointments during a 6-month period. Patients either had their 6-week and 6-month follow-ups through video calls or in the clinic.
Main outcome measurements:
After 6-week and 6-month follow-up appointments, the patients were given survey questions that were developed using literature-supported methods to compare follow-up experiences. The patients were monitored for complications.
Results:
There was no significant difference in patient satisfaction between telemedicine and in-person clinic visits (telemedicine: 89% satisfied; control: 100% satisfied; P = 0.74). Zero percent of patients in the telemedicine group took time off their work for their appointment compared with 55.6% in the control (P = 0.03). Telemedicine patients spent significantly less time on their visits (P = 0.01). The majority of the patients in the telemedicine group reported clear visual (87.5%) and sound quality (100%) through and agreed to future follow-up visits through telemedicine (75.0%). One patient in each group developed complications.
Conclusions:
Telemedicine may be a viable alternative to some in-person clinic visits because of similar measures of patient satisfaction but with significantly less time and distance traveled.
Level of evidence:
Therapeutic level II. See Instructions for authors for a complete description of levels of evidence.
The purpose of this study was to assess the feasibility, effectiveness and costs of a web-based follow-up compared to in-person assessment following primary total hip or total knee arthroplasty. Patients who were at least 12 months postoperative were randomized to follow-up method. We excluded patients who had revision surgery, osteolysis, complications or identified radiographic issues. 229 patients (118 Web, 111 in-person) completed the study. There were no patients who had an issue missed by the web-based follow-up. Patients in the web-based group travelled less (28.2 km vs 103.7 km, (p < 0.01)), had lower associated costs (21.36, (p < 0.01)) and took less time to complete (121.7 min web vs 228.7 min usual). Web-based follow-up is a feasible, clinically effective alternative with lower associated costs than in-person clinic assessment.
To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions.
Systematic reviews were conducted to source age-specific and sex-specific epidemiological data for hip and knee OA prevalence, incidence and mortality risk. The prevalence and incidence of symptomatic, radiographic and self-reported hip or knee OA were included. Three levels of severity were defined to derive disability weights (DWs) and severity distribution (proportion with mild, moderate and severe OA). The prevalence by country and region was multiplied by the severity distribution and the appropriate disability weight to calculate years of life lived with disability (YLDs). As there are no deaths directly attributed to OA, YLDs equate disability-adjusted life years (DALYs).
Globally, of the 291 conditions, hip and knee OA was ranked as the 11th highest contributor to global disability and 38th highest in DALYs. The global age-standardised prevalence of knee OA was 3.8% (95% uncertainty interval (UI) 3.6% to 4.1%) and hip OA was 0.85% (95% UI 0.74% to 1.02%), with no discernible change from 1990 to 2010. Prevalence was higher in females than males. YLDs for hip and knee OA increased from 10.5 million in 1990 (0.42% of total DALYs) to 17.1 million in 2010 (0.69% of total DALYs).
Hip and knee OA is one of the leading causes of global disability. Methodological issues within this study make it highly likely that the real burden of OA has been underestimated. With the aging and increasing obesity of the world's population, health professions need to prepare for a large increase in the demand for health services to treat hip and knee OA.
Objective:
To compare the effectiveness of a new interactive virtual telerehabilitation system and a conventional programme following total knee arthroplasty.
Design:
Randomized, controlled, single-blind clinical trial.
Participants:
A total of 142 total knee arthroplasty patients.
Methods:
Participants were randomly assigned to receive either: (i) conventional out-patient physical therapy; or (ii) interactive virtual telerehabilitation system. The main outcome was function assessed with active range of knee movement. Other variables, such as muscle strength, walk speed, pain and the Western Ontario and McMaster Universities osteoarthritis index, were also collected. Comparisons were made on the basis of data collected routinely before surgery, at the end of the rehabilitation programme, and at 3 months follow-up. Quantitative variables were compared by Mann-Whitney U test. The agreed alpha risk for all hypothesis testing was 0.05.
Results:
Baseline characteristics between groups were comparable. All participants improved after the 2-week intervention on all outcome variables (p < 0.05). Patients in the interactive virtual telerehabilitation group achieved improvements in the functional variables similar to those achieved in the conventional therapy group.
Conclusion:
A 2-week interactive virtual telerehabilitation programme is at least as effective as conventional therapy. Telerehabilitation is a promising alternative to traditional face-to-face therapies after discharge from total knee arthroplasty, especially for those patients who have difficulty with transportation to rehabilitation centres.
Most outpatient orthopedic follow-up visits for patients who had total joint arthroplasty are routine among those with well-functioning implants. The technology and resources now exist to enable patient assessment without requiring attendance in hospital. We tested an electronic clinic for routine follow-up in a small cohort of arthroplasty patients.
We randomly assigned primary arthroplasty patients scheduled for routine annual outpatient review into 2 groups: group A completed a Web-based assessment 4 weeks after the clinical assessment, whereas group B completed the Web-based assessment first. Standard clinical questionnaires were included. We also collected radiographic data and information on assessment duration and cost.
Forty patients participated in the study. The average age of participants was 58 years. There were 12 men and 8 women in each of the 2 groups. The average total time spent by patients on an outpatient visit was 115 minutes, compared with 52 minutes for the electronic assessment. Participants reported the electronic assessment to be more convenient and less costly.
This pilot study supports the practical use of an electronic clinic for the follow-up of arthroplasty patients. Further studies examining the complex interaction of factors involved in patient clinics are needed.
total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee. Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function. Access to high-quality rehabilitation services is not always possible, especially for those who live in rural or remote areas. The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty.
this investigation was a single-blinded, prospective, randomized, controlled noninferiority trial. Sixty-five participants were randomized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and six weeks by a blinded independent assessor. Secondary outcomes included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, limb girth measurements, and an assessment of gait. Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics.
baseline characteristics between groups were similar, and all participants had significant improvement on all outcome measures with the intervention (p < 0.01 for all). After the six-week intervention, participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, quality of life, and clinical gait and WOMAC scores. Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group (p < 0.05). The telerehabilitation intervention was well received by participants, who reported a high level of satisfaction with this novel technology.
the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation.
therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews
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- H. Moffet
- P. Boissy
- H. Corriveau
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- F. Marquis
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- J. Reponen
- M. Kangas
- P. Hämäläinen
- N. Keränen
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