Digital

Next step in telehealth could be surgery rehab led by an avatar

Using telerehabilitation following total hip and knee arthroplasty lowers rehabilitation costs by an estimated $1,000 per patient and boosts patient adherence with exercises as they recover, suggests an unpublished pilot study.

And patients say that they like the at-home option, according to the study, “Tele-Rehabilitation for Total Hip and Knee Arthroplasty Patients: No Increase in Readmissions,” which was presented at the American Academy of Orthopaedic Surgeons’ annual meeting.

“A surgeon can do a fabulous operation, but if the patient doesn’t do exercises, the outcome is often compromised. Now you are giving patients a tool to do exercises at home that engages them and provides feedback on how accurately and how often they are performing the exercises,” said orthopedic surgeon Mary I. O’Connor, MD, director of the Center for Musculoskeletal Care at Yale School of Medicine and Yale-New Haven Health, and an author of the study.

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Tele-rehabilitation wouldn’t replace all face-to-face time with a skilled physical therapist, Dr. O’Connor said, but it can lower the number of times a patient sees a physical therapist without compromising the recovery.

“Physical therapy with a physical therapist is a resource-heavy model,” she said. “When the patient can do routine exercises on their own with guidance and support through tele-rehabilitation, you are going to lower your costs. It doesn’t eliminate the need for a skilled physical therapist, but it is an extender of physical therapy.”

Good tele-rehabilitation outcomes

Dr. O’Connor and her colleagues analyzed data from 50 patients who enrolled in tele-rehabilitation for the pilot study. Patients went to between four and six face-to-face therapy sessions and did daily exercises at home with an animated avatar called VERA.

The device set up in a patient’s home recorded how often and for how long the patient did the exercises, how accurately the patient performed the exercises, and how much the patient improved. When study authors compared the data with data from patients who solely did face-to-face physical therapy in a home or outpatient setting, they found the 30-day and 90-day readmission rates were not significantly different. They also found that there was a near identical rate of emergency department visits at the 90-day post-operation mark.

They also discovered:

  • Total hip arthroplasty patients [THA] performed exercises accurately 90% of the time.
  • Total knee arthroplasty patients [TKA] performed exercises accurately 93% of the time.
  • THA patients averaged about 12 minutes of exercise daily, three days a week.
  • TKA patients averaged about 24 minutes of exercise daily, nearly 4.5 days a week.
  • No TKA tele-rehabilitation patients required manipulation, which is often used to treat knee stiffness after surgery.

Cutting stress during recovery

At the outset of the study, Dr. O’Connor believed that patients would like tele-rehabilitation. But she was surprised by just how much they liked it. Patients gave the program a 91.2% approval score.

“Patients enjoy having this type of support at home,” Dr. O’Connor said. “They are more engaged with telerehab than when they are just given a write-up with pictures of the exercises they are supposed to be doing at home.”

In talking with patients, she also discovered an unforeseen upside for those who otherwise may have had a physical therapist come into their home.

An elderly knee replacement patient told Dr. O’Connor she “absolutely loved VERA,” and the physician said she was not expecting such a strong response. Dr. O’Connor asked her why she liked it so much.

“She said, ‘Dr. O’Connor, I don’t have to make sure my house is clean, or my hair is done and I have makeup on as when the physical therapist comes to the house. I can do my exercises in my housecoat.’”

In other words, using VERA took away the stress of feeling pressure to pick up the house and get yourself together while trying to recover after surgery, Dr. O’Connor said, noting that “it was a wonderful perspective that I had not really appreciated.”