Discovering that a well-researched, evidence-based virtual physiotherapy program produces the same functional and patient-reported results as outpatient physiotherapy, even for outpatient TKA procedures, is a game-changer.
The increase in the use of musculoskeletal care is leading to the exploration of more sustainable models to encourage high-value care.
With many total joint replacement procedures already offered in paid packages, healthcare systems need to find new ways to reduce costs while maintaining clinical outcomes.
Reviews : - check here for more information Virtual physical therapy: A new horizon in ambulatory arthroplasty recovery
Many healthcare systems are investigating the effectiveness of remote patient monitoring and digital patient engagement in optimizing patients preoperatively and postoperatively recovering. For total knee arthroplasty (TKA) procedures, virtual physical therapy has been shown to produce similar results to outpatient physical therapy for traditional TKAs.
Currently, between 2.8% and 5% of TKAs in the United States are performed on an outpatient basis, typically in relatively young patients with few comorbidities. However, the prevalence of same-day TKA procedures is increasing exponentially, due to cost containment pressures and the recent removal of TKA and total hip arthroplasty (THA) procedures from the Medicare list for patients hospitalized only.
Some projections predict that more than 50% of TKAs will be offered on an outpatient basis over the next five years. While orthopedic practices have become much more comfortable with the benefits of remote physical therapy, there are still apprehensions about its adoption for outpatient procedures.
A study to evaluate outpatient physiotherapy versus virtual physiotherapy
Our institution designed a study to determine if formal physical therapy is necessary after outpatient TKA procedures. Patients who underwent same-day discharge TKA between August 2019 and March 2021 were randomized to receive either outpatient physiotherapy (OPT) or an internet-based virtual physiotherapy program (VPT).
Of the 194 patients who met the inclusion criteria, 99 were randomized to OPT and 95 to VPT. After withdrawals and crossovers due to clinical indications or patient preference, the study included 89 OPT patients and 72 TPV patients, with no significant differences in baseline variables (sex, age, BMI, and procedure laterality). between the groups.
All patients were enrolled in a remote care management and patient engagement platform during their care episode. The platform provides individualized care pathways based on the patient's demographic profile and clinical status, adjusted to reflect the patient's current activity level, pain, and range of motion.
All patients received preoperative education through a common virtual classroom with teaching questions, which provides procedure-specific content to help patients prepare and prepare their homes for recovery. In a previous study examining virtual or face-to-face preoperative training for total joint replacements, there were no statistically significant differences in patient satisfaction or functional outcomes.
During the 90 days following surgery, OPT patients completed a standard course of physical therapy, while VPT patients were enrolled in remote physical therapy through the care management platform. Patients watched videos and performed a series of prescribed exercises, such as assisted squats, as they progressed through the phases of their care plan.
The care management platform enabled remote tracking of all patients' adherence to their evidence-based care plan. Providers were notified if their patients were experiencing increased pain or decreased range of motion, allowing care teams to provide targeted intervention in the form of follow-up phone calls or in-person appointments.
In addition, all patients had access to the platform's direct doctor/patient messaging system.
Patients who were concerned about their pain, medication or swelling could contact their provider for an answer. Research shows that direct doctor-patient messaging can facilitate rapid, in-person treatment of wound complications while avoiding unnecessary visits for normally healing wounds.