HSS@Home, Physical Therapist-Led Telehealth Care Navigation for Arthroplasty Patients: A Retrospective Case Series

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Abstract

Background

As the rate of total joint arthroplasties performed in the USA continues to increase, so does the push for more value-based care. Bundled payments have encouraged organizations to be creative in limiting care overuse. Telehealth is one option for caring for arthroplasty patients post-surgery while limiting costs and improving communication with the surgical team.

Questions/Purposes

We sought to determine the effects of the implementation of HSS@Home, a telehealth rehabilitation program that uses patients’ existing technology, in patients after they had undergone total knee or total hip arthroplasty.

Methods

In this retrospective case series, of 32 patients referred, 19 patients (nine men and ten women; average age, 69 years) were enrolled in HSS@Home after undergoing a pre- and post-operative screening process. Telehealth video visits were conducted, wherein a physical therapy navigator assisted patients in following exercise and mobility programs, addressing patients’ concerns while transitioning to outpatient therapy. Patients were seen within 24 h of hospital discharge, 3 times a week for 3 weeks, for an average of 11 sessions. Episodes of care were recorded in the patient’s electronic medical record.

Results

There were no readmissions among the 19 patients. Nurse practitioners were consulted for all patients, predominantly for non-emergent reasons. Feedback from patients and physicians was positive, and no overutilization of care was found.

Conclusion

HSS@Home was a promising alternative to live, in-home physical therapy that was effective in monitoring this series of patients after hip or knee arthroplasty. This preliminary data sets the stage for further research into the use of telehealth technology to provide rehabilitative care to arthroplasty patients.

Electronic supplementary material

The online version of this article (10.1007/s11420-019-09714-x) contains supplementary material, which is available to authorized users.

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Most cited references 14

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Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

Jose Manuel Pastora-Bernal, Rocío Martín-Valero, Francisco Javier Barón-López … (2017)

Background In addition to traditional physiotherapy, studies based on telerehabilitation programs have published the results of effectiveness, validity, noninferiority, and important advantages in some neurological, cognitive, and musculoskeletal disorders, providing an opportunity to define new social policies and interventions. Objectives The aim of this systematic review is to investigate the effects of telerehabilitation after surgical procedures on orthopedic conditions as well as to describe how interventions are designed and to determine whether telerehabilitation is comparable with conventional methods of delivery. This systematic review summarizes the levels of evidence and grades of recommendation regarding telerehabilitation intervention (synchronous or asynchronous provided via the telerehabilitation medium, either in conjunction with, or in isolation of, other treatment interventions) after surgical procedures on orthopedic conditions. Methods Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scores and grade of recommendation following the recommendation of the Oxford Centre for Evidence-Based Medicine. Results We found 3 studies with PEDro scores between 6 and 8, which is considered as level 1 evidence (good; 20% [3/15]), 4 studies with a score of 5, which is considered as level 2 evidence (acceptable; 27% [4/15]), and the remaining 8 studies had scores of 4 or less, which is considered (poor; 53% [8/15]). A total of 1316 participants received telerehabilitation intervention in the selected studies, where knee and hip replacement were 75% of all the studies. Strong and moderate grades of evidence (grade of recommendation A–B) were found in knee and hip replacement interventions. Studies on the upper limb were 25% of the studies, but only 1 study presented a moderate grade of evidence (grade of recommendation B) and the rest were of poor methodological quality with weak evidence (grade of recommendation C). Conclusions Conclusive evidence on the efficacy of telerehabilitation for treatment after an orthopedic surgery, regardless of pathology, was not obtained. We found strong evidence in favor of telerehabilitation in patients following total knee and hip arthroplasty and limited evidence in the upper limb interventions (moderate and weak evidence). Future research needs to be more extensive and conclusive. To the best of the authors’ knowledge, this is the first attempt at evaluating the quality of telerehabilitation intervention research after surgical procedures on orthopedic conditions in a systematic review. Clinical messages and future research recommendations are included in the review.

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Cost Analysis of In-Home Telerehabilitation for Post-Knee Arthroplasty

Michel Tousignant, Hélène Moffet, Sylvie Nadeau … (2015)

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 $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient’s home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $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).

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Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial.

Hélène Corriveau, François Marquis, François Cabana … (2011)

We measured the satisfaction of both patients and healthcare professionals with the technologies and services provided during in-home telerehabilitation as an alternative to conventional rehabilitation after discharge from total knee arthroplasty surgery. This study was embedded in a larger controlled trial where 48 community-living older adults who received total knee arthroplasty were recruited prior to discharge from acute care following surgery and randomly assigned to treatment arms (Tele and Comparison). The participants' satisfaction with the services was assessed at the end of the intervention for both groups using the Healthcare Satisfaction Questionnaire. For the Tele group, the patients' perception of in-home telehealth was assessed before treatment and after completion of teletreatments. The satisfaction of the healthcare professionals with the technology during the telerehabilitation services was noted at the end of each treatment session using a technical quality subjective appreciation questionnaire. Both groups of patients (Tele and Comparison) were satisfied with the services received and no significant difference was observed between them. Moreover, the physiotherapists' satisfaction with regard to goal achievement, patient-therapist relationship, overall session satisfaction, and quality and performance of the technological platform was high. As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.

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Author and article information

Contributors

Charles Fisher: fisherc@hss.edu

Journal

Journal ID (nlm-ta): HSS J

Journal ID (iso-abbrev): HSS J

Title: HSS Journal

Publisher: Springer US (New York )

ISSN (Print): 1556-3316

ISSN (Electronic): 1556-3324

Publication date (Electronic): 22 August 2019

Publication date PMC-release: 22 August 2019

Publication date (Print): October 2019

Volume: 15

Issue: 3

Pages: 226-233

Affiliations

GRID grid.239915.5, ISNI 0000 0001 2285 8823, Hospital for Special Surgery, ; 535 East 70th Street, New York, NY 10021 USA

Article

Publisher ID: 9714

DOI: 10.1007/s11420-019-09714-x

PMC ID: 6778161

SO-VID: d5788285-29cd-41c1-bc9d-feeb889bb2cf

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 20 March 2019

Date accepted : 25 July 2019

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: telehealth,arthroplasty,physical therapy

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: telehealth, arthroplasty, physical therapy

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HSS@Home, Physical Therapist-Led Telehealth Care Navigation for Arthroplasty Patients: A Retrospective Case Series

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Abstract

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Electronic supplementary material

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Telehealth & Medicine Today

Most cited references 14

Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

Cost Analysis of In-Home Telerehabilitation for Post-Knee Arthroplasty

Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial.

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Cited by 6

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