Mobile-based in-home telerehabilitation compared with in-hospital face-to-face rehabilitation for elderly patients after total hip arthroplasty in China's level 1 trauma center: a noninferiority randomized controlled trial.
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Abstract
Background: Telerehabilitation is gaining popularity in European and American countries, but whether it can be successfully implemented in China still lacks support from clinical studies.
Objective: This trial aimed to determine if a home-based telerehabilitation method is clinically noninferior to standard in-hospital face-to-face rehabilitation for elderly patients with total hip arthroplasty (THA) in China.
Methods: This multicenter randomized controlled trial was conducted from January 2021 to June 2022 at The First Rehabilitation Hospital in Shanghai, Shanghai Jiao Tong University affiliated Sixth People's Hospital and Shanghai Tongji University affiliated Tenth People's Hospital. Sixty-four patients were recruited for this two-arm, single-assessor blinded, randomized controlled trial. The participants were randomly assigned to the in-home telerehabilitation group (TELE group) and the in-hospital physical therapist in-person group (PT group). The intervention consisted of a 12-week home-based rehabilitation program with video instructions and remote coaching on a mobile APP (TELE group). The PT group received a standard in-hospital rehabilitation intervention assisted by a physical therapist for one month and outpatient clinic for the next two months. Patients were evaluated at baseline, 4 weeks, and 12 weeks postoperatively employing functional tests (Timed Up & Go test and Berg balance test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score (HOOS) and Short Form 12 (SF-12)).
Results: There was no significant difference between the two groups for the demographic and clinical characteristics. 61 participants were analyzed (PT group: n = 31, women: 48.4% of participants; TELE group: n = 30, 33.3% of participants) whose median age was 70 and 69 years, in PT group (IQR: 63-73) and TELE group (IQR: 66-72) respectively. At 12 weeks follow-up evaluation, the main differences between the two groups regarding the HOOS gains, adjusted for baseline values, were close to zero (P > 0.05). There was no significant difference in primary and secondary outcome measures between the two groups.
Conclusion: Our results showed the noninferiority of in-home telerehabilitation and advocated its application as a reliable alternative to in-hospital face-to-face rehabilitation for patients who underwent THA.
Clinical trial registration: https://www.chictr.org.cn/, Chinese Clinical Trial Registry (Number: ChiCTR1900025825).
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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