Physical therapy following shoulder arthroplasty: an assessment of telerehabilitation vs. in-person physical therapy

Background

It is unclear whether supervised postoperative physical therapy (PT) is necessary after shoulder arthroplasty. The COVID-19 pandemic necessitated social distancing and limitation of nonessential exposure to health care, bringing remote health care, or “telehealth,” to the forefront. Telerehabilitation provides alternative PT that confers more flexible participation and limits extraneous travel and exposure. We hypothesize video-based, interactive telehealth PT after anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) demonstrates similar improvement in shoulder range of motion (ROM) and patient-reported outcome measures (PROMs) compared to conventional PT.

Materials and methods

This was a single-center, prospective, randomized controlled trial. All patients indicated for primary shoulder arthroplasty were screened for enrollment. Participants were randomized to in-person PT (control) or telerehabilitation postoperatively. Demographic information was collected. Outcome measures included American Shoulder and Elbow Surgeons, visual analog scale (VAS) pain, and Patient-Reported Outcomes Measurement Information System Pain Interference scores. Shoulder ROM, including forward elevation FE, abduction, internal rotation, and external rotation, was measured. Outcome measures were collected preoperatively and at postoperative visits at 2 and 6 weeks, 3 and 6 months, and 1 year.

Results

Eighty-one patients were randomized, and 70 had postoperative outcome data available. Between intervention groups, there were no significant differences in baseline characteristics, preoperative PROMs, or ROM (P > .05). Overall, more participants underwent RSA (62.7%). TSA and RSA patients tended to improve in a parallel fashion to each other over time, with a relative plateau after 6 months. Both telerehabilitation and in-person PT cohorts followed a similar pattern of improvement in PROMs and ROM outcomes up to 1 year postoperatively, with no statistically-significant differences between groups. In patients who underwent TSA or RSA, there were no statistically significant differences in postoperative PROMs or ROM, regardless of therapy modality.

Conclusion

Postoperative results suggest nearly parallel increases in PROMs and shoulder ROM, both during and after PT. There were no statistically significant differences in PROMs and ROM outcomes between telerehabilitation and in-person therapy 1 year postoperatively, irrespective of surgical intervention. Telerehabilitation after shoulder arthroplasty may offer similar outcomes with the benefit of instruction and oversight from a therapist within the patient's home. Policy change to allow insurance coverage of telerehabilitation should be considered given its viability as a rehabilitation strategy.