Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Mar 26, 2019
Date Accepted: Jan 24, 2020
Effectiveness of a home-based rehabilitation program driven by a tablet application and remote coaching: a comparison with usual care in the Netherlands for patients following total hip arthroplasty
ABSTRACT
Background:
Recent technological developments such as wearable sensors and tablet PC use with mobile internet connection look promising for providing e-health home-based programs with remote coaching. It can be hypothesized that in the end, such a home-based rehabilitation program can be an alternative to regular physiotherapy.
Objective:
To determine the effectiveness of a home-based rehabilitation program driven by a tablet application and remote coaching for patients following total hip arthroplasty (THA).
Methods:
A non-randomized controlled trial combining existing data of two studies, an intervention study and an observational study. Patients aged 18-65 years who had undergone THA as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a twelve-week home-based rehabilitation program with video instructions on a tablet PC and remote coaching (intervention group (IG)). Patients were asked to do strengthening and walking exercises at least 5 days a week. The IG was compared with patients who received usual care (control group (CG)). Effectiveness was measured at four moments (preoperatively, 4, 12 weeks and 6 months postoperatively) by means of functional tests (TUG, FTSST) and self-reported questionnaires (HOOS, SF-36). Each patient of the IG was matched with two patients of the CG. Descriptive statistics were used to describe patient characteristics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated (Cohen’s d).
Results:
Overall, 15 patients of the IG and 15 and 12 of the CG were included. The IG performed functional tests significantly faster at 12 weeks and 6 months postoperatively. On the subscales function in sport and recreational activities and hip-related QoL (HOOS) and on the subscale physical role limitations (SF-36), the IG scored significantly better at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (0.5-1.2), endorsed by effect sizes on the self-reported outcomes.
Conclusions:
Our results clearly demonstrate larger effects in the IG. These results imply that a home-based rehabilitation program delivered by means of internet technology after THA can be more effective than usual care. Hence such a program could be an alternative to regular physiotherapy. Clinical Trial: The home-based rehabilitation study was registered in ClinicalTrials.gov (NCT03846063) and the observational study was registered in the German Registry of Clinical Trials (DRKS00011345).
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.