Efficacy and Safety of Remote Physical Rehabilitation in Patients with Hip or Knee Replacement: a Prospective Randomized Comparative Study

Abstract

INTRODUCTION. An urgent problem of medical rehabilitation is the loss of results that were achieved at various stages due to the interruption of the recovery process and the absence of patients' classes at home after discharge from a medical institution. In this regard, at the third stage of medical rehabilitation, the remote (telemedicine) form of rehabilitation assistance is of particular importance, which has broad prospects for development due to the emergence of new information technologies that allow for active communication between a medical professional and a patient. Nevertheless, the issues of the effectiveness and safety of remote physical rehabilitation remain insufficiently studied, and therefore it is necessary to conduct randomized comparative trials with the analysis of long-term results.
 AIM. Evaluation of the effectiveness and safety of the remote physical rehabilitation (RPR) model for a group of patients who have undergone hip (HR) or knee (KR) replacement, the study of patient adherence, as well as the selection of the most informative evaluation tools.
 MATERIALS AND METHODS. The study included 30 patients aged 30 to 75 years who underwent HR or KR. The study participants were distributed by the envelope method into groups for remote rehabilitation in addition to routine clinical practice of providing medical rehabilitation (RPR group) or conducting only routine medical rehabilitation (comparison group), including daily independent physical exercises at home, mastered during inpatient medical rehabilitation, lifestyle modification, taking nonsteroidal anti-inflammatory drugs with the development of pain syndrome. An assessment of the effectiveness and safety of rehabilitation measures was carried out, including an analysis of physical examination data, vital signs, as well as data from various scales, tests and questionnaires (the 10-point visual-analog scale (VAS), the Timed 25-Foot Walk (T25-FW), the "Timed Up and Go Test", the Berg Balance Scale (BBS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC)).
 RESULTS AND DISCUSSION. 14 patients were randomized to the remote physical rehabilitation group (49.6 ± 12.4 years) and 16 to the comparison group (57.8 ± 11.2 years). Participation in the study was completed by 10 patients from the RPR group and all 16 patients in the comparison group. Comparing the results of rehabilitation between the groups 1 month after the inclusion of participants in the study revealed a more pronounced statistically significant improvement in the functional profile of the patient on the T25-FW (p 0.0001), the "Timed Up and Go Test" (p = 0.0064), the Berg Balance Scale (p = 0.0008) and WOMAC (p 0.0001) in group of RPR. The "Timed Up and Go Test", the visual analog scale and the WOMAC were selected based on the results obtained for further practical work. The most significant predictors of premature termination of RPR were older age (χ2 16.75, p 0.0001), pensioner status (χ2 11.75, p = 0.0006) and residence in the region (χ2 11.75, p = 0.0006). The analysis of adverse events showed that 4 patients in the RPR group and 6 in the comparison group had a periodic increase in pain syndrome in the operated limb.
 CONCLUSION. The results obtained demonstrate that of patients who have undergone hip or knee replacement is safe and effective in restoring functional mobility, reducing the risk of falls and the severity of pain syndrome, and increases adherence to physical exercises. The main limitations in the practical use of remote physical rehabilitation are related to the availability of high-speed Internet and the skills of using Internet portals.