Poster 169: Severe Attrition and Poor Satisfaction in Patients Undergoing Tele-Rehabilitation Versus Standard In-Office Rehabilitation After Arthroscopic Rotator Cuff Repair and Anterior Cruciate Ligament Reconstructions: Randomized Controlled Trials That Required Cessation

Abstract

Objectives: The use of telerehabilitation after sports medicine procedures such as arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, functional outcomes and patient satisfaction after telerehabilitation compared to in- person rehabilitation remain unclear. We hypothesized that functional outcomes and patient satisfaction would not differ significantly between the rehabilitation modalities. Methods: Two separate randomized-controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Initially 60 patients were included in each arm of the trial. Patients were randomized to receive telerehabilitation or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) scores (for ACLR), the American Shoulder & Elbow Surgeons (ASES) score (for ARCR), and satisfaction metrics were collected at timepoints of baseline and at each post-operative visit. Baseline characteristics and outcomes between the in-person and telerehabilitation arms of each cohort were compared using Mann-Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. P-values less than 0.05 were considered significant. Results: In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled of whom 20 (62.5%) were assigned to in-person rehabilitation and 12 (37.5%) were assigned to telerehabilitation. In both trials combined, of the 30 patients initially assigned to in-person rehabilitation, 24 (80%) completed the final follow-up survey and none reported crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey. Of these 12 patients, 11 (92%) reported crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and tele-rehabilitation. Conclusions: Though overall satisfaction with both modalities was high, patients preferred in-person rehabilitation to telerehabilitation after undergoing ACLR and ARCR as evidenced by nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. However, a hybrid model combining in-person and tele-visits may be acceptable to most patients.