Rehabilitation Services Research Articles

Corrigendum to: Healing Right Way randomised control trial enhancing rehabilitation services for Aboriginal people with brain injury in Western Australia: translation principles and activities

Corrigendum to: Healing Right Way randomised control trial enhancing rehabilitation services for Aboriginal people with brain injury in Western Australia: translation principles and activities

Understanding housing preferences and challenges of older adults in Kalisz, Poland

Purpose: This study aimed to identify the demographic, economic, and social factors that influence the housing demand of older adults in Kalisz, Poland, and assess their preferences and challenges in meeting their housing needs. Methodology: A quantitative survey was conducted among individuals aged 50 and above in Kalisz. The survey questionnaire covered various aspects, including current housing conditions, housing preferences, knowledge of senior housing options, and willingness to relocate to such housing. Data analysis involved descriptive statistics and correlation analysis. Results: The findings revealed that while most respondents were satisfied with their current housing situation, they acknowledged the need for housing options tailored to older adults. However, there was a lack of interest in relocating to designated senior housing due to concerns about affordability, accessibility, and amenities. Respondents expressed a preference for independent living arrangements with access to medical, care, and rehabilitation services. Theoretical contribution: The study contributes to the understanding of the housing needs and preferences of older adults in the context of a medium-sized city in Poland. It highlights the importance of considering demographic shifts and adapting housing policies and urban planning strategies to meet the diverse requirements of an aging population. Practical implications: The findings can inform policymakers, urban planners, and housing developers in designing and implementing housing solutions that cater to the specific needs of older adults, ensuring accessible, affordable, and supportive living environments. The study also emphasizes the need for public awareness and education regarding senior housing options.

Comprehensive Geriatric Assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial

RationaleMany people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated.AimTo determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation.MethodsMulticentre mixed-methods randomised controlled feasibility trial (“Breathe Plus”;ISRCTN13051922). People with COPD, aged ≥50, Clinical Frailty Scale ≥5, and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during Covid-19 restrictions. Outcomes (physical, psycho-social, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews.ResultsRecruitment stopped at 31 participants (mean age 72.4 [sd10.1], 68% MRC 4–5), due to Covid-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8–129) and prompted 46 individual care recommendations (median 3 per participant, range 0–12); 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it.ConclusionIntegrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.

How much does dysphagia cost? Understanding the additional costs of dysphagia for New Zealand in patients hospitalised with stroke.

Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand. Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between 1st May 2018 and 30th October 2018 including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a Speech Language Therapist review. Patients that required a nasogastric feeding tube in hospital were classified as 'severe'. Optimal linear propensity score matching was utilised to provide a group for patients to compare with stroke and dysphagia. All costs were converted to 2021NZ$. Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age:78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12-months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95%CI, 0.028 to 0.100), and severe dysphagia by 0.12 index points (95%CI, 0.03 to 0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was $24,200 on average per patient. This estimate includes the additional hospitalisation costs ($16,100), community rehabilitation services ($570), hospital-level aged residential care ($4,030) and reduced HRQoL ($3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was $34,000 per patient. We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.

Online dance versus online therapeutic exercise on quality of life - a study protocol for a randomized controlled trial investigating social telerehabilitation efficacy in Parkinson disease

Background Social telerehabilitation delivers rehabilitation services over online video conferencing within a social context. The modality of multimodal therapeutic exercises is the most recommended rehabilitation for individuals with PD, although other modalities, such as dance, have shown potential benefits. The investigation of the feasibility and efficacy of these therapeutic strategies in a remote online format is unknown. Methods This is a prospectively registered two-arm randomised controlled trial investigating the efficacy of online dance compared to online multimodal therapeutic exercise by looking at the biopsychosocial PD aspects. Individuals diagnosed with idiopathic PD between 40 and 90 years old, at any stage of disease severity, and without cognitive impairment will be recruited from the community. Participants will be randomly allocated to one of the two social telerehabilitation groups: (1) dance and music or (2) multimodal therapeutic exercise and music. Interventions will occur twice a week for twelve weeks. Each session will last 60 min. Tele-assessments will be conducted pre-, post-, and one-month follow-up through a videoconference platform. Results For feasibility, primary outcomes will include adherence, attendance, adverse events, and participants’ perceptions of enjoyment and socialisation. For efficacy, primary outcomes will investigate well-being by positive affect (by the Positive Affect and Negative Affect Schedule) and persistent anxiety, episodic anxiety, and avoidance behaviour (by the Parkinson Anxiety Scale). Secondary outcomes will include motor severity (by the UPDRS III), functional lower extremity strength (by the Five Times Sit to Stand Test), memory and attention (by the Attention and Recognition Memory Test), and quality of life (by the Parkinson’s Disease Questionnaire 39). Conclusion We hypothesise that both interventions would effectively ameliorate motor symptoms. However, we expect dance to be more enjoyable and improve well-being by increasing positive affect and reducing anxiety signs.

EvolvRehab–MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study

IntroductionStroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb...

Enhancing stroke care in Ghana: A systematic review of stroke rehabilitation services

ObjectiveIn Ghana, the shifting demographics of stroke incidence towards young adults have prompted the expansion of stroke care and rehabilitation efforts. Nevertheless, the precise impact of stroke rehabilitation remains unclear. We conducted a systematic review to explore the landscape and effects of stroke rehabilitation in Ghana. MethodWe identified articles on stroke rehabilitation services in Ghana through searches of PubMed, Scopus, Embase, and Web of Science from inception until February 2024. The Critical Appraisal Skills Programme (CASP) Qualitative Checklist was employed to assess the risk of bias in the included studies, supplemented by qualitative synthesis. ResultsAmong the 213 articles screened, 8 were deemed suitable for review. These studies primarily focused on two groups: stroke survivors (n = 335) and healthcare professionals (HCPs) (n = 257). Many stroke survivors reported significant benefits from telerehabilitation, with increased participation in rehabilitation activities correlating with improved physical and cognitive outcomes. The findings also underscored a lack of knowledge about stroke rehabilitation among HCPs, alongside variations in the availability of protocols and guidelines for stroke management across different hospital levels. ConclusionsThe review reveals several challenges in stroke rehabilitation in Ghana, including disparities in HCPs' perceptions and utilization of rehabilitation services. The findings emphasize the need for comprehensive, patient-centered approaches, standardized training for HCPs, improved resource allocation, and the integration of telehealth to overcome barriers and enhance stroke rehabilitation in Ghana. These insights hold significance not only for Ghana but also for guiding strategies in similar contexts worldwide, aiming to improve stroke rehabilitation outcomes.

Community rehabilitation by the trained village health volunteers on activities of daily living and quality of life in stroke survivors

Background: The number of people with disabilities resulting from strokes is increasing in Thailand. The major sequela of the disease was weakness in one side of the body that causes difficulty in activities of daily living (ADL) and poor quality of life (QOL) for stroke survivors. Community-based rehabilitation could be one of the strategies that enhances functional performance and improves QOL in these individuals. There were many disabled people in Mae Ka subdistrict, San Pa Tong District, Chiang Mai Province, where health care providers and local people were enthusiastic to take care of each other’s health in the community. Objective: The present study aimed to investigate rehabilitation outcomes in ADL and QOL of stroke participants who received rehabilitation services from trained village health volunteers (VHVs). Materials and methods: This study was a quasi-experimental research design. Subjects were recruited using purposive sampling, including 10 stroke survivors. Instruments used were 1) ADL Assessment for Occupational Therapy Clients; and 2) World Health Organization Quality of Life Assessment, Short Form-Thai version. The statistics used were descriptive, as well as the Wilcoxon Signed Ranks Test. Results: Results demonstrated that scores of basic activities of daily living (BADL) in the participants increased significantly (p<0.05) except for sexual expression. The score in the instrumental activities of daily living (IADL) was also significantly higher at post-rehabilitation than pre-intervention (p<0.05), as was the total ADL score. Stroke patients had significantly higher QOL scores after intervention than the pretest (p<0.05). Conclusion: These indicated that the community rehabilitation center at Mae Ka Subdistrict Administrative Organization, San Pa Tong District, Chiang Mai Province, run by the trained VHVs could promote ability in daily activities and improve QOL in stroke participants who come for their services.

Feasibility Telerehabilitation at Home on Body Composition, Anthropometric Measures and Muscular Strength After Interruption 4-5 Years of Spinal Cord Injury: Serial Cases Study on Islamic State of Iraq and Syria War Survivors in Iraq.

Introduction: The war caused huge devastation to rehabilitation centers in Mosul City, leading to a significant gap in rehabilitation services, which was further compounded by the COVID-19 pandemic. Objectives: We sought to incorporate simple and safe clinical exercises by utilizing common household items, thereby maximizing effectiveness through a combination of psychological simulation and physical impact while ensuring safety, and evaluate its efficacy as a home telerehabilitation program (HTRP) for participants with spinal cord injury (SCI) following a 4- to 5-year rehabilitation interruption. Methods: Eighteen volunteers, including 13 with SCI (injuries sustained 53.4-55 months prior), were split into an experimental group (Exp., n = 8), a first control group (first Con., n = 5), and a second control group of healthy individuals (second Con., n = 5), averaging 21.2 years old. The HTRP focused on muscles and whole-body joints, conducted with five weekly sessions gradually increasing from 45 to 120 min, with sufficient rest. Assessments occurred every 3 months. Results: The Friedman test indicated no significant effect of HTRP on weight, body mass index, 3 of 4 anthropometric measures, and 4 of 19 muscle strength tests, p > 0.05, and small effect sizes (ES). However, significant effects were observed in pelvic strength (p < 0.001, ES = 0.73), exceeding control groups (first Con. 1.6%, second Con. 1.0%). Muscle strength in the lower extremities, head, and trunk showed significant improvements (p < 0.05, ES = 18.3-81.8%), it is indicating functional enhancement despite morphological weaknesses, particularly in individuals with SCI. Conclusion: The HTRP demonstrated weak effects on muscle morphology but strong effects on functionality, highlighting its potential for long-term management and improvement of muscle functional outcomes in individuals with SCI, even after prolonged rehabilitation interruptions.

Harvey Rosenthal to receive the Lifetime Achievement Award from MHNE

Harvey Rosenthal, CEO of the Alliance for Rights and Recovery (formerly the New York Association of Psychiatric Rehabilitation Services [NYAPRS]) will receive the Lifetime Achievement Award on May 16 from Mental Health News Education (MHNE) at its 2024 Leadership Awards Reception. MHNE, a nonprofit organization, publishes Autism Spectrum News and Behavioral Health News. The leadership award celebrates outstanding leaders who are making a difference in people's lives.

A path to recovery for overlooked populations and their unique challenges: integrating rehabilitation in palliative care for patients with substance use disorders

Palliative care is a growing medical specialty focusing on providing compassionate and holistic management for those facing life-threatening diseases. These patients frequently present with physical, functional, emotional, and psychosocial problems that require comprehensive interdisciplinary management. However, there is a substantial opportunity to improve care for patients in palliative care who also have a substance use disorder (SUD). These opportunities include direct provision of SUD treatments by specialist palliative care providers and the integration of physical medicine and rehabilitation services. The purpose of this article is to examine the misunderstood and underutilized interaction between palliative care and SUDs, as well as describing the unique opportunities provided by physical medicine and rehabilitation providers to achieve a patient's palliative care goals and optimize overall quality of life. Substance Use Disorder is a chronic, often relapsing, illness that is relevant to palliative care practice due to the potential for significant morbidity and mortality through organ failure, chronic infections, and overdose syndromes. In traditional palliative care practice, it has been observed that past or current SUD diagnoses are often left untreated, resulting in increased distress, and exacerbating an already complex medical situation. Furthermore, many of these patients also experience physical, functional, or psychosocial changes that, when left untreated, will worsen distress and quality of life. To provide more comprehensive and successful palliative care for patients with SUD, the authors recommend an increased emphasis on specialist palliative care training in SUD management, proactive integration of rehabilitation services into the palliative care team, and consistent advocacy for these steps in various arenas. Combined, these actions can improve the care team's ability to provide a holistic, patient-centered approach that can have substantial positive outcomes for patients, health systems, and society.

Assessment of Level of Awareness and Barriers to Low Vision Rehabilitation Among Optometrists in Pakistan

Introduction: Low vision rehabilitation provides strategies to substitute for visual impairment and the resultant limitations of low vision by enhancing remaining vision and other sensory or motor abilities in individuals. The purpose of this study was to evaluate the level of knowledge of and perceived barriers to providing low vision rehabilitation by optometrists in Pakistan. Methods: In this qualitative, cross-sectional study, a convenient sample of 100 participants was included and a structured, validated, self-administered questionnaire was provided to collect demographic information and to identify the level of knowledge, awareness, and perceived barriers regarding low vision rehabilitation. Data was analyzed using frequency distribution and Pearson's chi-square test to understand the significance of barriers to low vision care provision. Results: A total of 100 participants completed the study questionnaire (59 males, 41 females) with a mean age of 26 (±6.1 SD) years. Eighty-two participants (82%) had an adequate understanding of low vision as per WHO's criteria. However, 47% of participants failed to identify the steps of low vision rehabilitation. Newly graduated practicing optometrists (i.e., those with less than 3 years’ experience) had a significantly better understanding of low vision definition and low vision rehabilitation steps, as compared to more experienced optometrists ( p &lt; .05). Also, those working in private practices were more likely to consider low vision rehabilitation as less profitable ( p = .025, odds ratio = 2.56, CI = 1.1–5.8), compared to those working in hospitals. Discussion: Lack of training and unavailability of low vision devices are major barriers, as perceived by optometrists in Pakistan. Rigorous attempts are needed to educate eye care practitioners specifically optometrists about the availability and usage of low-cost, improved-quality, and up-to-date low vision devices in the country. Implications for practitioners: Continuous professional development through refresher courses is crucial to enhance knowledge of low vision rehabilitation. Educating optometrists to adopt a multidisciplinary and empathetic approach toward patient management may improve patients’ satisfaction and success with rehabilitative services.

Associations of Mortality Outcomes With Employment Status at Discharge From VA Vocational Rehabilitation Service Programs.

The authors evaluated associations between employment at discharge from Veterans Health Administration Vocational Rehabilitation Service (VR) programs and suicide and other causes of death. For veterans receiving VR between October 1, 2005, and September 30, 2014 (N=78,293), proportional hazards analyses were used to test associations of employment with suicide, drug overdose, and external and natural cause mortality rates over 1 and 5 years postdischarge and through December 31, 2019. The analyses were adjusted for clinical and sociodemographic characteristics and propensity for employment. Of the veterans, 94.1% had a psychiatric diagnosis, and 35.5% were employed at VR discharge. In proportional hazards analyses, employment was associated with lower mortality rates through 1 year (suicide, hazard ratio [HR]=0.54; overdose, HR=0.70; external causes, HR=0.62; and natural causes, HR=0.51) and 5 years postdischarge (overdose, HR=0.72; external causes, HR=0.81; and natural causes, HR=0.72). Through December 31, 2019, employment was associated with lower risks for overdose (HR=0.80) and death by external (HR=0.81) and natural (HR=0.80) causes. Employment at VR discharge was associated with lower mortality risk among veterans with psychiatric diagnoses.

The chiropractors' dilemma in caring for older patients with musculoskeletal complaints: Collaborate, integrate, coexist, or separate?

The world's elderly population is growing at a rapid pace. This has led to an increase in demand on the health and welfare systems due to age-related disorders, with musculoskeletal complaints driving the need for rehabilitation services. However, there are concerns about health services' ability to meet this demand. While chiropractic care is gaining recognition for its benefits in treating older adults with musculoskeletal disorders, there is limited scientific literature on chiropractors' role and experiences in this area. To bridge this gap, we interviewed 21 chiropractors in Great Britain, the Netherlands, Norway, and Sweden. Inductive qualitative content analysis was used to analyse the interviews, and despite differences in integration and regulation between the countries, several common facilitators and barriers in caring for and managing older patients with musculoskeletal complaints emerged. While participants expressed optimism about future collaborations with other healthcare professionals and the integration of chiropractic into national healthcare systems, they also highlighted significant concerns regarding the existing healthcare infrastructure. The participants also felt that chiropractors, with their non-surgical and holistic approach, were well-positioned to be the primary point of contact for older patients. However, there were some common barriers, such as the affordability of care, limited integration of chiropractic, and the need to prioritise musculoskeletal complaints within public healthcare. Our findings suggest that chiropractors experience their clinical competencies as an underutilised resource in the available healthcare systems and that they could contribute to and potentially reduce the escalating burden of musculoskeletal complaints and associated costs among older patients. Additionally, our findings highlight the desire among the participants to foster collaboration among healthcare professionals and integrate chiropractic into the national public healthcare system. Integrating chiropractors as allied health professionals was also perceived to improve coordinated, patient-centred healthcare for older adults.

[The supportive environment in SRH: characteristics that promote self-determination].

Hospitalization is an important stage in the life of the elderly. All too often, this experience is accompanied by both physical and psychological decline. Based on self-determination theory, the aim was to qualitatively characterize support for self-determination in follow-up care and rehabilitation services (behaviours and attitudes of healthcare professionals, and patients' perception of them).

Rural-Urban Stroke Mortality Gaps in the United States

IntroductionDisparities in stroke outcomes, influenced by the use of systemic thrombolysis, endovascular therapies, and rehabilitation services, have been identified. Our study assesses these disparities in mortality after stroke between rural and urban areas across the United States (US). MethodsWe analyzed the CDC data on deaths attributed to cerebrovascular disease from 1999-2020. Data was categorized into rural and urban regions for comparative purposes. Age-adjusted mortality rates (AAMR) were computed using the direct method, allowing us to examine the ratios of rural to urban deaths for the cumulative population and among demographic subpopulations. Linear regression models were used to assess temporal changes in mortality ratios over the study period, yielding beta-coefficients (β). ResultsThere was a total of 628,309 stroke deaths in rural regions and 2,556,293 stroke deaths within urban regions. There were 1.13 rural deaths for each one urban death per 100,000 population in 1999 and 1.07 in 2020 (β=-0.001, ptrend=0.41). The rural-urban mortality ratio in Hispanic populations decreased from 1.32 rural deaths for each urban death per 100,000 population in 1999 to 0.85 in 2020 (β=-0.011, ptrend<0.001). For non-Hispanic populations, mortality remained stagnant with 1.12 rural deaths for each urban death per 100,000 population in 1999 and 1.07 in 2020 (β=-0.001, ptrend=0.543). Regionally, the Southern US exhibited the highest disparity with a urban-rural mortality ratio of 1.19, followed by the Northeast (1.13), Midwest (1.04), and West (1.01). ConclusionsOur findings depict marked disparities in stroke mortality between rural and urban regions, emphasizing the importance of targeted interventions to mitigate stroke-related disparities.

FITNESS FOR RECOVERY- FEASABILITY AND IMPACT OF AN EXERCISE PROGRAM DURING RESIDENTIAL REHABILITATION

INTRODUCTION AND AIMS Opioid use disorder has the lowest quality of life (QOL) and highest disease burden of all substance use disorders (SUD). While opioid treatment does improve QOL, it remains below that of the general population. Previous reviews have indicated that exercise offers benefits for QOL, however the evidence in an opioid treatment population is lacking. This study investigates the feasibility and impact of a 10-week exercise intervention on QOL and mood in a residential rehabilitation program. METHODS Participants admitted to an opioid substitution program within the We Help Ourselves (WHOS) rehabilitation service in Sydney, NSW Australia were invited to participate in a 10-week exercise intervention. Participants completed baseline screening assessing QOL, mood, exercise habits, and a fitness assessment. Willing participants then completed a twice weekly program delivered as part of the group therapy program. Sessions typically consisted of bodyweight exercises such as squats and push ups, and boxing. Following the completion of the training program assessments were repeated. Within group pre-post measures for QOL and mood outcomes were analysed using two-way ANOVA. This clinical trial was registered with Australia New Zealand clinical trial registry (ACTRN12622000213741). RESULTS 45 Participants completed baseline assessments with nine participants completing the intervention and follow up assessment. Significant improvements were seen in QOL (p=0.005), Psychological distress (p&amp;lt;.001), and PCL-5 scores (p=.011). Participants performed well in grip strength, but below norms in all other exercise assessments. Exercise capacity improved following the intervention. CONCLUSIONS Exercise programs are both feasible and beneficial when run as part of SUD improving a range of QOL and mood outcomes. Exercise capacity was generally poor, however improved through the course of the study, often nearing population norms. Exercise should be integrated widely as an adjunct therapy for SUD.

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

ObjectiveTo assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile.DesignLongitudinal cross-sectional study.SettingNational level.ParticipantsData from the...

Intelligent speech elderly rehabilitation learning assistance system based on deep learning and sensor networks

Recently, deep learning has been proved to significantly improve the quality of speech recognition. Convolutional neural networks are often used in speech recognition tasks because of their special network structure and powerful learning function. In order to solve the problem that the traditional convolutional neural network can not reflect the one-dimensional basic attributes of speech signal, this paper proposes to set the number of frames for one dimension of convolution kernel, and use one-dimensional model and two-dimensional convolutional network model for speech recognition. By moving the convolution kernel of time axis and frequency band, it can adapt to the time change of speech signal and maintain the correlation between frequency bands to a great extent. At the same time, this paper also discusses the speech signal preprocessing, feature parameter extraction and regularization algorithm. Due to the lack of hospital resources, the lag of information technology, the poor ability of accompanying and other reasons, the current accompanying service for elderly rehabilitation can not meet the needs of elderly patients. The rapid development and wide use of information technology provide opportunities for the optimization of health services for the elderly. In view of the difficulty of word memory and interpretation in current rehabilitation courses, a VR intelligent teaching system based on intelligent voice technology is developed. The application results show that the system can effectively improve the ability of language expression and word writing. At present, the system of intelligent speech function has not been completed, and lacks speech synthesis function. The next research will focus on the use of speech synthesis technology, in order to realize the man-machine dialogue between people and the system, and show a more real training situation.

Role of Virtual Rehabilitation in Total Knee Arthroplasty: Functional Outcomes and Cost-Effectiveness

This review article aims to explore the role of virtual rehabilitation in total knee arthroplasty in terms of functional outcomes and cost-effectiveness. Total knee arthroplasty (TKA) is a widely performed surgery for end-stage knee osteoarthritis, requiring supervised rehabilitation for rapid recovery and pain relief. Virtual rehabilitation has been evolving as an alternative to the traditional rehabilitation program in the recent years especially during the predicament of COVID-19 pandemic. Virtual rehabilitation leverages virtual reality (VR) technology to provide innovative, engaging, and measurable rehabilitation services that can complement or replace traditional therapy approaches. Virtual reality and telerehabilitation represent evolving fields in TKA rehabilitation, offering advantages over traditional therapy in terms of cost-effectiveness, improved outcomes, enhanced exercise adherence, and reduced barriers to accessing postoperative therapy. Despite the need for more research and standardized protocols, VR-based rehabilitation holds significant potential for optimizing the recovery process for patients undergoing TKA. The research indicates that VR-based rehabilitation programs for TKA patients have utilized a variety of interactive virtual environments, gaming activities, and feedback mechanisms to supplement traditional physical therapy exercises. Virtual rehabilitation for TKA encourages clinician-patient interaction beyond the hospital setting and offers the advantages of cost savings, convenience, at-home monitoring, and coordination of care, improved functional outcomes, increased exercise adherence, better balance performance, and psychological benefits like reduced stress and anxiety, all of which are geared to improve adherence and overall patient satisfaction. This review article outlines the importance of virtual rehabilitation in TKA, emphasizing cost-effectiveness and improved balance and function while maintaining enhanced adherence and exercise performance. This article also delves into the mode of administration of VR-based rehabilitation and its delivery, safety concerns, advantages and disadvantages, as well as the most common VR-based rehabilitation protocols for TKA. Further, it discusses the implications of virtual rehabilitation in the healthcare system and future directions for virtual rehabilitation in TKA. In conclusion, the evidence indicates that virtual physical therapy (PT) with remote clinical oversight is a safe, effective, and more cost-effective alternative to traditional in-person PT for patients undergoing TKA. Keywords: Virtual rehabilitation, virtual physical therapy, telehealth, telerehabilitation, total knee arthroplasty.