Study Finds Similar Outcomes, Lower Costs for Virtual vs. Traditional PT after TKA
A virtual system for in-home physical therapy (PT) provides good outcomes with lower costs than traditional in-person PT for patients undergoing rehabilitation following total knee arthroplasty (TKA), according to a study published in The Journal of Bone & Joint Surgery.
The study included patients from 4 institutions in the US who were randomly assigned on a 1:1 basis to receive traditional PT, either at home or in an outpatient clinic, or virtual PT with the use of a virtual telehealth system. Of the 306 patients who were randomized for the trial between November 2016 and November 2017, 290 underwent TKA and 287 completed the study (n=144 for traditional PT and n=143 for virtual PT).
The virtual PT system used in the study was the FDA-cleared Virtual Exercise Rehabilitation Assistant (VERA), which was designed to provide remote rehabilitation services. The cloud-based system features a digitally simulated coach to demonstrate and guide activity, including visual and audio instructions. The system also uses 3D tracking technology to assess the patient’s pose and movement, enabling immediate feedback on exercise quality.
The VERA system provides a virtual video connection for weekly live telehealth visits with a remote physical therapist, who monitors the patient’s progress and reports back to the surgeon before follow-up clinic visits. Patients were able to receive in-person PT if deemed necessary.
The study compared the costs and effectiveness of rehabilitation following TKA for the virtual and traditional PT groups. In the 12 weeks after TKA, median total costs were $1050 for patients assigned to the virtual PT system, compared with $2805 for traditional PT. Mean costs were $2745 lower in the virtual PT group.
Patients using the VERA system participated in PT an average of 5.9 days per week, compared with 3.3 days in the traditional PT group. Eighty-eight percent of patients in the virtual PT group said they completed all assigned exercises, compared with 65% in the traditional PT group.
After 12 weeks of rehabilitation, knee function, walking speed, and other functional outcomes were similar with virtual and traditional PT. Patients in the virtual PT group reported less difficulty with knee function during sports and recreational activities.
There were no differences in physician, urgent care, or emergency department visits, but patients in the virtual PT group had fewer hospital readmissions. Safety outcomes were also similar between groups. The risk of falls was somewhat higher for patients assigned to virtual PT.
Postoperative PT is important for helping patients to regain physical function following TKA. But PT care can be challenging to access, with barriers including cost and a shortage of physical therapists. Virtual or telerehabilitation programs such as VERA might help to increase home-based access to PT for patients undergoing TKA.
The study found substantially lower costs in the 3 months after TKA for patients assigned to virtual PT, compared with traditional PT. Effectiveness and safety are similar between groups. Some outcomes might be even better with virtual PT, which as knee function during sports and activities and rehospitalization risk, although the risk of falls may be higher.
“These findings have important implications for patients, health systems, and payers and suggest that virtual PT with a telehealth therapist for remote clinical monitoring and guidance should be considered for patients after TKA,” the authors concluded.
Although further study to guide implementation and uptake is needed, the authors believe that virtual PT systems have the potential to improve access while lowering costs of PT for patients undergoing TKA.
Prvu Bettger J, Green CL, Holmes DN, et al. Effects of virtual exercise rehabilitation in-home therapy compared with traditional care after total knee arthroplasty: VERITAS, a randomized controlled trial. J Bone Joint Surg Am. 2020 Jan 15;102(2):101-109. doi: 10.2106/JBJS.19.00695.