Virtual Physical Therapy Shows Promise Following Knee Surgery

Janet Prvu Bettger, ScD

Results of a randomized, multicenter clinical trial examining the efficacy and cost-effectiveness of virtual rehabilitation for patients after undergoing total knee arthroplasty (TKA) could have major implications as telemedicine becomes more commonplace.

The VERITAS trial revealed virtual physical therapy with telerehabilitation achieved similar results to those randomized to at home or clinic physical therapy. The results also suggested patients could significantly lower healthcare costs at 3 months.

With rates of TKA skyrocketing in recent years, investigators from Duke University conducted a randomized trial involving 306 patients across 4 clinical sites in North Carolina. Patients included in the study were randomized in a 1:1 ratio to virtual physical therapy or usual care for 3 months following TKA.

Of the 306 who underwent randomization, which took place between November 2016 and November 2017, 287 completed the trail—143 in the virtual physical therapy group and 144 in the usual care group. Patients randomized to virtual physical therapy had the Virtual Exercise Rehabilitation Assistant (VERA) system from Reflexion Health installed in their homes prior to surgery.

In short, the VERA system activity, performance, exercise quality, and adherence of patients when using the system. Per the study protocol, all participants had hospital admission, surgery and discharge dates, discharge destination, pain score, 10-m gait speed, and inpatient falls at discharge from surgery. Investigators noted gait speed and measured knee flexion and extension were measured at the 6-week clinic visit.

The primary endpoint of the study was the total health service use costs in the 12 weeks following hospital discharge. Secondary outcomes included 6 and 12-week Knee injury and Osteoarthritis Outcome Score (KOOS), 6-week knee extension, knee flexion, and gait speed.

Upon analysis, investigators observed the virtual physical therapy group had lower costs at 12 weeks than those in the usual care group ($1,050 versus $2,805; P<0.001). Furthermore, mean costs were $2745 lower for virtual physical therapy patients.

Patients in the virtual therapy group experienced fewer hospitalizations following discharge than patients in the usual care group (12 versus 30; P=0.007). In regard to KOOS, investigators noted analyses revealed virtual physical therapy was noninferior to usual care at both 6 weeks (difference, 0.77; 90% CI, −1.68 to 3.23) and 12 weeks (difference, −2.33; 90% CI, −4.98 to 0.31).

When examining other secondary endpoints, virtual therapy proved to be noninferior in regard to knee extension, knee flexion, and gait speed at 6 weeks. Virtual therapy was also noninferior to usual care when evaluating pain and hospital readmissions at 12 weeks. Investigators pointed out that falls were increased in the virtual therapy group compared to those in the usual care group (difference, 4.83%; 90% CI, −2.60 to 12.25).

Based on the results of their analyses, investigators concluded virtual physical therapy with telerehabilitation appeared to be a cost-effective option for patients without sacrificing the efficacy of a standard physical therapy program. Investigators also called for further research to evaluate social and behavioral aspects related to virtual physical therapy.

This study, titled “Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty,” was published in The Journal of Bone and Joint Surgery.