Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls.
Annet Wijnen, Jildou Hoogland, Tjerk Munsterman and 9 others
PMID 32338621WHAT IT FOUND
For 15 patients after hip replacement, a 12-week home exercise program using a tablet app, weekly physiotherapist calls, and three home visits was associated with faster walking and sit-to-stand than usual care; overall patient-reported scores were slightly higher but not clearly better.
Key findings
01After baseline correction, TUG was significantly faster at 4 weeks, 12 weeks, and 6 months, and FTSST was significantly faster at 12 weeks and 6 months, in favour of the intervention group.
02Overall patient-reported hip and general health scores were slightly higher but not significantly different, although sport and recreation, hip quality of life, and physical role limitations showed significant differences.
03The authors reported medium to very large effects on the objective tests at 12 weeks, and these effects were still present at 6 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a small nonrandomized pilot, not a randomised trial. Only 15 intervention patients and 15 and 12 control patients were analysed, from 30 intervention and 33 control patients included. Intervention patients older than 65 years were excluded, so the results do not cover that age group. The intervention group was probably more motivated than average, introducing selection bias. The intervention group was already better on some baseline function measures, and although analyses corrected for baseline, this cannot fully remove nonrandomisation. Usual care varied widely, from no physiotherapy to 48 hours, and the control group was heterogeneous. Controls were historical patients from a separate observational study with different inclusion periods and hospitals. The intervention combined home exercises, tablet app feedback, weekly phone coaching, and home visits, so the contribution of any single component cannot be separated. The paper does not name a single primary outcome, so the relative weight of objective and self-reported findings is unclear. The study was conducted in the Netherlands, where postoperative physiotherapy reimbursement and usual care differ from other settings.
The easy way to misread this
Do not read this as proof that a tablet app alone improves hip recovery. The program also included home exercises, tablet app feedback, weekly physiotherapist phone calls, and three home visits, and this was a small nonrandomized pilot, so the contribution of any single component cannot be separated.