The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial.

Only 111 of 476 screened patients were randomized, and only 87 were analyzed at baseline, so the sample may not represent typical patients. The paper gives inconsistent control group counts: one baseline sentence says 37 controls, while the table and later results use 39 controls. Patients had to be expected to achieve full-load walking by the end of inpatient rehabilitation and had to meet home technology requirements, so more impaired patients and patients without suitable home setup were excluded. The sample had above-average education, with 43.7% holding a polytechnic or university degree, and 5.4% unemployment, compared with 8.4% in Berlin, so the results may not apply to more disadvantaged or distant populations. Participants and investigators were not blinded, which can affect subjective and functional outcomes. Both groups also used usual aftercare, including IRENA and physiotherapy, so the effect of telerehabilitation alone cannot be separated. Baseline function was already high, so there was little room for further improvement. The control group had a higher dropout rate (29.1%; 11/39) than the intervention group (14.1%; 7/48), which may have affected the return-to-work comparison. The significant return-to-work difference was secondary, and the authors state it cannot be explained by improved physical performance, quality of life, or reduced joint complaints.

The authors declared no conflicts of interest.

Do not conclude that telerehabilitation caused the higher return-to-work rate. The primary 6-minute walk outcome showed no group difference (P = .95), both groups used usual aftercare, and the control group had more dropouts.