A total of 14 articles from 8 Randomized Control Trials met the inclusion criteria. Multiple articles from the same RCT were included where they reported on different outcomes.¹ No differences in patient satisfaction, functional outcomes and PROMs were observed between the telemedicine and conventional groups.¹

Video consultation

Two trials compared real-time video patient-doctor consultations with standard in-person consultations. In both studies, the video groups were equally satisfied with their consultation and therapeutic decisions about surgical indications did not differ between the two groups.¹ One of the studies reporting on the consultation time, complication rate, and PROMs also found no differences between the groups.¹ Both studies found that there was a breakeven point from which video consultations became more cost-effective than in-person consultations.¹ This break-even point ranged from 80 consultations per year in one study to 151 per year in the other.¹

Tele-rehabilitation

Six RCTs, including a total of 768 patients, evaluated the efficacy of tele-rehabilitation following total knee and/or total hip replacement.¹ Four of those studies used the WOMAC to measure patient reported outcomes. The WOMAC scores improved in all studies and there were no differences observed between tele-rehab and conventional rehab groups.¹ Four studies also reported on functional parameters like range of motion, strength, balance, walking and functional autonomy. All improved pre- to post-op, and again no between-group differences for any parameter were observed at the final follow-up.¹ Of the two studies evaluating patient satisfaction with their rehabilitation, neither found any differences between tele- and face-to-face rehab groups.¹ While another study found more patients from the tele-rehab group returned to work than in the conventional group (64.6 Vs 46.2%).¹ When it came to cost-effectiveness, tele-rehab was shown to deliver savings over face-to-face treatment when the patient’s travel distance to the hospital was 30 km or more.¹

Future developments: motion sensors

One proposal to advance the precision of telemedical examination in the context of rehabilitation is the use of motion sensors.¹ Modern motion sensors are small and can be attached locally to capture movement.¹ The authors believe that these sensors are “already so inexpensively available that their use in monitoring therapies and rehabilitation seems to be realistic.”¹ They have already been shown to be as accurate as a marker-supported movement analysis and have been used experimentally in several studies to monitor rehab following knee arthroplasty.¹

The authors concluded that “The current evidence is very convincing for tele-rehabilitation after implantation of a knee prosthesis, since six different RCTs on this topic have already been published, and because it has been shown that the results after tele-rehabilitation are comparable to conventional rehabilitation after knee arthroplasty.”¹