MSK – Muskuloskelettale Physiotherapie 2022; 26(04): 204-210
DOI: 10.1055/a-1899-2309
Originalarbeit

Teletherapie – Möglichkeiten der Rehabilitation bei Patient*innen nach Knie-Totalendoprothese

Critical Appraised Topic (CAT)Teletherapy – Rehabilitation Options after Total Knee ArthroplastyCritical Appraised Topic (CAT)
Dmitry Ayzikov
„Help yourself – Physiotherapy“
› Author Affiliations

Zusammenfassung

Um den Bedarf an Physiotherapie bei der steigenden Zahl an Patient*innen nach einer endoprothetischen Versorgung auch in Zukunft zu decken, benötigen die Gesundheitsdienstleister*innen eine Lösung für die Bereitstellung einer angemessenen Therapie. Eine mögliche Option könnte die Teletherapie sein, die aufgrund der pandemischen Lage von SARS-COV-2 zunehmend an Bedeutung gewinnt. Teletherapie kann Menschen, die aus diversen Gründen nicht in die Praxis kommen können, eine Therapie ermöglichen, und birgt ein kostensparendes Potenzial.

Diese Arbeit sollte klären, ob die physiotherapeutische Teletherapie bei Patient*innen nach einer endprothetischen Versorgung des Knies mit einer konventionellen Physiotherapie vergleichbar ist. Anhand einer Literaturrecherche auf den Datenbanken Cochrane, Europe PMC und PubMed vom 01.01.-04.05.2021 wurden 4 geeignete RCTs gefunden. Alle 4 RCTs zeigten, dass die Teletherapie positive Auswirkungen auf die Funktion der Patient*innen nach einer Knie-Totalendoprothese hat und einer konventionellen Physiotherapie nicht unterlegen ist. Die Ergebnisse waren klinisch signifikant. Die Teletherapie kann demnach als Alternative in Betracht gezogen werden.

Allerdings sind manche Studien auf Grund von methodologischen Schwächen kritisch zu betrachten, sodass diese Arbeit keine eindeutige Empfehlung aussprechen kann. Für ein eindeutiges Ergebnis und eine starke klinische Empfehlung bei Patient*innen nach Knie-Totalendoprothese sind weitere Studien nötig.

Abstract

To meet the future demand for physiotherapy in the face of a growing number of patients after arthroplasty, health service providers need a solution for the provision of appropriate therapy. One potential option could be teletherapy, which is becoming increasingly important due to the pandemic situation surrounding SARS-COV-2. Remote options can enable therapy for people who cannot visit a practice for different reasons. They also have the potential to realize cost savings.

This review aimed to clarify whether remote physiotherapy in patients after knee arthroplasty was comparable to conventional physiotherapy. A literature review, carried out across the Cochrane, Europe PMC and PubMed databases for the period from January 1 to May 4, 2021, identified 4 suitable RCTs. All of the 4 RCTs demonstrated that remote therapy has a positive impact on function in patients after total arthroplasty of the knee and is not inferior to conventional physiotherapy. Results were clinically significant. Accordingly, teletherapy can be considered as an alternative.

However, some of the trials were viewed critically due to methodological weaknesses. Consequently, this review cannot give a definite recommendation. Further studies are required to get clear results and issue a strong clinical recommendation for patients after total knee arthroplasty.



Publication History

Received: 18 December 2021

Accepted: 01 February 2022

Article published online:
12 September 2022

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Holland AE. Telephysiotherapy: time to get online. J Physiother 2017; 63: 193-195 DOI: 10.1016/j.jphys.2017.08.001.
  • 2 Tack C, Grodon J, Shorthouse F. et al. “Physio anywhere”: digitally-enhanced outpatient care as a legacy of coronavirus 2020. Physiotherapy 2021; 110: A26-A28 DOI: 10.1016/j.physio.2020.07.004.
  • 3 Wong MYZ, Gunasekeran DV, Nusinovici S. et al. Telehealth Demand Trends During the COVID- 19 Pandemic in the Top 50 Most Affected Countries: Infodemiological Evaluation. JMIR Public Health Surveil 2021; 7: e24445 DOI: 10.2196/24445.
  • 4 World Confederation for Physical Therapy & International Network of Physiotherapy Regulatory Authorities (März 2020). REPORT OF THE WCPT/INPTRA DIGITAL PHYSICAL THERAPY PRACTICE TASK FORCE. Im Internet: Accessed July 05, 2022 at: https://bit.ly/3IhpuUv
  • 5 John M, Einhaus J, Klose S. et al. Bericht Telerehabilitation 2015. Medizinische Assistenzsysteme in der Prävention, Rehabilitation und Nachsorge. Berlin: Fraunhofer-Institut für offene Kommunikationssysteme Fokus. Im Internet: Accessed July 04, 2022 at: https://bit.ly/3P3JCvq
  • 6 Peretti A, Amenta F, Tayebati SK. et al. Telerehabilitation: Review of the State-of-the-Art and Areas of Application. JMIR Rehabil Assist Technol 2017; 4: e7 DOI: 10.2196/rehab.7511.
  • 7 Adams R, Jones A, Lefmann S. et al. Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making. BMC Health Serv Res 2015; 15: 121 DOI: 10.1186/s12913-015-0786-3.
  • 8 Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health 2020; 20: 1193 DOI: 10.1186/s12889-020-09301-4.
  • 9 Klug A, Gramlich Y, Rudert M. et al. The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 2021; 29: 3287-3298 DOI: 10.1007/s00167-020-06154-7.
  • 10 Rupp M, Lau E, Kurtz SM. et al. Projections of Primary TKA and THA in Germany From 2016 Through 2040. Clin Orthop Relat Res 2020; 478: 1622-1633 DOI: 10.1097/corr.0000000000001214.
  • 11 Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res 2018; 104: S41-S46 DOI: 10.1016/j.otsr.2017.04.017.
  • 12 Klem N-R, Smith A, O’Sullivan P. et al. What Influences Patient Satisfaction after TKA? A Qualitative Investigation. Clin Orthop Relat Res 2020; 478: 1850-1866 DOI: 10.1097/corr.0000000000001284.
  • 13 Ditton E, Johnson S, Hodyl N. et al. Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Front Psychol 2020; 11: 1061 DOI: 10.3389/fpsyg.2020.01061.
  • 14 Bini SA, Mahajan J. Clinical outcomes of remote asynchronous telerehabilitation are equivalent to traditional therapy following total knee arthroplasty: A randomized control study. J Telemed Telecare 2017; 23: 239-247 DOI: 10.1177/1357633×16634518.
  • 15 Moffet H, Tousignant M, Nadeau S. et al. In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty. J Bone Joint Surg Am 2015; 97: 1129-1141 DOI: 10.2106/jbjs.n.01066.
  • 16 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. J Bone Joint Surg Am 2020; 102: 101-109 DOI: 10.2106/jbjs.19.00695.
  • 17 Russell TG, Buttrum P, Wootton R. et al. Internet-Based Outpatient Telerehabilitation for Patients Following Total Knee Arthroplasty. J Bone Joint Surg Am 2011; 93: 113-120 DOI: 10.2106/jbjs.i.01375.
  • 18 de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 2009; 55: 129-133 DOI: 10.1016/s0004-9514(09)70043-1.
  • 19 Foley NC, Teasell RW, Bhogal SK. et al. Stroke Rehabilitation Evidence-Based Review: Methodology. Top Stroke Rehabil 2003; 10: 1-7
  • 20 Moseley A, Costa LOP, Hegenscheidt S. Interrater- und Paralleltest-Reliabilität der deutschen Version der PEDro-Skala. Physioscience 2015; 11: 164-170 DOI: 10.1055/s-0035-1554029.
  • 21 Moseley AM, Herbert RD, Sherrington C. et al. Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro). Aust J Pysiother 2002; 48: 43-49 DOI: 10.1016/s0004-9514(14)60281–6.
  • 22 Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum 2001; 45: 384-391 DOI: 10.1002/1529–0131(200108)45:4<384::AID-ART352>3.0.CO;2–0.
  • 23 Angst F, Benz T, Lehmann S. et al. Multidimensional minimal clinically important differences in knee osteoarthritis after comprehensive rehabilitation: a prospective evaluation from the Bad Zurzach Osteoarthritis Study. RMD Open 2018; 4: e000685 DOI: 10.1136/rmdopen-2018-000685.
  • 24 Copsey B, Thompson JY, Vadher K. et al. Problems persist in reporting of methods and results for the WOMAC measure in hip and knee osteoarthritis trials. Qual Life Res 2019; 28: 335-343 DOI: 10.1007/s11136-018-1978-1.
  • 25 Davis AM, Perruccio AV, Canizares M. et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for Osteoarthritis. Osteoarthritis and Cartilage 2009; 17: 843-847 DOI: 10.1016/j.joca.2009.01.005.
  • 26 Lyman S, Lee Y-Y, McLawhorn AS. et al. What Are the Minimal and Substantial Improvements in the HOOS and KOOS and JR Versions After Total Joint Replacement?. Clin Orthop Relat Res 2018; 476: 2432-2441 DOI: 10.1097/corr.0000000000000456.
  • 27 MacKay C, Clements N, Wong R. et al. A systematic review of estimates of the minimal clinically important difference and patient acceptable symptom state of the Western Ontario and McMaster Universities Osteoarthritis Index in patients who underwent total hip and total knee replacement. Osteoarthritis Cartilage 2019; 27: 1408-1419 DOI: 10.1016/j.joca.2019.05.002.
  • 28 Maredupaka S, Meshram P, Chatte M. et al. Minimal clinically important difference of commonly used patient-reported outcome measures in total knee arthroplasty: review of terminologies, methods and proposed values. Knee Surg Relat Res 2020; 32: 19 DOI: 10.1186/s43019-020-00038-3.
  • 29 Perruccio A, Stefan Lohmander L, Canizares M. et al. The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS) – an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008; 16: 542-550 DOI: 10.1016/j.joca.2007.12.014.
  • 30 Reynaud V, Verdilos A, Pereira B. et al. Core Outcome Measurement Instruments for Clinical Trials of Total Knee Arthroplasty: A Systematic Review. J Clin Med 2020; 9: 2439 DOI: 10.3390/jcm9082439.
  • 31 Ruyssen-Witrand A, Fernandez-Lopez CJ, Gossec L. et al. Psychometric properties of the OARSI/OMERACT osteoarthritis pain and functional impairment scales: ICOAP, KOOS-PS and HOOS- PS. Clin Exp Rheumatol 2011; 29: 231-237
  • 32 Quintana JM, Escobar A, Arostegui I. et al. Health-Related Quality of Life and Appropriateness of Knee or Hip Joint Replacement. Arch Intern Med 2006; 166: 220-226 DOI: 10.1001/archinte.166.2.220.
  • 33 Goodman SM, Mehta BY, Mandl LA. et al. Validation of the Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score Pain and Function Subscales for Use in Total Hip Replacement and Total Knee Replacement Clinical Trials. J Arthroplasty 2020; 35: 1200-1207.e4 DOI: 10.1016/j.arth.2019.12.038.
  • 34 Singh JA, Luo R, Landon GC. et al. Reliability and Clinically Important Improvement Thresholds for Osteoarthritis Pain and Function Scales: A Multicenter Study. J Rheumatol 2014; 41: 509-515 DOI: 10.3899/jrheum.130609.
  • 35 Tobinaga T, Obayashi S, Miyazaki C. et al. The impact of self-efficacy for physical activity on health-related quality of life in total knee arthroplasty recipients. J Back Musculoskelet Rehabil 2021; 34: 829-835 DOI: 10.3233/bmr-200017.
  • 36 Tsai LLY, McNamara RJ, Moddel C. et al. Home-based telerehabilitation via real-time videoconferencing improves endurance exercise capacity in patients with COPD: The randomized controlled TeleR Study. Respirology 2017; 22: 699-707 DOI: 10.1111/resp.12966.
  • 37 Riva G, Gaggioli A. Rehabilitation as empowerment: the role of advanced technologies. Stud Health Technol Inform 2009; 145: 3-22
  • 38 Singh JA, Lewallen DG. Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function. BMC Musculoskeletal Disord 2014; 15: 127 DOI: 10.1186/1471-2474-15-127.
  • 39 Rawlinson G, Connell L. Out-patient physiotherapy service delivery post COVID-19: opportunity for a re-set and a new normal?. Physiotherapy 2021; 111: 1-3 DOI: 10.1016/j.physio.2021.02.001.
  • 40 Seron P, Oliveros M-J, Gutierrez-Arias R. et al. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther 2021; 101: pzab053 DOI: 10.1093/ptj/pzab053.
  • 41 Shukla H, Nair S, Thakker D. Role of telerehabilitation in patients following total knee arthroplasty: Evidence from a systematic literature review and meta-analysis. J Telemedicine Telecare 2017; 23: 339-346 DOI: 10.1177/1357633×16628996.
  • 42 Cottrell MA, Galea OA, O’Leary SP. et al. Real- time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil 2017; 31: 625-638 DOI: 10.1177/0269215516645148.
  • 43 Fillingham YA, Darrith B, Lonner JH. et al. Formal Physical Therapy May Not Be Necessary After Unicompartmental Knee Arthroplasty: A Randomized Clinical Trial. J Arthroplasty 2018; 33: S93-S99.e3 DOI: 10.1016/j.arth.2018.02.049.
  • 44 Papalia R, Vasta S, Tecame A. et al. Home-based vs supervised rehabilitation programs following knee surgery: a systematic review. Br Med Bull 2013; 108: 55-72 DOI: 10.1093/bmb/ldt014.
  • 45 Klement MR, Rondon AJ, McEntee RM. et al. Web-Based, Self-Directed Physical Therapy After Total Knee Arthroplasty Is Safe and Effective for Most, but Not All, Patients. J Arthroplasty 2019; 34: S178-S182 DOI: 10.1016/j.arth.2018.11.040.
  • 46 Brennan DM, Barker LM. Human factors in the development and implementation of telerehabilitation systems. J Telemed Telecare 2008; 14: 55-58 DOI: 10.1258/jtt.2007.007040.
  • 47 Lawford B, Delany C, Bennell K. et al. “I was really sceptical…But it worked really well”: a qualitative study of patient perceptions of telephone- delivered exercise therapy by physiotherapists for people with knee osteoarthritis. Osteoarthritis Cartilage 2018; 26: 741-750 DOI: 10.1016/j.joca.2018.02.909.
  • 48 Fortune Business Insights. Telerehabilitation Market Size, Share and Covid-19 Impact Analysis, By Type (Products, Services), By Application (Occupational Therapy, Physical Therapy, Chronic Diseases, and Others), By End-User (Healthcare Facilities and Homecare); and Regional Forecast, 2020–2027 (Juni 2020). Im Internet: Accessed July 05, 2022 at: https://bit.ly/3nGeNRW