Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty VERITAS, a Randomized Controlled Trial
Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty VERITAS, a Randomized Controlled Trial
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DOI：
10.2106/jbjs.19.00695
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发表时间：
2020-01-15
影响因子：
5.3
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Bettger, Janet;Green, Cynthia L.;Peterson, Eric D.
背景：全膝关节置换术（TKA）后，患者、医疗服务提供者和支付者的经济负担会减少物理治疗（PT）的使用。本研究的目的是检查虚拟PT计划与TKA后传统护理相比对医疗保健成本和临床结局的影响。研究方法：在单侧TKA前至少10天，入组了来自4个临床研究中心的患者，并以1：1的比例随机分配至虚拟PT项目（涉及化身[数字模拟]教练、家庭三维生物测定和远程康复，由物理治疗师进行远程临床医生监督）或家庭或门诊的传统PT护理。主要结局是住院后12周的总医疗费用。次要（非劣效性）结局包括6周和12周膝关节损伤和骨关节炎结局评分（KOOS）; 6周膝关节伸展、膝关节屈曲和步态速度;以及12周安全性指标（患者报告的福尔斯、疼痛和再次入院）。所有结果均在改良的意向治疗基础上进行分析。结果如下：在2016年11月至2017年11月随机分配的306例患者（平均年龄65岁; 62.5%为女性）中，290例接受了TKA，287例（包括虚拟PT组的143例和常规护理组的144例）完成了试验。出院后12周，虚拟PT的成本低于常规护理（中位数为1，050美元，而常规护理为2，805美元; p < 0.001）。虚拟PT患者的平均成本低2，745美元。虚拟PT患者的再住院率低于常规治疗组（12比30; p = 0.007）。在6周（差异，0.77; 90%置信区间[CI]，-1.68至3.23）和12周（差异，-2.33; 90% CI，-4.98至0.31）时，虚拟PT的KOOS不劣于常规PT。虚拟PT在6周时膝关节伸展、膝关节屈曲和步态速度方面以及12周时疼痛和再入院方面也不劣于常规治疗。19.4%的虚拟PT患者和14.6%的常规护理患者报告了福尔斯（差异，4.83%; 90% CI，-2.60至12.25）。结论：相对于传统的家庭或诊所PT，虚拟PT与远程康复的熟练的临床监督显着降低了3个月的医疗保健成本TKA后，同时提供了类似的有效性。这些发现对患者、卫生系统和支付者都有重要意义。对于接受TKA治疗的患者，应考虑虚拟PT和临床监督。
Background: Financial burden for patients, providers, and payers can reduce access to physical therapy (PT) after total knee arthroplasty (TKA). The purpose of the present study was to examine the effect of a virtual PT program on health-care costs and clinical outcomes as compared with traditional care after TKA. Methods: At least 10 days before unilateral TKA, patients from 4 clinical sites were enrolled and randomized 1:1 to the virtual PT program (involving an avatar [digitally simulated] coach, in-home 3-dimensional biometrics, and telerehabilitation with remote clinician oversight by a physical therapist) or to traditional PT care in the home or outpatient clinic. The primary outcome was total health-care costs for the 12-week post-hospital period. Secondary (noninferiority) outcomes included 6 and 12-week Knee injury and Osteoarthritis Outcome Score (KOOS); 6-week knee extension, knee flexion, and gait speed; and 12-week safety measures (patient-reported falls, pain, and hospital readmissions). All outcomes were analyzed on a modified intent-to-treat basis. Results: Of 306 patients (mean age, 65 years; 62.5% women) who were randomized from November 2016 to November 2017, 290 had TKA and 287 (including 143 in the virtual PT group and 144 in the usual care group) completed the trial. Virtual PT had lower costs at 12 weeks after discharge than usual care (median, $1,050 compared with $2,805; p < 0.001). Mean costs were $2,745 lower for virtual PT patients. Virtual PT patients had fewer rehospitalizations than the usual care group (12 compared with 30; p = 0.007). Virtual PT was noninferior to usual PT in terms of the KOOS at 6 weeks (difference, 0.77; 90% confidence interval [CI], -1.68 to 3.23) and 12 weeks (difference, -2.33; 90% CI, -4.98 to 0.31). Virtual PT was also noninferior to usual care at 6 weeks in terms of knee extension, knee flexion, and gait speed and at 12 weeks in terms of pain and hospital readmissions. Falls were reported by 19.4% of virtual PT patients and 14.6% of usual care patients (difference, 4.83%; 90% CI, -2.60 to 12.25). Conclusions: Relative to traditional home or clinic PT, virtual PT with telerehabilitation for skilled clinical oversight significantly lowered 3-month health-care costs after TKA while providing similar effectiveness. These findings have important implications for patients, health systems, and payers. Virtual PT with clinical oversight should be considered for patients managed with TKA.