Knee Replacement Rehab Exercises by Internet . . . ?

More and more often, older people are having knee joint replacements, usually with excellent results. However, a good result depends quite considerably on rehabilitation supervised by expert physical therapists. Unfortunately, access to high-quality rehabilitation services is not always possible, especially for those who live in remote areas. Therefore Australian physical therapists decided to see if an Internet-based rehabilitation program could be used that was as effective as conventional outpatient physical therapy. They report their findings in the Journal of Bone and Joint Surgery.

Sixty-five patients who had had total knee replacements were randomly assigned to a 6-week program of outpatient physical therapy either in the conventional manner, or using an Internet-based program. For the purpose of the study, patients in the Internet-rehab group performed their therapy in a hospital room designed and furnished to resemble a typical home environment.  Audio and visual contact between the patient and therapist was ensured via a home computer and web camera. 

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to measure the response to treatment and recovery at baseline and six weeks. Other measures included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, joint flexion and extension, quadriceps muscle strength, and an assessment of gait.

All the participants had significant improvement on the WOMAC score and other outcome measures with either rehabilitation program. The outcomes for the Internet-based rehabilitation were comparable to those of the conventional rehab group with practically all measures. The only differences were better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC scale in the Internet-based group.

The subjects using the Internet rehabilitation program were very satisfied with the technology. They were also more compliant – they completed an average of 2.2 exercise sessions a day, compared with 1.7 sessions a day for the conventional group subjects.  This is clearly a step forward, as many post-op patients have transport difficulties, and live some distance from physical therapy units.  It’s important that the study showed equality in effectiveness, acceptability and improved compliance.