Moffet H.1,2, Tousignant M.3,4, Nadeau S.5,6, Mérette C.7, Boissy P.3, Corriveau H.3, Marquis F.8, Cabana F.9, Ranger P.10, Belzile E.8, Dimentberg R.11
1Laval University, Department of Rehabilitation, Quebec, Canada, 2Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada, 3University of Sherbrooke, Faculty of Medicine, Sherbrooke, Canada, 4Research Centre on Aging, Sherbrooke, Canada, 5University of Montreal, Montreal, Canada, 6CRIR Research Centre, Montreal, Canada, 7Laval University, Faculty of Medicine, Quebec, Canada, 8CHUQ, Hotel-Dieu de Québec, Quebec, Canada, 9CHUS, Sherbrooke, Canada, 10Hopital Jean-Talon, Montreal, Canada, 11Ste-Mary's Hospital, Montreal, Canada
Background: In recent years, the possibility of therapy through telerehabilitation has gained popularity among physiotherapy researchers. This approach is believed to offer great potential in developing cost-effective rehabilitation programs, as supported by strong evidence from previous research. The non-inferiority of the clinical effectiveness of telerehabilitation compared with face-to-face interventions has recently been demonstrated by our team in a large-scale clinical trial, suggesting that telerehabilitation after TKA is highly effective. However, satisfaction of patients toward in-home Telerehabilitation (TELE) after total knee arthroplasty (TKA) has not yet been examined thoroughly in large-scale clinical trials. Patients may be preoccupied by the quality of distant therapeutic therapy as opposed to face-to-face home visit (STD).
Purpose: To compare the level of satisfaction in patients who received TELE and STD interventions following TKA. This study also aimed at determining whether any of the clinical (e.g. walking performance, stair-climbing performance) and personal (e.g. age, gender, BMI) variables measured were associated with the level of satisfaction.
Methods: This study was part of a large multicenter randomized controlled trial during which the noninferiority of TELE interventions was compared to STD interventions after TKA. A total of 205 patients were randomized either in the TELE group or the STD group. Rehabilitation intervention was the same for both groups (16 supervised exercise sessions) over the first 2 months following hospital discharge. Participants were assessed 4 times during the study: at baseline before TKA (E1), at hospital discharge (E2), and at 2 months (E3) and 4 months post-discharge (E4). Patient satisfaction was assessed through the validated Health Care Satisfaction Questionnaire (HCSQ) at E4, in either French or English version, according to the patients native language. The HCSQ measures satisfaction through three different dimensions: satisfaction with the relationship with the professional, satisfaction with the delivery of services and satisfaction with the organization of services. Assessors were unaware of group allocation of participants within groups when they administered this questionnaire.
Results: There were no significant differences between baseline characteristics within groups for most variables. The three dimensions of perceived satisfaction and the total satisfaction scores were similar between groups. Satisfaction level for both groups was very high (over 85%). Mean satisfaction scores for each question varied from 3.1/4 to 3.8/4 for the TELE group and from 3.2/4 to 3.8/4 for the STD group. There was no correlation between satisfaction and personal characteristics, nor between satisfaction and improvements of functional level from preoperative to E4. However, at E3 and E4, satisfaction was associated with walking and stair-climbing performances.
Conclusion(s): Similar levels of satisfaction with the services received were observed between patients receiving in-home telerehabilitation after TKA and the ones receiving face-to-face rehabilitation. Functional level reached at the end of the follow-up was associated to the level of satisfaction.
Implications: The results of this study support the use of telerehabilitation following TKA to increase access to and efficiency of rehabilitation services. These observations, in addition to previous studies on efficacy and costs performed over the same sample of subjects, justify the use of telerehabilitation to deliver post-TKA physiotherapy services.
Funding acknowledgements: This study was supported by a grant from the Canadian Institutes of Health Research (CIHR).
Topic: Musculoskeletal: peripheral
Ethics approval: The Ethics Committees of the CHUQ-Hôtel-Dieu de Québec and of 7 hospitals and 3 research centers approved the study.
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