REMOTE TELEREHABILITATION TO MAINTAIN ADHERENCE TO HOME-BASED EXERCISE THERAPY IN PEOPLE WITH MUSCULOSKELETAL DISORDERS: A PILOT STUDY

A. Rören¹, D. Marie-Yagappa², C. Théry³, L.-C. Marie-Martine⁴, F. Rannou⁴, C. Nguyen⁴

¹Université Paris Cité, Rehabilitation Department, Paris, France, ²AP-HP, Hôpital Corentin Celton, Rehabilitation Department, Paris, France, ³Hôpital Cochin, Rehabilitation Department, Paris, France, ⁴Université Paris Cité, Faculty of Medicine, Paris, France

Background: Exercise therapy can reduce pain and activity limitations in people with chronic musculoskeletal disorders. Adherence to exercise impacts treatment efficacy. Adherence is poor in the medium and long term. Telerehabilitation allows for supervised exercises to be performed and monitored at home and may produce similar clinical outcomes as rehabilitation delivered face-to-face.

Purpose: We aimed to assess adherence over 6 months to home-based exercises in people with musculoskeletal disorders who had remote telerehabilitation sessions.

Methods: We conducted a prospective mixed-methods pilot study. Outpatients who had knee osteoarthritis or non-specific chronic low-back or neck pain were consecutively enrolled. All participants received a single supervised face-to-face rehabilitation session and three follow-up telerehabilitation sessions were scheduled according to participants’ availability at 1 week and at 1 and 3 months. The primary outcome was the mean change from 1 week in in the total score for the Exercise Adherence Rating Scale (0, no adherence, and 24, maximal adherence) at 1, 3 and 6 months after the face-to-face rehabilitation session. A qualitative study assessed participants' feedback regarding telerehabilitation.

Results: Overall, 43 participants were included: 33/43 (77%) had low-back pain, 7/43 (16%) neck pain and 3/43 (7%) knee osteoarthritis; 27/43 (63%) were women. At baseline, the mean (SD) age was 49.1 (15.6) years and mean pain intensity 44.2/100 (25.2). The mean EARS total score decreased from 16.1/24 [95% CI, 14.5;17.8] at 1 week to 15.6/24 [13.6;17.6] at 1 month (absolute difference 0.5 [-1.2;2.2], p=0.8), 13.6 [7.2;20.0] at 3 months (absolute difference 0.2 [-1.5; 1.8], p=0.004) and 12.7 [10.4; 15.0] at 6 months (absolute difference 3.7 [1.5;5.8], p=0.004). The maximal decrease in mean EARS total score was between 1 and 3 months. At 6 months, 15/35 (43%) participants reported performing exercises as often as prescribed. Participants claimed for more face-to-face sessions.

Conclusions: In the present study, adherence to home-based exercises decreased over 6 months in people with musculoskeletal disorders despite remote telerehabilitation sessions. The variations observed were numerically small. Qualitative assessments showed that participants valued face-to-face follow-up rehabilitation sessions.

Implications: Remote telerehabilitation may be an option to improve the adherence to treatment based on exercise therapy and therefore the efficacy of physiotherapy in the medium and long term. Future randomized controlled studies should assess the efficacy of remote telerehabilitation to improve pain and activity limitation in people with chronic musculoskeletal diseases.

Funding acknowledgements: The study was granted by the APRES (AP-HP) fund call for projects.

Keywords:
Participant compliance
Exercise therapy
Telerehabilitation

Topics:
Disability & rehabilitation
Musculoskeletal
Rheumatology

Did this work require ethics approval? Yes

Institution: AP-HP

Committee: Centre Research Ethics Committee (C.E.R)

Ethics number: #00011928, ref: 2020-07-09