Kamran Azma1,2, Zahra RezaSoltani2 , Farid Rezaeimoghaddam2 , Afsaneh Dadarkhah2 and Sarasadat Mohsenolhosseini2

Abstract

Introduction: Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite being effective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming. We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with knee osteoarthritis.

Methods: In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate in either a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the mean change from the baseline until 1 and 6 month’s post-intervention in scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis of variance for the repeated measure statistical test.

Results: A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2  7.41 years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months postintervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPT groups in any of the studied scales.

Discussion: The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis. Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older population living in remote sites.

Keywords

Tele-rehabilitation, efficacy, middle-aged, knee, osteoarthritis, pain measurement, Iran

Ashley M. Hughes, PhD*,†; Shirley C. Sonesh, PhD‡; Rachel E. Mason, MPH§; Megan E. Gregory, PhD∥,¶ ; Antonio Marttos, MD **; Carl I. Schulman, MD**; Eduardo Salas, PhD †,†

Presented at 2019 Human Factors and Ergonomics Society Healthcare Symposium, Human Factors and Ergonomics Society, Chicago, IL, March 25, 2019; University of Illinois at Chicago Impact and Research Day, University of Illinois at Chicago, University of Illinois at Chicago Forum, April 10, 2019.

The views expressed in this work are those of the authors and do not necessarily reflect the organizations with which they are affiliated or their sponsoring institutions or agencies. doi:https://doi.org/10.1093/milmed/usaa434

ABSTRACT

Introduction:

Mass casualty events (MASCAL) are on the rise globally. Although natural disasters are often unavoidable, the preparation to respond to unique patient demands in MASCAL can be improved. Utilizing telemedicine can allow for a better response to such disasters by providing access to a virtual team member with necessary specialized expertise. The purpose of this study was to examine the positive and/or negative impacts of telemedicine on teamwork in teams responding to MASCAL events.

Methods:

We introduced a telemedical device (DiMobile Care) to Forward Surgical Teams during a MASCAL simulated training event. We assessed teamwork-related attitudes, behaviors, and cognitions during the MASCAL scenario through pre-post surveys and observations of use. Analyses compare users and nonusers of telemedicine and pre-post training differences in teamwork.

Results:

We received 50 complete responses to our surveys. Overall, clinicians have positive reactions toward the potential benefits of telemedicine; further, participants report a significant decrease in psychological safety after training, with users rating psychological safety as significantly higher than non-telemedicine users. Neither training nor telemedicine use produced significant changes in cognitive and behavioral-based teamwork. Nonetheless, participants reported perceiving that telemedicine improved leadership and adaptive care plans.

Conclusions:

Telemedicine shows promise in connecting Forward Surgical Teams with nuanced surgical expertise without harming quality of care metrics (i.e., teamwork). However, we advise future iterations of DiMobile Care and other telemedical devices to consider contextual features of information flow to ensure favorable use by teams in time-intensive, high-stakes environments, such as MASCAL.

Guido M Peters1,2 , MSc; Laura Kooij2,3,4 , MSc; Anke Lenferink2 , PhD; Wim H van Harten2,4,5 , MD, Prof Dr; Carine J M Doggen1,2 , Prof Dr

1. Department of Clinical Research, Rijnstate Hospital, Arnhem, Netherlands

2. Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands

3. Department of Information and Medical Technology, Rijnstate Hospital, Arnhem, Netherlands

4. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands

5. Rijnstate Hospital, Arnhem, Netherlands

Corresponding Author:

Carine J M Doggen, Prof Dr

Department of Health Technology and Services Research

Technical Medical Centre

University of Twente

Drienerlolaan 5

Enschede, 7522NB

Netherlands

Phone: 31 534897475

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Abstract

Background: Telehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear.

Objective: The aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions.

Methods: We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.

Results: We included 127 RCTs in the meta-analysis. Of these RCTs, 82.7% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95% CI 0-30) and 37 (95% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95% CI −1.76 to −0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95% CI −1.42 to −0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger  effects.

Conclusions: Small to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically  significant.

(J Med Internet Res 2021;23(9):e25195) doi: 10.2196/25195

KEYWORDS

telehealth; systematic review; meta-analysis; hospitalization; health services use; eHealth.