Early Post-Operative Clinical Outcomes in Patients Undergoing Total Knee Arthroplasty Comparing in-Person Clinic Versus Telehealth-Delivered Rehabilitation Program: A Non-Inferiority Trial

INTRODUCTION AND AIMS Rehabilitation following total knee arthroplasty (TKA) is essential to mitigate delay in physical recovery and facilitate optimum patient outcomes. Telehealth is emerging as a cost-effective and efficacious delivery method. The aim of this study was to investigate the early post-operative outcomes of patients following a telehealth-delivered rehabilitation program (Tele) compared with those following conventional outpatient rehabilitation (Clinic) in patients following TKA. METHODS A single-blinded, randomized controlled non-inferiority trial was conducted, with 108 participants scheduled for primary TKA randomly allocated to a 6-week, telehealth-delivered rehabilitation program (n=54) or a 6-week supervised, in-person rehabilitation program (n=54). Knee flexion range of motion (KF-ROM) and the Quality of Life subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-QOL) were collected pre-surgery and 7-weeks post-surgery. A linear mixed-effect model was used to assess differences between groups over time for both outcome measures. Change in KOOS-QOL of greater than 10 points was used to establish minimally clinically important change (MCIC), with chi square analyses used to assess between-group differences. RESULTS Baseline KF-ROM measures were 124.1° and 122.2° for telehealth-delivered and in-person groups respectively; and 108.7° and 111.6° at 7-week post-surgery. KOOS-QOL scores were 32.7 and 33.3 at baseline for the respective groups; and 60.9 and 62.9 at week-7. There were no significant differences in between group changes over time for both KF-ROM (mean difference = -2.9°, 95% CI = -7.7 to 1.8; p=0.226) and KOOS-QOL (mean difference = -2.1, 95% CI: -10.0 to 5.9; p=0.611). Chi square analyses revealed no differences between groups meeting the MCIC (Tele = 71%; Clinic = 79%) in KF-ROM (X2 = 0.78, p = 0.377). CONCLUSION Short term outcomes following TKA are not different between telehealth-delivered and conventional supervised rehabilitation. Telehealth may provide an effective rehabilitation option for patients undergoing TKA.