Remote-Based Rehab Still Works

Using mobile phone apps for rehabilitation is a slick new way to meet your postop, rehab goals 

Lower extremity joint replacement is a common procedure to alleviate pain and improve mobility in patients with joint disease. Total knee and hip replacements have seen a dramatic uptick in demand and price over the past decade. In contrast, healthcare in hospitals and community rehabilitation facilities have seen cutbacks. The average length of hospital stay for patients undergoing THA has decreased from 5 days to under four days, while the average length of hospital stay for patients undergoing TKA has decreased from 2 days to 1.3 days, all thanks to the fast-track discharge methodology1.

The rehabilitation period after joint replacement surgery is critical for achieving optimal outcomes, including restoring range of motion, improving strength, and increasing functional abilities2. The traditional rehabilitation approach typically involves face-to-face consultations with a physical therapist, which can be time-consuming, costly, and inconvenient for patients, especially those who live in remote areas or have mobility issues.

Remote-based rehab or telerehabilitation is a general concept for the remote delivery of physical rehabilitation services (e.g., assessment, monitoring, intervention, supervision, education, consultation, and counseling) using information and telecommunication technologies3. Additionally, Telerehabilitation may replace or supplement conventional face-to-face interventions.

Telerehabilitation may offer a technology-based solution for meeting the increased demands of THA/TKA patient care. In fact, Internet usage among patients with orthopedic conditions has increased rapidly, particularly in developed nations. Simultaneously, Telerehabilitation has been utilized to provide ongoing rehabilitation, primarily in cardiac, neurological, and physiotherapy rehabilitation, to reduce patient hospitalization times and healthcare provider costs4.

With the advancement of technology, mobile phone applications have emerged as promising tools for improving rehabilitation outcomes after lower extremity joint replacement. Mobile phone applications have the potential to provide patients with personalized rehabilitation programs, enhance patient engagement, and improve patient education. Mobile phone applications can be designed to provide patients with exercises tailored to their specific needs based on their medical history, surgical procedure, and current physical abilities.

Most studies have shown that conventional in-person outpatient physical therapy, Telerehabilitation showed no significant difference in active and passive knee extension or flexion. Similarly, ROM extension and flexion of the involved knee, the quadriceps and isometric strength of the involved knee, the KOOS, limb girth, clinical gait5, the 6-minute walk test, the chair stand test, and the timed stair test has shown no particular difference as well.

Recent meta-analyses on pain relief have shown contradictory findings. The home-based rehabilitation group outperformed the hospital-based group regarding knee movement, while the pain intensity was reduced in both groups6.

One of the most significant effects of Telerehabilitation has been the drastic reduction of cost and increased willingness of patients to show up for rehabilitation. A research paper published in 2022 shows a significant p-value of < 0.001 when comparing the cost of conventional in-person physical therapy and telerehabilitation7. In addition, Telerehabilitation showed a significant difference in the total number of calls to the office  (mean calls, 0.6 ± 0.8 compared with 2.6 ± 3.4 for the control group; p < 0.001)8.

Having pointed out how the new technology makes a difference, there is clear room for improvement. We already know Telerehabilitation has reduced the number of calls to the hospital. Mobile phone applications can also be designed to provide patients with real-time feedback on their progress, which can motivate patients to continue with their rehabilitation programs. Mobile phone applications can potentially enhance patient engagement in rehabilitation after lower extremity joint replacement. They probably actively participate in their healthcare, which has been shown to improve patient outcomes, reduce healthcare costs, and increase patient satisfaction.

Enhancing patient education is another potential advantage of using mobile phone applications in rehabilitation following lower extremity joint replacement. Patient education informs patients about their medical conditions, available treatments, and self-care techniques.

In conclusion, we understand that patients who completed Telerehabilitation had similar physical functioning compared to patients who completed traditional in-person outpatient physical therapy without an increase in adverse events or resource utilization. Not to mention, it decreased hospital calls and costs to a considerable extent. This clearly shows that remote-based rehab is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. More robust studies, however, are needed to build evidence about Telerehabilitation.

Remote-based rehab certainly presents a convenient and promising option to traditional physical therapy. Kinomatic has now been using OneStep’s solution for remote PT for over a year now and we have found that patient satisfaction, engagement, and adherence can be even greater than in-person PT.


1. Hansen, Torben Bæk. “Fast track in hip arthroplasty.” EFORT open reviews 2.5 (2017): 179.
2. Roos, Ewa M. “Effectiveness and practice variation of rehabilitation after joint replacement.” Current opinion in rheumatology 15.2 (2003): 160-162.
3. Shukla, H., et al. “Role of telerehabilitation in patients following total knee arthroplasty: Evidence from systematic literature review.” Value in Health 17.3 (2014): A182.
4. Peretti, Alessandro, et al. “Telerehabilitation: review of the state-of-the-art and areas of application.” JMIR rehabilitation and assistive technologies 4.2 (2017): e7511.
5. Russell, Trevor G., et al. “Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial.” JBJS 93.2 (2011): 113-120.
6. Li, Donghai, et al. “Home-based compared with hospital-based rehabilitation program for patients undergoing total knee arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.” American journal of physical medicine & rehabilitation 96.6 (2017): 440-447.
7. Jansson, Miia M., et al. “The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis.” Journal of Telemedicine and Telecare 28.2 (2022): 96-114.
8. Campbell, Kevin J., et al. “A novel, automated text-messaging system is effective in patients undergoing total joint arthroplasty.” JBJS 101.2 (2019): 145-151.


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