Background/Purpose:

The global uptake of digital health technologies in rehabilitation is increasing, but their effectiveness warrants further investigation. We aim to evaluate the effects of digital solutions used in musculoskeletal rehabilitation for people who underwent orthopaedic surgeries.

Methods:

Six databases were searched from the earliest records to October 2017. Eligible studies were randomised controlled trials (RCT) that investigated the effectiveness of disruptive digital technology-based intervention, solo or in combination with other interventions, compared with a control group for people who underwent elective total knee/hip replacement (TKR/THR) or lumbar spinal surgeries. Two researchers independently reviewed the studies as per the Cochrane methodology for the systematic literature review. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale (0-10). Trials deemed clinically homogeneous were grouped in meta-analyses. Meta-analyses were performed using random-effects model, and results expressed as mean differences (MD), or standardised MDs (SMD) with 95% confidence interval (CI). The primary outcomes included visual analogue scale (VAS) for pain and functional assessments: the timed up-and-go (TUG) and 6-minute walk test (6MWT).

Results:

We identified 19 eligible RCTs with 15 trials (n=1706) for people who underwent TKR, 3 trials (n=383) for THR and 1 (n=60) for lumbar discectomy. There were 3 types of digital rehabilitation interventions involved in this review: telerehabilitation relying on either telephone counselling (8 trials, n=1130) or videoconferencing (4 trials, n=384), game-based therapy (5 trials, n=308) and software (3 trials, n=327). Seven studies were rated as good quality (a PEDro score of 7 or greater).

The pooled analysis of VAS pain data included 5 trials (n=438) assessing post TKR rehabilitation and 1 trial (n=60) assessing post lumbar discectomy rehabilitation. The results showed that, compared to usual care, disruptive technology-based interventions are more effective in reducing pain (MD = -0.19; 95% CI: -0.35, -0.02) for people undergoing TKR. Results of TUG were available from 2 trials (n=207) assessing post TKR rehabilitation and 1 trial (n=72) in THR. Compared to usual care, the intervention showed significant effects in TUG for people who underwent TKR (MD: -7.03; 95% CI: -11.18, -2.88). Pooled estimates from 2 trials (n=258) for people undergoing TKR showed the digital-enabled rehabilitation was not superior to usual care in the 6MWT (MD: -29.36; 95% CI: -65.71, 6.99).

Three trials for people who underwent TKR investigated patient compliance via exercise diaries, leaving inconclusive results. No difference in rates of hospital readmissions or treatment-related adverse events were observed.

Conclusion: There is moderate quality evidence that current digital-enabled rehabilitation shows small but significant effects over usual rehabilitation in reducing pain and improving mobility post TKR. No evidence was observed for people undergoing THR or lumbar spinal surgery rehabilitation. Digital rehabilitation is technically feasible, well-accepted and can be used safely in people undergoing musculoskeletal surgeries.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/digital-disruptive-technology-for-rehabilitation-following-elective-surgery-for-low-back-pain-knee-and-hip-osteoarthritis-a-systematic-review-and-meta-analysis/