Total-knee replacement patients who used an app-based video physical therapy program progressed similarly to those who did their PT in person, according to a recent study.
Lead author Dr. Stefano Bini, a professor of clinical orthopedics at the University of California, San Francisco, presented the results at this week’s ATA 2016 conference in Minneapolis.
The therapists created 23 short videos with on-screen text instructions illustrating the same exercises that patients would have done in outpatient visits. Patients responded with videos of themselves performing the exercises. The PTs compared the patients’ progress to previous videos (patients could do the same), commented and uploaded more advanced videos based on patient progress. The cycle was repeated until the patient or therapist chose to end the intervention.
Video-based physical therapy is nothing new, but rather than jump on the live-streaming bandwagon, Bini chose to use asynchronous video, for a variety of reasons. Live-streaming would still have required an appointment of sorts. Technicians would have to set up complicated video equipment in the office and in patients’ homes. If either side ran into technical trouble during the virtual appointment, time and money would be wasted. Live-streamed video is not typically recorded, so neither side would have been able to view videos repeatedly to track progress, Bini said.
Twenty-nine patients completed the randomized study’s final survey, with 15 in the traditional therapy group and 14 in the video therapy group. The average video user logged in 49 times, posted nine videos and five photographs, and sent 10 messages to the therapists. The two therapists logged in 84 and 121 times respectively, and spent an average of about 5 minutes in a patient session, compared with an hour per traditional patient session.
The researchers did not do a true cost analysis, but to Bini, the study seemed to save money. Plus, the video group also reported exercising longer than the traditional PT group.
“We had a huge drop in patient visits in the folks who had the app,” Bini said. “That was quite gratifying.”
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Both groups reported similarly high satisfaction at the end, which surprised the researchers. The patients, whose average age was 62, were not “digital natives,” but the video group appreciated being able to do their therapy when, where, and how they wanted it, Bini said.
Only a couple of studies of recorded-video PT have been published, he added, probably because a protocol requiring fewer outpatient visits would generate less income for health systems. CMA’s bundled-care requirements, which emphasize money-saving measures, may change that, he added.
The study took place at Kaiser Permanente Medical Center in Oakland, where Bini worked until joining UCSF in October. Kaiser uses a prepaid system.
“The paper has gotten a lot of attention because it does quantify using objective and standardized methodology of the ability of this technology to deliver equivalent care,” Bini said.
The real value isn’t in equivalency, however. It’s in convenience. Most of his patients are elderly, many live alone, and none want to spend more time at the hospital than necessary. Participating in traditional PT following surgery would also require them to find a driver, which can be difficult for those who live alone, Bini added.
Bini and his team are considering doing a multi-center study using the same technology with patients before surgery so the providers can deliver pre-operative instructions. This would eliminate the need for in-person pre-op classes and might be better than virtual classes, because pre-op patients typically have lots of questions, he said.
If it works, the team might get a similar patient reaction to this one they received following the first study:
“So, is this a publicly traded company? I’d like to buy some stock.”
Photo: Flickr
