Summary

Though overall satisfaction with both modalities was high, patients preferred in-person rehabilitation to telerehabilitation after undergoing ACLR and ARCR as evidenced by nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies.

Abstract

Background

The use of telerehabilitation after sports medicine procedures such as arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, functional outcomes and patient satisfaction after telerehabilitation compared to in-person rehabilitation remain unclear. We hypothesized that functional outcomes and patient satisfaction would not differ significantly between the rehabilitation modalities.

Methods

Two separate randomized-controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Initially 60 patients were included in each arm of the trial. Patients were randomized to receive telerehabilitation or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) scores (for ACLR), the American Shoulder & Elbow Surgeons (ASES) score (for ARCR), and satisfaction metrics were collected at timepoints of baseline and at each post-operative visit. Baseline characteristics and outcomes between the in-person and telerehabilitation arms of each cohort were compared using Mann-Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. P-values less than 0.05 were considered significant.

Results

In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled of whom 20 (62.5%) were assigned to in-person rehabilitation and 12 (37.5%) were assigned to telerehabilitation. In both trials combined, of the 30 patients initially assigned to in-person rehabilitation, 24 (80%) completed the final follow-up survey and none reported crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey. Of these 12 patients, 11 (92%) reported crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and tele-rehabilitation.

Conclusions

Though overall satisfaction with both modalities was high, patients preferred in-person rehabilitation to telerehabilitation after undergoing ACLR and ARCR as evidenced by nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. However, a hybrid model combining in-person and tele-visits may be acceptable to most patients. This study provides evidence that patients exhibit a strong preference for in-person rehabilitation programs versus telerehabilitation programs after ACLR and ARCR procedures. However, feedback from patients suggests that most would be amenable to a hybrid model combining both modalities, although further exploration is needed.