Summary

The purpose of this study was to evaluate the perceptions of both sports medicine orthopedic surgeons and physical therapists with regards to perceived provider and patient satisfaction when utilizing telerehab and to assess opinions regarding specific conditions that would benefit from use of telerehabilitation as the primary therapeutic modality.

Abstract

Purpose

A rapid proliferation of telerehabilitation (“telerehab”) use was observed during the COVID-19 pandemic. There is a paucity of literature describing the barriers that may inhibit the adoption of a care modality that seemingly increases access and convenience to provider and patient; even less is known about the differences in opinion that may exist between surgeons and physical therapists. We aimed to compare the perceptions of sports medicine orthopedic surgeons and physical therapists (PTs) regarding the utilization of telerehab, its potential limitations, and ascertain which sports medicine conditions could most benefit from this modality.

Methods

A 15-question online survey was distributed to members of the American Orthopaedic Society for Sports Medicine (AOSSM) and American Physical Therapy Association (APTA) with a 4-month response window. Questions assessed prevalence of telerehab use and satisfaction on a Visual Analog Scale (VAS). Participants were asked whether telerehab could achieve equivalent results compared to standard therapy for certain orthopedic conditions, including patellofemoral syndrome, rotator cuff tendinopathy, knee osteoarthritis, meniscus tear, and post-operative rehab for anterior cruciate ligament (ACL) reconstruction, rotator cuff repair (RCR), and meniscectomy. An optional qualitative component invited providers to further elaborate.

Results

85 total responses were collected. Approximately half (49%) of surgeons utilized telerehab, while 64% of PTs utilized it regularly. Satisfaction was moderate (surgeons: 64%; PTs: 63%). Surgeons more often perceived rotator cuff tendinopathy (p=0.005) and meniscus tears (p=0.036) to be amenable to telerehab compared to PTs. There was consensus with respect to knee osteoarthritis being most conducive to telerehab (surgeons: 54%; PTs: 42%), and ACL reconstruction least appropriate (surgeons: 9%; PTs: 8%). 100% of surgeons and 81% of PTs believed hybrid programs would be more beneficial compared to telerehab alone. In the optional open-response section, 32 respondents elaborated on their concerns with most sentiments falling into three predominant themes: a) better technology or access is required is required (10, 31.3%); b) hybrid therapy is optimal (8, 25.0%); c) patient safety is a concern (5, 15.6%).

Conclusions

Telerehab is more commonly utilized in the clinical practices of physical therapists compared to sports surgeons, and overall satisfaction is moderate, though there is consensus for the potential role of telerehab for specific orthopedic conditions. Current barriers to its routine clinical use include technological limitations, provider/patient familiarity with the interface, proper patient selection, and optimal implementation of hybrid rehabilitation. A preponderance of clinicians believe that a hybrid approach may optimize patient access to physical therapy and outcomes.