PaTIO: Physiotherapeutic Treat-to-target Intervention after Orthopaedic surgery; a cost-effectiveness study
This study aims to compare the cost-effectiveness of optimized, tailored, physical therapy (PPT) by using a treat to target strategy in combination with a clinical pathway that is embedded in the continuum of care with usual PPT care in total hip arthroplasty patients and total knee arthroplasty patients , embedded in the continuum of care. We assume that with the optimized strategy faster recovery can be achieved, at lower costs. The results of this study can be used to develop and implement a nationwide care pathway for PPT after THA/TKA.
Patient AdhereNce To Home Exercise pRograms (PANTHER)
Exercise is an integral component of the conservative management of most musculoskeletal conditions. However adherence to exercises is often low and this impacts on treatment effectiveness. The aim of this randomised controlled trial is to evaluate whether the addition of a web-based system, Physitrack, to usual physiotherapy treatment improves patient adherence levels to exercises compared to the usual non web-based methods physiotherapists use to deliver exercise programs to people with musculoskeletal conditions.
PANTHER is a a 2-year study run by the University of Melbourne, comparing exercise prescription via Physitrack to paper handouts and the effect that has on patient adherence and other outcomes. Results are expected to be published in 2018.
Implementing a web based and mobile application exercise prescription programme in Fracture Clinic at St Thomas’ Hospital
With over 2 million patient contacts each year, GSTT is one of the busiest NHS trusts in the UK. The Fracture Clinic set out to establish patient exercise adherence and staff satisfaction with the use of Physitrack in treating Achilles tendon ruptures, anterior glenohumeral joint dislocations, Weber A ankle fractures and distal radius fractures.
Engagement with digital exercise
Implementation of a web and smartphone based exercise prescription program in MSK Physiotherapy.
St George’s serves a population of 1.3 million patients in southwest London. To help the team to manage an ever growing caseload, St George’s embarked on a study to look at the engagement with a digital exercise prescription tool versus paper based programmes.
Adherence to exercise was better for patients using the digital platforms compared to a paper version.
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Fast@Home
FAST @ HOME wants to enable rehab at home after getting a stroke through a composite program of digital, already existing interventions. Based on the wishes of professionals, stroke patients and informal caregivers, multiple existing and evaluated interventions are combined in a digital environment.
In an effect study with 150 rehabilitants, the effectiveness of this platform will be tested: "To what extent is the quality of care improved as a result of digital support for home rehabilitation for stroke patients?" This question is answered from the perspective of the patient and from the healthcare providers.
Flitz!-project
Research shows that movement and training prior to surgery aid in outcomes post surgery. We expect that exercise during and after hospitalization also has this beneficial effect. In the FLITZ study, LUMC measures recovery to daily activities after surgery with several online/digital interventions.
Project VEERKRACHT
The project VEERKRACHT aims to develop physiotherapeutically supported interventions for women with metastatic breast cancer. The aim is to promote fitness and well-being in order to maintain or improve the quality of life.
Fysio Future Lab
For the Fysio Future Lab, a group of innovative physiotherapists test technological applications in daily practice. By means of short questionnaires and interviews, the user-friendliness, applicability and physiotherapeutic added value are mapped out for each application. These pilot studies focus on the perspective of the therapist and the patient. In addition, it is possible for both patients and therapists to complete a short questionnaire for technological applications that are already used. Physitrack was subject of the first study.
CONNECT
This RCT will test the effectiveness of remote health coaching on health outcomes in low back pain (physical activity, exercise complience, pain, QoL, function/disability). Physitrack is used for the delivery of the health coaching intervention via Telehealth. Researchers also assign specific exercise programs and educational content to each participant and use Physitrack to monitor increase in pain or reduction in compliance to enable them to contact the participant sooner for further/additional health coaching via Physitrack.
PhD Project
A 12-month randomised controlled trial investigating the ability of an exercise training (aerobic and resistance-based exercise), scheduled during and following chemotherapy for breast cancer, to prevent reductions in cardiovascular and physical function.
Charles Sturt University
A study in partnership with NSW Ambulance to investigate the effects of different types of exercise training on a range of cardio-metabolic and musculoskeletal health outcomes in regional and rural paramedics.
Ability Centre
A randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities (cerebral palsy) using Physitrack.
FASHIoN
This study focuses on the delivery of physiotherapy and dietitian interventions remotely to measure cost-effectiveness and outcomes of remote health interventions for patients with chronic conditions. Physitrack is used to deliver the exercise interventions and educational content to participants, track adherence to the exercise interventions and have video calls with patients.
PhysioFIRST
PhysioFIRST is an assessor and participant blinded randomised controlled trial comparing the effectiveness of two physiotherapy interventions for hip pain (FAI) in adults aged 18-50 years. The physitrack app is being used to deliver the exercise interventions to participants in both groups, and to track adherence to the exercise interventions.
HIPARTI
Through a global collaboration, HIPARTI aims to determine the efficacy of hip arthroscopic surgery compared to a sham surgery (diagnostic arthroscopy only) for patients with symptomatic and radiological findings related to impingement (FAI) and/or labral tears using a randomized controlled design. Physitrack is used to deliver standardised exercise programs and collect outcomes data for analysis.
GAP4
Through a global collaboration, GAP4 executes a large-scale (800 patients), multi-centred and multi-national trial designed to test the effects of exercise on prostate cancer progression and treatment side effects. Physitrack is used to prescribe standardised exercise programs to patients, track their outcomes remotely and collect outcomes data incl. adherence and RPE for further analysis.
Home-based exercise rehabilitation with telemedicine following cardiac surgery.
We evaluated the feasibility of a home-based rehabilitation programme, which was designed to resemble an in-hospital rehabilitation programme. Patients who underwent cardiac surgery (EuroSCORE 0-10) followed a one-month home rehabilitation programme supervised by a nurse-tutor and a physiotherapist. Physiotherapy was performed at home with calisthenic exercises and bicycle-ergometer tests. Patients transmitted the recorded ECGs by telephone to a service centre. They also performed a 6-minute walking test and filled in a satisfaction questionnaire at the end of the programme. A total of 47 patients were enrolled in the study. There were 3050 telephone calls, of which 3012 (99%) were scheduled and 38 were unscheduled. No further action was required in 95% of calls. There were 809 sessions for calisthenic exercises and 1039 for exercise training. There was a significant increase in the 6-minute walking test distance at the end of the programme compared to the baseline (404 m vs. 307 m, P < 0.001). Patient satisfaction, as measured in a questionnaire, was about 95% overall. This type of home rehabilitation using telemedicine appears to be worth implementing in selected categories of patients.
Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial
Background: Effective, accessible biopsychosocial treatments are needed to manage chronic knee pain on a population level.
Objective: To evaluate the effectiveness of Internet-delivered, physiotherapist-prescribed home exercise and pain-coping skills training (PCST).
Design: Pragmatic parallel-group randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12614000243617)
Setting: Community (Australia).
Patients: 148 persons aged 50 years or older with chronic knee pain.
Intervention: The intervention was delivered via the Internet and included educational material, 7 videoconferencing (Skype [Microsoft]) sessions with a physiotherapist for home exercise, and a PCST program over 3 months. The control was Internet-based educational material.
Measurements: Primary outcomes were pain during walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index) at 3 months. Secondary outcomes were knee pain, quality of life, global change (overall, pain, and functional status), arthritis self-efficacy, coping, and pain catastrophizing. Outcomes were also measured at 9 months.
Results: Of participants enrolled, 139 (94%) completed primary outcome measures at 3 months and 133 (90%) completed secondary outcome measures at 9 months; multiple imputation was used for missing data. The intervention group reported significantly more improvement in pain (mean difference, 1.6 units [95% CI, 0.9 to 2.3 units]) and physical function (mean difference, 9.3 units [CI, 5.9 to 12.7 units]) than the control group at 3 months, and improvements were sustained at 9 months (mean differences, 1.1 units [CI, 0.4 to 1.8 units] and 7.0 units [CI, 3.4 to 10.5 units], respectively). Intervention participants showed significantly more improvement in most secondary outcomes than control participants. At both time points, significantly more intervention participants reported global improvements.
Limitation: Participants were unblinded.
Conclusion: For persons with chronic knee pain, Internet-delivered, physiotherapist-prescribed exercise and PCST provide clinically meaningful improvements in pain and function that are sustained for at least 6 months.
Primary Funding Source: National Health and Medical Research Council.
Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: part 2 of a phase II preclinical exploratory trial.
A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program. Social or individual motivation strategies were equally effective. The most prominent differences were observed between active and inactive participants. These findings suggest that in older adults a tablet-based intervention enhances training compliance; hence, it is an effective way to improve gait.
Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults.
Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.
Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial.
Join2move (Web-based intervention) resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.
“Patients are likely to be more compliant if they are financially vested in their recovery”
In behavioral economics, the endowment effect (also known as divestiture aversion) is the hypothesis that people ascribe more value to things merely because they own them. This is illustrated by the fact that people will pay more to retain something they own than to obtain something owned by someone else—even when there is no cause for attachment, or even if the item was only obtained minutes ago.
Physiotherapy home exercise program for haemophiliacs.
A HEP can help to advance in physical fitness and coordination and may reduce bleeding tendency, but needs to be accomplished regularly. Patients are interested but the motivation to exercise at home is low. Disorders measured by motion analysis seem not to be sufficiently influenced by our surrogate training program.
Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial.
Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training.
Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.
A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.
The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review.
From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.
Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial.
As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.
A randomized controlled trial of home telerehabilitation for post-knee arthroplasty.
Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.
Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction.
We reviewed 100 patients retrospectively following primary ACL reconstruction with quadruple hamstring autografts to evaluate the incidence and factors associated with postoperative stiffness. Stiffness was defined as any loss of motion using the contra-lateral leg as a control. The median delay between injury and operation was 15 months. The incidence of stiffness was 12% at 6 months post-reconstruction. Both incomplete attendance at physiotherapy (p<0.005) and previous knee surgery (p<0.005) were the strongest predictors of the stiffness....
Effects of a home program on strength, walking speed, and function after total hip replacement.
The designed home program was effective in improving hip muscle strength, walking speed, and function in patients after THR who practiced the program at least 3 times a week, but adherence to this home program may be a problem.
Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.
A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.
Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty?
Patients who were more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.
Videotape instruction versus illustrations for influencing quality of performance, motivation, and confidence to perform simple and complex exercises in healthy subjects.
The findings suggested dynamic modeling via videotape was more effective than static illustrations for promoting correct form for the exercises. In addition, videotape modeling was indicated as more appropriate for encouraging confidence and motivation in an unsupervised exercise environment, such as a home exercise program.
Effects of live, videotaped, or written instruction on learning an upper-extremity exercise program.
Live and videotaped modeling are more effective than a handout alone for achieving performance accuracy of a basic exercise program, as measured by immediate and delayed retention tests.
Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture.
Among patients who had completed standard rehabilitation after hip fracture, the use of a home exercise program that included exercises such as standing from a chair or climbing a step resulted in improved physical function, according to a study. More than 250,000 people in the United States fracture their hip each year, with many experiencing severe long-term consequences. Many of these patients are no longer able to independently complete basic functional tasks that they could perform prior to the fracture, such as walking 1 block or climbing 5 steps 2 years after a fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. This new study addresses this type of cost-effective program.
Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence
Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.
Physical therapy instructional video may be as good as an in-person visit for shoulder rehabilitation exercises
A rehab video may get the same results as an in-person visit for shoulder rehabilitation exercises, a new study suggests. "These results are significant for two reasons," said the lead researcher. First, having an additional tool to augment what the patient learns at an initial physical therapy visit may help with exercise accuracy and hopefully therefore improve outcomes. Additionally as access to physical therapy becomes more limited due either to cost or insurance, identifying new tools to better help out patients will be essential.
Benefits of a home-based physical exercise program in elderly subjects with type 2 diabetes mellitus
A home-based physical exercise program improves quality of life, glycemic control, and weight in type 2 diabetic patients older than 60 years.
Exercise in combination with education is likely to prevent the risk of lower back pain
The results of this systematic review and meta-analysis of RCTs indicate that exercise in combination with education is likely to reduce the risk of LBP and that exercise alone may reduce the risk of an episode of LBP and sick leave due to LBP, at least for the short-term. The available evidence suggests that educa- tion alone, back belts, shoe insoles, and ergonomics do not pre- vent LBP. It is uncertain whether education, training, or ergo- nomic adjustments prevent sick leave due to LBP because the quality of evidence is very low.