Whitepaper: Telehealth by physiotherapists in Australia during the COVID-19 pandemic
The research study was developed with input from clinicians, telehealth experts, business owners and funding bodies to evaluate the effectiveness and value of physiotherapy treatment delivered via telehealth during the COVID-19 pandemic.
The project measured the following objectives:
• the characteristics of physiotherapists who implemented telehealth services
• the nature of the services
• the types of patients who utilised telehealth physiotherapy services
• the types of conditions that were treated and their management
• patient outcomes and experiences
• consultation features
This information will be used to advocate for ongoing
funding of telehealth services by physiotherapists. It
is a cross-sectional online survey with ethics approval
obtained through the University of Melbourne.
Whitepaper: Opportunities for Telehealth and Physical Therapy: What a New Patient Survey Reveals
Bay State Physical Therapy, leading Physical Therapy care provider in the US North East, used Physitrack Telehealth (PTT) and patient engagement systems to stay connected to their patients during the Covid-19 global pandemic – with great success.
Within a matter of a few days, Physitrack was able to get all BSPT practitioners set-up, and trained on using Telehealth. By mid-March BSPT was 100% virtual – using Physitrack’s award-winning technology and patient apps.
You can read more about the research that was done in this published study, which highlights the objective success BSPT has had with PTT and virtual care.
Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis
Background: Over the last few years, telerehabilitation services have developed rapidly, and patients value benefits such as reduced travelling barriers, flexible exercise hours, and the possibility to better integrate skills into daily life. However, the effects of physiotherapy with telerehabilitation on postoperative functional outcomes compared with usual care in surgical populations are still inconclusive.
Objectives: To study the effectiveness of physiotherapy with telerehabilitation on postoperative functional outcomes and quality of life in surgical patients.
Data sources: Relevant studies were obtained from MEDLINE, EMBASE, CINAHL, the Cochrane Library, PEDro, Google Scholar and the World Health Organization International Clinical Trials Registry Platform.
Study selection: Randomised controlled trials, controlled clinical trials, quasi-randomised studies and quasi-experimental studies with comparative controls were included with no restrictions in terms of language or date of publication.
Data extraction and synthesis: Methodological quality was assessed using the Cochrane risk of bias tool. Twenty-three records were included for qualitative synthesis. Seven studies were eligible for quantitative synthesis on quality of life, and the overall pooled standardised mean difference was 1.01 (95% confidence interval 0.18 to 1.84), indicating an increase in favour of telerehabilitation in surgical patients.
Limitations: The variety in contents of intervention and outcome measures restricted the performance of a meta-analysis on all clinical outcome measures.
Conclusions: Physiotherapy with telerehabilitation has the potential to increase quality of life, is feasible, and is at least equally effective as usual care in surgical populations. This may be sufficient reason to choose physiotherapy with telerehabilitation for surgical populations, although the overall effectiveness on physical outcomes remains unclear. PROSPERO registration number: CRD42015017744.
Keywords: Exercise; Functional status; Physiotherapy; Surgery; Telehealth; Telemedicine; Telerehabilitation.
Copyright © 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Comparing the results of virtual and in-person treatment
Background
A comparative observational study was conducted using data collected from routine care provided by qualified Ascenti physiotherapy practitioners. Patients involved in the study were referred to Ascenti for a range of needs.
The study involved exporting anonymised data that mapped the treatment journeys of 27,096 patients who had accessed virtual physiotherapy support before and during the Covid-19 crisis - running up until 10 June 2020. Of this population, 9,506 had received virtual-only treatment, while 17,590 had received a mix of virtual and face-to-face care.
A control group was then built using the data of 6,226 patients who had been treated with in-person physiotherapy only.
Results
Measured on a 10-point pain Numerical Rating Scale (NRS) all patient groups saw significant reductions in their levels of pain following treatment, regardless of what type of treatment they accessed and regardless of the severity of their injury or condition.
In the population-level analysis, patients that combined face-to-face treatment with virtual sessions delivered through the app saw the biggest improvements, moving from a 5.4 NRS score at initial assessment to 1.8 at discharge - an improvement of 3.6 points on average. Patients who only accessed face-to-face treatment reduced their pain by 3.4 points on average, while people who were treated virtually and didn’t see a physio in-person improved by an average of 3.1 points.
A proximal progressive resistance training program targeting strength and power is feasible in people with patellofemoral pain
Objectives:
To evaluate the feasibility of a 12-week progressive resistance training program for people with patellofemoral pain (PFP) targeting proximal muscle strength and power; and resulting clinical and muscle capacity outcomes.
Main outcome measures:
Feasibility outcomes included eligibility, recruitment rate, intervention adherence, and drop-outs. Secondary outcomes included perceived recovery, physical function (AKPS and KOOS-PF), worst pain (VAS-cm), kinesiophobia (Tampa), physical activity (IPAQ), and hip strength (isometric and 10 repetition maximum) and power.
Results:
Eleven people, from 36 who responded to advertisements, commenced the program. One participant withdrew. Ten participants who completed the program reported improvement (3 completely recovered; 6 marked; and 1 moderate). Higher AKPS (effect size [ES] = 1.81), improved KOOS-PF (ES = 1.37), and reduced pain (ES = 3.36) occurred alongside increased hip abduction and extension dynamic strength (ES = 2.22 and 1.92, respectively) and power (ES = 0.78 and 0.77, respectively). Isometric strength improved for hip abduction (ES = 0.99), but not hip extension.
Conclusion
A 12-week progressive resistance training program targeting proximal muscle strength and power is feasible and associated with moderate-large improvements in pain, function, and hip muscle capacity in people with PFP. Further research evaluating the efficacy of progressive resistance training is warranted.
PaTIO: Physiotherapeutic Treat-to-target Intervention after Orthopaedic surgery; a cost-effectiveness study
Background
Physiotherapy is a proven effective treatment strategy after total knee and hip arthroplasty (TKA/THA), however there is considerable practice variation regarding its timing, content and duration. This study aims to compare the (cost-) effectiveness of a standardized, treat-to-target postoperative physiotherapy strategy with usual postoperative care.
Methods
Using a cluster randomized study design, consecutive patients scheduled for a primary TKA/THA in 18 hospitals in the Netherlands will be assigned to the treat-to-target physio therapy strategy or usual postoperative care. With the treat-to-target strategy a standardized, individually tailored, exercise program is aimed at the attainment of specific functional milestones. Assessments are done at baseline, 6 weeks and 3, 6, 9 and 12 months follow up. The primary outcome will be the Knee injury / Hip disability and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS / HOOS-PS) at 3 months follow up. Secondary outcomes are the numeric rating scale for pain, the Oxford Knee and Hip Scores, performance-based test and the EuroQol 5D-5L for quality of life. Healthcare use, productivity and satisfaction with postoperative care are measured by means of questionnaires. In total, 624 patients will be needed of which 312 TKA and 312 THA patients.
Discussion
The study will provide evidence concerning the (cost-) effectiveness of the treat-to-target postoperative physiotherapy treatment compared to usual postoperative care. The results of this study will address an important evidence gap and will have a significant impact in daily practice of the physio therapist.
Trial registration
Registered in the Dutch Trial Registry on April 15, 2018. Registration number: NTR7129.
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.
You can see the poster presented here: https://www.dropbox.com/s/lztj7mzl9hughqm/Physiouk%20poster%202017%203.pdf?dl=0
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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
Objective: The aim of this study was to evaluate the feasibility and preliminary effects of a multicomponentintervention to decrease sedentary time during and shortly after hospitalization.
Design: This is a quasi-experimental pilot study comparing outcomes in patients admitted before andafter the implementation of the intervention.
Setting: The study was conducted in a university hospital.
Subjects: Participants were adult patients undergoing elective organ transplantation or vascular surgery.
Interventions: In the control phase, patients received usual care, whereas in the intervention phase,patients also received a multicomponent intervention to decrease sedentary time. The interventioncomprised eight elements: paper and digital information, an exercise movie, an activity planner, apedometer and Fitbit Flex™, a personal activity coach and an individualized digital training program.
Measures: Measures of feasiblity were the self-reported use of the intervention components (yes/no) and satisfaction (low–high = 0–10). Main outcome measure was the median % of sedentary timemeasured by an accelerometer worn during hospitalization and 7–14days thereafter.
Results: A total of 42 controls (mean age = 59 years, 62% male) and 52 intervention patients (58years,52%) were included. The exercise movie, paper information and Fitbit Flex were the three most frequentlyused components, with highest satisfaction scores for the fitbit, paper information, exercise movie anddigital training. Median sedentary time decreased from 99.6% to 95.7% and 99.3% to 91.0% between Days 1 and 6 in patients admitted in the control and intervention phases, respectively. The difference a Day 6 reached statistical significance (difference = 41min/day, P=0.01). No differences were seen afterdischarge.
Conclusion: Implementing a multicomponent intervention to reduce sedentary time appeared feasibleand may be effective during but not directly after hospitalization.
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.
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
INTRODUCTION: Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).
METHODS AND ANALYSIS: Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.
ETHICS AND DISSEMINATION: Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.
TRIAL REGISTRATION NUMBER: NCT02730338.
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.
Background: Regular physiotherapy can improve the stability and flexibility of joints and decrease the bleeding risk in patients with haemophilia. To reduce the appointments for the patients and to make exercising a part of daily live, an individualized home exercise program (HEP) was designed. Retrospectively the number of bleedings during the HEP was compared to number of bleedings before.
Method: 8 patients aged between 4 and 16 years with haemophilia A were evaluated. At start and after 13 month patients had a motion analysis via topographic ultrasound. According to the results and clinical findings an individualized HEP was created. Standardised scores for clinical evaluation and the patient based evaluation of exercises were designed. At every appointment exercises were individually adjusted.
Results: Patients exercised in median 1.7 times a week. No training related bleeds occurred. 7 of 8 patients showed reduced joint and/or muscle bleeds (p<0.02). Clinical scores raised slightly in every patient. However the second motion analysis of squat and gait showed a worsening in 7 of 8 patients (p>0.05).
Conclusion: 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.
© Georg Thieme Verlag KG Stuttgart · New York.
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....
(You can also check https://linkinghub.elsevier.com/retrieve/pii/S0968016008002469)
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.
(please also see https://www.tandfonline.com/doi/abs/10.1080/09593980290058454)
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.
Importance For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established.
Objective To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended.
Design, Setting, and Participants Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture.
Interventions The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education.
Main Outcomes and Measures Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function).
Results Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation.
Conclusions and Relevance Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined.
Trial Registration clinicaltrials.gov Identifier: NCT00592813
Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review
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
Background and Purpose
The accurate performance of physical therapy exercises can be difficult. In this evolving healthcare climate it is important to continually look for better methods to educate patients. The use of handouts, in-person demonstration, and video instruction are all potential avenues used to teach proper exercise form. The purpose of this study was to examine if a corrected error video (CEV) would be as effective as a single visit with a physical therapist (PT) to teach healthy subjects how to properly perform four different shoulder rehabilitation exercises.
Study Design
This was a prospective, single-blinded interventional trial.
Methods
Fifty-eight subjects with no shoulder complaints were recruited from two institutions and randomized into one of two groups: the CEV group (30 subjects) was given a CEV comprised of four shoulder exercises, while the physical therapy group (28 subjects) had one session with a PT as well as a handout of how to complete the exercises. Each subject practiced the exercises for one week and was then videotaped performing them during a return visit. Videos were scored with the shoulder exam assessment tool (SEAT) created by the authors.
Results
There was no difference between the groups on total SEAT score (13.66 ± 0.29 vs 13.46 ± 0.30 for CEV vs PT, p = 0.64, 95% CI [−0.06, 0.037]). Average scores for individual exercises also showed no significant difference.
Conclusion/Clinical Relevance
These results demonstrate that the inexpensive and accessible CEV is as beneficial as direct instruction in teaching subjects to properly perform shoulder rehabilitation exercises.
Level of Evidence
1b
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.