title: In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty: A Noninferiority Randomized Controlled Trial.
abstract: BACKGROUND
  The availability of less resource-intensive alternatives to home visits for rehabilitation following orthopaedic surgeries is important, given the increasing need for home care services and the shortage of health resources. The goal of this trial was to determine whether an in-home telerehabilitation program is not clinically inferior to a face-to-face home visit approach (standard care) after hospital discharge of patients following a total knee arthroplasty.
  
  
  METHODS
  Two hundred and five patients who had a total knee arthroplasty were randomized before hospital discharge to the telerehabilitation group or the face-to-face home visit group. Both groups received the same rehabilitation intervention for two months after hospital discharge. Patients were evaluated at baseline (before total knee arthroplasty), immediately after the rehabilitation intervention (two months after discharge), and two months later (four months after discharge). The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the last follow-up evaluation. Secondary outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, functional and strength tests, and knee range of motion. The noninferiority margin was set at 9% for the WOMAC.
  
  
  RESULTS
  The demographic and clinical characteristics of the two groups of patients were similar at baseline. At the last follow-up evaluation, the mean differences between the groups with regard to the WOMAC gains, adjusted for baseline values, were near zero (for 182 patients in the per-protocol analysis): -1.6% (95% confidence interval [CI]: -5.6%, 2.3%) for the total score, -1.6% (95% CI: -5.9%, 2.8%) for pain, -0.7% (95% CI: -6.8%, 5.4%) for stiffness, and -1.8% (95% CI: -5.9%, 2.3%) for function. The confidence intervals were all within the predetermined zone of noninferiority. The secondary outcomes had similar results, as did the intention-to-treat analysis, which was conducted afterward for 198 patients.
  
  
  CONCLUSIONS
  Our results demonstrated the noninferiority of in-home telerehabilitation and support its use as an effective alternative to face-to-face service delivery after hospital discharge of patients following a total knee arthroplasty.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Université Laval, 1050 avenue de la Médicine, Québec QC G1V 0A6, Canada. E-mail address for H. Moffet: helene.moffet@rea.ulaval.ca.
authors.forename: Hélène
authors.initials: H
authors.lastname: Moffet
authors.affiliation: Research Centre on Aging (M.T., P.B., and H.C.) and Department of Surgery (F.C.), Université de Sherbrooke, 3001 12ieme Avenue Nord, Sherbrooke, QC J1H 5N4, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Tousignant
authors.affiliation: Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Université de Montréal, 7077 avenue du Parc, Montréal, QC H3N 1X7, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Nadeau
authors.affiliation: Centre de recherche de l'Institut universitaire en santé mentale, Université Laval, 1050 avenue de la Médicine, Québec, QC G1V 0A6, Canada.
authors.forename: Chantal
authors.initials: C
authors.lastname: Mérette
authors.affiliation: Research Centre on Aging (M.T., P.B., and H.C.) and Department of Surgery (F.C.), Université de Sherbrooke, 3001 12ieme Avenue Nord, Sherbrooke, QC J1H 5N4, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Boissy
authors.affiliation: Research Centre on Aging (M.T., P.B., and H.C.) and Department of Surgery (F.C.), Université de Sherbrooke, 3001 12ieme Avenue Nord, Sherbrooke, QC J1H 5N4, Canada.
authors.forename: Hélène
authors.initials: H
authors.lastname: Corriveau
authors.affiliation: Centre hospitalier universitaire de Québec (CHU-Q), 11 Côte du Palais, Québec, QC G1R 2J6, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Marquis
authors.affiliation: Research Centre on Aging (M.T., P.B., and H.C.) and Department of Surgery (F.C.), Université de Sherbrooke, 3001 12ieme Avenue Nord, Sherbrooke, QC J1H 5N4, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Cabana
authors.affiliation: Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montréal, QC H2E 1S6, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ranger
authors.affiliation: Centre hospitalier universitaire de Québec (CHU-Q), 11 Côte du Palais, Québec, QC G1R 2J6, Canada.
authors.forename: Étienne L
authors.initials: ÉL
authors.lastname: Belzile
authors.affiliation: St. Mary's Hospital Center, 3830 avenue Lacombe, Montréal, QC H3T 1M5, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Dimentberg
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006792:House Calls; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome