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Evaluation of a Smartphone Application for Self-Rehabilitation after Anterior Cruciate Ligament Reconstruction during a COVID-19 Lockdown.
Bauwens, Paul-Henri; Fayard, Jean-Marie; Tatar, Maxime; Abid, Hichem; Freychet, Benjamin; Sonnery-Cottet, Bertrand; Thaunat, Mathieu.
  • Bauwens PH; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
  • Fayard JM; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
  • Tatar M; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
  • Abid H; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
  • Freychet B; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
  • Sonnery-Cottet B; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
  • Thaunat M; Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France. Electronic address: mathieuthaunat@yahoo.fr.
Orthop Traumatol Surg Res ; : 103342, 2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-2228012
ABSTRACT

BACKGROUND:

Rehabilitation after surgery is a crucial process that governs the final functional outcome. The self-rehabilitation smartphone application Doct'up (Healing SAS, Lyon, France) is designed for patients who have had anterior cruciate ligament (ACL) reconstruction surgery. In France in the spring of 2020, the lockdown mandated due to the COVID-19 pandemic prevented patients from seeing their physiotherapists for 2 months. The objective of this study was to compare the clinical outcomes in two groups of patients who underwent ACL reconstruction surgery in one group, surgery performed before the lockdown was followed by standard in-person physiotherapy while, in the other, surgery was done just before the lockdown and rehabilitation was performed by the patients themselves using the phone application.

HYPOTHESIS:

Using a self-rehabilitation smartphone app limits the negative effects of not receiving physiotherapist rehabilitation after ACL reconstruction. MATERIAL AND

METHODS:

We performed a case-control study involving the retrospective analysis of prospectively collected data from two groups of patients who had undergone ACL reconstruction surgery. Patients in the App group had surgery just before the 2-month COVID-19-related lockdown that started in France on March 17, 2020,and used only the smartphone app for rehabilitation. The standard-care group was composed of matched controls who had surgery 1 year before the cases and received rehabilitation therapy during in-person physiotherapist visits. The ACL reconstruction technique was the same in the two groups. The primary outcome measure was extension lag 6 weeks after surgery. The secondary outcome measures were extension lag 3 weeks and 6 months after surgery, quadriceps muscle activation, knee extension locking 3 and 6 weeks after surgery, and the 6-month rate of surgical revision for cyclops syndrome.

RESULTS:

We included 32 cases managed using only self-rehabilitation guided by the phone app, and we identified 101 matched controls managed using standard care. We found no significant between-group difference in extension lag after 6 weeks 9.4% (28/32) vs. 4.6% (87/101), p=0.39. After 3 weeks, the App group had a higher proportions of patients with quadriceps activation (94% [30/32] vs. 73% [74/101], p=0.015) and extension control using canes (78.1% [25/32] vs. 40.6% [41/101], p=0.0002). None of the other measured outcomes differed significantly between the two groups (extension lag after 3 weeks 12.5% [4/32] vs. 13.8% 14/101]; extension lag after 6 months 3.2% [1/32] vs. 1% [1/101]; quadriceps activation after 6 weeks 97% [31/32] vs. 99% [100/101]; extension locking with canes after 6 weeks 96.9% [31/32] vs. 93.1% [94/101]; extension locking without canes after 3 weeks 53.2% [17/32] vs. 47.5% [48/101]; extension locking without canes after 6 weeks 93.7% [30/32] vs. 82.2% [83/101]; and surgery for cyclops syndrome (3.1% [1/32] vs. 1% [1/101]).

DISCUSSION:

The use of a self-rehabilitation phone app after ACL reconstruction during a COVID-19 lockdown limited the adverse effects of not receiving in-person physiotherapy. The 6-month outcomes were similar to those seen with standard rehabilitation. The study results demonstrate the usefulness of self-rehabilitation after ACL reconstruction surgery. Self-rehabilitation guided by a phone app could be used as a complement to the protocols generally applied by physiotherapists. LEVEL OF EVIDENCE IV, single-centre retrospective case-control study.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Orthop Traumatol Surg Res Year: 2022 Document Type: Article Affiliation country: J.otsr.2022.103342

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Orthop Traumatol Surg Res Year: 2022 Document Type: Article Affiliation country: J.otsr.2022.103342