Effectiveness of Telerehabilitation Programs in Elderly with Hip or Knee Arthroplasty: A Systematic Review.

Background: Lower limb osteoarthritis (OA) often generates musculoskeletal pain causing functional impairment and decreasing mobility, autonomy, and quality of life. Patients with OA are commonly prescribed specific care for total hip arthroplasty or total knee arthroplasty (THA or TKA), when patients present symptoms that are refractory to nondrug treatments. Currently, when patients are discharged from orthopedic surgery, they are either referred to a rehabilitation department, or sent directly home with assistance such as remote monitoring by teleconsultation or a mobile application. In recent years, there has been an evolution in digital health and in particular telerehabilitation. To determine utility and effectiveness, the aim of this systematic review was to highlight and evaluate different telerehabilitation programs using new information and communication technologies. Methods: Five databases, ScienceDirect, PubMed, Web of Sciences, Scopus, and Google scholar, were searched until 30 June 30, 2023. All studies written in English and meeting our inclusion criteria were included. Databases were screened for "Total Hip Arthroplasty," "Total Knee Arthroplasty," "Total Hip Replacement," "Total Knee Replacement," "Rehabilitation," "Physical Activity," "Physiotherapy," "Telerehabilitation," "Telecommunication*," "Senior*," and "Elderly" in accordance with PRISMA-ScR guideline. Results: Fourteen articles were selected according to inclusion criteria. Telerehabilitation was offered in seven different ways (video call, applications smartphones, website, etc.). Assessments included were mainly quality of life questionnaires, perceived effort after exercises, field surveys on the tool experience, and physical tests to assess motor functions. Conclusion: This review highlights the importance and relevance of evaluating the contributions and limits of new health technologies to improve patient monitoring and thus enable better remote clinical care.

The rehabilitation robot: factors influencing its use, advantages and limitations in clinical rehabilitation.

PURPOSE: Despite the proven effectiveness of rehabilitation robots (RR) in the literature, they are still little used in clinical rehabilitation. The aim of this study was to analyse the factors influencing the use of RR and the perception of therapists who used RR. METHOD: In order to characterize the factors influencing the use of RR by therapists, a semi-structured interview was conducted with 18 therapists. These interviews are based on an interview guide inspired by the Unified Theory of Acceptance and Use of Technology model. The interviews were recorded and then transcribed, summarized and finally synthesized cross-sectionally. In addition and in parallel, the System Usability Scale (SUS) was also proposed to clinicians in order to collect quantitative data. RESULTS: The interviews highlight the facilitators perceived by the therapists, such as the intensity of the movement, the complementarity with conventional rehabilitation. The results also showed the possible barriers perceived, these can be sometimes inconclusive (e.g., bugs). The SUS results show no effect, either on the gender of the users, their therapists, or the duration of use of the tool. CONCLUSION: Better communication on the functionality of the robot and the construction of achievable goals would lead to more results that are conclusive but also better patient care. To date, and despite the evidence for the effectiveness of RRs, therapists believe that there are still many barriers to their use. They agree, however, that if changes are made, RRs will become an integral part of therapy.IMPLICATIONS FOR REHABILITATIONThe study idenfied and highlighted the factors influencing the use of the rehabilitation robot in the clinics through metric and ergonomic evaluations.The study allowed to quantify the level of acceptance of the Lokomat among therapists.This study allowed to identify negative factors that could be resolved through the implementation of a structured and generalized protocol for patients and thus improve their care.