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Would Telerehabilitation Address Gaps in ACL Post-Operative Care?

a stethascope around an iPhone

We are just beginning to understand the applicability of telehealth. Primarily used as an alternative to in-person care, telehealth is often as inferior. Therapists frequently cite the inability to put their hands on patients, both for assessment and treatment. But what about the patients?

Treatment should be a shared decision, and the patient experience plays a critical role in the delivery of healthcare. Would telehealth improve adherence to care? Would patients be more committed to treatment if they have the option of where to receive treatment?

This paper surveyed patients aged 16 years or older who had undergone ACL reconstruction within the past 5 years. They were invited to give their “thoughts and opinions regarding a potentially new approach to post-surgical rehab” and introduced to the possibility of telerehabilitation in addition to usual care.

Only 26% (25/96) of patients felt that they had fully recovered at the end of their PT; 77% of patients felt that they had sufficient PT. Moreover, 69% of patients stated that their physical therapy was ended by their physical therapist, whereas 51% ended physical therapy themselves (overlap likely indicates joint decision), and 39% said that travel, time commitments, and other factors were causal for ending their physical therapy. When asked in which phase they preferred to use their allocated physical therapy appointments, 60% said they preferred face-to-face in the early stages of care, 33% said they preferred to use face-to-face with the return-to-sport care, and 6% chose other.

The primary pros were telehealth can save appointments, fill gaps between phases of care or breaks, and save time and money. The cons were concerns about a difference in value between in-person and over a screen and the access to technology to facilitate a high-quality telehealth experience. The predominant theme was that telerehabilitation needed to be used as an adjunct to physical therapy rather than instead of it.


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