Comparing in-person physical therapy to video physical therapy in terms of cost, convenience and adherence. Image by instaphotos from Canva

Rehabilitation is an essential part of the path to recovery after a knee replacement, hip replacement or ACL surgery! Lack of rehabilitation and poor adherence to the physical therapy protocol suggested by your healthcare provider can lead to increased pain, stiffness, and poor range of motion. Although many people picture their physical therapist's office when they hear the word 'rehabilitation', newer alternatives such as online video-based physical therapy (also referred to as telerehabilitation or video physical therapy) are becoming more common. Video-based physical therapy can take many forms, such as calling your physical therapist via video for a physical therapy session, or following a pre-recorded video session provided to you by your physical therapist. With the new options, people have more choices when it comes to the format of their rehabilitation: in-person physical therapy, video-based physical therapy, or even a combination of both! In this blog, we will compare in-person physical therapy to video-based physical therapy in terms of cost, effectiveness, convenience, and adherence, to expand your range of choices when it comes to how you want to approach your rehab after an injury or surgery.

Effectiveness

The main question people have is: Does video-based physical therapy work as well as in-person physical therapy? The answer is yes! People who are using video-based physical therapy report the same results in terms of improvements in knee function, ability to exercise, range of motion, and pain reduction as do those using in-person physical therapy.[1][2][3] One study that included 205 participants, with an average age of 66 years old (101 participants in the in-person physical therapy group and 104 participants in the video-based physical therapy group), showed that the two groups had a similar reduction in stiffness and pain, as well as similar improvements in mobility and ability to complete daily activities after a knee replacement.[3] Furthermore, another study that summarized and analyzed the results of 6 studies comparing video-based rehabilitation and in-person rehabilitation showed that both of these types of rehabilitation improved leg muscle strength and reduced swelling in the knee, and the results were slightly better in the video-based physical therapy group.[4]

Although video-based physical therapy is an effective way of rehabilitation, many people who have not had a chance to experience it are concerned about the lack of physical contact with a physical therapist.[5] One study found that people who initially experienced such anxiety reported that when trying video-based physical therapy, they felt that they were able to emotionally connect with their physical therapist even though they did not meet face-to-face.[5] People in this study also reported that their therapist was able to provide them with an exercise program that was adjusted to their abilities and their level of fatigue and pain even though the sessions were conducted online.[5] Therefore, you should not worry that the lack of physical contact will act as a barrier in your rehabilitation. If you prefer to have some physical contact but are interested in incorporating video-based physical therapy because of its convenience, you can combine in-person physical therapy with video-based physical therapy. For example, you can attend the initial assessment with the physical therapist in person and then switch to video-based physical therapy if this is an option.

Convenience

Initially, video-based physical therapy was primarily intended for people who live in remote areas or do not have reliable transportation to attend in-person physical therapy sessions.[6] However, at the beginning of the COVID-19 pandemic, more people began to use video-based physical therapy because of its convenience and safety.[6] Video-based physical therapy is also a more time-efficient type of rehabilitation because of the reduced travel and waiting times.[7] It is also a great option for people who are weakened after their surgery and otherwise would not be able to attend the necessary in-person physical therapy sessions.[7] Video-based physical therapy sessions can be conducted in a manner that is secure and adheres to health care policies safeguarding your privacy such that you feel safe and secure from the comfort of your home.[8]

Video-based physical therapy is a convenient option for many people; however, some people may feel hesitant or not confident when using video-based rehabilitation due to the need to use technology.[9] One study conducted with people who were 66 and older stated that they were less confident when using technologies for video-based physical therapy.[9] However, this study has also shown that many people who were not very confident in using technologies were highly motivated to learn how to use them.[9] Given that you do not need a lot of technical skills to attend video-based physical therapy, simple training might help a person to feel more confident using the required technologies. If a person is willing to learn and motivated to try video-based physical therapy, with some training, video-based physical therapy can be effectively incorporated into their rehabilitation.[9]

However, in-person physical therapy might be more convenient for people who do not have access to high-speed internet, a mobile device, or a computer at home.[9] Video-based physical therapy involves connecting with your physical therapist on a computer or mobile device over the internet which would be difficult to do if you do not have access to this technology.

Adherence

Long-term rehabilitation after knee replacement, hip replacement, and ACL surgery has been shown to yield many positive outcomes, including improved muscle strength, range of motion, and the ability to complete activities of daily living.[10] However, many people do not adhere to (or stick to) the exercise plan prescribed by their physical therapist for various reasons.[11] Studies have shown that around 14% of people that require long-term physical therapy do not show up for follow-up in-person appointments with their physical therapist, and up to 70% of people do not follow the exercise plan prescribed by their physical therapist.[11] Using the combination of video-based physical therapy and in-person physical therapy, or video-based physical therapy alone can help improve your adherence to an exercise plan for better outcomes in your rehbailitation.[10][12] One reason in the resesarch for poor adherehnce is the inability to fit the physical therapy session in your schedule, as well as long travel times to in-person physical therapy.[12] Video-based physical therapy provides more flexibility in the time scheduling for your appointment and reduces the need to travel to the physical therapist’s office.[12] The flexibility of video-based physical therapy allows for close monitoring and feedback from your physical therapist.[10][12] Many people in research studies say that they are unsure if they are doing the exercises correctly, which discourages them from adhering to an exercise plan, and people say that supervision helps them with their adherence.[10][12] Therefore, receiving feedback specifically about your exercise form and technique from your physical therapist without the need to travel to their office can help you stay motivated and on track throughout your rehabilitation journey!

Cost

Lastly, video-based physical therapy is a more cost-effective method of rehabilitation than in-person physical therapy.[7] In Ontario, Canada, publicly funded physical therapy is only available to people who are over the age of 65, under the age of 19, living in a long-term care home, or who have certain disabilities.[13] If you have had a knee replacement or hip replacement and you do not fit the above criteria, you will recieve 2-3 sessions of publicly funded physical therapy. Since proper rehabilitation after a knee replacement or hip repalcement takes 8-12 months, 2-3 sessions is grossly inadaquate for everyone who recieves a knee replacement or hip replacement. A full course of in-person physical therapy can be very expensive unless you have private health insurance. For more information read this blog about the cost of in-person physical therapy in Canada after a knee replacement! Video-based physical therapy can be a cost effective alternative to in-person physical therapy! Curovate provides an 9 month rehabilitation plan, video guided daily exercises, in-app chat with a licensed physical therapist and 1-on-1 video physical therapy sessions through our app links below. Video-based physical therapy, as provided by Curovate, reduces travel costs to the physical therapist’s office, which is especially important for people who live in rural areas.

Conclusion

In conclusion, video-based physical therapy is a more time-efficient and cost-effective type of rehabilitation that is just as effective as traditional in-person physical therapy based on the research reviewed for this blog. People who were initially hesitant to use video-based physical therapy report that the lack of physical contact does not prevent them from establishing a bond with their physical therapist and receiving a personalized rehabilitation plan.[5] In addition, video-based physical therapy can provide better adherence to your rehabilitation plan because of its flexibility and the ongoing supervision by your physical therapist.[10][12] If you are hesitant to start with video-based physical therapy but cannot afford a full course of in-person rehabilitation, you can start with in-person physical therapy (for example, attending 3 in-person physical therapy sessions that are covered by health insurance) and once you feel comfortable, continue your long-term rehabilitation using video-based physical therapy.

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References

1. Odole, Adesola C., and Oluwatobi D. Ojo. “A Telephone-Based Physiotherapy Intervention for Patients with Osteoarthritis of the Knee.” International Journal of Telerehabilitation, vol. 5, no. 2, 2013, pp. 11–20, https://doi.org/10.5195/ijt.2013.6125.

2. Russell, Trevor G., et al. “Internet-Based Outpatient Telerehabilitation for Patients Following Total Knee Arthroplasty: A Randomized Controlled Trial.” Journal of Bone and Joint Surgery. American Volume, vol. 93, no. 2, 2011, pp. 113–20, https://doi.org/10.2106/JBJS.I.01375.

3. Moffet, Hélène, et al. “In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty: A Noninferiority Randomized Controlled Trial.” Journal of Bone and Joint Surgery. American Volume, vol. 97, no. 14, The Journal of Bone and Joint Surgery, Incorporated, 2015, pp. 1129–41, https://doi.org/10.2106/JBJS.N.01066.

4.Shukla, H., et al. “Role of Telerehabilitation in Patients Following Total Knee Arthroplasty: Evidence from a Systematic Literature Review and Meta-Analysis.” Journal of Telemedicine and Telecare, vol. 23, no. 2, 2017, pp. 339–46, https://doi.org/10.1177/1357633X16628996.

5.Kairy, Dahlia, et al. “The Patient’s Perspective of in-Home Telerehabilitation Physiotherapy Services Following Total Knee Arthroplasty.” International Journal of Environmental Research and Public Health, vol. 10, no. 9, 2013, pp. 3998–4011, https://doi.org/10.3390/ijerph10093998.

6.Seron, Pamela, et al. “Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview.” Physical Therapy, vol. 101, no. 6, 2021, doi:10.1093/ptj/pzab053.

7.Azma, Kamran, et al. “Efficacy of Tele-Rehabilitation Compared with Office-Based Physical Therapy in Patients with Knee Osteoarthritis: A Randomized Clinical Trial.” Journal of Telemedicine and Telecare, vol. 24, no. 8, 2018, pp. 560–65, https://doi.org/10.1177/1357633X17723368.

8.“Virtual Physiotherapy: Video Appointments.” Pt Health, www.pthealth.ca/clinic-page/virtual-care/.

9.Nelson, Mark J., et al. “Telerehabilitation Feasibility in Total Joint Replacement.” International Journal of Telerehabilitation, vol. 9, no. 2, 2017, pp. 31–38, https://doi.org/10.5195/ijt.2017.6235.

10.Jack, Kirsten, et al. “Barriers to Treatment Adherence in Physiotherapy Outpatient Clinics: A Systematic Review.” Manual Therapy, vol. 15, no. 3, 2009, pp. 220–28, https://doi.org/10.1016/j.math.2009.12.004.

11.Eichler, Sarah, et al. “Effectiveness of an Interactive Telerehabilitation System with Home-Based Exercise Training in Patients after Total Hip or Knee Replacement: Study Protocol for a Multicenter, Superiority, No-Blinded Randomized Controlled Trial.” Trials, vol. 18, no. 1, 2017, pp. 438–438, https://doi.org/10.1186/s13063-017-2173-3.

12.“Get Physiotherapy.” Ontario.ca, 3 May 2022, www.ontario.ca/page/get-physiotherapy?_ga=2.135301240.832047899.1650378187-24823868.1650378187.