VIRTUAL VERSUS IN-PERSON PHYSIOTHERAPY FOLLOWING TOTAL KNEE ARTHROPLASTY: A COMPARATIVE ANALYSIS

Virtual health care delivery accelerated during the COVID-19 Pandemic as healthcare providers and institutions innovated to continue providing high quality patient care. At our tertiary-level arthroplasty center, we developed and implemented a video-based post-operative physiotherapy program since March 2020 for patients undergoing total knee arthroplasty (TKA). The protocol was based on our centre's award-winning in-person physiotherapy post-operative program and administered by experienced physiotherapists via video-based software. In this study, we aimed to analyse and compare the outcomes of this program to a historical in-person cohort. We retrospectively reviewed the outcomes of the first 100 consecutive patients undergoing the virtual physiotherapy program at our institution (i.e., the virtual cohort). We captured range-of-motion (ROM) measurements and pain scores (as measured by the P4 questionnaire) as part of our standard practice, and these were summarized via descriptive statistics (means and standard deviations). We compared the outcomes to a historical cohort of 175 consecutive patients undergoing in-person physiotherapy at our institution (i.e., the in-person cohort). Comparative analysis was performed using a two-tailed Student's t-test. An alpha value of less than 0.05 was considered as statistically significant. At the initial post-operative visit, the virtual cohort had mean flexion of 92.0 (SD 15.6) degrees and extension of −9.7 (SD 6.7) degrees. At the discharge visit, mean flexion had improved to 122.6 (SD 7.6) degrees and mean extension to 1.0 (SD 2.1) degrees. Mean time to discharge was 6.2 (SD 1.2) weeks. The in-person cohort had mean initial flexion and extension of 94 (SD 17) degrees and −13.9 (SD 6.8) degrees, respectively. At the discharge visit, mean flexion had improved to 128.5 (SD 8.0) degrees and mean extension to −0.54 (SD 1) degrees. There was no difference in improvement in flexion from the initial visit (mean 30.6 degrees increase [virtual] vs 34.5 degrees increase [in-person], p=0.06). Both groups achieved near-full knee extension (£1 degree), although the in-person cohort experienced a greater improvement for this to occur (13.2 degree improvement vs 8.6 degree improvement, p < 0 .001). There was no difference in the number of physiotherapy visits to discharge between the cohorts (10.5 virtual vs 11.1 in-person, p=0.14). There was also no difference in final pain scores as measured by the P4 questionnaire (12.4 virtual vs 11.9 in-person, p =0.61) Physiotherapy following total knee arthroplasty can be delivered effectively virtually via video-based software and administered by experienced physiotherapists. Improvements in range-of-motion measures are comparable to those obtained in-person, with both groups achieving similar gains in flexion and near-full knee extension. These findings may have implications for the virtual delivery of post-operative care moving forward, especially among remote populations and patients with mobility limitations restricting travel.