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Internet-Based Outpatient Telerehabilitation for Patients Following Total Knee ArthroplastyA Randomized Controlled Trial
Trevor G. Russell, PhD1; Peter Buttrum, BPhty, Grad Cert (Health Management)2; Richard Wootton, DSc, PhD3; Gwendolen A. Jull, PhD1
1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, Australia. E-mail address for T. Russell: t.russell@shrs.uq.edu.au
2 Department of Physiotherapy, QEII Jubilee Hospital, Kessels Road, Brisbane 4108, Australia
3 The Scottish Centre for Telehealth, Top Floor, Foresterhill Lea, Foresterhill, Aberdeen AB25 2ZY, Scotland
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Allan Gross, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.
Investigation performed at the Queen Elizabeth II Jubilee Hospital, Brisbane, Australia

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jan 19;93(2):113-120. doi: 10.2106/JBJS.I.01375
A commentary by Allan E. Gross, MD, FRCSC, O.Ont., is available here
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Total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee. Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function. Access to high-quality rehabilitation services is not always possible, especially for those who live in rural or remote areas. The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty.


This investigation was a single-blinded, prospective, randomized, controlled noninferiority trial. Sixty-five participants were randomized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and six weeks by a blinded independent assessor. Secondary outcomes included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, limb girth measurements, and an assessment of gait. Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics.


Baseline characteristics between groups were similar, and all participants had significant improvement on all outcome measures with the intervention (p < 0.01 for all). After the six-week intervention, participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, quality of life, and clinical gait and WOMAC scores. Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group (p < 0.05). The telerehabilitation intervention was well received by participants, who reported a high level of satisfaction with this novel technology.


The outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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