Provision of a Home-Based Video-Assisted Therapy Program Is Noninferior to In-Person Hand Therapy After Thumb Carpometacarpal Arthroplasty.

Autor:	Barrett PC; Virginia Tech Carilion School of Medicine, Roanoke, Virginia., Hackley DT; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Yu-Shan AA; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Shumate TG; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Larson KG; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Deneault CR; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Bravo CJ; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Peterman NJ; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia., Apel PJ; Virginia Tech Carilion School of Medicine, Roanoke, Virginia.; Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Virginia.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2024 Apr 17; Vol. 106 (8), pp. 674-680. Date of Electronic Publication: 2024 Apr 12.
DOI:	10.2106/JBJS.23.00597
Abstrakt:	Background: In-person hand therapy is commonly prescribed for rehabilitation after thumb carpometacarpal (CMC) arthroplasty but may be burdensome to patients because of the need to travel to appointments. Asynchronous, video-assisted home therapy is a method of care in which videos containing instructions and exercises are provided to the patient, without the need for in-person or telemedicine visits. The purpose of the present study was to evaluate the effectiveness of providing video-only therapy (VOT) as compared with scheduled in-person therapy (IPT) after thumb CMC arthroplasty. Methods: We performed a single-site, prospective, randomized controlled trial of patients undergoing primary thumb CMC arthroplasty without an implant. The study included 50 women and 8 men, with a mean age of 61 years (range, 41 to 83 years). Of these, 96.6% were White, 3.4% were Black, and 13.8% were of Hispanic ethnicity. The primary outcome measure was the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) score. Subjects in the VOT group were provided with 3 videos of home exercises to perform. Subjects in the control group received standardized IPT with a hand therapist. Improvements in the PROMIS UE score from preoperatively to 12 weeks and 1 year postoperatively were compared. Results: Fifty-eight subjects (29 control, 29 experimental) were included in the analysis at the 12-week time point, and 54 (27 control, 27 experimental) were included in the analysis at the 1-year time point. VOT was noninferior to IPT for the PROMIS UE score at 12 weeks and 1 year postoperatively, with a difference of mean improvement (VOT - IPT) of 1.5 (95% confidence interval [CI], -3.6 to 6.6) and 2.2 (95% CI, -3.0 to 7.3), respectively, both of which were below the minimal clinically important difference (4.1). Patients in the VOT group potentially saved on average 201.3 miles in travel. Conclusions: VOT was noninferior to IPT for upper extremity function after thumb CMC arthroplasty. Time saved in commutes was considerable for those who did not attend IPT. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: This trial was supported with internal funding through Carilion Clinic’s Research Acceleration Program. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H886 ). (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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