The effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty: A systematic review and meta-analysis of randomised controlled trials

Aim: To systematically evaluate the available evidence on the effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty regarding pain, range of motion, physical function, health-related quality of life, satisfaction, and psychological well-being. Methods: This was a systematic review with meta-analysis based on the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Studies published in English or Chinese were searched using defined search periods, databases, and search terms. Two reviewers assessed independently the quality of studies. RevMan 5.3 was used for meta-analysis. Heterogeneity was assessed using 2 and 2 statistic. Random effect model and mean difference with 95% confidence interval was adopted. Standardized mean difference was used if the outcome was measured by different scales. Results: Eleven studies with 1,020 participants were analysed. Compared to face-to-face rehabilitation, internet-based telerehabilitation showed no significant difference in outcomes of pain (SMD -0.11, 95% CI -0.32 to 0.10), range of motion in flexion (MD 0.65, 95% CI -1.18 to 2.48) and extension (MD -0.38, 95% CI -1.16 to 0.40), patient-reported physical function (SMD 0.01, 95% CI -0.15 to 0.17), health-related quality of life (SMD -0.09, 95% CI -0.26 to 0.07), satisfaction (SMD -0.04, 95% CI -0.21 to 0.14), and psychological well-being (SMD 0.10, 95% CI -0.13 to 0.33). Internet-based telerehabilitation showed better outcomes in physical functional tests (SMD -0.54, 95% CI -1.08 to -0.01). Discussion: This review suggests that internet-based telerehabilitation has comparable effectiveness to face-to-face rehabilitation on rehabilitation outcomes among patients after total joint arthroplasty.