UI Hospitals & Clinics studies virtual physical therapy after shoulder replacement
Patients offered chance to do therapy at home
After more than 30 years as a maintenance worker for a PVC pipe company, Tim McHugh wasn’t surprised he needed shoulder replacement surgery. What was surprising was that he had the option to complete his physical therapy from home.
After his shoulder surgery in January 2022, the 74-year-old wasn’t looking forward to the 25-mile winter drive from his West Liberty, Iowa home to University of Iowa Hospitals & Clinics for his follow-up physical therapy appointments.
Fortunately, McHugh didn’t have to, thanks to a clinical trial being conducted by the hospital’s Department of Orthopedics and Rehabilitation.
James Nepola, MD, and Brendan Patterson, MD, MPH, are leading a team of orthopedic surgeons testing the efficacy of using telehealth – video health visits – to provide physical therapy to patients following shoulder replacement. Just like in-person visits, the virtual visits are scheduled regularly, but the rehabilitating patient can do the therapy from the comfort of their own home.
“You do the same therapy and see the same therapist online that you would see in person, so you’re not doing it alone,” Patterson says.
Broadening patient access
The idea was born out of necessity during the pandemic, Patterson says, as a way of maintaining patient access to physical therapy.
“At UI Hospitals & Clinics we are always looking to be on the cutting edge of new treatments and research, we wanted to investigate an easier way to do PT after shoulder surgery.” Patterson says. “We partnered with one of our senior residents, Olivia O’Reilly, MD, to develop a prospective randomized controlled trial to investigate in-person PT compared to telehealth therapy after shoulder replacement.”
Once Patterson and Nepola started seeing how well it was working, they decided to take a more serious look at using it on a more permanent basis. They developed the trial to gather data-informed evidence to investigate if telehealth could be just as effective as in-person visits, which would then pave the way for it to become an accepted standard practice.
Telehealth vs. On-site physical therapy
Patients interested in participating in the study are divided into two groups: those using telehealth, and those attending in-person visits. Group selection is randomized, meaning neither the patient nor the therapist or surgeon can determine who goes into which group.
“The difference is that the in-person group does more therapy with a therapist in person and the telehealth group does most of it through telehealth, with a few in-person checkups just to make sure the patient is on the right path,” Patterson says.
The trial, which started in August 2021, is still accepting new participants and will continue for about another year, Patterson says. They hope to study 140 patients and have seen about 40 so far.
“This type of research design is the highest level of clinical research and is the gold standard to which all other research is compared. The study isn’t complete, but we’ve seen good results thus far with the telehealth patients,” Patterson says.
McHugh is happy he got to do the therapy in the comfort of his own home on a computer.
“They had me use different resistance bands and it worked out just fine,” he says. “It saved us a long drive, especially that time of year.”
He says he started out doing physical therapy twice a week, then he progressed so well his physicians moved him to once a week.
“He did exceptionally well with his shoulder surgery and then again with the physical therapy,” says McHugh’s wife, Deb. “We just saw the doctor and they’re amazed at how well he’s doing. Now they’re starting to talk about doing the other shoulder.”
Patterson says a number of telehealth options became available during the pandemic when clinics were closed and hospitals had limited access. Like the in-person physical therapy visits, many of these virtual care approaches are being given a second look to determine whether a telehealth option can provide comparable outcomes. He said patients interested in participating in the study should talk with their doctor or surgeon following surgery.