The Efficacy of Home-Based Remote Rehabilitation versus Usual Rehabilitation for Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis
E. Pasqualotto, R.O.M. Ferreira, L.S. Migliardi, P.H.F. Silva, T. Pasqualotto, L.F.Z. FunchalObjectives:
To compare home-based remote rehabilitation with usual rehabilitation care for knee osteoarthritis (OA).
Methods:
PubMed, Cochrane, and Embase databases were searched for randomized controlled trials (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95% confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1.
Results:
A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6%) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95% CI -0.67 to -0.02) and significantly improved physical activity levels (SMD -0.45; 95% CI -0.85 to -0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD -0.95 points; 95% CI -1.84 to -0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 seconds; 95% CI -1.64 to -0.02), and a greater patient satisfaction (RR 2.01; 95% CI 1.46 to 2.76).
Conclusion:
The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.