• Hélène Moffet, Michel Tousignant, Sylvie Nadeau, Chantal Mérette, Patrick Boissy, Hélène Corriveau, François Marquis, François Cabana, Pierre Ranger, Étienne L Belzile, and Ronald Dimentberg.
• Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Université Laval, 1050 avenue de la Médicine, Québec QC G1V 0A6, Canada. E-mail address for H. Moffet: helene.moffet@rea.ulaval.ca.
• J Bone Joint Surg Am. 2015 Jul 15;97(14):1129-41.

BackgroundThe availability of less resource-intensive alternatives to home visits for rehabilitation following orthopaedic surgeries is important, given the increasing need for home care services and the shortage of health resources. The goal of this trial was to determine whether an in-home telerehabilitation program is not clinically inferior to a face-to-face home visit approach (standard care) after hospital discharge of patients following a total knee arthroplasty.MethodsTwo hundred and five patients who had a total knee arthroplasty were randomized before hospital discharge to the telerehabilitation group or the face-to-face home visit group. Both groups received the same rehabilitation intervention for two months after hospital discharge. Patients were evaluated at baseline (before total knee arthroplasty), immediately after the rehabilitation intervention (two months after discharge), and two months later (four months after discharge). The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the last follow-up evaluation. Secondary outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, functional and strength tests, and knee range of motion. The noninferiority margin was set at 9% for the WOMAC.ResultsThe demographic and clinical characteristics of the two groups of patients were similar at baseline. At the last follow-up evaluation, the mean differences between the groups with regard to the WOMAC gains, adjusted for baseline values, were near zero (for 182 patients in the per-protocol analysis): -1.6% (95% confidence interval [CI]: -5.6%, 2.3%) for the total score, -1.6% (95% CI: -5.9%, 2.8%) for pain, -0.7% (95% CI: -6.8%, 5.4%) for stiffness, and -1.8% (95% CI: -5.9%, 2.3%) for function. The confidence intervals were all within the predetermined zone of noninferiority. The secondary outcomes had similar results, as did the intention-to-treat analysis, which was conducted afterward for 198 patients.ConclusionsOur results demonstrated the noninferiority of in-home telerehabilitation and support its use as an effective alternative to face-to-face service delivery after hospital discharge of patients following a total knee arthroplasty.Level Of EvidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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