The Effectiveness of Telerehabilitation After Arthroscopic Meniscus Repair
Condition: Telerehabilitation; Meniscus Tear; Physiotherapy; Rehabilitation; Postoperative
Study type: Interventional

Summary: 
      This study was performed on 42 patients, who underwent arthroscopic meniscus repair surgery
      in the Orthopedics and Traumatology Department of Acıbadem Maslak Hospital. 42 patients
      randomly assigned to 14 synchronized telerehabilitation, 14 asynchronous telerehabilitation,
      14 conventional physiotherapy groups and included in the study. The evaluation form created
      for the provision of demographic information are used.

      Primary outcome measures are muscle strength, range of motion (ROM) and pain intensity.

      Secondary outcome measures are general health profile and functional status assessment of the
      knee joint .

      Evaluation methods: All evaluations were performed in the preoperative period, 10. day, 6.
      week and 6. month postoperatively. ROM and pain measurements repeated every week during the
      6-week rehabilitation process.

      Pain, general health profile and functional status assessment of the knee joint were assessed
      via a telerehabilitation application, Albert Health Assistant.

      Postoperative first day, the 14-day exercise program was taught to all patients practically
      and was given as a brochure.

      Patients in the synchronized telerehabilitation group started physiotherapy postoperative 14.
      day, met with the physiotherapist in real time via the Albert Health Assistant application
      and they were treated 2 days a week until 6. week. In the remaining days, they asked to
      follow the exercise videos uploaded to the Albert system, it was checked whether they are
      doing daily exercises, and a daily reminder message was sent via the system.

      The exercise program for the asynchronous telerehabilitation group was uploaded to the Albert
      Health Assistant as a video from the 14th day in the form of 2-week programs. It was checked
      over the system whether the patients apply these videos on a daily basis, and a message
      reminding the daily routine exercise program was sent through the system.

      Patients in the supervised physiotherapy group started to take supervized rehabilitation
      after 10-14 days postoperatively, 2 times a week until 6th week postoperatively in Maslak
      Acıbadem Hospital Orthopedics and Traumatology Department. ROM, Pain, functional and general
      health evaluations of the patients in this group were performed on the online platform. In
      addition, daily routine exercises will be followed over the Albert system on the days they do
      not come for treatment.
    

Detailed description: 
      Albert Health Assistant is an artificial intelligence-based digital health assistant that
      helps patients with their treatment. Albert is a healthcare assistant who ensures that
      patients take their medications at the right dose and at the right time, helps them with
      treatment compliance, and allows patient relatives and the attending physician to closely
      monitor the patient's treatment. Albert is a mobile software and sensitive qualified personal
      health data (patient information) are stored in accordance with the personal data protection
      law. n this process, which will be created with the Albert treatment tracking system, the
      following data types can be tracked remotely.

      Primary Outcome measures:

      Joint Range of Motion (ROM) measurement: Passive hyperextension angles was measured with the
      knee in active flexion and prone position (with gravity effect).

      Joint range of motion measurement was performed with Dr Goniometer, a smartphone app. With
      this application, a photograph was taken from the patient at the maximum flexion angle that
      he can perform, and the measurement was made by placing markers on the reference points
      determined on the photograph. This application is found to be reliable in measuring the knee
      joint angle.

      Muscle strength measurement: It was performed with a Lafayette hand dynamometer. The maximal
      isometric muscle strength of the hamstring and quadriceps muscles were tested 3 times and the
      average of 3 measurements were taken. The contraction time is 5 seconds, the rest time is 10
      seconds, there was a resting period of 2 minutes in the tests between the two muscles.
      Measurements will be performed by placing the dynamometer on the distal 1/3 of the thigh
      while the prone knee is in the 45 degree flexion position.

      Pain assessment: Visual Pain Scale (VAS) was used. VAS is a scale between 0-10 points. 0
      corresponds to no pain, 10 corresponds to unbearable pain. It is a validated scale in which
      the patient self-assesses his pain at the time of evaluation.

      Secondary Outcomes:

      General Health profile measurement: It will was performed using the PROMIS 29 Health Profile
      Questionnaire. The Patient-Reported Outcomes Measurement Information System (PROMIS) is a
      general health scale created by the National Institutes of Health, in which the patient can
      self-report to assess functioning and well-being in the physical, mental and social areas of
      health.

      IKDC subjective knee form: The IKDC (International Knee Documentation Committee) subjective
      knee form is designed to measure symptoms and limitations in function and sports activity for
      various knee conditions, including ligament, meniscus, and cartilage injuries, as well as
      patellofemoral pain.
    

Intervention name(s): synchronized telerehabilitation; asynchronized telerehabilitation; supervised (face to face) rehabilitation
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): In the synchronized telerehabilitation group, the exercise program of the first 2 weeks was submitted via Albert Health Assistant application and patients were asked to do these exercises regularly during this process. after 2 weeks, they were treated 2 days a week until the 6th week by meeting with the physiotherapist in real time via the Albert Health Assistant application. In the remaining days, they were asked to follow the exercise videos uploaded to the Albert system, it will be checked whether they have done the daily exercises, and a daily reminder message will be sent through the system.; The exercise program for the asynchronized telerehabilitation group will be uploaded to the Albert Health Assistant in the form of 2-week programs in video form from the first Day. Whether the patients apply these videos on a daily basis will be checked through the system, a message reminding the daily routine exercise program will be sent through the system.; In the supervised physiotherapy group, the exercise program of the first 2 weeks was submitted via Albert Health Assistant application and patients were asked to do these exercises regularly during this process. After 2 weeks, they attended the rehabilitation program in the physical therapy department of the hospital accompanied by a physiotherapist, starting from the 14th postoperative day, 2 days a week until the 6th week. The ROM, pain, functional and general health evaluations of the patients in this group were carried out on the online platform. In addition, on the days when they did not come to treatment, their daily routine exercises were followed through the Albert system.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment