Internet Enhanced, Patient-Centered Orthopedic Care: A Prospective, Randomized, Controlled Pilot Trial

Study Overview
=================
Brief Summary
-----------------
The investigators have previously reported on patient utilization of an eRehab patient education web portal that utilizes streaming, clinician prescribed video instruction to motivate and inform patients in self-care of their orthopedic condition, focusing on the importance of a home exercise program. The greatest barrier to patient use of this web-based home exercise treatment plan was the initial access to the program. The purpose of this study is to compare an Internet-based patient education rehab portal (eRehab) to formal physical therapy (PT) in terms of patient costs and outcomes.

Detailed Description
-----------------
This is a prospective, randomized, controlled pilot study. Twenty-four patients who were candidates for a knee or shoulder orthopedic outpatient physical therapy referral were randomized to a 6-week treatment course of either PT or eRehab. Patients were evaluated for outcome scores (KOOS or DASH), pain NRS-11 scores, patient subjective outcomes and cost of treatment.

Official Title
-----------------
Phase I Study Comparing Internet Delivered Home Exercise Programs to Standard Orthopedic Care and Outpatient Physical Therapy.

Conditions
-----------------
Knee Injuries, Shoulder Injuries, Rotator Cuff Disease, Meniscus Tear, Patellofemoral Pain

Intervention / Treatment
-----------------
* Other: eRehab
* Other: Formal Physical Therapy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patient diagnosed by board certified orthopedic surgeon to be in need of formal physical therapy referral had the ability to access and use the Internet and email English-speaking non-pregnant adults had not received formal physical therapy for their current diagnosis Exclusion Criteria: work-related injuries pain NRS-11 score greater than or equal to 6

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Physical Therapy<br>This arm will receive the standard of care for orthopedic patients receiving a diagnosis and then a recommendation for outpatient physical therapy referral. They will follow through on the referral and attend physical therapy. | Other: Formal Physical Therapy<br>* This intervention involves referral to a licensed physical therapist or supervised ATC-L.<br>|
| Experimental: eRehab<br>This group will not go to formal therapy but receive Internet delivered patient education and exercise instruction. This group will then perform those exercises at home. | Other: eRehab<br>* Growth in e-Health applications, defined as any computer or Internet application integrated into health services, has resulted in the development of treatment strategies to improve healthcare while reducing costs. The utilization of e-Health to provide a rehabilitative intervention has recently been identified in the cardiac literature as e-rehabilitation or eRehab. This study specifically compares an orthopedic eRehab Internet application to standard outpatient physical therapy as an adjunct in the treatment of non-complicated knee and shoulder disorders.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Outcome scores for knee (KOOS) and shoulder (DASH) |  | six weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NRS-11 pain scores |  | 6 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Rehabilitation, eRehab, Physical Therapy, e-Health, Telemedicine, Telerehabilitation, Patient-Centered