Clinician-Controlled Teletherapy: A New Way to Increase Patient Engagement for Knee Surgery Rehabilitation 

With approximately 790,000 procedures annually, knee replacement surgeries, or total knee arthroplasties (TKAs), are among the most common orthopedical procedures done in the US. These interventions are poised to increase exponentially, reaching a staggering 3.48 million per year by 2030.  

As TKAs become more prevalent, so does the demand for physical therapy. After all, surgery patients need professional guidance in performing movements to restore mobility and alleviate pain. Unfortunately, conventional face-to-face physical therapy encounters certain limitations that hinder its effectiveness. These include the ability for patients to routinely attend in-person therapy, thus the challenges of keeping patients engaged with the process and preventing them from dropping out.  

Clinician-controlled teletherapy, which aims to make physical therapy accessible from the comfort of the patients’ homes, addresses many of the factors that cause patients to drop out from standard physical therapy. In other words, the widespread adoption of clinician-controlled teletherapy should result in a greater number of TKA patients consistently receiving professional care, ultimately leading to a healthier and more mobile population.  

Attrition in physical therapy  

Heidi Jannenga, president and co-founder of WebPT, claims that 20% of patients drop out within the first three visits, and 70% do not complete their full treatment. This claim is in line with academic research; according to a 2022 study, 44% of TKA patients halted physical therapy 90 days after operation. A 2021 study shows that 30% of TKA patients fail to consistently follow up with a healthcare practitioner.  

Patients have a multitude of reasons as to why they find it challenging to remain engaged in their treatment:  

• Lack of motivation: In the absence of guidance and verbal encouragement from their physical therapist, TKA patients are prone to losing motivation during home workouts. In fact, 69.8% of TKA patients have acknowledged that they do not adhere to the prescribed mobility regimen. 
• Financial costs: Physical therapy for TKA can be expensive for many. On average, TKA patients can expect to pay $8,930 in physical therapy costs within the first year of their surgery. 
• Accessibility issues: Physical therapist services tend to be concentrated urban areas. As a result, TKA patients residing in non-urban areas are 28% less likely to utilize physical therapy compared to their urban counterparts.  
• Transportation challenges: It is routine for TKA patients to be unable to drive for at least two weeks following surgery. This restriction can make it difficult to attend in-person physical therapy sessions, particularly for those who lack reliable transportation support.

As long as these concerns persist, attrition rates are likely to remain significant – even as the need for physical therapy rises in the coming years. To render physical therapy more engaging to a broader spectrum of patients, a solution that tackles these root causes is needed.  

Using clinician-controlled teletherapy to keep TKA patients engaged 

Clinician-controlled teletherapy might just be the solution the field needs to maintain engagement among TKA patients during their rehabilitation process. By combining wearable or portable devices with AI, it empowers patients to conduct the bulk of their recovery at home. Machine learning capabilities provide adaptive feedback to patients’ movements, tracking key health metrics, while connectivity services enable virtual follow-ups with their physical therapist. 

The concept of “bringing the physical therapist home” resolves most of the factors contributing to attrition in traditional physical therapy, including those mentioned earlier:  

• Clinician-controlled teletherapy is stimulating: Thanks to the ease with which TKA patients can connect with their healthcare provider, users of clinician-controlled teletherapy are 12% likelier to adhere to treatment interventions and mobility routines compared to users of traditional physical therapy.  
• Clinician-controlled teletherapy is affordable: In large part because teletherapy requires fewer clinical resources, it is on average $2,460 cheaper than traditional physical therapy 
• Clinician-controlled teletherapy works anywhere: As clinician-controlled teletherapy is virtual, TKA patients can connect with their provider team, including their orthopedic surgeon from the comfort of their homes, bypassing any logistical and accessibility challenges.  

Above all, clinician-controlled teletherapy maintains a high standard of care. The preponderance of research has shown that it is just as effective – if not more – than traditional physical therapy. For example, TKA patients using clinician-controlled teletherapy have demonstrated faster and more sustained motion improvements over those relying on traditional physical therapy. TKA patients also experience lower rehospitalization rates and shorter in-person visits with their physical therapists.  

Given its numerous incentives to keep patients engaged during their recovery process, clinician-controlled teletherapy deserves consideration as the primary rehabilitation solution for a population that will increasingly require assistance in healing from TKAs.  

The paradigm shift starts now 

As the number of Americans undergoing Total Knee Arthroplasty (TKA) continues to rise, the importance of a comprehensive and adaptable rehabilitation strategy becomes increasingly clear. While traditional physical therapy has been a cornerstone of patient recovery, some patients face challenges related to motivation, finances, and accessibility. In this evolving landscape, clinician-controlled teletherapy emerges as a complementary approach, addressing these challenges and potentially enhancing patient engagement. By integrating clinician-controlled teletherapy with established physical therapy protocols, we can work together to improve outcomes for TKA patients, ensuring they receive consistent and effective care throughout their recovery journey.