Web-Based,Self-Directed Physical Therapy After Total Hip Arthroplasty Is Safe and Effective for Most,but Not All,Patients

Background

Recent data suggested that unsupervised, self-directed physical therapy (SDPT) is both safe and efficacious for patients undergoing total hip arthroplasty (THA) and that formal outpatient physical therapy (OPPT) may not be routinely required. The purpose of this study was to evaluate the routine use of an SDPT program in a nonselect patient population.

Methods

This is a multi-surgeon, single-institution, retrospective study of 941 consecutive patients discharged home, from January 2016 to December 2016, after primary, unilateral THA and enrolled in a web-based SDPT program. Patients were seen 4 weeks after surgery and OPPT was prescribed for perceived need, patient request, or if unable to use the web-based program. Patient-reported outcomes, medical comorbidities, and assessment of home environment were prospectively recorded.

Results

Overall, 646 of 941 patients (68.7%) were not prescribed OPPT (SDPT-only group) while 295 of 941 patients (31.3%) were prescribed OPPT (SDPT + OPPT group). In the SDPT + OPPT group, 88.2% were for perceived need, 10.8% for patient request, and 1.0% due to inability to use the web-based platform. Multivariate analysis identified male sex (odds ratio, 0.64; 0.45-0.90; P = .012) and a higher preoperative Short Form-12 physical component (odds ratio, 0.98; 0.96-0.99; P = .036) as independent variables protective against requiring OPPT. At a minimum 6-month follow-up, the SDPT-only group had statistically higher hip disability and osteoarthritis outcome score junior compared to the SDPT + OPPT cohort (85.0 vs 80.9; P = .012).

Conclusion

Web-based SDPT is safe and effective for most, but not all, patients eligible for home discharge after THA. It is critical to preserve OPPT services for the one-third of patients who require them.

Level of Evidence

Level III.