Cited by 169Telemedicine and Telehealth ImplementationTotal Knee Arthroplasty OutcomesHealth Systems, Economic Evaluations, Quality of Life

Cost Analysis of In-Home Telerehabilitation for Post-Knee Arthroplasty

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Tousignant, Michel, Moffet, Hélène, Nadeau, Sylvie, Mérette, Chantal, Boissy, Patrick, Corriveau, Hélène, Marquis, François, Cabana, François +3 more·2015·Journal of Medical Internet Research

Abstract

BACKGROUND: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation. OBJECTIVE: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits. METHODS: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student's t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs). RESULTS: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient's home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $90<$152, P<.001). CONCLUSIONS: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient's home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient's home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic. TRIAL REGISTRATION: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4).

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  • Face-to-face home-based rehabilitation remains impersonal and a cost burden to both clinicians and patients.

    “Although face-to-face home-based rehabilitation provides individualized services via physical consults from the rehabilitation team, it remains impersonal and a cost burden to both clinicians and patients [4].”

    From High-Tech Home-Based Rehabilitation after Stroke: A Systematic Review and Meta-Analysis (2023) · cites this paper as [4]

    The Discussion’s Principal Findings describe clinician travel time and distance-dependent costs for home visits, supporting a qualified cost concern. The paper does not describe face-to-face visits as impersonal or establish a cost burden for patients; it also says home-visit costs were not higher overall. Our copy provides section labels but no page numbers. (LLM, conf=0.87)

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  1. [1]World Report on Disability 2011 2015-03-06 Geneva, Switzerland WHO Press, World Health Organization http://www.unicef.org/protection/World_report_on_disability_eng.pdf 26131540

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Authors
Tousignant, M., Moffet, H., Nadeau, S., Mérette, C., Boissy, P., Corriveau, H., Marquis, F., Cabana, F., Ranger, P., Belzile, É. L., & Dimentberg, R.
Affiliations
  • Université de Sherbrooke (CA)
  • Université Laval (CA)
  • Centre for Interdisciplinary Research in Rehabilitation (CA)
  • Institut Universitaire en Santé Mentale de Québec (CA)
  • Centre hospitalier universitaire de Québec (CA)
  • St Mary's Hospital Centre (CA)
Corresponding author
Tousignant, Michel
Venue
Journal of Medical Internet Research
Published
2015-03-31
Volume
17
Issue
3
Pages
e83
ISSN
1438-8871 (ISSN-L)
OpenAlex
W2124216067
Cited by
169
References
10
Citations by year
2026: 5 · 2025: 15 · 2024: 12 · 2023: 22 · 2022: 18 · 2021: 34 · 2020: 21 · 2019: 11 · 2018: 5 · 2017: 12 · 2016: 10 · 2015: 4
FWCI
11.08
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
total knee arthroplasty, postoperative rehabilitation, home-visit rehabilitation, videoconferencing, supervised physiotherapy, cost analysis, service delivery methods, continuity of care, telemedicine, Canada, health care costs, patient-reported outcomes
MeSH terms
Aged, Costs and Cost Analysis, Female, Humans, Male, Middle Aged, Telemedicine, Arthroplasty, Replacement, Knee, Internet

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