Can telerehabilitation for frail aged community dwelling patients following femoral or pelvic fracture achieve equivalent functional outcomes as traditional care?

Introduction: Despite growing evidence of the effectiveness of telerehabilitation (TR) for patients with a wide range of conditions, and the need for improved access by frail aged patients to rehabilitation following hip and pelvic fractures,
there is limited evidence of the provision of TR to this demographic. The aim of the study was to ascertain whether TR delivered within a home rehabilitation
service (HRS) can achieve equivalent functional outcomes to traditional rehabilitation.
Methods: Between January and November 2017, all community dwelling patients admitted to HRS at a metropolitan hospital in Adelaide (Australia) following femoral or pelvic fracture were offered TR. Using iPad technology, multidisciplinary rehabilitation was delivered via videoconferencing and therapeutic apps, as an alternative or in addition to usual care. Outcomes measures included Functional Independence Measure (FIM), Timed Up and Go (TUG) and length of stay (LOS). The number of therapy sessions and adverse events were also reported. We compared functional levels at admission and discharge between those who received TR (group 1) with a matched historical group (group 2) who received HRS prior to the introduction of TR.
Results: FIM scores for group 1 were significantly lower (p=.012) at admission. However, a significantly higher change in FIM in group 1 (p=.028) resulted to similar FIM scores at discharge (p=.0128) despite a shorter LOS in this group (p=.000). There was no significant difference in discharge TUG scores (p=.472) between the groups. There was no significant difference between the two
groups in the number of received therapy sessions per day when adjusted for LOS (group 1 1.43±0.55 vs group 2 1.26±0.60). There were no falls in group 1.
Conclusion: Frail elderly with fractured hip or pelvis admitted to HRS and receiving TR achieve equivalent functional outcomes to the historical group receiving usual care.