Abstract
<jats:p>INTRODUCTION. Interruption of the recovery process and lack of exercise or activities at home after discharge from a medical facility lead to a loss of the results achieved at various stages of medical rehabilitation (MR). In this regard, remote rehabilitation care is becoming particularly important. Issues related to the effectiveness and safety of remote rehabilitation remain insufficiently studied. AIM. To assess the effectiveness and safety of remote physical rehabilitation (RPR) for patients who have undergone hip or knee replacement surgery and to study patients' adherence to remote medical rehabilitation. MATERIALS AND METHODS. The trial included 150 patients aged 30 to 75 years who underwent HR or KR. The trial participants were assigned to groups in a 1 : 1 ratio for RPR in addition to routine clinical practice of providing MR (RPR group) or conducting only routine MR (comparison group). The patients in the comparison group were instructed to perform physical exercises independently at home on a daily basis. Routine MR included lifestyle modification and non-steroidal anti-inflammatory drugs when pain syndrome developed. The effectiveness and safety of rehabilitation measures were assessed using the data from the clinical and anamnestic examination, the 10-point visual-analog scale (VAS) of pain, the Timed Up and Go (TUG) test and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for assessing osteoarthritis of the knee and/or hip joint. RESULTS. 75 subjects were randomized to the remote physical rehabilitation group (57.2 ± 11.3 years) and 75 — to the comparison group (57.4 ± 9.0 years). Participation in the trial was completed by 56 patients from the RPR group and 63 patients in the comparison group. Comparing the results of rehabilitation between the groups 1 month after the inclusion of participants in the trial, a more pronounced statistically significant improvement in the patient's functional profile was found in the Timed Up and Go (TUG) test (р 0.001) and WOMAC (p 0.0001) in the RPR group. The most significant predictors of premature discontinuation of RPR were older age (χ2 = 18.922; p 0.001), education level ≤ 12 years (χ2 = 18.568; p 0.001), being a pensioner (χ2 = 26.901; p 0.001) and living in a rural area (χ2 = 33.629; p 0.001). The analysis of adverse events showed that 25 patients in the RPR group and 23 in the comparison group had a periodic increase in pain syndrome in the operated limb. DISCUSSION. The RPR model that has been developed involves the provision of personalized exercise programmes in the form of video clips, as well as the ability to monitor the patient's condition online. The findings indicated that remote physical rehabilitation for patients who have undergone arthroplasty of the large joints of the lower extremities is both safe and effective in terms of restoring functional mobility, reducing the risk of falls and the severity of pain syndrome, and increasing adherence to physical exercise. The primary constraints on the practical implementation of RPR pertain to the availability of high-speed Internet and skills in using Internet portals. CONCLUSION. RPR of patients who have undergone HR or KR is safe and effective in improving the functional profile and reducing the severity of pain syndrome.</jats:p>