Effects and patients' experiences of interactive video-based physiotherapy at home after shoulder joint replacement

Abstract: Physiotherapy is essential to optimize the results of shoulder joint replacement, but requires a close monitoring and co-operation between patient and physiotherapist. The development of telerehabilitation brings opportunities for distance-spanning and home-based physiotherapy interventions. The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement. A series of 22 patients underwent shoulder joint replacement and initial physiotherapy at the hospital. After discharge, 12 patients were referred to conventional out-patient physiotherapy (control), while 10 patients participated in a telerehabilitation intervention in the form of interactive video-based physiotherapy at home. Shoulder function, activity limitations and health-related quality of life were assessed before surgery and two months after surgery. The experiences of participating in the telerehabilitation were described using open interviews and qualitative content analysis. Two months post surgery, members of the telerehabilitation group had participated in more physiotherapy sessions (p<.001) and showed significantly better recovery regarding shoulder pain (p<.001), shoulder joint external rotation (p=.002), shoulder function and activity limitations (p<.001) and in two dimensions of health-related quality of life (p=.004 and p=.001) compared to the control group. All telerehabilitation group participants expressed that they were satisfied with the rehabilitation and that they had experienced technique and exercise as safe. In the interviews seven categories of the participants' experiences were revealed: An odd reinforced communication;  Pain-free exercising as an effective routine; The home as an exercising arena; Closeness at a distance; From a dependent patient to a strengthened person; Facilitated daily living; Continuous rehabilitation process. The identified theme was: Achieving prerequisites for recovery competence. In conclusion, interactive video-based physiotherapy at home after shoulder joint replacement was experienced positively by the participating patients and seemed more effective than conventional post-discharge rehabilitation procedures concerning short-time recovery. This could be explained by the fact that the telerehabilitation group participated in more patient-physiotherapy sessions compared to the control group, but the interviews also indicate that the modality might have promoted continuity and patient participation and competence.