Effectiveness of a telerehabilitation evidence-based tablet app for rehabilitation in traumatic bone and soft tissue injuries of the hand, wrist, and fingers

Abstract

Objective To assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. Design A multicenter assessor-blinded, parallel, 2-group controlled trial. Setting Trauma and rehabilitation services of 4 hospitals. Participants Six hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). Interventions The experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. Main Outcome Measures The primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). Results The experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=−1.64; 95% confidence interval, −2.64 to −0.65) and physiotherapy sessions (mean difference=−8.52, 95% confidence interval, −16.92 to −0.65) compared to the control group. Conclusions In patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients’ functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.