Physical Therapy Following Shoulder Arthroplasty: An Assessment of Telerehabilitation Versus In-Person Physical Therapy

Olivia C. O'Reilly; Maria Bozoghlian; Natalie Glass; Mike Shaffer; Jeffrey Fleming; James V. Nepola; Brendan M. Patterson

doi:10.1053/j.sart.2025.04.009

Introduction It is unclear whether supervised postoperative physical therapy (PT) is necessary after shoulder arthroplasty. The COVID-19 pandemic necessitated social distancing and limitation of non-essential exposure to healthcare, bringing remote health care, or “telehealth,” to the forefront. Telerehabilitation provides alternative PT that confers more flexible participation and limits extraneous travel and exposure. We hypothesize video-based interactive telehealth PT after anatomic (TSA) and reverse shoulder arthroplasty (RSA) demonstrate similar improvement in shoulder range of motion (ROM) and patient-reported outcome measures (PROMs) compared to conventional PT. Materials and Methods This was a single-center prospective randomized controlled trial. All patients indicated for primary shoulder arthroplasty were screened for enrollment. Participants were randomized to in-person PT (control) or telerehabilitation postoperatively. Demographic information was collected. Outcome measures included American Shoulder and Elbow Surgeons (ASES),VAS pain, and PROMIS Pain Interference scores. Shoulder range of motion including forward elevation (FE), abduction, internal and external rotation (IR, ER) was measured. Outcome measures were collected preoperatively and at postoperative visits at 2 and 6 weeks, 3 and 6 months, and 1 year. Results Eighty-one patients were randomized and 70 had postoperative outcome data available. Between intervention groups, there were no significant differences in baseline characteristics, preoperative PROMs or ROM (p > 0.05). Overall, more participants underwent RSA (62.7%). TSA and RSA patients tended to improve in a parallel fashion to each other over time with a relative plateau after 6 months. Both telerehabilitation and in-person PT cohorts followed a similar pattern of improvement in PROMs and ROM outcomes up to 1-year postoperatively, with no statistically-significant differences between groups. In patients who underwent TSA or RSA, there were no statistically significant differences in postoperative PROMs or ROM, regardless of therapy modality. Conclusion Postoperative results suggest nearly parallel increases in PROMs and shoulder ROM, both during and after physical therapy. There were no statistically significant differences in PROMs and ROM outcomes between telerehabilitation and in-person therapy one year postoperatively, irrespective of surgical intervention. Telerehabilitation after shoulder arthroplasty may offer similar outcomes with the benefit of instruction and oversight from a therapist within the patient’s home. Policy change to allow insurance coverage of telerehabilitation should be considered given its viability as a rehabilitation strategy.

Physical Therapy Following Shoulder Arthroplasty: An Assessment of Telerehabilitation Versus In-Person Physical Therapy

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