I selected this study from the July 15, 2015 Journal because it highlights where we need to be headed with innovation for musculoskeletal care. Health care budget pressures and patient satisfaction measurements are pushing us to develop cost-effective care that also offers greater patient convenience.
Dr. Helene Moffet and her colleagues conducted a well-designed, randomized controlled trial, and they found that in-home telerehabilitation was “noninferior” to face-to-face delivery of home-rehab services among more than 200 post-TKA patients. These are important findings, but I surmise that only patients who preferred care in the home and/or were equipped to manage the requisite technology agreed to be randomized. In fact, as Dr. Mark Spangehl observed in his accompanying Commentary, more than one-third of patients assessed for eligibility declined to participate in the study. “Patients who are less motivated or less computer savvy or are technologically adverse may not be able to navigate this type of system,” Dr. Spangehl wrote. Other patients will simply require the human touch to motivate them to work on strength, gait, and range of motion.
So, in addition to developing innovations like this that lower the total cost of care while maintaining or improving its quality, we need to conduct research that will identify the patients who will do well with innovation and those who will do better with more traditional care. Today, this two-pronged type of systems-innovation research is essential for patients and health systems worldwide.
Marc Swiontkowski, MD