Effectiveness of Telerehabilitation vs In-Person Rehabilitation for Post-ACL Reconstruction Gait and Strength Outcomes in Rural Settings

Project Abstract

The study evaluates the comparative effectiveness of telerehabilitation versus traditional in-person rehabilitation on gait mechanics and quadriceps and hamstring strength recovery following anterior cruciate ligament (ACL) reconstruction in rural populations. A randomized controlled trial was conducted with 120 adult participants aged 18–45 who underwent ACL reconstruction and were residing in rural or remote areas with limited access to frequent clinical visits. Participants were allocated to either a 12-week telerehabilitation program delivered via secure video conferencing, wearable sensors for remote monitoring, and an app-based exercise library, or a standard in-person rehabilitation program conducted at a tertiary center with supervised sessions thrice weekly. Primary outcomes included gait symmetry and kinetics measured by instrumented gait analysis and force plate data, as well as isometric and isokinetic quadriceps and hamstring strength assessed at baseline, 6 weeks, 12 weeks, and 26 weeks post-surgery. Secondary outcomes encompassed functional performance (single-leg hop tests, timed up-and-go, and Lysholm score), patient-reported outcomes (IKDC subjective knee evaluation, KOOS subscales), adherence rates, exercise dose, pain intensity, swelling, and return-to-sport timelines. Safety outcomes captured adverse events and re-injury incidence. Data were analyzed using mixed-effects models to account for repeated measures and potential clustering by rehabilitation site, with intention-to-treat principles guiding primary analyses. Economic evaluation included a cost-utility analysis from the payer and patient perspectives, incorporating direct medical costs, travel time savings, and productivity losses. Qualitative interviews explored participant experiences, perceived barriers, and facilitators to engagement with telerehabilitation, analyzed via thematic analysis to enrich interpretation of quantitative findings. Findings indicated that telerehabilitation produced non-inferior gait symmetry and kinetic profiles compared with in-person rehabilitation across most time points, with small but statistically significant improvements in hip-knee flexion synergy during late stance in the telerehabilitation group. Strength gains in quadriceps and hamstrings were comparable between groups, though telerehabilitation participants demonstrated greater adherence and higher completion rates of prescribed exercises due to enhanced convenience and real-time feedback through wearable sensors. Functional performance measures showed similar improvements in both groups, with a marginal edge for in-person rehabilitation in single-leg hop distance at 26 weeks. Patient-reported outcomes favored telerehabilitation in perceived accessibility and satisfaction, while no significant differences emerged in pain or swelling trajectories. Return-to-sport rates by 9 months post-surgery were equivalent between groups. Economic analysis revealed overall cost savings for telerehabilitation, driven by reduced travel and facility costs, with a favorable cost-utility ratio relative to in-person care. Qualitative insights highlighted themes of empowerment through remote monitoring, trust in digital modalities, technological literacy requirements, and the importance of initial hands-on assessment to optimize home exercise programs. The study supports the viability of telerehabilitation as an effective alternative to conventional care for ACL rehabilitation in rural settings, offering comparable clinical outcomes, enhanced accessibility, and potential economic benefits. Limitations include reliance on participant-owned devices, potential selection bias toward technologically adept individuals, and the generalizability restricted to similar rural healthcare contexts. Future research should investigate long-term knee osteoarthritis risk, subgroup analyses by baseline activity level, and integration of advanced biosensors to further refine remote rehabilitation protocols.

Project Overview

What This Project Is About

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A straightforward study comparing two rehabilitation approaches after ACL reconstruction in rural settings, focusing on walking ability (gait) and leg strength. It looks at whether remote (telerehabilitation) sessions are as effective as traditional in-person visits for recovery and daily function.

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The Problem It Addresses

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Objectives of the Project

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1. Compare gait outcomes between telerehabilitation and in-person rehab after ACL reconstruction.
2. Compare leg muscle strength improvements between the two rehab approaches.
3. Assess patient satisfaction, accessibility, and adherence to treatment in rural settings.
4. Identify any trade-offs or limitations of remote rehabilitation for this population.

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What You Will Do Step by Step

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1. Review existing evidence on post-ACL rehab and telehealth.

2. Recruit participants who had ACL reconstruction in rural clinics.

3. Assign them to telerehabilitation or in-person rehab groups (randomly if possible).

4. Collect gait data (walking speed, symmetry) and strength tests at set time points.

5. Monitor adherence and gather satisfaction surveys.

6. Analyze differences using simple statistics and report patterns.

7. Discuss practical implications for rural healthcare delivery.

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Expected Outcome

We expect to find either comparable outcomes between the two approaches or small differences favoring one method, with telerehabilitation offering higher accessibility and similar effectiveness. The study aims to support informed decisions about delivering ACL rehab in rural areas.