Duke study to evaluate use of virtual assistant in rehabilitation for total knee replacement

By Heather Mack
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A new study by researchers at the Duke Clinical Research Institute is evaluating the use of a virtual physical therapy program for people recovering from total knee replacement surgery. The study, entitled Virtual Exercise Rehabilitation In-Home Therapy: A Research Study (VERITAS), is using an in-home, on demand virtual rehabilitative therapy program called Vera from San Diego-based digital healthcare company Reflexion Health.

The study, which is now enrolling patients and will be carried out at six different sites in the US with about 300 participants, will look at how Vera compares to traditional in-home or clinic-based physical therapy. Vera, which is FDA-cleared, acts as a virtual assistant: it guides users through their prescribed physical therapy exercises and uses 3D monitors to measure and record each patient’s performance. It gives patients feedback in real-time, and the session is recorded, analyzed and presented on a dashboard the physician can review. This way, patients who need additional, in-person services can be quickly identified.

Dr. Janet Prvu Bettger, associate professor with the Duke Department of Orthopedic Surgery and principle investigator of the study, said since physical therapy is a critical component of care for patients following total knee replacement surgery, it’s important to identify best practices for recovery at a time where value-based care is the goal. Currently, the Center for Disease Control puts the average Medicare expenditure for the surgery, hospitalization and recovery in the range of $16,500 to $33,000.

“Digital health technology, including virtual and telehealth options, may increase access, improve quality, and lower healthcare costs,” Bettger said in a statement. “Extending the reach of physical therapists into the home using a digital healthcare platform like Vera can provide remote guidance and supervision for a home-based therapy program; however, implementation in the US has not been widely evaluated until now.”

Total knee replacements are the most frequently performed surgeries in the United States, and the CDC counts some 700,000 as being done each year. That number is expected to climb to over three million by 2030, the agency says, citing an increase of the procedure among younger adults due to knee osteoporosis, an aging population that stays in the workforce longer, and the shift to value-based care.

The study, which was designed based on pilots Reflexion has previously run at hospitals and clinics, will include 150 adults who will use Vera both pre- and post-surgery and compare them with 150 adults who receive traditional in-home or clinic-based therapy at the six different sites. Three months after surgery, the researchers will look at clinical outcomes, health service use and costs.

“With Veritas, we are eager to confirm what we’ve already seen demonstrated with hospitals and pilot studies,” Reflexion Health CEO Dr. Joseph Smith said in a statement. “Vera is a cost-effective, scalable and effective option for improving compliance and recovery in home-based physical therapy following total knee replacement surgery. Vera embodies our commitment to delivering solutions that improve the patient experience by saving time, travel and costs for both patients and the healthcare system.”