Telerehabilitation Following Total Hip Replacement (THR)

This RCT will compare traditional face to face rehabilitation to a telerehabilitation program. The study will comprise approximately 70 THR patients randomly assigned to a face-to-face group or telerehabilitation group. The telerehabilitation protocol will involve a program similar in timing and content to the face-to-face rehabilitation program, except delivery will be directly into the homes of the participant via telerehabilitation technology on an iPad. The application used to deliver this rehabilitation is ‘Wellpepper Clinic’ by Wellpepper, Inc. Wellpepper is an application enabling healthcare professionals to create exercise programs that patients follow on a tablet device. The application provides notifications to complete the exercises, pre-recorded videos and instructions of their exercises and also enables the patient to record pain levels and difficulty at the conclusion of the exercise. Patients can contact their health care provider through a messaging system built in to the application. The healthcare professional has a ‘clinic’ version of Wellpepper installed on a tablet that enables them to review and adjust exercises and communicate with all patients under their care. On discharge from hospital, participants randomised to the telerehabilitation group will either be provided an iPad with Wellpepper installed or if owning an iPad, have Wellpepper installed by a member of the research team prior to their discharge. They will undergo a single one to one twenty minute training session in the use of the Wellpepper application and eHAB system on iPads. Telerehabilitation participants will have videos and instructions installed on to their Wellpepper application targeting strengthening exercises for quadriceps, hip abductors, extensors and flexors. They will receive three notifications per day via the Wellpepper application reminding them to perform their home exercise program (HEP). Participants will be expected to perform their HEP each time they receive a notification. Each HEP session will take approximately 20 minutes to complete. At the conclusion of each exercise they will be prompted by the application to record how much pain they experienced during the exercise and how difficult they found the exercise. Once recorded, this information becomes immediately available to the physiotherapist. A physiotherapist will review the Wellpepper clinic application weekly to review participant’s progress, adjust exercises as required and respond to any communication via the messaging system. Patients who have not accessed the application and recorded exercises in Wellpepper over 3 consecutive days will be contacted via telephone to discuss their progress. At two weeks following hospital discharge, participants will receive a thirty minute physiotherapy session via real time video-conferencing using the eHAB system. This session will enable analysis and advice regarding gait retraining and exercise progression. Following this session participants will continue to use the Wellpepper application to facilitate them performing their HEP for approximately twenty minutes, three times per day until six weeks post-operatively.