Impact of Tele-rehabilitation on Post-CIPPT Recovery in a National Hospital System

Thesis Abstract

Tele-rehabilitation has emerged as a scalable alternative to in-person postoperative care for CIPPT recovery, yet evidence on its effectiveness within national hospital systems remains fragmented and context-dependent. This study addresses the problem of variable post-CIPPT recovery outcomes and unequal access to rehabilitation services across geographic regions, aiming to determine whether structured tele-rehabilitation improves functional recovery, reduces complications, and enhances patient satisfaction compared with standard in-clinic care within a national hospital network. The objective is to evaluate (1) functional outcomes at 6 and 12 weeks post-CIPPT, (2) incidence of post-operative complications and re-hospitalizations within 90 days, (3) patient adherence to prescribed rehabilitation regimens, (4) patient-reported outcomes on quality of life and satisfaction, and (5) cost-effectiveness from the health system perspective. Guided by the Self-Efficacy Theory and the Technology Acceptance Model, the study hypothesizes that tele-rehabilitation will yield superior functional scores, equivalent or lower complication rates, higher adherence, and favorable cost-effectiveness relative to conventional care, moderated by patient digital literacy and perceived usefulness. A mixed-methods, multi-centre quasi-experimental design will be employed. The quantitative strand will involve a sample of 480 adults undergoing CIPPT across eight tertiary hospitals, randomized at the patient level to tele-rehabilitation (n=240) or usual care (n=240) for 12 weeks. Data collection will utilize validated instruments the Knee Society Function score or Constant-Mosiro scale for joint-specific function, the Timed Up and Go test, and the Western Ontario and McMaster Universities Osteoarthritis Index, complemented by the EQ-5D-5L for health-related quality of life. Adherence will be tracked via a connected rehabilitation platform recording session frequency, duration, and exercise completion. Complications and readmissions will be extracted from electronic medical records. Economic evaluation will encompass micro-costing of tele-rehabilitation delivery, including platform maintenance, clinician time, and hardware, with a cost-utility analysis using quality-adjusted life years (QALYs). The qualitative strand will include semi-structured interviews with a purposive subsample of 40 patients and 20 clinicians to explore experiences, barriers, facilitators, and perceived value, analyzed using thematic analysis. Quantitative data will be analyzed with intention-to-treat principles. Primary outcomes will be compared using analysis of covariance (ANCOVA) adjusting for baseline scores; repeated-measures ANOVA will assess trajectories over time. Multivariate regression will identify predictors of adherence and functional recovery. Mediation analysis will test whether adherence mediates the relationship between tele-rehabilitation and outcomes. The economic evaluation will report incremental cost-effectiveness ratios (ICERs) and conduct sensitivity analyses. Qualitative data will be coded and synthesized into themes aligning with the theoretical framework, with triangulation informing interpretation. Expected findings include statistically significant improvements in function at 12 weeks in the tele-rehabilitation group (mean difference exceeding the minimal clinically important difference), reduced 90-day readmission rates, and higher adherence levels. It is anticipated that tele-rehabilitation will be cost-effective at a willingness-to-pay threshold commonly used in national health technology assessments, particularly when patient travel avoidance and reduced facility utilization are considered. The study is expected to identify subgroups with enhanced benefit, such as patients with limited access to in-person services or higher baseline impairment, and to reveal pivotal factors influencing adoption, such as digital literacy and perceived ease of use. This research will contribute to knowledge by providing robust, multicentre evidence on the effectiveness and economic value of tele-rehabilitation for post-CIPPT recovery within a national hospital system, thereby informing policy, standardizing tele-rehabilitation protocols, and guiding resource allocation. Practical implications include recommendations for integration of tele-rehabilitation into postoperative pathways, clinician training curricula, and patient education strategies. The study concludes with guidance for scalable deployment, safeguards for data privacy, and future research directions on personalization of remote rehabilitation regimens.