Study: Virtual physical therapy could significantly reduce postsurgical costs 

Researchers at Duke piloted a virtual system for physical therapy and saw significant savings in postsurgical costs. (Courtesy of Reflexion Health)

Physical therapy is a crucial part of recovery after orthopedic surgery, and a new study suggests that patients may do just as well meeting with a virtual therapist. 

Researchers at Duke Clinical Research Institute piloted a digital physical therapist tool with 143 patients who underwent total knee replacement at four different providers. A control group of 144 patients were prescribed traditional physical therapy. 

The virtual therapist, named VERA (or Virtual Exercise Rehabilitation Assistant) and developed by Reflexion Health, guides patients through exercises prescribed by a physical therapist. The tech also monitors patients’ performance in those exercises, allowing clinicians to tailor the recovery plan to their needs. 


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Janet Bettger, Ph.D., associate professor with the Duke Department of Orthopedic Surgery and the study’s lead author, told FierceHealthcare that the tech feels like “standing in front of a mirror” and following a virtual reflection. The physical therapist receives the data on each patient’s progress and then checks in at least weekly to discuss progress and make any adjustments, Bettger said. 

“In this particular program, the therapists were able to monitor every component of what they prescribed, and that’s a big difference from usual care,” she said. 

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In the early pilot, the program shows promising results, according to the study. The researchers found an average cost savings of $2,745 per patient treated using VERA, and safety and quality metrics were on par between the two approaches. Outcomes and costs were measured three months after the procedure, according to the study. 

Bettger said the patient experience was also positive. Pilot participants who underwent a second knee replacement requested physical therapy through VERA on their second surgery, she said. 

Patients “felt empowered and built from it,” Bettger said. “We had a really high retention rate in this study, and that’s a really positive thing.” 

Another positive for patients in the study, she said, was VERA’s impact on pain management after surgery. New tech like virtual reality shows promise as alternative pain therapy, especially as policymakers and providers address the opioid addiction crisis

Bettger said that both groups of patients in the study scored similarly in pain management, and she said that finding is important to demonstrating that virtual reality programs like VERA can provide a safe and effective alternative to drugs for postsurgical pain. 

RELATED: Industry Voices—What the Super Bowl taught me about balancing in-person care with digital tools 

Joseph Smith, M.D., Ph.D., CEO of Reflexion Health, said that new technology solutions like VERA play directly into the industry’s goal of transition to more value-based care models. New platforms can help patients meet their goals, such as receiving treatment in the home, while still saving money and providing quality outcomes. 

This can pay off for patients in the form of time savings, he said, and for providers could offer a gateway to value-based payments.

“There are rather significant cost savings, but it's also saving them the hassle and cost logistics of getting back and forth,” Smith said. “We’re also cognizant of the fact that CMS started the new sequence of bundled payments, and this plays right into that.” 

The Duke researchers are planning to present more granular findings on the VERA pilot at the American Association of Hip and Knee Surgeons annual meeting in early November.

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