Disclosures: Andrea Cheville, MD, MSCE, FAAPMR: No financial relationships or conflicts of interest  

Objective: Functional losses among patients with advanced stage cancers degrade quality of life (QoL) and increase health care utilization. To determine whether collaborative tele-rehabilitation improved patient-centered outcomes and reduced costs.

Design: Three-arm, multi-site, randomized controlled trial.

Setting: Three geographically dispersed medical centers within a single health care system.

Participants: 516 low-level community or household ambulators with Stage IIIC or IV solid or hematologic malignancies.

Interventions: Participants were randomly assigned to: 1) control, 2) tele-rehabilitation, and 3) tele-rehabilitation + pharmacological pain management. Arms 2 and 3 received 6 months of centralized tele-rehabilitation provided by a physical therapist-physiatrist team. Arm 3 received nurse-coordinated pain management.

Main Outcome Measures: Blinded assessment at baseline and months 3 and 6 for function (Activity Measure for Post Acute Care [AM-PAC]), pain interference and average intensity (BPI), and QoL (EQ-5D-3L); hospitalizations and discharges to post-acute care facilities; estimated and actual costs.

Results: Compared with Arm 1, Arm 2 had improved function (1.3; 95% confidence interval [CI] 0.08 to 2.35; P=.03) and QoL (0.04; 95% CI 0.004 to 0.07; P=.01), while both tele-rehabilitation Arm 2 and 3 groups had reduced pain interference (respectively, -0.4; 95% CI -0.78 to -0.09; P=.01, and -0.4; 95% CI -0.79 to -0.10; P=.01), and average intensity (respectively, -0.4; 95% CI -0.78 to -0.07; P=.02, and -0.5; 95% CI -0.84 to -0.11; P=.006). Tele-rehabilitation was associated with higher odds of home discharge in Arms 2 (OR 4.3; 95% CI 1.3 to 14.3; P=.02) and 3 (OR 3.8; 95% CI 1.1 to 12.4; P=.03) and shorter hospitalizations in Arm 2 (difference -3.9 days; 95% CI -2.4 to -4.6; P=.01). Arm 2 had an incremental cost-effectiveness ratio of $15,494/QALY. Total costs were significantly lower in both Arm 2 and Arm 3 (P = .048).

Conclusions: Collaborative tele-rehabilitation improved function, QoL, and pain; decreased hospital lengths of stay and use of post-acute care; and was highly cost-effective.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/effectiveness-and-cost-effectiveness-of-collaborative-tele-rehabilitation-among-patients-with-advanced-stage-cancer-a-randomized-controlled-trial/