Adjunctive Hybrid Telerehabilitation Is Associated With Comparable Clinical Outcomes to In-Person Physical Therapy After Shoulder Arthroplasty and Arthroscopic Rotator Cuff Repair: A Cohort Study.

Abstract

We hypothesized that hybrid telerehabilitation, delivered as an adjunct to standard in-person physical therapy (PT), would demonstrate similar improvements in functional scores, pain, and range of motion (ROM) compared with traditional PT, while reducing PT utilization in patients undergoing shoulder arthroplasty and arthroscopic rotator cuff repair (RCR). This retrospective cohort study included 207 adults who underwent shoulder arthroplasty or arthroscopic RCR between 2021 and 2025. Historical controls receiving standard in-person postoperative PT alone (IP-PT; n = 134) were compared with patients receiving hybrid telerehabilitation with the Band Connect platform in addition to in-person postoperative PT (BC+IP-PT; n = 73). Primary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and active range of motion (ROM), assessed preoperatively and at 3 and 6 months postoperatively. Analyses were performed separately for arthroplasty and RCR cohorts using stabilized inverse probability of treatment weighting and generalized estimating equations with additional covariate adjustment for residual imbalance. Secondary outcomes included PT utilization, complications, and reoperations. The study included 85 patients in the arthroplasty cohort (33 BC+IP-PT, 52 IP-PT) and 122 patients in the RCR cohort (40 BC+IP-PT, 82 IP-PT). In both cohorts, changes in ASES score, VAS pain, forward flexion, external rotation, and internal rotation over 6 months were similar between groups (all FDR-p > 0.05). In the arthroplasty cohort, the hybrid group completed fewer weeks of PT (16 ± 6 vs 22 ± 9 weeks; FDR-p = 0.023), fewer in-clinic visits (19 ± 7 vs 24 ± 10; FDR-p = 0.026), and fewer missed appointments (0 ± 1 vs 1 ± 3; FDR-p = 0.030). In the RCR cohort, the hybrid group completed fewer weeks of PT (18 ± 6 vs 23 ± 7 weeks; FDR-p = 0.026) and fewer in-clinic visits (21 ± 8 vs 27 ± 10; FDR-p = 0.020), whereas missed appointments were similar between groups (FDR-p = 0.190). Complication and reoperation rates were similar in the arthroplasty (BC+IP-PT 9.1% vs IP-PT 11.5%, FDR-p = 1.000; BC+IP-PT 3.0% vs IP-PT 1.9%, FDR-p = 1.000) and RCR cohorts (BC+IP-PT 0.0% vs IP-PT 11.0%, FDR-p = 0.059; BC+IP-PT 0.0% vs IP-PT 2.4%, FDR-p = 1.000). Hybrid telerehabilitation following shoulder surgery was associated with comparable clinical outcomes, as well as fewer weeks of physical therapy and fewer in-clinic therapy sessions, supporting its use as an efficient adjunct to traditional postoperative rehabilitation. Level III; Retrospective Cohort Comparison; Treatment Study.