Video-Assisted Hand Therapy After Surgery for Thumb Arthritis Is “Efficient and Effective”

According to a clinical trial published in The Journal of Bone & Joint Surgery, the use of online video instruction for postoperative hand therapy is associated with outcomes similar to in-person therapy visits, while substantially reducing travel time and distance, among patients undergoing carpometacarpal (CMC) joint surgery for treatment of thumb osteoarthritis.

Video-administered hand therapy provides an “efficient and effective” alternative to in-person therapy after CMC arthroplasty, according to the new research from Virginia Tech Carilion School of Medicine and Carilion Clinic in Roanoke.

Potential Benefits of “Video-Only” Hand Therapy

Thumb CMC arthroplasty is a common surgical procedure for patients with painful osteoarthritis of the thumb. Although the benefits of hand therapy remain open to debate, most hand surgeons prescribe in-person therapy visits for patients who have undergone CMC arthroplasty.

“While supervised in-person therapy may help to enhance postoperative hand function for daily activities, it can be burdensome to complete, especially for patients in rural or remote areas,” the researchers write. Asynchronous, or “video-only,” physical therapy is being explored as an alternative to in-person visits in a wide range of medical settings, including other orthopaedic surgery procedures.

The researchers designed a randomized trial evaluating hand therapy visits in 58 patients undergoing CMC arthroplasty. One group was assigned to video-only therapy, consisting of online videos demonstrating hand therapy exercises to be performed at home. Patients in the control group received an average of 5 in-person visits with a hand therapist.

The two approaches yielded similar significant improvement, as measured with use of patient-reported ratings of hand function after 12 weeks. Objective measures of pinch strength and grip strength were also comparable between groups. All outcomes remained similar at one-year postoperatively.

A “More Patient-Driven Approach” to Hand Rehab

A geospatial analysis suggested that video-only therapy reduced travel distance by an average of 278 miles and travel time by 5 hours – even more for patients living in sparsely populated areas. On a nationwide basis, switching from in-person visits to video-only hand therapy could save over 7 million miles of patient travel per year, the researchers estimated.

Patients were enthusiastic about video-only hand therapy, with 6 potential participants dropping out of the study on learning that they had been assigned to the in-person control group. Two patients initially assigned to the video intervention were switched to in-person visits.

The authors acknowledge some study limitations, including a lack of data on whether or how patients used the videos. The researchers also note the potential for selection bias, as the study excluded patients who lacked home internet access or were not comfortable using the video technology.

“This trial yields evidence that a more patient-driven approach with provision of videos is an acceptable alternative to traditional in-person therapy after thumb CMC arthroplasty and has the added benefit of reducing the potential travel burden for patients,” the researchers concluded.

They added that video-only therapy may offer “an efficient and effective method of delivering education and care with flexible scheduling and self-pacing.”


Barrett PC, Hackley DT, Yu-Shan AA, et al. Provision of a home-based video-assisted therapy program is noninferior to in-person hand therapy after thumb carpometacarpal arthroplasty. J Bone Joint Surg Am. 2024 Apr 17;106(8):674-680. doi: 10.2106/JBJS.23.00597. Epub 2024 Apr 12.

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