Telehealth program for the rehabilitation of post-chikungunya joint sequelae
Keywords:
chikungunya virus; health services accessibility; mobile applications; physical and rehabilitation medicine; telemedicineAbstract
Introduction: persistent arthralgia in individuals infected with chikungunya, which may last for years, constitutes a public health problem of increasing magnitude.
Objective: to evaluate the clinical effectiveness and the technical and operational feasibility of a telehealth-based rehabilitation program for patients with post-chikungunya joint sequelae, as well as its efficiency in resource utilization.
Methods: a pragmatic clinical trial was carried out involving 150 patients from three polyclinics in the province of Sancti Spíritus who met the inclusion criteria (confirmed diagnosis of chikungunya with persistent arthralgia lasting more than 3 months). Participants were randomly assigned to three groups: telehealth (n = 50), face-to-face rehabilitation (n=50), and a waiting-list control group (n=50). The eight-week program included guided synchronous sessions, a mobile application with personalized exercises, remote adherence monitoring, and virtual consultations. The primary outcome variables were pain intensity (VAS) and functional capacity (HAQ); secondary outcomes included quality of life (SF-36), patient satisfaction, adherence (completion rate), usability (System Usability Scale), and an analysis of resource utilization in Relative Cost Units (RCUs).
Results: significant improvements were found in both intervention groups compared with the control group in terms of pain (VAS: −3.8 ± 1.2 in the telehealth group vs. −3.5 ± 1.4 in the face-to-face group vs. −1.1 ± 0.9 in the control group; p < 0.001), functionality (HAQ: −0.9 ± 0.3 vs. −0.8 ± 0.4 vs. −0.3 ± 0.2; p < 0.01), and quality of life (SF-36 physical component: +12.5 ± 4.1 vs. +11.8 ± 3.9 vs. +3.2 ± 2.1; p < 0.001). No significant differences were observed between the intervention groups. Resource utilization analysis showed a 78.50 % reduction in Relative Cost Units (RCUs) in the telehealth group.
Conclusions: the telehealth program constitutes an effective, feasible, and resource-efficient alternative for post-chikungunya rehabilitation in the Cuban context, particularly valuable for extending coverage to hard-to-reach areas.
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