A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Bell, Kevin; Onyeukwu, Chukwudi; Smith, Clair; Oh, Adrianna; Dabbs, Annette DeVito; Piva, Sara R.; Popchak, Adam; Lynch, Andrew D.; Irrgang, James J.; McClincy, Michael P.

doi:10.3390/s20216118

Cited by 27 publications

(23 citation statements)

References 55 publications

(67 reference statements)

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“…Doiron-Cadrin et al [ 63 ] found high satisfaction and clinically meaningful within-group improvements in pain and function with a 12-week prehabilitation program using real-time videoconferencing, which were similar to those in people who received the 12-week prehabilitation program in person. Similar outcomes between digital and in-person PT interventions have also been reported in individuals after KR for video-based and inertial motion sensor–based digital health interventions [ 63 - 66 ]. However, some outcomes (physical activity, muscle strength, exercise behavior, climbing stairs, walking, and body pain) favored in-person PT at longer follow-up periods (2, 4, 12, or 18 months after the intervention) [ 65 , 52 ].…”

Section: Resultssupporting

confidence: 59%

“…In people with KOA, the benefits of digital health for exercise and physical activity interventions in people with KOA appear mixed. In contrast, in people with KR, many studies reported significant improvements in self-reported outcomes with digital exercise interventions that were similar to in-person treatments [ 63 - 66 ]. Although the different technologies used in these studies (eg, websites, telephone, mobile apps, videoconferencing, and multi-technology systems) were generally acceptable to people with KOA and KR, some participants who used telephone-based interventions stated the need for visual contact with their physical therapists [ 96 - 98 ].…”

Section: Discussionmentioning

confidence: 99%

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Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Shah¹,

Costello²,

Mehta³

et al. 2022

JMIR Rehabil Assist Technol

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Background With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR). Objective This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR. Methods In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included. Results Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively. Conclusions For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes.

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Section: Resultssupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Shah¹,

Costello²,

Mehta³

et al. 2022

JMIR Rehabil Assist Technol

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“…For chronic musculoskeletal spinal conditions, results were unambiguous and warrant further investigations [ 25 ]. Most studies in the field of orthopaedics investigated the efficacy of telemedicine in postoperative care [ 27 – 32 ]. In the field of trauma, the success of prevention programs was evaluated in two studies [ 33 , 34 ], pre-treatment optimisation in one study [ 35 ], and conservative treatment/outpatient care in four studies [ 36 – 39 ].…”

Section: Resultsmentioning

confidence: 99%

Telemedicine in orthopaedics and trauma surgery during the first year of COVID pandemic: a systematic review

Hofmann

Hildebrand

Mederake

et al. 2023

BMC Musculoskelet Disord

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Purpose Prior to the COVID-19 pandemic, telemedicine in orthopaedics and trauma surgery had mostly developed for joint arthroplasty, fracture management, and general pre- and postoperative care including teleradiology. With the corona-outbreak, telemedicine was applied on a broad scale to prevent assemblage and to guarantee access to medical care protecting critical areas. The purpose of the present study was to give an overview of the spectrum of clinical applications and the efficacy of telemedicine in orthopaedic and trauma surgery as published in times of the COVID-19 pandemic. Methods All published studies investigating the application of telemedicine related to orthopaedics and trauma during the COVID-19 pandemic were accessed and screened for suitability. The primary outcome of interest was the efficacy of telemedicine in various clinical applications. The secondary outcome of interest was the spectrum of different applications in which telemedicine applications were investigated. Results The literature search resulted in 1047 articles. After the removal of duplicates, 894 articles were screened of which 31 finally met the inclusion criteria. Dimensions that were described by studies in the literature to have positive effects were preoperative patient optimisation, the usefulness of telemedicine to correctly diagnose a condition, conservative treatment, willingness to and feasibility for telemedicine in patients and doctors, and postoperative/post-trauma care improvement. The efficacy of telemedicine applications or interventions thereby strongly varied and seemed to depend on the exact study design and the research question addressed. Conclusion Various successful applications of telemedicine have already been reported in orthopaedics and trauma surgery, with a strong increase in scientific output during the COVID-19 years 2020–2021. Whether the advantages of such an approach will lead to a relevant implementation of telemedicine in everyday clinical practice should be monitored after the COVID-19 pandemic.

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“…There is a potential role for IMUs to be used to supplement existing post-operative function measures (i.e., PROMs and PBOMs) and provide additional diagnostic value through clinic- and home-based RPM [ 7 ]. IMUs have been applied extensively in younger orthopaedic patients following sports injury [ 17 , 18 , 19 , 20 ] and are becoming increasingly common in evaluation of knee arthroplasty procedures [ 7 , 21 , 22 , 23 , 24 ]. However, many of these previous studies reported functional performance based on a single stand-alone function score, as opposed to using a variety of gait parameters, or have not combined IMU measurements with existing validated PROMS and PBOMs.…”

Section: Introductionmentioning

confidence: 99%

Remote Patient Monitoring with Wearable Sensors Following Knee Arthroplasty

Bolam

Batinica

Yeung

et al. 2021

Sensors

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(Background) Inertial Measurement Units (IMUs) provide a low-cost, portable solution to obtain functional measures similar to those captured with three-dimensional gait analysis, including spatiotemporal gait characteristics. The primary aim of this study was to determine the feasibility of a remote patient monitoring (RPM) workflow using ankle-worn IMUs measuring impact load, limb impact load asymmetry and knee range of motion in combination with patient-reported outcome measures. (Methods) A pilot cohort of 14 patients undergoing primary knee arthroplasty for osteoarthritis was prospectively enrolled. RPM in the community was performed weekly from 2 up to 6 weeks post-operatively using wearable IMUs. The following data were collected using IMUs: mobility (Bone Stimulus and cumulative impact load), impact load asymmetry and maximum knee flexion angle. In addition, scores from the Oxford Knee Score (OKS), EuroQol Five-dimension (EQ-5D) with EuroQol visual analogue scale (EQ-VAS) and 6 Minute Walk Test were collected. (Results) On average, the Bone Stimulus and cumulative impact load improved 52% (p = 0.002) and 371% (p = 0.035), compared to Post-Op Week 2. The impact load asymmetry value trended (p = 0.372) towards equal impact loading between the operative and non-operative limb. The mean maximum flexion angle achieved was 99.25° at Post-Operative Week 6, but this was not significantly different from pre-operative measurements (p = 0.1563). There were significant improvements in the mean EQ-5D (0.20; p = 0.047) and OKS (10.86; p < 0.001) scores both by 6 weeks after surgery, compared to pre-operative scores. (Conclusions) This pilot study demonstrates the feasibility of a reliable and low-maintenance workflow system to remotely monitor post-operative progress in knee arthroplasty patients. Preliminary data indicate IMU outputs relating to mobility, impact load asymmetry and range of motion can be obtained using commercially available IMU sensors. Further studies are required to directly correlate the IMU sensor outputs with patient outcomes to establish clinical significance.

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A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Cited by 27 publications

References 55 publications

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Telemedicine in orthopaedics and trauma surgery during the first year of COVID pandemic: a systematic review

Remote Patient Monitoring with Wearable Sensors Following Knee Arthroplasty

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