App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial

Abstract

Introduction New app-based programs for postoperative rehabilitation have been developed, but no long-term study has been published to date. Thus, a prospective randomized control trial with 2-year follow-up was performed to evaluate the effectiveness of app-based rehabilitation (GenuSport) compared to a control group after total knee arthroplasty (TKA). Methods Between April and October 2016, 60 patients were enrolled in the study. Twenty-five patients were lost to follow-up, leaving 35 patients undergoing TKA for inclusion. In this group, twenty patients received app-based exercise program and 15 were randomized to the control group. The mean age was 64.37 ± 9.32 years with a mean follow-up of 23.51 ± 1.63 months. Patients in the app group underwent an app-based knee training starting on the day of surgery; whereas, patients in the control group underwent regular physiotherapy. Functional outcome scores using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and VAS of pain were analyzed. Results In the short term, significant differences between the app group and control group in time of 10-m walk (19.66 ± 7.80 vs. 27.08 ± 15.46 s; p = 0.029), VAS pain at rest and activity (2.65 ± 0.82 vs. 3.57 ± 1.58, respectively 4.03 ± 1.26 vs. 5.05 ± 1.21; p < 0.05) were observed. In the long term, a variety of different tendencies was found, highest in KSS Function with 76.32 ± 16.49 (app group) vs. 67.67 ± 16.57 (control group) (p = 0.130). Additionally, patients in the app group required less painkillers (10.0% vs. 26.7%) and more likely to participate in sports (65.0% vs. 53.3%). Conclusions An app-based knee trainer is a promising tool in improving functional outcomes such as KSS function score and VAS after TKA. Level of evidence Level II, prospective randomized control trial.

Assessment of a Downloadable Application with Avatar Guidance for PT-Prescribed Home Exercise after Total Knee Arthroplasty: A 30-Day Usability and Feasibility Study

“…Our comparable results are in alignment with the randomized trial by Fleischman et al [38] who found no differences in knee range of motion at six months post-TKA between unsupervised home exercise implemented either by paper or web-based delivery versus clinic-based physical therapy. In a recent randomized trial, Bäcker et al [9] found no long-term differences in outcomes between a six-week app-based rehabilitation program and a regular physical therapy program. There is a small but growing base of evidence that app-based rehabilitation methods may be feasible in the home environment.…”

“…The feasibility criterion of 75% computing device ownership and study use among potential study enrollees proved to be a high mark. Where other studies, including Chughtai et al [10], delivered an eHealth system to all participants [9] [10], we were interested in pre-existing computing device ownership and study use in the TKA population as an indicator of the potential for immediate adoption and implementation of the Health-in-Motion® app. While the percentage of computing device ownership and use among potential enrollees was fairly robust at 71.4%, it failed to meet our criterion of 75%.…”

“…Digital health technologies have grown exponentially in recent years. Despite this growth, few studies have investigated applications specifically designed for rehabilitation after TKA [8] [9], and even fewer have assessed user experience by measuring ease of use, learnability, and efficiency of the technology [10]. Moreover, most studies have used technology primarily for communication and reminder systems rather than tools for exer-DOI: 10.4236/aar.2022.114008 100 Advances in Aging Research cise, or they were limited by requiring additional, specially designed hardware [8] [9] [10].…”

Development of a mobile application to improve exercise accuracy and quality of life in knee osteoarthritis patients: a randomized controlled trial

“…A different RCT compared adherence to home-based exercise between knee OA patients who used a mobile application and those who used handouts and found that those who used the mobile had a better adherence rate, lower VAS-pain scores, and stronger improvements of physical function and lower-limb muscle strength [ 28 ]. It is worthy to note that our trial assessed knee OA patients that did not require surgery; however, in the postoperative setting, the use of a mobile app during rehabilitation led to reduced opiate usage for pain management [ 11 ] and may become a promising tool in improving functional outcomes [ 29 ]. Thus, this developed mobile app has proven to be a valuable tool for OA patients for motivating patients to exercise, educating patients on disease progression and improving the accuracy of rehabilitation.…”

A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation

“…Nonadherence is a multidimensional process not easily solved including internal factors (such as patient’s locus of control, depression, belief in importance of activities) and external factors (such as supportive environment and access to transportation) [ 1 , 6 ]. Digital delivery of HEPs has already been shown to enhance patient adherence [ 8 , 9 , 10 , 11 ] and with the relatively high rate of smartphone ownership [ 12 ] there is a growing body of work investigating the use of smartphones, apps, and sensing technologies to facilitate rehabilitation and remote care [ 13 , 14 , 15 , 16 ]. However there has been limited study of implementation of mobile health applications in routine care settings [ 13 , 16 ], and most efforts have focused on specific medical conditions [ 15 ] or have a limited set of exercises which can be performed using the system [ 16 , 17 , 18 ].…”