Abstract
BackgroundPhysical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times.ObjectiveThis study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring.MethodsThe digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion.ResultsA total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group.ConclusionsThe present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources.Trial RegistrationClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252
Highlights
Total knee arthroplasty (TKA) is the third most commonly performed surgery in the United States, with over 700,000 procedures performed annually [1]
At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P
There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01)
Summary
Total knee arthroplasty (TKA) is the third most commonly performed surgery in the United States, with over 700,000 procedures performed annually [1]. Reducing costs of care is a priority, with several initiatives already in place, such as the implementation of Bundled Payment options and the Comprehensive Care for Joint Replacement models [4,5]. These are examples of a broader trend favoring discharge from hospital to home, as opposed to more costly facility-based care [6]. The evidence-based [7] standard of care immediately following TKA, is being increasingly delivered to TKA recipients at home. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times
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