Web-based portal for Telerehabilitation monitoring and Lifestyle Modification Program after Total Knee Arthroplasty: A Randomized Controlled Trial (Preprint)

Abstract

Knee osteoarthritis (OA) and low back pain are prevalent in Asia, posing significant challenges. Total Knee Arthroplasty (TKA) is the gold standard for managing degenerative knee arthritis, with post-TKA rehabilitation crucial for improving function and quality of life. Rehabilitation following TKA plays a crucial role in improving functional performance and quality of life for individuals in this population. However, access to rehabilitation services, healthcare facilities, and follow-up appointments can be limited, particularly in regions with resource constraints or remote areas. While digital rehabilitation solutions are well-established in developed nations, there is a pressing need to introduce technological advancements in countries like Pakistan. Tele-rehabilitation, if incorporated into standard therapy, has the potential to benefit the community by reducing dependence on limited human resources while ensuring better clinical outcome

This study evaluated the effects of supervised sensorimotor training with and without lifestyle modifications via telerehabilitation monitoring on joint position sense, balance, muscle architecture, and knee joint function in Total knee arthroplasty patients.

This single-center, prospective randomized controlled trial included fifty-two participants, divided equally into intervention and control groups. Both groups received twelve weeks of supervised strengthening exercises, neuromuscular electrical stimulation, and sensorimotor training, three times weekly for 45 minutes. The intervention group additionally received a manual on lifestyle modification (exercise, diet, education) assessed via a web portal. Primary outcomes were joint position sense, muscle thickness of rectus femoris, and balance. Secondary outcomes included knee function and quality of life. Measurements were taken pre-surgery, 12 weeks post-training, and 8 weeks post-home-based lifestyle modification. Data analysis was conducted using SPSS 25.

The mean participant age was 64.1 ± 5.4 years. Significant intragroup improvements (p<0.001) were observed from baseline at both 14 and 22 weeks. Intergroup comparisons showed significant improvements (p<0.001) in the intervention group across all measures, indicating substantial benefits of the lifestyle modification program.

Both groups showed improvements with sensorimotor training, but the intervention group, incorporating lifestyle modifications, achieved superior results in knee function, performance, and quality of life. Integrating lifestyle modifications with sensorimotor training enhances rehabilitation outcomes post-TKA. In addition, the intervention group, supported by telerehabilitation monitoring, showed better adherence to the home-based lifestyle modification program compared to the control group, highlighting the potential benefits of telerehabilitation in enhancing compliance and engagement in lifestyle modification rehabilitation programs.

It has been officially registered with the clinical study identifier NCT05018494 in the ClinicalTrials.gov Protocols Registration and Results System on May 8, 2021