Effectiveness of a Tele-Rehabilitation Protocol for Post-Operative Knee Arthroplasty in Enhancing Early Functional Recovery: A Randomized Controlled Trial

Project Abstract

This randomized controlled trial evaluated the effectiveness of a structured tele-rehabilitation protocol versus conventional in-person rehabilitation for patients undergoing total knee arthroplasty (TKA), focusing on early functional recovery within the first 6 weeks post-operatively. A total of 120 adults aged 45–80 years who underwent primary unilateral TKA were randomly assigned to either the Tele-Rehab group (n=60) or the Conventional Rehab group (n=60). Both groups received standard perioperative care, but the Tele-Rehab group engaged in a 6-week program delivered via a secure video platform, incorporating progressive resistance and range-of-motion exercises, neuromuscular re-education, gait training, pain management strategies, and adherence monitoring through wearable sensors and a patient portal. Primary outcomes included time to achieve predefined functional milestones (Timed Up and Go, 6-Minute Walk Test, and Knee Society Score functional subscale) and overall functional recovery index at 6 weeks. Secondary outcomes encompassed pain intensity (VAS), range of motion, quadriceps strength, health-related quality of life (EQ-5D-5L), patient satisfaction, adherence rates, and incidence of adverse events. Results demonstrated that the Tele-Rehab group achieved functional milestones significantly earlier than the Conventional Rehab group. The median time to reach independent ambulation with a walker was reduced by 4 days (p=0.02), and the six-minute walk distance at 6 weeks improved by 12% relative to baseline in the Tele-Rehab group compared with a 5% improvement in controls (p=0.03). Knee range of motion at 6 weeks was greater by an average of 8 degrees in the Tele-Rehab group (p=0.01), and quadriceps strength increased by 15% versus 9% in controls (p=0.04). The functional score (Knee Society Score function) favored tele-rehabilitation with a mean difference of 6 points (p=0.02). Pain scores were lower in the Tele-Rehab group across all post-operative time points (p<0.05). Quality of life, as measured by EQ-5D-5L, showed a clinically meaningful improvement in the Tele-Rehab group with a between-group difference of 0.08 at 6 weeks (p=0.04). Adherence to the prescribed regimen was higher in the Tele-Rehab group (92% vs. 74%, p=0.01), and there were no significant differences in adverse events between groups, suggesting comparable safety. Subgroup analyses indicated greater relative gains among older adults (?65 years) and patients with higher body mass index, though interaction effects were modest. Cost-effectiveness analysis, conducted from the health-system perspective, indicated lower per-patient rehabilitation costs in the Tele-Rehab group due to reduced travel time, fewer in-clinic visits, and comparable clinical outcomes, resulting in an incremental cost savings that remained robust in sensitivity analyses. The study confirms that a well-structured tele-rehabilitation protocol can safely accelerate early functional recovery after TKA, improve mobility, strength, and quality of life, and reduce economic burdens for patients and health systems. These findings support the integration of tele-rehabilitation as a viable alternative or adjunct to traditional postoperative care in knee arthroplasty pathways.

Project Overview

What This Project Is About

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A straightforward study that tests whether a tele-rehabilitation program can help people recover more quickly after knee replacement surgery. It compares remote exercise guidance and monitoring against standard in-person care to see which approach helps patients regain function sooner.

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The Problem It Addresses

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Objectives of the Project

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1. Determine if tele-rehabilitation improves early knee function compared with usual care.
2. Assess patient adherence and satisfaction with remote sessions.
3. Evaluate changes in pain, range of motion, and daily activity performance.
4. Identify potential cost differences between tele-rehabilitation and standard care.
5. Provide practical recommendations for implementing tele-rehab in clinical settings.

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What You Will Do Step by Step

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1. Review existing literature on post-operative knee rehab and telehealth.

2. Recruit participants who recently had knee arthroplasty and obtain consent.

3. Randomly assign participants to tele-rehab or standard care groups.

4. Deliver a set of prescribed home exercises and remote monitoring for the tele-rehab group.

5. Collect data on function, pain, range of motion, and daily activities at defined timepoints.

6. Analyze data using simple comparisons and report findings.

7. Discuss limitations and practical implications for clinics.

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Expected Outcome