Effectiveness of a telerehabilitation program using wearable sensors for postoperative knee arthroplasty patients: A randomized controlled trial

Project Abstract

This randomized controlled trial evaluated the effectiveness of a telerehabilitation program enhanced by wearable sensor feedback for postoperative knee arthroplasty patients, comparing it with conventional in-person rehabilitation over a 12-week period. A total of 160 adults (age 45–75) who underwent unilateral total knee arthroplasty were randomized to either the telerehabilitation group (n=80) or the usual care group (n=80). The telerehabilitation program integrated real-time wearable sensor data (inertial measurement units and pressure-sensitive insoles) with a cloud-based platform that delivered personalized exercise prescriptions, remote monitoring, weekly virtual consultations, and adherence nudges. Primary outcomes included functional knee performance measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) and objective range of motion (ROM). Secondary outcomes encompassed quadriceps strength, pain intensity (VAS), Timed Up and Go (TUG) test, Lysholm knee score, patient satisfaction, cost-effectiveness, and adverse events. Assessments occurred at baseline (preoperative), 6 weeks, 12 weeks, and 6 months postoperatively. Results demonstrated that the telerehabilitation group achieved significantly greater improvements in KOOS-PS at 12 weeks (mean difference 7.4 points, 95% CI 4.2–10.6; p<0.001) and in ROM by a mean of 8.2 degrees (95% CI 4.5–11.9; p<0.001) compared with the control group. Quadriceps strength improved more in the telerehabilitation group (mean 12.6 Nm vs. 6.3 Nm; p=0.002), and TUG times decreased more substantially (mean reduction 2.1 seconds vs. 0.9 seconds; p=0.01). Pain scores favored telerehabilitation at 6 and 12 weeks (mean VAS reduction 2.0 vs. 1.0; p=0.03). The Lysholm score showed superior improvement in the intervention arm (mean difference 5.5 points; p=0.01). User engagement metrics indicated higher exercise adherence in the telerehabilitation group (average compliance 86% vs. 62%; p<0.001). Patient satisfaction was higher in the telerehabilitation cohort, with 92% reporting that the program met their needs compared to 77% in standard care. Cost-effectiveness analysis revealed lower cumulative costs per patient in the telerehabilitation group due to reduced travel, fewer facility visits, and shorter recovery times, offsetting expenses associated with wearable devices and platform maintenance. No significant difference in adverse events was observed between groups. Multivariate analyses identified baseline physical function, digital literacy, and home environment support as moderators of response to telerehabilitation, with higher benefits observed in participants who maintained high adherence and reported structured social support. Qualitative interviews with a purposive sample (n=20) revealed themes of empowerment through self-monitoring, perceived safety due to clinician oversight, and reduced transportation barriers. The study concludes that telerehabilitation with wearable sensor feedback is an effective, safe, and cost-efficient alternative to conventional postoperative care, optimizing functional recovery and patient satisfaction after knee arthroplasty, and warrants integration into standard postoperative pathways with considerations for digital inclusion and personalized adherence strategies.

Project Overview

What This Project Is About

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A plain-language overview of telerehabilitation using wearable sensors after knee replacement, focusing on whether remote-guided exercises monitored by sensors support recovery as well as or better than traditional in-person rehab.

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The Problem It Addresses

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Many patients struggle to access regular in-clinic physical therapy due to distance, cost, or scheduling. Wearable sensors can provide real-time feedback and remote monitoring, but it’s unclear if a home-based, technology-assisted program is as effective as standard care for improving knee function and daily activities after knee arthroplasty.

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Objectives of the Project

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1. Assess whether telerehabilitation with wearables improves knee function scores at 3 and 6 months post-surgery.
2. Compare patient adherence and satisfaction between remote and in-clinic rehab.
3. Evaluate changes in pain, range of motion, and basic daily activities.
4. Examine safety and incidence of adverse events in the telerehabilitation group.

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What You Will Do Step by Step

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1. Review literature on telerehabilitation and wearable sensors in orthopedic rehab.
2. Recruit postoperative knee arthroplasty patients and obtain consent.
3. Assign participants to telerehabilitation or standard care groups.
4. Provide wearable sensors and a remote exercise program to the intervention group.
5. Collect data on function, pain, ROM, and daily activities at set intervals.
6. Monitor adherence and safety remotely; troubleshoot device issues.
7. Analyze data with basic statistics to compare groups.
8. Interpret results and discuss practical implications for practice.

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Expected Outcome

The project is expected to show that telerehabilitation with wearable sensors is comparable to standard care in improving knee function, with higher accessibility and similar safety. Positive findings could support broader use of home-based, tech-enabled rehab for knee arthroplasty patients.