Effectiveness of a Telerehabilitation Protocol Using Guided Tele-Exercise for Postoperative Total Knee Arthroplasty Patients: A Randomized Controlled Trial

Project Abstract

This randomized controlled trial evaluates the effectiveness of a telerehabilitation protocol employing guided tele-exercise for adults recovering from postoperative total knee arthroplasty (TKA). A total of 180 participants aged 50–80 years undergoing primary TKA were recruited from three tertiary care centers and randomly assigned to either the telerehabilitation group or conventional in-person rehabilitation over a 12-week period. The telerehabilitation protocol integrated synchronous video-guided exercise sessions, asynchronous instructional videos, wearable sensor feedback for real-time movement monitoring, and weekly teleconsultations with a licensed physical therapist. Primary outcomes measured at baseline, 6 weeks, and 12 weeks included knee range of motion (ROM), timed up-and-go (TUG) test, knee extensor strength, and functional performance via the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes encompassed pain intensity (VAS), patient satisfaction, adherence rates, health-related quality of life (SF-12), and incidence of adverse events. Results demonstrated that the telerehabilitation group achieved non-inferiority to conventional rehabilitation in primary outcomes at 12 weeks. Mean improvements in knee flexion ROM were 28.6° (telerehab) vs 29.4° (control), with no statistically significant difference (p=0.42). Knee extension ROM improved by an average of 6.2° (telerehab) versus 6.0° (control). TUG times decreased by 3.8 seconds in the telerehabilitation group and 3.9 seconds in the control group, indicating comparable gains in mobility (p=0.66). Isometric quadriceps strength increased by 22.5 N·m in telerehabilitation and 23.1 N·m in control (p=0.58). KOOS total scores improved by 34.2 points (telerehab) and 35.1 points (control). Pain levels decreased similarly, with mean VAS reductions of 2.8 points in both groups (p=0.74). Adherence to prescribed sessions averaged 85% in the telerehabilitation group and 88% in the conventional group (p=0.28). Patient satisfaction was high in both cohorts, with a marginally greater satisfaction reported in the telerehabilitation group (p=0.05). No significant differences were observed in SF-12 physical or mental component scores. Adverse events were infrequent and comparable, with no reported thromboembolic events or severe surgical complications attributable to the rehabilitation modality. Cost-effectiveness analysis revealed that telerehabilitation reduced mean healthcare utilization costs by 18% per patient over the 12-week period, primarily due to decreased transportation and facility-use expenses, without compromising clinical outcomes. Subgroup analyses suggested greater relative benefit in participants with transportation constraints or higher baseline functional limitations. These findings support the clinical viability of a guided telerehabilitation approach for postoperative TKA, offering non-inferior functional recovery and potential economic advantages. The study provides practical implications for healthcare systems aiming to expand access to rehabilitation services while maintaining quality standards, and it highlights the role of technology-enabled monitoring and tele-therapy in optimizing postoperative recovery trajectories.

Project Overview

What This Project Is About

---

The project looks at whether a telerehabilitation program, guided by simple online exercises, helps people recover after knee replacement surgery. It compares this remote approach to standard in-person rehab to see if patients can regain movement and strength effectively from home.

---

---

The Problem It Addresses

---

---

---

Objectives of the Project

---

1. Assess whether telerehabilitation improves knee function after surgery compared to standard care.
2. Evaluate patient safety and adherence to the remote program.
3. Measure changes in pain, mobility, and daily activities.
4. Identify what makes telerehabilitation easy or harder for patients to follow.

---

---

What You Will Do Step by Step

---

1) Review background literature on knee replacement rehab and telehealth.

2) Recruit eligible participants and randomly assign them to telerehabilitation or standard care.

3) Deliver guided online exercise sessions and track progress for a set period.

4) Collect data on function, pain, range of motion, and safety at scheduled times.

5) Analyze results to compare groups and identify trends.

6) Summarize findings and discuss practical implications for clinics and patients.

---

---

Expected Outcome

Anticipated results include similar or better functional scores in the telerehabilitation group, with high adherence and satisfaction, suggesting remote rehab is a viable option for many patients after knee replacement.