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Postoperative rehabilitation using a digital healthcare system in patients with total knee arthroplasty: a randomized controlled trial

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Digital healthcare systems based on augmented reality (AR) show promise for postoperative rehabilitation. We compared the effectiveness of AR-based rehabilitation and conventional rehabilitation after total knee arthroplasty (TKA).

Materials and methods

We randomly allocated 56 participants to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). Participants in the CR group performed brochure-based home exercises for 12 weeks, whereas those in the DR group performed AR-based home exercises that showed each motion on a monitor and provided real-time feedback. The primary outcome was change in 4-m gait speed. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, health-related quality of life [assessed by the EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire], pain [measured using a numeric rating scale (NRS)], Berg Balance Scale (BBS), range of motion (ROM), and muscle strength. Outcomes were measured at baseline (T0) and 3 (T1), 12 (T2), and 24 (T3) weeks after randomization.

Results

There was no significant difference in baseline characteristics of participants between two groups, except age and body mass index. No group difference was observed in 4-m gait speed (0.37 ± 0.19 and 0.42 ± 0.28 for the DR and CR groups, respectively; p = 0.438). The generalized estimating equation model revealed no significant group by time interaction regarding for 4-m gait speed, WOMAC, EQ5D5L, NRS, BBS, ROM, and muscle strength score. All outcomes were significantly improved in both groups (p < 0.001).

Conclusion

The use of a digital healthcare system based on AR improved the functional outcomes, pain, and quality of life of patients after TKA. AR-based rehabilitation may be useful treatment as an alternative to conventional rehabilitation.

Trial registration

ClinicalTrials.gov (identifier: NCT04513353). Registered on August 9, 2020. http://clinicaltrials.gov/ct2/show/NCT04513353.

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Data availability

Data are available from the authors upon reasonable request.

References

  1. Woo GJ, Oh KW (2015) Prevalence of osteoarthritis among adults over 50 years old in Korea, 2010–2013. Public Health Wkly Rep 8(4):82–84

    Google Scholar 

  2. Genet F, Schnitzler A, Lapeyre E et al (2008) Change of impairment, disability and patient satisfaction after total knee arthroplasty in secondary care practice. Ann Readapt Med Phys 51(8):671–682

    Article  CAS  PubMed  Google Scholar 

  3. Park JH, Hong JY, Han K et al (2017) Prevalence of symptomatic hip, knee, and spine osteoarthritis nationwide health survey analysis of an elderly Korean population. Medicine (Baltimore) 96(12):e6372

    Article  CAS  PubMed  Google Scholar 

  4. Kim TW, Kang SB, Chang CB, Moon SY, Lee YK, Koo KH (2021) Current trends and projected burden of primary and revision total knee arthroplasty in Korea between 2010 and 2030. J Arthroplasty 36(1):93–101

    Article  PubMed  Google Scholar 

  5. Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L (2005) Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Jt Surg Am 87(5):1047–1053

    Article  Google Scholar 

  6. Bade MJ, Stevens-Lapsley JE (2012) Restoration of physical function in patients following total knee arthroplasty: an update on rehabilitation practices. Curr Opin Rheumatol 24(2):208–214

    Article  PubMed  Google Scholar 

  7. Kittelson A, Carmichael J, Stevens-Lapsley J, Bade M (2022) Psychometric properties of the 4-meter walk test after total knee arthroplasty. Disabil Rehabil 44(13):3204–3210

    Article  PubMed  Google Scholar 

  8. Brennan D, Tindall L, Theodoros D et al (2010) A blueprint for telerehabilitation guidelines. Int J Telerehabil 2(2):31–34

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tsang MP, Man GCW, Xin H, Chong YC, Ong MT, Yung PS (2022) The effectiveness of telerehabilitation in patients after total knee replacement: a systematic review and meta-analysis of randomized controlled trials. J Telemed Telecare. https://doi.org/10.1177/1357633X221097469

    Article  PubMed  Google Scholar 

  10. LeBrun DG, Martino B, Biehl E, Fisher CM, Gonzalez Della Valle A, Ast MP (2022) Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-06931-

    Article  PubMed  Google Scholar 

  11. Milgram P, Takemura H, Utsumi A, Kishino F (1995) Augmented reality: a class of displays on the reality-virtuality continuum. Telemanipulator and telepresence technologies. Spie, pp 282–292

    Chapter  Google Scholar 

  12. Portalés C, Lerma JL, Navarro S (2010) Augmented reality and photogrammetry: a synergy to visualize physical and virtual city environments. ISPRS J Photogramm Remote Sens 65(1):134–142

    Article  Google Scholar 

  13. Colomer C, Llorens R, Noe E, Alcaniz M (2016) Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J Neuroeng Rehabil 13(1):45

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ortiz-Catalan M, Guethmundsdottir RA, Kristoffersen MB et al (2016) Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain. Lancet 388(10062):2885–2894

    Article  PubMed  Google Scholar 

  15. Jeon S, Kim JJIjoer, health p, (2020) Effects of augmented-reality-based exercise on muscle parameters, physical performance, and exercise self-efficacy for older adults. IJERPH 17(9):3260

    Article  PubMed  PubMed Central  Google Scholar 

  16. Munoz-Mendoza CL, Cabanero-Martinez MJ, Millan-Calenti JC, Cabrero-Garcia J, Lopez-Sanchez R, Maseda-Rodriguez A (2011) Reliability of 4-m and 6-m walking speed tests in elderly people with cognitive impairment. Arch Gerontol Geriatr 52(2):e67-70

    Article  PubMed  Google Scholar 

  17. Unver B, Baris RH, Yuksel E, Cekmece S, Kalkan S, Karatosun V (2017) Reliability of 4-meter and 10-meter walk tests after lower extremity surgery. Disabil Rehabil 39(25):2572–2576

    Article  PubMed  Google Scholar 

  18. McKay C, Prapavessis H, McNair P (2013) Comparing the lower limb tasks questionnaire to the Western Ontario and McMaster Universities Osteoarthritis Index: agreement, responsiveness, and convergence with physical performance for knee osteoarthritis patients. Arch Phys Med Rehabil 94(3):474–479

    Article  PubMed  Google Scholar 

  19. Brooks R, Rabin R, De Charro F (2013) The measurement and valuation of health status using EQ-5D: a European perspective: evidence from the EuroQol BIOMED Research Programme. Springer Science & Business Media

    Google Scholar 

  20. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL (1992) Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 73(11):1073–1080

    CAS  PubMed  Google Scholar 

  21. Chan ZYS, MacPhail AJC, Au IPH et al (2019) Walking with head-mounted virtual and augmented reality devices: effects on position control and gait biomechanics. PLoS ONE 14(12):e0225972

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gupta SK (2011) Intention-to-treat concept: a review. Perspect Clin Res 2(3):109–112

    Article  PubMed  PubMed Central  Google Scholar 

  23. Correia FD, Nogueira A, Magalhaes I et al (2018) Home-based rehabilitation with a novel digital biofeedback system versus conventional in-person rehabilitation after total knee replacement: a feasibility study. Sci Rep 8(1):11299

    Article  PubMed  PubMed Central  Google Scholar 

  24. Correia FD, Nogueira A, Magalhaes I et al (2019) Medium-term outcomes of digital versus conventional home-based rehabilitation after total knee arthroplasty: prospective, parallel-group feasibility study. JMIR Rehabil Assist Technol 6(1):e13111

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dias Correia F, Nogueira A, Magalhaes I et al (2019) Digital versus conventional rehabilitation after total hip arthroplasty: a single-center, parallel-group pilot study. JMIR Rehabil Assist Technol 6(1):e14523

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nelson M, Bourke M, Crossley K, Russell T (2020) Telerehabilitation is non-inferior to usual care following total hip replacement - a randomized controlled non-inferiority trial. Physiotherapy 107:19–27

    Article  CAS  PubMed  Google Scholar 

  27. Eichler S, Salzwedel A, Rabe S et al (2019) The effectiveness of telerehabilitation as a supplement to rehabilitation in patients after total knee or hip replacement: randomized controlled trial. JMIR Rehabil Assist Technol 6(2):e14236

    Article  PubMed  PubMed Central  Google Scholar 

  28. van den Akker-Scheek I, Stevens M, Bulstra SK, Groothoff JW, van Horn JR, Zijlstra W (2007) Recovery of gait after short-stay total hip arthroplasty. Arch Phys Med Rehabil 88(3):361–367

    Article  PubMed  Google Scholar 

  29. Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD (2008) Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 88(1):22–32

    Article  PubMed  Google Scholar 

  30. White DK, Felson DT, Niu J et al (2011) Reasons for functional decline despite reductions in knee pain: the multicenter osteoarthritis study. Phys Ther 91(12):1849–1856

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gianola S, Stucovitz E, Castellini G et al (2020) Effects of early virtual reality-based rehabilitation in patients with total knee arthroplasty: a randomized controlled trial. Medicine (Baltimore) 99(7):e19136

    Article  PubMed  Google Scholar 

  32. Moffet H, Tousignant M, Nadeau S et al (2015) In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty: a noninferiority randomized controlled trial. J Bone Jt Surg Am 97(14):1129–1141

    Article  Google Scholar 

  33. Cheok G, Tan D, Low A, Hewitt J (2015) Is nintendo wii an effective intervention for individuals with stroke? A systematic review and meta-analysis. J Am Med Dir Assoc 16(11):923–932

    Article  PubMed  Google Scholar 

  34. Wang X, Hunter DJ, Vesentini G, Pozzobon D, Ferreira ML (2019) Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 20(1):506

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Yoon Jeong Baek and Bo Ram Kim for assistance with data collection and randomization in this trial.

Funding

This study was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute and funded by the Ministry of Health Welfare, Republic of Korea (grant no.: HR19C0781).

Author information

Author notes

  1. Ji Hye Hwang and Jae-Young Lim contributed equally to this work as co-corresponding authors.

Authors and Affiliations

  1. Department of Physical and Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea

    Ga Yang Shim

  2. Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea

    Eun Hye Kim, Seong Joo Lee & Jae-Young Lim

  3. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea

    Chong Bum Chang & Yong Seuk Lee

  4. Department of Rehabilitation Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea

    Jong In Lee

  5. Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-Gu, Seoul, Republic of Korea

    Ji Hye Hwang

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  1. Ga Yang Shim
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Corresponding authors

Correspondence to Ji Hye Hwang or Jae-Young Lim.

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All the authors declare that they have no conflict of interest.

Ethical approval

Ethics Committee Approval was granted by Institutional Review Board of Seoul National University at Bundang Hospital (SNUBH) (IRB no.: B-2005–612-001) and Samsung Medical Center (SMC) (IRB no.: SMC-2019–05-021).

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Informed consent was obtained from all participants included in this study.

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Shim, G.Y., Kim, E.H., Lee, S.J. et al. Postoperative rehabilitation using a digital healthcare system in patients with total knee arthroplasty: a randomized controlled trial. Arch Orthop Trauma Surg 143, 6361–6370 (2023). https://doi.org/10.1007/s00402-023-04894-y

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  • DOI: https://doi.org/10.1007/s00402-023-04894-y

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