ABSTRACT
Introduction:
Total Knee Arthroplasty (TKA) is widely performed for severe knee osteoarthritis, and postoperative rehabilitation plays a key role in optimizing functional recovery. This study compares the efficacy of conventional physiotherapy, virtual rehabilitation, and home-based telerehabilitation following TKA.
Methods:
A randomized controlled trial involving 120 patients was conducted. Participants were randomly assigned to one of three rehabilitation protocols. Outcomes were measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), and Visual Analog Scale (VAS) for pain at 3 and 6 months postoperatively. Statistical analysis was performed using ANOVA (P < 0.05).
Results:
Virtual rehabilitation showed significantly better KOOS and ROM outcomes at both follow-up points (P < 0.01), while home-based telerehabilitation demonstrated greater pain relief at 6 months (P = 0.03).
Conclusion:
Virtual rehabilitation led to superior functional improvements, while home-based telerehabilitation effectively reduced the pain. These findings suggest that incorporating technology into rehabilitation enhances recovery post-TKA.
KEYWORDS: Physiotherapy, rehabilitation, telerehabilitation, total knee arthroplasty, virtual rehabilitation
INTRODUCTION
Total Knee Arthroplasty (TKA) is a common intervention for advanced knee osteoarthritis, providing pain relief and improved joint function. However, postoperative rehabilitation is crucial to ensure optimal recovery of mobility and function. Conventional rehabilitation protocols have been the standard approach for many years, involving supervised physiotherapy sessions focusing on restoring range of motion (ROM) and strengthening the quadriceps. Recent advancements in technology have introduced virtual rehabilitation and home-based telerehabilitation as potential alternatives or adjuncts to conventional methods.[1,2,3] Virtual rehabilitation utilizes computer-based systems to provide biofeedback and guided exercises, while telerehabilitation allows patients to engage in therapy remotely via telecommunication technologies. These approaches offer flexibility, accessibility, and potentially enhanced outcomes. This study aims to compare the efficacy of these three rehabilitation protocols, focusing on functional recovery and pain management.[4]
METHODS
This randomized controlled trial enrolled 120 patients who underwent primary TKA between January and June 2022. Participants were randomly allocated to one of three rehabilitation groups:
Group A: Conventional physiotherapy, involving bi-weekly supervised sessions for 12 weeks.
Group B: Virtual rehabilitation, utilizing a computer-based system with real-time biofeedback and exercise guidance.
Group C: Home-based telerehabilitation, involving remote physiotherapy through video consultations and digital exercise programs.
Outcomes were measured at 3 months and 6 months postoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), ROM (measured by a goniometer), and Visual Analog Scale (VAS) for pain. Data analysis was conducted using ANOVA to compare the means between groups, with statistical significance set at P < 0.05. Ethical approval was obtained, and all participants provided informed consent.
RESULTS
At 3 months, the KOOS score for Group B was 80 ± 4, notably higher than Group A’s score of 65 ± 5, and Group C’s score of 70 ± 6. This trend continued at the 6-month follow-up, with Group B achieving a KOOS score of 85 ± 5, compared to 70 ± 4 in Group A and 75 ± 5 in Group C. The range of motion (ROM) measurements followed a similar pattern. At 3 months, Group B had an average ROM of 125 ± 5 degrees, which was greater than Group A’s 110 ± 6 degrees, and Group C’s 115 ± 7 degrees. By 6 months, Group B reached an average ROM of 130 ± 4 degrees, again surpassing the 115 ± 5 degrees observed in Group A and the 120 ± 6 degrees in Group C. These results indicate that virtual rehabilitation is more effective in enhancing both functional recovery and joint mobility following TKA. Table 1
Table 1.
Comparative Functional Outcomes (KOOS and ROM) at 3 and 6 Months Post-TKA
| Outcome | Group A (Conventional) | Group B (Virtual Rehabilitation) | Group C (Telerehabilitation) |
|---|---|---|---|
| KOOS (3 Months) | 65±5 | 80±4 | 70±6 |
| KOOS (6 Months) | 70±4 | 85±5 | 75±5 |
| ROM (3 Months) | 110±6 | 125±5 | 115±7 |
| ROM (6 Months) | 115±5 | 130±4 | 120±6 |
In terms of pain management, the telerehabilitation group (Group C) demonstrated the most significant reduction in pain scores over time. At the 3-month mark, the VAS pain score for Group C was 2.8 ± 1.3, which was lower than the 3.5 ± 1.2 observed in Group A (conventional physiotherapy) but slightly higher than the 2.5 ± 1.1 in Group B (virtual rehabilitation). However, by 6 months, Group C exhibited the lowest pain levels, with a VAS score of 2.0 ± 0.8, indicating superior pain control. In comparison, Group B had a pain score of 2.2 ± 0.9, and Group A had the highest pain levels at 3.0 ± 1.1. These findings suggest that home-based telerehabilitation was particularly effective in managing pain, especially at the 6-month follow-up, making it a viable alternative for postoperative pain reduction. Table 2
Table 2.
Comparative Pain Outcomes (VAS Pain Scores) at 3 and 6 Months Post-TKA
| Outcome | Group A (Conventional) | Group B (Virtual Rehabilitation) | Group C (Telerehabilitation) |
|---|---|---|---|
| VAS Pain (3 Months) | 3.5±1.2 | 2.5±1.1 | 2.8±1.3 |
| VAS Pain (6 Months) | 3.0±1.1 | 2.2±0.9 | 2.0±0.8 |
DISCUSSION
The results of this study highlight the potential benefits of integrating technology into postoperative rehabilitation following TKA. Patients undergoing virtual rehabilitation exhibited significant improvements in both KOOS and ROM scores at 3 and 6 months compared to conventional physiotherapy. These findings are consistent with previous studies, such as those by Chughtai et al.,[3] who reported superior functional outcomes in patients utilizing virtual rehabilitation tools. Virtual rehabilitation offers a structured, interactive platform that allows patients to engage more actively in their recovery. The biofeedback component likely plays a role in encouraging better movement patterns, ultimately resulting in improved mobility.
In contrast, home-based telerehabilitation was associated with the most significant reduction in pain scores, particularly at the 6-month follow-up. Telerehabilitation provides the convenience of at-home therapy sessions, reducing the burden of travel for patients and allowing for greater comfort during recovery. These findings align with the study by Pfeufer et al.,[5] which demonstrated the efficacy of remote rehabilitation in reducing postoperative pain. This suggests that telerehabilitation may be an effective option for pain management, especially for patients with limited access to in-person care or those with mobility constraints.[5,6,7,8]
Despite the success of these technology-based interventions, conventional physiotherapy remains an effective method for postoperative recovery. However, the slower progress observed in this study may be due to limited patient engagement and access to supervised therapy sessions. Kayani et al.[6] also reported similar findings, indicating that more frequent and structured interventions, such as virtual rehabilitation, could accelerate functional recovery in TKA patients. Future research should explore the long-term outcomes of these rehabilitation protocols and assess patient satisfaction, adherence, and cost-effectiveness to determine the most appropriate strategies for different patient populations.[9,10,11]
CONCLUSION
This study demonstrates that virtual rehabilitation is superior in improving functional outcomes, while home-based telerehabilitation is more effective for pain management following TKA. Integrating technology-based rehabilitation into standard postoperative care could enhance recovery outcomes and patient satisfaction. Further research is needed to explore long-term benefits and optimize rehabilitation protocols for TKA patients.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Dávila Castrodad IM, Recai TM, Abraham MM, Etcheson JI, Mohamed NS, Edalatpour A, et al. Rehabilitation protocols following total knee arthroplasty: A review of study designs and outcome measures. Ann Transl Med. 2019;7(Suppl 7):S255. doi: 10.21037/atm.2019.08.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Schache MB, McClelland JA, Webster KE. Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? BMC Musculoskelet Disord. 2016;17:259. doi: 10.1186/s12891-016-1104-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Chughtai M, Kelly JJ, Newman JM, Sultan AA, Khlopas A, Sodhi N, et al. The role of virtual rehabilitation in total and unicompartmental knee arthroplasty. J Knee Surg. 2019;32:105–10. doi: 10.1055/s-0038-1637018. [DOI] [PubMed] [Google Scholar]
- 4.Liptak MG, Theodoulou A, Kaambwa B, Saunders S, Hinrichs SW, Woodman RJ, et al. The safety, efficacy and cost-effectiveness of the Maxm Skate, a lower limb rehabilitation device. Trials. 2019;20:36. doi: 10.1186/s13063-018-3102-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Pfeufer D, Gililland J, Böcker W, Kammerlander C, Anderson M, Krähenbühl N, et al. Training with biofeedback devices improves clinical outcome in patients with unilateral TKA: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2019;27:1611–20. doi: 10.1007/s00167-018-5217-7. [DOI] [PubMed] [Google Scholar]
- 6.Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: A prospective cohort study. Bone Joint J. 2018;100(B):930–7. doi: 10.1302/0301-620X.100B7.BJJ-2017-1449.R1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Buhagiar MA, Naylor JM, Harris IA, Xuan W, Adie S, Lewin A. Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. JAMA Netw Open. 2019;2:e192810. doi: 10.1001/jamanetworkopen.2019.2810. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Eichler S, Rabe S, Salzwedel A, Müller S, Stoll J, Tilgner N, et al. Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement: Study protocol for a multicenter, superiority, no-blinded randomized controlled trial. Trials. 2017;18:438. doi: 10.1186/s13063-017-2173-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Lenssen AF, Crijns YH, Waltjé EM, Roox GM, van Steyn MJ, Geesink RJ, et al. Effectiveness of prolonged use of continuous passive motion (CPM) as an adjunct to physiotherapy following total knee arthroplasty: Design of a randomised controlled trial. BMC Musculoskelet Disord. 2006;7:15. doi: 10.1186/1471-2474-7-15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Levine M, McElroy K, Stakich V, Cicco J. Comparing conventional physical therapy rehabilitation with neuromuscular electrical stimulation after TKA. Orthopedics. 2013;36:e319–24. doi: 10.3928/01477447-20130222-20. [DOI] [PubMed] [Google Scholar]
- 11.Rohella D, Swathy APJ, Ajmeera R, Das P, Tiwari RV, Tiwari HD. Comparison of quality of life in patients operated for knee surgery via conventional method and arthroscopy: An original research. J Pharm Bioallied Sci. 2023;15(Suppl 1):S293-8. doi: 10.4103/jpbs.jpbs_498_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
