N. Ferrer1, D. Rodríguez2, A. Modrego2, M. Nuevo3,4, S. Prat3,5, R. Jauregui2, H. Mahdavi2, M. Conti6
1University of Barcelona, Barcelona, Spain, 2Dycare, Barcelona, Spain, 3Hospital Clínic of Barcelona, Clinic Institute of Medical and Surgical Specialties (ICEMEQ), Knee Unit, Barcelona, Spain, 4University of Barcelona, Faculty of Medicine and Health Sciences, Barcelona, Spain, 5University of Barcelona, Medicine School. Campus Casanova, Barcelona, Spain, 6Humanitas Research Hospital, Milan, Italy
Background: Over the last 10 years, the number of Total Knee Arthroplasty (TKA) interventions has highly increased due to the progressive population ageing and the effectiveness of the intervention. Nonetheless, the early start of the rehabilitation and its proper continuation is crucial in ensuring such effectiveness.
The rehabilitation process starts approximately two days after the surgery at patients’ homes, following instructions from the physiotherapist. However, it is difficult to ensure whether the patients perform the exercises correctly and continuously since it is a self-declared feedback provided by the patients.
The rehabilitation process starts approximately two days after the surgery at patients’ homes, following instructions from the physiotherapist. However, it is difficult to ensure whether the patients perform the exercises correctly and continuously since it is a self-declared feedback provided by the patients.
Purpose: The objective of the study is to evaluate the effectiveness of using a telerehabilitation platform based on inertial sensors (ReHub) in patients who underwent TKA. Physiotherapists use the platform to define a rehabilitation plan for the patients and follow patients’ progress remotely and the patients use the platform to perform the exercises from home. The platform -using intelligent algorithms- provides continuous feedback to the patients regarding their performance.
Methods: Fifty-two subjects, between 18 and 75 years old, who had recently undergone a TKA in Hospital Clínic of Barcelona (HCB) were selected for the study and randomly allocated in a control or experimental group (1:1 ratio) after signing an informed consent form.
As it is the usual protocol in HCB, patients were discharged two or three days after the surgery and they were prescribed with five daily rehabilitation exercises to do at home. The control group patients had to perform the exercises on their own, and complete a diary indicating which of the prescribed exercises they did each day, while patients in the experimental group performed the exercises using a sensor-based telerehabilitation platform. Both groups started receiving domiciliary visits by a physiotherapist two weeks after the surgery, distributed in two or three visits per week.
Control visits took place on the day of discharge, after two weeks and after four weeks, where several outcome measures were collected to monitor the progress of the patients’ recovery.
As it is the usual protocol in HCB, patients were discharged two or three days after the surgery and they were prescribed with five daily rehabilitation exercises to do at home. The control group patients had to perform the exercises on their own, and complete a diary indicating which of the prescribed exercises they did each day, while patients in the experimental group performed the exercises using a sensor-based telerehabilitation platform. Both groups started receiving domiciliary visits by a physiotherapist two weeks after the surgery, distributed in two or three visits per week.
Control visits took place on the day of discharge, after two weeks and after four weeks, where several outcome measures were collected to monitor the progress of the patients’ recovery.
Results: The results demonstrate a significant improvement in the majority of measured outcomes for the experimental group compared to the control group, namely the active range of motion of the knee (+22% vs. +13%), the quadriceps strength (+188% vs. +150%), the hamstring strength (+94% vs. +72%) and the WOMAC index (-64% vs. -52%).
Both groups show similar adherence levels to the exercise program. The high adherence level among experimental patients is obtained thanks to the real-time feedback and interactive features. However, in the control group, the adherence is measured through self-declared information which could face self-reporting bias.
Both groups show similar adherence levels to the exercise program. The high adherence level among experimental patients is obtained thanks to the real-time feedback and interactive features. However, in the control group, the adherence is measured through self-declared information which could face self-reporting bias.
Conclusion(s): Based on the results, it can be noted that telerehabilitation is contributing positively in the quicker recovery process for TKA patients and improves the overall quality of rehabilitation process.
Implications: The project aims to demonstrate the aplicability and effectiveness of telerehabilitation in the recovery process. The results will contribute to navigating the shift from traditional telerehabilitation practices to agile, patient-centric processes driven by digital health technologies such as ReHub.
Funding, acknowledgements: This study is supported by the European Union’s H2020-SME Instrument programme under grant agreement No 811755.
Keywords: Telerehabilitation, Total Knee Arthroplasty, Digital health
Topic: Innovative technology: information management, big data and artificial intelligence
Did this work require ethics approval? Yes
Institution: Hospital Clínic of Barcelona
Committee: Hospital Clínic of Barcelona’s Ethics Committee
Ethics number: HCB/2019/0571
All authors, affiliations and abstracts have been published as submitted.
