Conventional rehabilitation post-TKA achieves better knee flexion with higher resource utilization compared to application-based rehabilitation - a systematic review and meta-analysis

Arghya Kundu Choudhury; Shivam Bansal; Akash Jain; Balgovind S Raja; Bishwa Bandhu Niraula; Roop Bhushan Kalia

doi:10.1016/j.jor.2023.08.009

Conventional rehabilitation post-TKA achieves better knee flexion with higher resource utilization compared to application-based rehabilitation - a systematic review and meta-analysis

J Orthop. 2023 Sep 3:44:77-85. doi: 10.1016/j.jor.2023.08.009. eCollection 2023 Oct.

Authors

Arghya Kundu Choudhury¹, Shivam Bansal¹, Akash Jain¹, Balgovind S Raja², Bishwa Bandhu Niraula¹, Roop Bhushan Kalia¹

Affiliations

¹ Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
² Department of Orthopedics, All India Institute of Medical Sciences, Patna, India.

Abstract

Background: Post-operative physiotherapy is a major component of the effectiveness of knee replacement. Adequate rehabilitation protocols are required for better functional outcomes. With the advent of smartphones and smartwatches, the use of telerehabilitation has increased recently. This study aims to compare tele rehabilitation using various mobile-based applications to conventional rehabilitation protocols.

Methods: From Jan 2000 to Jun 2022, all the RCTs from SCOPUS, EMBASE and PUBMED comparing patient-related outcome measures between the smartphone-based app and conventional rehabilitation protocols were scanned and seven studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The quantitative analysis compared outcomes using the knee injury and osteoarthritis outcome score (KOOS), the knee society function score (KSFS), the active range of motion (AROM), Euro-Qol-5D-5L, and MUA. The qualitative analysis compared VAS, NRS, and Time up and go (TUG).

Results: The study shows statistically significant improvement in traditional rehabilitation over app based on KSFS score (M.D.: 6.05, p = 0.05) and AROM on long-term follow-up (12 months) (M.D.: 2.46, p = 0.02). AROM was insignificant on 3 months or less follow-up. NRS and VAS were found to be statistically better in app-based groups. No statistically significant results were seen on KOOS, Euro-Qol-5D-5L, MUA and TUG. 90 days of readmission and a number of physiotherapy visits were more in conventional groups. No difference was seen in single-leg stance and satisfaction rates.

Conclusions: The present review highlights improved early pain scores and comparable patient-reported outcome analysis at a short-term follow-up period among patients receiving mobile app-based rehabilitation. However, knee range of motion and KSFS score achieved after surgery is analysed to be better with traditional rehabilitation at the one-year end follow-up period.

Keywords: App-based rehabilitation; Meta-analysis; Mobile-based rehabilitation; Outcomes; Rehab; Smartphone application; Total knee arthroplasty.

Publication types

Review