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Can digitally delivered rehab improve post-op outcomes following knee replacement?

September 28, 2023

What’s new in digital intervention following knee surgery?

Digitally delivered interventions are frequently used in a variety of contexts, including endocrinology, mental health, and postoperative care. Recent research has focused on the effects of combined digital intervention and digital monitoring following total knee replacement (TKR) surgery.

What’s the potential patient impact?

The use of digitally delivered interventions may improve the delivery of rehabilitation, delivering cost savings to the healthcare system and decreasing the burden on health workers.

Postsurgical rehabilitation is crucial for optimal recovery. However, outcomes following TKR vary, with some individuals continuing to experience ongoing pain and limited function even after surgery. (Duong, 2023) By utilizing digital technologies, patients can access personalized exercise programs, track their activity levels, and receive ongoing support from HCPs. These interventions can significantly improve pain levels, increase physical activity, and enhance overall quality of life for patients with osteoarthritis who have undergone TKR surgery. (Duong, 2023; Lebleu, 2023)

How does it work?

Post-operative digital intervention packages aim to optimize adherence and engagement with rehabilitation programs. For example, an Australian randomized trial combined several digital tools, including the PhysiApp Apple iPad app, a Fitbit tracker, and health coaching twice a month for a total of six months. (Duong, 2023)

A Belgium-based multicenter longitudinal cohort study involved a personalized and adaptive app-based digital monitoring and rehabilitation program for patients who had TKR. The moveUP cloud-based rehabilitation application was used to provide personalized, adaptive treatment and facilitate interaction between physical therapists and patients. (Lebleu, 2023)

What’s the evidence?

A multicenter, randomized clinical trial of 102 adults found that combined digital intervention can significantly improve outcomes for patients who have undergone TKR surgery for osteoarthritis. Patients were assigned to either a control group that received standard care or an intervention group that received the combined digital intervention described above. The intervention group experienced a clinically significant reduction in pain as compared to the control group. The intervention group also had lower disability scores, engaged in more physical activity, and spent less time being sedentary. (Duong, 2023)

Authors of the Belgian study concluded that personalized human-backed up digital solutions can help to improve the rehabilitation journey of patients after TKR, lower healthcare-related costs by lowering the complication and readmission rate, and improve patient reported outcomes. The study, published this May in Journal of Personalized Medicine, included 127 patients and studied the use of a personalized, adaptive app-based human-supported digital monitoring and rehabilitation program. The adherence to the program was 77%, and 89% of participants said that they would recommend use of the program. (Lebleu, 2023)

Authors of both studies point out limitations of digitally delivered interventions. Too often, digital interventions are based on standardized protocols that do not take into consideration an individual’s pain, participation, and speed of recovery. Most digital solutions also lack human support in case of need. Ultimately, further research is needed to evaluate the long-term effects and cost-effectiveness of these interventions. (Duong, 2023; Lebleu, 2023)

Sources:

Duong V. (2023, Sep 15). JAMA Netw Open.Combined Digital Interventions for Pain Reduction in Patients Undergoing Knee Replacement: A Randomized Clinical Trial.  https://pubmed.ncbi.nlm.nih.gov/37713201/

Lebleu J. (2023, May 13). J Pers Med. Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study. https://pubmed.ncbi.nlm.nih.gov/37240994/