App-based rehabilitation after total hip or knee arthroplasty: a randomised controlled trial

Brief name: mobile app-based telerehabilitation program The participants in the experimental group will receive a six-week mobile app-based telerehabilitation program on top of usual care. This program is based on the exercise regime of usual care, literature evidence, and the theoretical framework of this study – Bandura’s self-efficacy theory and Illeris’ model of learning. It aims to enhance patients’ self-efficacy in rehabilitation after total hip arthroplasty (THA) or total knee arthroplasty (TKA), improve their clinical outcomes such as physical function, pain, depression, anxiety, and eventually improve their health-related quality of life (HRQoL). The program consists of physical exercises as well as techniques for enhancing self-efficacy and reducing stress. The exercise regime used in the telerehabilitation program is the same one as usual care. It includes exercises aiming to improve range of motion, muscle strength, activities and balance, such as heel slides, hip abduction and adduction, straight leg raise, bridge, standing march, walking, and steps and curbs. The exercises will be demonstrated by videos or photos via the mobile app WeChat. The participants will be recommended to practice the exercises for one hour daily and at least five days per week. On top of that, strategies to enhance participants’ self-efficacy in rehabilitation will be provided. To enhance participants’ direct mastery experiences, exercise goals are established and rehabilitation instructions are broken down into small tasks to help participants to achieve these goals. The participants will be encouraged to record their achievements in rehabilitation and pain relief on an in-paper diary, which aims to build their confidence based on their accomplishments. Each Monday the researcher (QW) will send a message to remind the participants of taking exercises as well as recording the diary. Videos and messages where previous patients who have participated in rehabilitation share their experiences are provided in WeChat. An asynchronous discussion forum which involves participants, researchers, an arthroplasty surgeon, a nurse, and a physiotherapist will be held via WeChat. Participants in the experimental group will be included in the discussion forum from the day before hospital discharge to six weeks after discharge. The participants may post their experiences and questions about rehabilitation at any time. The questions will be responded to by the researcher (QW) within 24 hours. To help relieve stress and anxiety, techniques such as muscle relaxation exercises will be included in this program. A validation panel which consists of an arthroplasty surgeon, a nurse, a physiotherapist, and two patients will be invited to review the content and give feedback about appropriateness and feasibility. The researcher (QW) will deliver the intervention via WeChat to participants who rehabilitate at home. QW has experience in patient education and research experience in randomised controlled trials (RCTs). She receives rehabilitation training from the arthroplasty surgeon and will develop and conduct the intervention under the guidance of this surgeon. The mobile app WeChat will be the delivery medium as it is the most popular networking platform in China and is free of charge. Prior to the intervention, the researcher (QW) will teach the participants in the experimental group to use the rehabilitation program on WeChat. A take-home booklet will be provided to demonstrate how to use the app step by step. Strategies will be adopted to assess patient adherence to the intervention. The numbers of days in which the participants use the WeChat program and complete their rehabilitation tasks will be tracked through the written rehabilitation diaries. The frequency of participants’ posts in discussion forum on WeChat will be counted to understand the online engagement.