A Personalised, Remote- monitored Cycling Rehabilitation program following knee replacement surgery: a feasibility and acceptability trial.

Study Name: Feasibility of Personalised Remote-monitored Cycling following TKA The rationale for the intervention is to evaluate the feasibility of remote-monitored cycling rehabilitation that will commence 2-weeks after total knee replacement surgery. The intervention will continue for 4-weeks, based in the participant's home and monitored remotely by the research team for compliance and patient feedback. Participants will take home a portable cycle ergometer and electronic device with the pre-installed digital application (App) that records and provides real-time feedback during each cycling session, as well as an instruction booklet for the setup and use of the devices. Research personnel have a combined 30 years' experience in musculoskeletal rehabilitation and research to deliver the intervention and have undertaken technical training in use of the App and cycle ergometer from the developer. Participants are recruited from an orthopaedic clinic located in a private hospital where all pre-operative and follow-up visits are conducted. A familiarisation and information session for each participant will be held during their post-operative appointment at 2-weeks, where participants are shown how to setup and use the cycling ergometer, tablet and app. Average power output will be measured during the session to serve as the baseline exercise prescription. The 4-week home-based intervention involves 20 minute sessions, 5 times per week, with power output in the prescribed 'target' zone. If needed, the prescribed cycling program can be completed over more sessions per day (i.e. 4x5min or 2x10min sessions). Participants then report pain intensity and rate their perceived exertion via the App after each cycling session. Each intervention is personalised based on patient-reported feedback and compliance that is collected and remotely monitored by the research team through the web-based clinician interface. The exercise compliance and patient feedback is then reviewed by the research team and the power output increased if the baseline level is achieved, and level of perceived exertion is between 3 or 4 (moderate/ sort of hard) on the Borg scale. To progress the exercise dose, the resistance will be increased on the ergometer to achieve an increase in average power output. The participant will be notified of these changes via email or text. If the thresholds are not achieved, the dose may be decreased or remain unchanged, continually adapting to the participants capability to complete the prescribed exercise. Any participants not achieving prescribed exercise targets will be followed-up. To evaluate the success of the program delivery, feasibility criteria will be used which includes participant recruitment rate, participant retention, dose-goal attainment of the prescribed exercise, and participant adherence to feedback reporting. Key areas of feasibility will be quantitatively assessed from the post-operative feasibility questionnaire completed after the cycling rehabilitation program (6-weeks post-surgery), including acceptability, satisfaction, practicality and safety of the cycling program. Participants will also be completing self-reported outcome measures to assess symptoms and knee function at baseline (pre-surgery), 6-weeks post-surgery (after the intervention) and 12 months post-surgery.