Total Knee Replacement, Total Knee Arthroplasty
Conditions
Brief summary
Despite best efforts to provide standardized and effective rehabilitation sessions post-total knee replacement (TKR), there are a few factors that may result in sub-optimal recovery in this group of patients. There is a need to develop innovative rehabilitation strategies that (i) provide patients with accurate cues allowing for better compliance and exercise performance, (ii) allow for therapists to ensure continuity of care, monitor compliance, and identify deviation from recovery trajectories post-discharge, prior to their first outpatient appointment, and (iii) reduce reliance on manpower and variability during rehabilitation sessions. Technological solutions that empower patients and allow home-based rehabilitation to take place without the need for real-time human supervision could be the key to improving effectiveness and lowering costs. A mobile application which detects key landmarks on the body for human pose estimation will allow patients to perform their rehabilitation exercises with real-time feedback allowing for proper execution of the exercises. Physiotherapists will be able to access the data generated from the exercise session via a command centre to monitor patients' recovery progress and compliance. The primary aim of this pilot study is to evaluate the feasibility of using a mobile application during rehabilitation in patients after a TKR surgery. The secondary aim is to study the effects of using a mobile application during rehabilitation on knee functional status, exercise self-efficacy, and treatment satisfaction after TKR surgery.
Interventions
DEVICEMobile application
Participants will be instructed on the installation and use of the mobile application on their personal mobile phones. Participants will then have to perform the assigned exercises using the mobile application 3 times daily. Physiotherapists will still perform the required assessment/review, education, and intervention.
All participants will be seen by physiotherapists in the ward post-TKR surgery and undergo standard inpatient rehabilitation. Patients will be given instructions to perform assigned exercises 3 times daily. Physiotherapists will perform the required assessment/review, education, and intervention.
Sponsors
Singapore General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
45 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1. Primary unilateral total knee replacement 2. Age \>= 45 years 3. Under the Enhanced Recovery After Surgery (ERAS) programme (discharge on post-operative day 0/1) 4. Willingness to be randomized to either mobile application group or standard hospital-based rehabilitation group 5. Ability to provide informed consent 6. Is technologically savvy - at least 6 months' experience using a smartphone and able to key in data into a smartphone 7. English-speaking
Exclusion criteria
1. Rheumatoid arthritis and other systemic arthritis 2. A previous history of stroke and other major neurological conditions 3. An intention to transfer to step-down care facilities post-operatively or intention to continue outpatient physiotherapy service at another institution 4. Unable to perform 5 repetitions of inner-range quadriceps exercise
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Compliance | 6 weeks post-surgery | Frequency of exercise sessions completed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gait speed | Pre-operation; 6 weeks post-surgery | Usual and fast gait speed |
| Knee Pain | Pre-operation; 6 weeks post-surgery | Knee will be measured using separate 11-point numeric pain rating scale, with zero representing no pain at all and 10 representing worst imaginable pain. |
| 30 second sit to stand | Pre-operation; 6 weeks post-surgery | 30 second sit to stand test |
| Self-report physical function | Pre-operation; 6 weeks post-surgery | All items are scored on 5-point Likert scales. With100 indicating no symptoms and 0 indicating extreme symptoms. |
| Self-efficacy | Pre-operation; 6 weeks post-surgery | Self-efficacy questionnaire |
| Knee range-of-motion | Pre-operation; 6 weeks post-surgery | A long-arm goniometer will be used to measure knee flexion and extension range-of-motion. |
| Quality of the mobile application | 6 weeks post-surgery | Quality of the mobile application questionnaire. All items are scored on 5-point Likert scales with 1 indicating Inadequate and 5 indicating Excellent. |
| Participant satisfaction | 6 weeks post-surgery | Participants will rate their satisfaction with treatment on an 11-point Likert scale, with 0 indicating no satisfaction and 10 indicating complete satisfaction. |
| Treatment credibility | 6 weeks post-surgery | Participants will rate their confidence about the benefits of the intervention on an 11-point Likert scale, with 0 indicating not confident and 10 indicating extremely confident. |
| Perceived usefulness and ease of use | 6 weeks post-surgery | Participants will rate their perceived usefulness and ease of use of the intervention on an 11-point Likert scale, with 0 indicating not useful or not easy and 10 indicating extremely useful or extremely easy. |
| Total contact time | 6 weeks post-surgery | Time spent with the patients |
Countries
Singapore
Outcome results
None listed