Can We Improve Clinical Outcomes and Patient Engagement after TKA Using a Digital Health Remote Monitoring Platform? Perioperative Results with Recupe
Timothy Hui *
Plethy, USA.
Subu Subramanian
Plethy, USA.
Atul Kamath
Cleveland Clinic, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: In their recovery plan, total knee arthroplasty (TKA) patients generally receive outpatient physical therapy and a home exercise plan. However, in the past home exercise plan compliance was not able to be tracked. With the advent of digital health, such as Plethy’s Recupe mobile app, home exercise plans can now be measured, providing compliance data along with exercise specific data.
Methods: Out of 245 TKA patients on Recupe, 53 patients were selected who performed exercises both pre-op and post-op, and also stayed on their program for at least 40 days and had a minimum of 50% engagement.
Results: Pain decreased significantly from pre-op (3.6/10) and 1st week (4.28/10) post op to 1 month post-op (2.65/10). Knee Flexion ROM increased significantly from the 1st week post op (44.72) to 1 month Post op (58.13). This was the range of motion performed during home exercises, not the max measurement from a healthcare provider.
Patients engaged the app 5.6 times per week. Previous research showed non-compliance at up to 70%.
Conclusions: This study suggests that digital health can help keep patients engaged in their home exercises. Those who adopt it show excellent engagement. This will likely lead to improved pain and ROM compared to those without digital health, who are not likely to comply with their prescribed home exercise plan.
Keywords: Clinical outcomes, home exercises, ROM, digital health
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References
Bandholm Thomas, Thomas W, Wainwright, Henrik Kehlet. Rehabilitation strategies for optimisation of functional recovery after major joint replacement. Journal of Experimental Orthopaedics. 2018;(5).
Artz, Neil, et al. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC musculoskeletal disorders. 2015;16(1):1-21.
Essery R, Geraghty AWA, Kirby S, Yardley L. Predictors of adherence to home-based physical therapies: A systematic review. 2016;39:519–534. Available: https://doi.org/10.3109/09638288.2016.1153160
Thorsteinsson, Hunbogi, et al. Manipulation under anesthesia after primary knee arthroplasty in Sweden: incidence, patient characteristics and risk of revision. Acta Orthopaedica. 2019;90(5) 484-488.
Crawford, David A, et al. Manipulation under anesthesia after knee arthroplasty is associated with worse long-term clinical outcomes and survivorship. The Journal of Knee Surgery. 2021;34(07):739-744.
Kalore N V, Gioe TJ, Singh JA. Diagnosis and management of infected total knee arthroplasty. The Open Orthopaedics Journal. 2011;5:86.
Chiang CY, Chen KH, Liu KC, Hsu SJ, P, Chan CT. Data collection and analysis using wearable sensors for monitoring knee range of motion after total knee arthroplasty. Sensors. 2017;17(2):418.
Katz, Nathaniel. The impact of pain management on quality of life. Journal of pain and symptom management 2002; 24(1):38-47.
Bergbom, Sofia, et al. Relationship among pain catastrophizing, depressed mood and outcomes across physical therapy treatments. Physical therapy 2011;91(5): 754-764.
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T. Ranawat award paper: Predicting total knee replacement pain: A prospective, observational study. Clinical Orthopaedics and Related Research®. 2003;416:27-36.
Pozzi F, Snyder-Mackler L, Zeni J. Physical exercise after knee arthroplasty: A systematic review of controlled trials. Eur. J. Phys. Rehabil. Med. 2013;49:877.
Marcus RL, Yoshida Y, Meier W, Peters C. LaStayo PC. An eccentrically biased rehabilitation program early after TKA surgery. Arthritis 2011;1–10.
Moyer R, Ikert K, Long K. & Marsh J. The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: A systematic review and meta-analysis. JBJS Rev. 2017;5:2.
Chen H, Li S, Ruan T, Liu L, Fang L. Is it necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty: Meta-analysis of randomized controlled trials. Phys. Sportsmed. 2018; 46:36–43.
McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database Syst. Rev; 2014.
Edwards PK, Mears SC, Lowry Barnes C. Preoperative education for hip and knee replacement: Never stop learning. curr. Rev. Musculoskelet. Med. 2017;10:356–364.
Matassi F, Duerinckx J, Vandenneucker H, Bellemans J. Range of motion after total knee arthroplasty: The effect of a preoperative home exercise program. Knee Surgery, Sports Traumatology, Arthroscopy. 2014;22(3)703-709.
Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(9): 2864-2872.
Fleischman AN, Crizer MP, Tarabichi M, Smith S, Rothman RH, Lonner JH, Chen AF. 2018 John N. Insall Award: Recovery of knee flexion with unsupervised home exercise is not inferior to outpatient physic; 2019.
Buhagiar Mark A, et al. Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty: A systematic review and meta-analysis." JAMA network open 2019; 2(4):192810-192810.
Bergbom Sofia, et al. Relationship among pain catastrophizing, depressed mood and outcomes across physical therapy treatments. Physical Therapy 2011;9(1)5: 754-764.
Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Man Ther. 2010; 15(3):220-8. DOI: 10.1016/j.math.2009.12.004. Epub 2010 Feb 16. PMID: 20163979; PMCID: PMC2923776.
Hui T, West A, Gorham J, Woldebirhan Y, Subramanian S. Decreased Mood Correlated with Decreased Exercise Adherence and Increased Pain. JAMMR [Internet]. May 20 [cited 2023 May 22]. 2023;35(14):72-6.
Kittelson Andrew J, et al. Reference chart for knee flexion following total knee arthroplasty: A novel tool for monitoring postoperative recovery. BMC Musculoskeletal Disorders. 2020;21(1): 1-8.