Adherence to a Digital Knee Rehabilitation Platform Among Patients With Knee Osteoarthritis and Anterior Cruciate Ligament Reconstruction in Hong Kong: Qualitative Study.
Nipuna Cooray, Stacie Powell, Mingqian Yu and 2 others
Patients with knee OA or post-ACL surgery described the platform as redundant with their physiotherapy, mismatched to their recovery stage, and harder to reach than YouTube or a reminder app.
When any fit point broke, they stopped using it but often kept exercising elsewhere.
Key findings
1Adherence was shaped by the degree of fit across three dimensions (content, motivational, access) rather than by any single factor. When all three aligned, participants kept exercising on the platform. When any one broke, engagement dropped.
2Participants across both groups perceived the platform's exercises as overlapping with what their physiotherapist already prescribed. When the QR-code access mechanism failed (lost pamphlet, no data plan, display bug), they switched to YouTube, the HA Go app with daily reminders, or a personal coach rather than stopping exercise altogether.
3Pain worked in two opposite directions: for some older participants it was the reason to keep exercising (fear of decline), while for a younger postoperative participant the absence of pain removed the perceived need to continue, so he skipped sessions.
Still to come
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Diagnosis, age, and surgical stage were tightly intertwined: ACL participants were predominantly younger and postoperative, OA participants predominantly older and preoperative. Differences between the two groups cannot be attributed to diagnosis alone. Convenience sample from a single public hospital in Hong Kong; no exclusion criteria were defined. No objective platform usage data were captured. All engagement information is self-reported in interviews. Transcripts were translated from Cantonese or Mandarin into English without back-translation or independent verification. Fifteen participants; the authors note that theoretical saturation was not pursued and some perspectives may not have been captured. The consulting clinician (MTYO) introduced patients to the platform as part of routine care and was involved in study design. The authors acknowledge this may have influenced willingness to participate or candor.
Declared interests
Funded by the Chinese University of Hong Kong-The George Institute Joint Collaborative Research Fund. No conflicts of interest declared. The platform itself was developed by the Department of Orthopaedics and Traumatology at the Chinese University of Hong Kong, and the consulting clinician on the study team introduced patients to it as part of routine clinical care.
The easy way to misread this
Do not read the low platform engagement as evidence that these patients did not exercise. Several substituted YouTube, the HA Go app, or a personal coach and continued their rehabilitation. The finding is about the platform's access design and content timing, not about the patients' willingness to do the work. Also, because ACL participants were almost all younger and postoperative while OA participants were almost all older and preoperative, you cannot separate the effect of diagnosis from the effect of age or surgical stage in any between-group comparison.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →