Feasibility and usability of a wearable sensor-based telerehabilitation program for home-based exercise in patients with lower limb amputation: a pilot study.
Ravi Shankar, Pei Shan Tong, Emily Yee and 1 others
PMID 42564145WHAT IT FOUND
Ten amputee patients did 30 days of sensor-guided home exercises plus their usual physiotherapy.
Hip strength improved significantly over 8 weeks, but with no control group you cannot tell whether the app caused the gain or it was just the usual therapy. The system was easy to use and patients liked it.
Key findings
01Hip extensor strength improved from a median of 8.43 kg to 10.88 kg over 8 weeks (median gain 2.45 kg), and hip abductor strength from 8.01 kg to 9.70 kg (median gain 1.69 kg); both reached statistical significance on the Friedman test (p < 0.05).
02Exercise compliance averaged 68% over the 30-day period (range 20%–100%), and the correlation between how often patients exercised and how much their strength improved was weak and non-significant (r = 0.3042, p = 0.3928 for extensors; r = 0.3878, p = 0.2681 for abductors).
03All 10 participants rated the system favourably: the mean SUS score was 75.8 (range 60–90), above the 68 acceptability benchmark, and every participant agreed or strongly agreed on all six satisfaction items.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
No control group: participants also received standard physiotherapy every two weeks, so the hip-strength gains cannot be separated from the effect of usual care or natural recovery. Only 10 participants, all from one clinic in Singapore, with a mix of below-knee and above-knee amputations and different causes—results are not generalisable. Outcome assessors were not blinded, so the physiotherapists measuring hip strength knew which group they were treating (though there was only one group). Exercise compliance varied widely (20% to 100%), and the correlation between how much a patient exercised and how much their strength improved was non-significant, so you cannot say more exercise caused more gain. Quality-of-life data were descriptive only (no inferential testing) and showed a confusing pattern where the global score improved but individual dimensions worsened; the authors do not claim a QoL benefit. Follow-up was only 8 weeks; there is no information on whether the strength gains lasted or translated into better prosthetic walking. The Rebee sensor has been validated for shoulder assessment against motion capture, but specific validation for hip exercises in amputee patients has not been published. Recruitment was limited by practical barriers (work commitments, lack of a caregiver, reluctance to use technology), so the sample may not represent the broader amputee population.
Declared interests
Funded by the National Healthcare Innovation Programme (NTF-HIP) Grant. The funding body declared no role in study design, data collection, analysis, interpretation, or manuscript preparation. The Rebee sensor is a commercially available product (XCLR8, Singapore), and the study was conducted at the manufacturer's validation site context, though no direct industry funding is stated.
The easy way to misread this
Do not read the 2.45 kg hip-extensor gain as proof that the Rebee app caused the improvement. This was a single-arm study of ten patients who also attended their usual physiotherapy every two weeks, with no control group and no blinding of the assessors. The authors themselves state that in the absence of a control group, these changes cannot be attributed to the intervention. A larger randomised trial is needed before you change your referral or discharge planning.