Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study.
Fernando Dias Correia, André Nogueira, Ivo Magalhães and 9 others
PMID 30816849WHAT IT FOUND
Patients using a digital home-rehab system after knee replacement showed greater improvement in walking speed and knee motion at 3 and 6 months than those receiving standard physiotherapy.
However, the digital group had more treatment hours, and the study was not randomized.
Key findings
01The digital group had better Timed Up and Go scores at both 3 and 6 months compared to the conventional group.
02The digital group received significantly more active treatment hours (median 31.5 hours) than the conventional group.
03Allocation was based on patient address (geographic location), not randomization.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study used geographic allocation (patient address) instead of randomization, introducing potential selection bias and confounding variables like socioeconomic status. The digital group received more active treatment hours (median 31.5 hours) than the conventional group (24 hours), making it impossible to separate the effect of the technology from the effect of increased exercise dose. The baseline KOOS scores were significantly lower in the digital group, which may have influenced the magnitude of reported improvement. There was a high withdrawal rate (18%) in the digital group during the first week due to usability issues, suggesting the remaining participants were more technologically adept. The study was a feasibility trial, not powered for definitive efficacy comparisons, and conducted at a single center with a low-volume hospital setting.
Declared interests
Several authors are employees, shareholders, or honorarium recipients of SWORD Health, the company that develops the digital intervention used in the study.
The easy way to misread this
Do not conclude that the digital technology itself caused the superior outcomes. The digital group received significantly more active treatment time (median 31.5 hours) than the conventional group (24 hours), and allocation was based on address rather than randomization. The results may reflect the benefit of higher exercise dose or pre-existing differences between the geographic groups rather than the effectiveness of the app.