Total Diz Artroplastili Bireylerde İki Farklı Telerehabilitasyon Uygulamasının Etkinliğinin Karşılaştırılması

Abstract

The aim of this study was to compare the effectiveness of standard telerehabilitation (STR) versus digital content-integrated telerehabilitation (DITR) in individuals with knee osteoarthritis undergoing total knee arthroplasty, in terms of pain, range of motion (ROM), joint position sense (JPS), Quadriceps muscle strength, knee function, functional performance, artificial joint awareness, kinesiophobia, and exercise adherence. Additionally, our study aimed to determine the satisfaction with telerehabilitation among individuals in the DITR group. Thirty-six participants with an average age of 68.94±8.66 years were included. Participants were divided into two groups using a simple randomization method: the DITR group (n=18, mean age: 67.33±9.62 years) and the STR group (n=18, mean age: 70.56±7.52 years). Both groups were advised to perform an 8- week standard home exercises, three times daily with 10 repetitions each session. Participants in the STR group received their exercises through paper-based brochures and were monitored via phone calls three times a week, while those in the DITR group received their exercises through digital brochures and asynchronous videos and were monitored via phone calls, text messages, and video calls three times a week. Pain at rest, during activity, and at night was assessed using the Visual Analog Scale (VAS); ROM and JPS with an digital goniometer; muscle strength with a handheld dynamometer; knee function with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS); functional performance with the 5-Repetition Sit-to-Stand Test (5RSTS); artificial joint awareness with the Forgotten Joint Score-12 (FJS-12); kinesiophobia with the Brief Fear of Movement Scale (BFoM); exercise adherence with the Exercise Adherence Rating Scale (EARS); and the telerehabilitation satisfaction with the Telerehabilitation Usefulness and Satisfaction Questionnaire (TSUQ). On the discharge day, pain, ROM, JPS, knee function, functional performance, and kinesiophobia were assessed, while all assessments were conducted at the 4th and 8th weeks. At the end of the 4th week, there were significant differences between the groups in terms of pain (p<0.005), operated-side ROM (p<0.05), 5RSTS (p=0.029), knee function (p<0.001), Quadriceps strength (p=0.006), BFoM (p<0.001), FJS-12 (p<0.001), and EARS (p<0.005), while JPS was similar between the groups (p>0.05). By the 8th week, significant differences favoring the DITR group were found in pain (p<0.001), operated-side ROM (p<0.05), Quadriceps strength (p<0.001), knee function (p<0.05), 5TOTK (p<0.05), FJS-12 (p<0.001), and EARS (p<0.005), while JPS remained similar between the groups (p>0.05). The TSUQ scores in the DITR group were high both at 4th week (min-max 101.00-105.00) and at the 8th week (min- max 103.50-105.00). As a result, we suggest digital telerehabilitation interventions in individuals with total knee arthroplasty as it demonstrates better outcomes then standard telerehabilitation in parameters such as pain, range of motion, muscle strength, knee function, functional performance, joint awareness, kinesiophobia, and exercise adherence both at the postoperative 4th and 8th weeks.