A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Kevin M Bell, Chukwudi Onyeukwu, Clair N Smith, Adrianna Oh, Annette Devito Dabbs, Sara R Piva, Adam J Popchak, Andrew D Lynch, James J Irrgang, Michael P McClincy, Kevin M Bell, Chukwudi Onyeukwu, Clair N Smith, Adrianna Oh, Annette Devito Dabbs, Sara R Piva, Adam J Popchak, Andrew D Lynch, James J Irrgang, Michael P McClincy

Abstract

Rehabilitation has been shown to improve functional outcomes following total knee replacement (TKR). However, its delivery and associated costs are highly variable. The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study's objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after TKR and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Specifically, we tested post-operative outpatient rehabilitation supplemented with interACTION (n = 13) by comparing it to a standard post-operative outpatient rehabilitation program (n = 12) using a randomized design. Attrition rates were relatively low and not significantly different between groups, indicating that participants found both interventions acceptable. A small (not statistically significant) decrease in the number of physical therapy visits was observed in the interACTION Group, therefore no significant difference in total cost could be observed. All patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial. Trial registration: ClinicalTrials.gov NCT02646761 "interACTION: A Portable Joint Function Monitoring and Training System for Remote Rehabilitation Following TKA" 6 January 2016.

Keywords: interactive health technologies; remote rehabilitation; total knee replacement.

Conflict of interest statement

Kevin Bell, Michael McClincy, Andrew Lynch, and James Irrgang have financial interest with interACTION (University of Pittsburgh Reference #04275) being evaluated in this research study. This means that it is possible that the results of this study could lead to personal profit for the individual investigator(s) and/or the University of Pittsburgh.

Figures

Figure 1
Figure 1
Conceptual flowchart of the interACTION platform: (1) inertial measurement units (IMUs) attached to the patient’s thigh and shank using neoprene straps and 3D-printed cases, (2) mobile application utilized by the patient to complete their prescribed home exercises, (3) screenshot of clinician portal depicting the patient dashboard which is utilized by the physical therapist to manage the patient’s rehabilitation remotely.
Figure 2
Figure 2
Consolidated standards of reporting trials (CONSORT) diagram of participant flow during the study.

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