Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study

Fernando Dias Correia, André Nogueira, Ivo Magalhães, Joana Guimarães, Maria Moreira, Isabel Barradas, Maria Molinos, Laetitia Teixeira, Joaquim Pires, Rosmaninho Seabra, Jorge Lains, Virgílio Bento, Fernando Dias Correia, André Nogueira, Ivo Magalhães, Joana Guimarães, Maria Moreira, Isabel Barradas, Maria Molinos, Laetitia Teixeira, Joaquim Pires, Rosmaninho Seabra, Jorge Lains, Virgílio Bento

Abstract

Background: The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care.

Objective: The aim of this study was to assess the feasibility of a novel artificial intelligence-powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation.

Methods: This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM).

Results: A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of -4.79 seconds (95% CI -7.24 to -1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion.

Conclusions: This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources.

Trial registration: ClinicalTrials.gov NCT03045549; https://ichgcp.net/clinical-trials-registry/NCT03045549.

Keywords: AI-powered rehabilitation; THA; THR; biofeedback; digital physiotherapy; motion trackers; telerehabilitation.

Conflict of interest statement

Conflicts of Interest: FDC and VB have a shareholder position at SWORD Health, a company that develops and commercializes SWORD-related products. AN, IM, JG, MM, and IB are employees of SWORD Health but do not have shareholder positions. LT and JL receive honoraria from SWORD Health. JP and RS have no conflicts of interest to report.

©Fernando Dias Correia, André Nogueira, Ivo Magalhães, Joana Guimarães, Maria Moreira, Isabel Barradas, Maria Molinos, Laetitia Teixeira, Joaquim Pires, Rosmaninho Seabra, Jorge Lains, Virgílio Bento. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 21.06.2019.

Figures

Figure 1
Figure 1
System components. (A) Mobile app. Preparation screen (top left): this screen displays video and audio instructions for each exercise. Execution screen (bottom left). (B) Web portal. Prescription screen (top right) displaying the exercise list and session layout. Results screen (bottom right) presenting (1) date, time, and session duration; (2) pain and fatigue scores; and (3) information on each repetition-range of motion and movement errors.
Figure 2
Figure 2
CONSORT (Consolidated Standards of Reporting Trials) diagram. PT: physiotherapy; THA: total hip arthroplasty.
Figure 3
Figure 3
Evolution of the outcomes over time in both groups based on the repeated measures analysis (estimated marginal means are presented). (A) Timed Up and Go (TUG) score, (B) lying hip flexion, (C) lying hip abduction, (D) standing hip flexion, (E) standing hip hyperextension, (F) standing hip abduction. PT: physiotherapy.

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