Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial

J Bone Joint Surg Am. 2011 Jan 19;93(2):113-20. doi: 10.2106/JBJS.I.01375.


Background: total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee. Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function. Access to high-quality rehabilitation services is not always possible, especially for those who live in rural or remote areas. The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty.

Methods: this investigation was a single-blinded, prospective, randomized, controlled noninferiority trial. Sixty-five participants were randomized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and six weeks by a blinded independent assessor. Secondary outcomes included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, limb girth measurements, and an assessment of gait. Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics.

Results: baseline characteristics between groups were similar, and all participants had significant improvement on all outcome measures with the intervention (p < 0.01 for all). After the six-week intervention, participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, quality of life, and clinical gait and WOMAC scores. Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group (p < 0.05). The telerehabilitation intervention was well received by participants, who reported a high level of satisfaction with this novel technology.

Conclusions: the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation.

Level of evidence: therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Ambulatory Care / methods
  • Arthroplasty, Replacement, Knee / methods
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Confidence Intervals
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Internet*
  • Knee Prosthesis
  • Male
  • Middle Aged
  • Ontario
  • Osteoarthritis, Knee / diagnosis
  • Osteoarthritis, Knee / surgery*
  • Outpatients
  • Pain Measurement
  • Physical Therapy Modalities
  • Postoperative Care / methods
  • Prognosis
  • Prospective Studies
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Reference Values
  • Single-Blind Method
  • Statistics, Nonparametric
  • Telemedicine / methods*
  • Therapy, Computer-Assisted / methods
  • Treatment Outcome