Purpose: Technology assisted exercise are increasingly used in exercise rehabilitation often without appropriate clinical evaluation. The aim of this study is to assess the effectiveness of a 6 weeks technology assisted exercise intervention (ICURA) compared to supervised group exercise twice weekly in 6 weeks in patients after total knee arthroplasty (TKA). Methods: Participants after TKA admitted to post-surgery rehabilitation in 4 municipalities in Copenhagen were randomized to either ICURA or supervised group exercise for 6 weeks. The randomization was performed with permuted blocks on 4, 6 and 8 and was stratified on municipality. The ICURA group received one supervised group session every week and was instructed to perform exercise at home using a predefined exercise program in a smartphone app. Exercise performance was monitored via sensor technology. Physical therapists monitor exercise progression on a website and adjust with the patient on the weekly session. The supervised exercise group received supervised exercise on a rehabilitation centre twice weekly. Primary outcome were 10 meters walk, secondary outcomes were 30 seconds sit-to-stand, 2.45 meters “Up and Go” test and Knee disability and Osteoarthritis Outcome Score (KOOS). Difference in outcomes after 6 weeks was adjusted for baseline-score and municipality. Analysis was firstly performed as completer analysis and secondly as intention-to-treat using the baseline score carried forward (BOCF). Finally the differences between the two interventions were compared to the predefined equality point, which was set at 20%. Results: 141 TKA patients were included and allocated to the intervention groups (70 to ICURA and 71 to supervised group exercise) and 111 (55 and 56 respectively) completed the 6 weeks intervention. The completer analysis showed only small, and not clinical relevant differences in the effect between the two interventions in 10 meters walk (0.15 seconds 95%CI -0.32-0.62; P = 0.54), 30 seconds sit-to-stand (-0.07 times 95%CI -1.13-1.00; P = 0.90) and 2.45 meters “Up and Go” (-0.02 95%CI -0.43-0.40; P = 0.94), where negative is in favour of the supervised exercise group. Furthermore only small differences between the interventions was seen in the five domains of the KOOS; pain (6.02 95%CI 0.16-11.89; P = 0.04) other symptoms (1.97 95%CI -3.22-7.16; P = 0.46), Activities of Daily Living (ADL) (3.66 95%CI -1.28-8.60; P = 0.15), sport and recreation function (-3.30 95%CI -13.95-7.35; P = 0.54) knee-related Quality of Life (QoL) (5.12 95%CI -1.58 to 11.83; P = 0.13). Similar results were seen in the intention-to-treat analysis for all the tested outcomes. Conclusions: Similar effects of 6 weeks rehabilitation were seen in patients with TKA receiving either ICURA or supervised group exercise. In conclusion the technology assisted exercise intervention (ICURA) is an equally effective alternative to supervised group exercise performed in a rehabilitation center for patients after total knee replacement.
Juhl, C. B., Roth, S., Schierbeck, R., Nielsen, L. N., Nordlien, A.-D., Hansen, N. F., … Hofland, D. T. (2016). Effectiveness of technology assisted exercise compared to usual care in total knee arthroplasty. Osteoarthritis and Cartilage, 24, S473. https://doi.org/10.1016/j.joca.2016.01.864