Comparison Of Three Unsupervised Home-based Therapies After Total Knee Arthroplasty

Objective: Postoperative rehabilitation is an essential component of total knee arthroplasty,which is important for improving function of keen,improving quality of life,reducing pain,and increasing surgical satisfaction.The effectiveness of unsupervised,home-based rehabilitation has been proven,and it has advantages such as convenience and low cost.It has gradually been promoted in recent years,which is routine rehabilitation programs after primary TKA in most institutions in China.However,no studies have yet compared the efficacy of different unsupervised,home-based rehabilitation.And no research has been conducted to find out which patient populations are not suitable for unsupervised,home-based rehabilitation.The objectives of this study include:1.Determine whether video-based physical therapy and We Chat-based physical therapy are better than paper manual-based physical therapy.2.Find the patient population that is not suitable for unsupervised,home-based rehabilitation.Methods: We conducted a prospective,single-center,single-blind,randomized controlled trial involving 201 patients who underwent primary,unilateral TKA.Patients were randomly divided into three groups and received three types of unsupervised home-based rehabilitation,included paper manual-based physical therapy(paper PT),video-based physical therapy(video PT)and We Chat-based physical therapy(Wechat PT).We followed up the patients at 4 weeks,12 weeks,6 months,and 12 months.The primary outcome was passive knee flexion(ROM).Secondary outcomes included Knee Injury and Osteoarthritis Outcome Score(KOOS);Timed-Up-and-Go(TUG);The MOS Item Short From Health Survey(SF-36);Forgotten Joint Score(FJS);Tampa Scale for Kinesiophobia(TSK);surgical satisfaction.In addition,we collected adverse events within 90 days postoperative period.Intention-to-treat analysis was conducted.Results: Demographic and clinical characteristics of the three groups of patients were similar at baseline(P> 0.05).The ROM of Paper PT,Video PT,and Wechat PT was 115.81 ± 6.93,120.13 ± 6.61,122.51 ± 6.44 at the last follow-up at 12 months postoperative.The ROM of Video PT and We Chat PT were better than those in Paper PT(P <0.05),ROM in We Chat PT was better than Video PT(P <0.05).In the subgroup analysis using the education level as the grouping standard,in the Paper PT group,the ROM of the high education level group and the middle education level group was better than ROM of the low education level group at 12 months postoperative(P <0.05);In the Video PT group and the Wechat PT group,there was no difference in ROM between patients with different educational levels at 12 months postoperative(P> 0.05).After All patients were regrouped according to the standard of living alone or not living alone.At 12 months after surgery,ROM of the not living alone group was better than that of the living alone group(P <0.05).Conclusion:For patients with first-time,unilateral TKA,Compared with Paper PT,Video PT and We Chat PT can provide superior effects within 1 year postoperative for patients who underwent primary,unilateral TKA;Patients with elementary education and below are not suitable for Paper PT;Patients who live alone may not be suitable for Unsupervised,home-based rehabilitation.