Digital Versus Conventional Rehabilitation after Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study
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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://clinicaltrials.gov/ct2/show/NCT03045549.
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The authors have previously demonstrated the utility of a completely remote digital care program integrating exercise, education, and cognitive behavioral therapy in several MSK conditions, including for upper limb.
“Previously, we have demonstrated the utility of a completely remote digital care program (DCP) integrating exercise, education, and cognitive behavioral therapy (CBT) in several MSK conditions [42,43,44,45], including for upper limb [46,47,48].”
From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [45]
The Results (Outcomes Assessment; page not provided) report benefits of digital physiotherapy after total hip arthroplasty, supporting this paper as one example of an MSK rehabilitation program. But Methods (Intervention; page not provided) describes in-person visits, so the program was not completely remote; the described intervention includes exercise guidance but does not establish an education-and-CBT component. The separate upper-limb claim is attached to citations [46–48], not this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTelerehabilitation provides comparable results to outpatient physical therapy and face-to-face home rehabilitation, while reducing costs.
“Telerehabilitation has shown to provide comparable results to outpatient physical therapy [35–39] and to face-to-face home rehabilitation [40, 41], while reducing costs [42–44].”
From Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study (2022) · cites this paper as [38]
This DCP was previously validated for feasibility and effectiveness in post-surgery MSK rehabilitation.
“This DCP was previously validated (feasibility and effectiveness) in post-surgery MSK rehabilitation [38, 41, 45, 46].”
From Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study (2022) · cites this paper as [38]
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References 71 · Cited by 60
- Authors
- Dias Correia, F., Nogueira, A., Magalhães, I., Guimarães, J., Moreira, M., Barradas, I., Molinos, M., Teixeira, L., Pires, J., Seabra, R., Lains, J., & Bento, V.
- Affiliations
- Sword Health, SA (Portugal) (PT)
- Universidade do Porto (PT)
- Hospital da Prelada (PT)
- Instituto Superior da Maia (PT)
- ORCID
- Venue
- JMIR Rehabilitation and Assistive Technologies
- Publisher
- JMIR Publications Inc.
- Published
- 2019-06-21
- Volume
- 6
- Issue
- 1
- Pages
- e14523
- ISSN
- 2369-2529 (ISSN-L)
- PMC
- PMC6611148
- OpenAlex
- W2947984306
- Cited by
- 60
- References
- 71
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 8 · 2023: 12 · 2022: 16 · 2021: 5 · 2020: 4
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Rehabilitation and Assistive Technologies (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Surgery › Orthopaedic implants and arthroplasty
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- total hip arthroplasty, digital rehabilitation, home-based physiotherapy, artificial intelligence, biofeedback, conventional rehabilitation, Timed Up and Go test, HOOS, hip range of motion, patient-reported outcomes, feasibility, cost-effectiveness
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