Effect of Lifestyle Modification Through Web-Based Telerehabilitation Monitoring Combined With Supervised Sensorimotor Training After Total Knee Arthroplasty: Randomized Controlled Trial.

Background: Total knee arthroplasty (TKA) is commonly performed to manage end-stage knee osteoarthritis, yet postsurgical recovery varies significantly among patients. Lifestyle modification and rehabilitation interventions play a critical role in optimizing outcomes. While telerehabilitation has shown promise in enhancing accessibility and compliance, its role in supporting lifestyle behavior change alongside supervised sensorimotor training remains underexplored. Objective: This study aimed to evaluate the effects of a home-based lifestyle modification program delivered through web-based telerehabilitation monitoring in addition to supervised sensorimotor training, in improving physical function, pain, balance, quality of life (QOL), and adherence in patients undergoing TKA. Methods: A single-blinded randomized controlled trial was conducted among 52 participants undergoing primary TKA, who were randomly assigned to either the intervention group (IG) (supervised sensorimotor training plus a telerehabilitation-supported lifestyle modification program) or the control group (CG) (supervised sensorimotor training alone and a traditional home exercise plan). The intervention lasted 22 weeks, and participants were assessed at baseline (presurgery), 14 weeks, and 22 weeks postsurgery. Outcome measures included joint position sense (JPS), musculoskeletal ultrasound of the rectus femoris muscle, Berg Balance Scale, knee function using the Knee Injury and Osteoarthritis Outcome Score, and QOL via EuroQol 5-dimension 5-level questionnaire. Results: Significant improvements were observed in the IG across all outcomes compared with the CG. Notably, the IG showed greater improvements in musculoskeletal ultrasound thickness. JPS showed superior accuracy in the experimental group (baseline [3.2 degrees] to 22 wk postsurgery [0.05 degrees]) compared with the CG (baseline [3.1 degrees] to 22 wk postsurgery [1.8 degrees]), with significant improvements noted (P=.001, Cohen d=3.1 vs 0.7), Knee Injury and Osteoarthritis Outcome Score subscales (pain, symptoms, activities of daily living, sport, and QOL), and JPS (mean absolute error 0.05 vs 1.8 degrees). Berg Balance Scale demonstrated significant gains in balance for the experimental group (baseline [34] to 22 wk postsurgery [53]) relative to the CG (baseline [37] to 22 wk postsurgery [48]), with substantial differences observed (P=.001, Cohen d=1.8 vs 0.4). The EuroQol 5-dimension 5-level questionnaire health-related QOL scores were markedly higher for the experimental group (baseline [45.4] to 22 wk postsurgery [88.1]) compared with the CG (baseline [42.8] to 22 wk postsurgery [70.9]), indicating substantial gains in overall health status (P=.001, Cohen d=2.4 vs 1.3). The IG also reported higher compliance, with 81.8% (18/22) achieving over 90% adherence compared with 68.18% (15/22) in the CG. Conclusions: Home-based lifestyle modification program through telerehabilitation monitoring significantly improved functional and patient-reported outcomes in individuals following TKA. These findings support the integration of lifestyle modification programs through telerehabilitation monitoring into post-TKA recovery pathways to optimize rehabilitation outcomes.