Abstract
Introduction
A smartphone-based care platform allows a customizable educational and exercise interface with patients, allowing many to recover after surgery without the need for formal physical therapy (PT). Furthermore, advances in wearable technology to monitor physical activity (PA) provides patients and physicians quantifiable metrics of the patient's recovery. The purpose of this study is to determine the feasibility of a smartphone-based exercise educational platform after primary knee arthroplasty as well as identifying factors that may predict the need for formal physical therapy.
Methods
This study is part of a multi-institution, prospective study of patients after primary total knee arthroplasty (TKA) and partial knee arthroplasty (PKA) enrolled in a smartphone with smartwatch-based episode of care platform that recorded multimodal PA (steps, kcal, stairs). Postoperatively, all patients initially followed the smartphone-based exercise program. At the surgeon's discretion, patients were prescribed therapy if needed. The outcome of this study was the need for PT outside the app-based exercise program as well as time to return to preoperative step count. Variables assessed were preoperative weekly step counts (steps/day), weekly postoperative activity level (weekly step count compared to preoperative level), compliance with the exercise program (>75% completion) and patient demographic data including gender, age, BMI and narcotic use. One hundred eighty-eight patients were included in analysis: 45 PKA (24%) and 143 TKA (76%). Step count data was available on 135 patients and physical therapy data on 174.
Results
Overall educational compliance was 91% and exercise compliance 34%. By 4-weeks postop, 45.6% of patients reached or exceeded their preoperative step count, including 60% of PKA and 41% of TKA (p=0.05). There was no significant difference in reaching step count based on gender (p=0.7), BMI <40kg/m2 (p=0.9) or age <65-years old (p=0.67). Sixty-three percent of patients that were compliant with the exercise program reached the step count compared to 40% of patients that weren't complaint (p=0.01). One hundred thirty-three patients (76.4%) completed the app-based exercise program without the need for PT, which included 81.4% of PKA patients and 75% of TKA patients (p=0.38). Weekly compliance with the exercise program (>75%) was significantly associated with not needing PT (p<0.001). Other factors that were significantly associated with the need for PT were a high physical activity level in postoperative week 1 (p<0.001) and a low physical activity level in postoperative week 2 (p=0.002).
Conclusion
A high percentage of patients after primary knee arthroplasty were able to successfully complete the smartphone-based exercise program without the need for PT. Compliance with the exercise program was an important predictor of success. Postoperative activity level may also indicate the need for therapy as patients who were very active in the first postoperative week and then saw a decline in activity in the second week were more likely to be prescribed PT. With this platform, surgeons can monitor a patient's exercise compliance and postoperative activity level allowing many to recover at home, while being able to identify those within the first few weeks who may need structured physical therapy.
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