Overview
The objective of this clinical trial is to determine the effects of a newly formed treatment protocol implemented as telerehabilitation and compare it with conventional physical therapy in patient recovery after Total Knee Arthroplasty.
The main questions this study aims to answer are:
Does telerehabilitation improve pain, range of motion, and gait as effectively as conventional physical therapy?
Does telerehabilitation enhance exercise adherence, reduce kinesiophobia, and improve quality of life and patient satisfaction?
Can a hybrid rehabilitation protocol combining both approaches optimize clinical and functional outcomes?
Researcher will compare telerehabilitation-based physical therapy with traditional in-person therapy to see which method provides superior results in post-TKA recovery.
Participants Will:
Be adults aged 50-65 years who have undergone primary total knee arthroplasty
Receive either conventional physical therapy or a telerehabilitation-based exercise plan for a defined intervention period
Attend scheduled follow-up assessments to measure pain, range of motion, gait, functional performance, and satisfaction
Complete validated questionnaires on quality of life, kinesiophobia, and exercise adherence
Study Significance
Osteoarthritis is a growing health concern in Pakistan, with prevalence rising from 2.85 million in 1990 to 8.49 million in 2021. The increasing number of TKA procedures has created a demand for accessible, cost-effective, and evidence-based rehabilitation models. Telerehabilitation offers an innovative solution by extending professional care to patients' homes, enhancing accessibility, and ensuring continuity of therapy.
This study will provide locally relevant evidence and may lead to the development of a standardized rehabilitation protocol for Pakistani patients - improving recovery outcomes, reducing healthcare burden, and enhancing post-surgical quality of life
Ultimately, this research seeks to strengthen evidence-based rehabilitation in Pakistan, reduce the post-surgical burden of disability, and enhance the quality of life for individuals recovering from knee arthroplasty.
This RCT is based on a comparison of 2 groups. One will receive the MSTITP and other group will receive in person conventional physical therapy plan. This is based on 2 arm testing and the hypothesis is that the MSTITP is more effective in improving patient related outcomes in patients undergoing Total Knee Arthroplasty.
Participants in group A will perform a specific set of exercises ( details can be provided as and when asked) in a mode as convenient for the patients. The effect of Telerehabilitation will also be evaluated.
Participants in Group B will receive Conventional Physical Therapt as documented in in person sessions and will be followed for the same duration as of Patients in Group A.
Description
This randomized controlled trial (RCT) is designed to evaluate the effectiveness of a newly developed rehabilitation protocol delivered through telerehabilitation compared with conventional in-person physical therapy in patients undergoing Total Knee Arthroplasty (TKA). The study further explores whether a hybrid rehabilitation model can optimize patient outcomes by integrating both approaches.
The primary objective of this study is to determine the effects of a structured telerehabilitation-based treatment protocol (MSTITP) on post-operative recovery following TKA and to compare its effectiveness with conventional face-to-face physical therapy.
This study aims to address the following key clinical questions:
Does telerehabilitation improve pain, range of motion, and gait performance as effectively as conventional physical therapy? Does telerehabilitation enhance exercise adherence, reduce kinesiophobia, and improve quality of life and patient satisfaction? Can a hybrid rehabilitation protocol combining telerehabilitation and in-person therapy produce superior clinical and functional outcomes? This is a two-arm parallel-group randomized controlled trial.
Participants are randomly allocated into:
Group A (Intervention Group):
Participants receive the Modified Structured Telerehabilitation Intervention Protocol (MSTITP), consisting of supervised and guided exercise programs delivered remotely through digital platforms. The intervention is designed to allow flexibility and accessibility while maintaining clinical supervision.
Group B (Control Group):
Participants receive conventional in-person physical therapy, following standard post-operative rehabilitation protocols conducted in a clinical setting.
Both groups will be followed for the same intervention duration to ensure comparability.
Eligible participants are:
Adults aged 50-65 years Have undergone primary Total Knee Arthroplasty Be medically stable and cleared for rehabilitation Provide informed consent to participate
Participants in both groups will undergo structured rehabilitation programs focusing on:
Pain management Range of motion (ROM) exercises Muscle strengthening Gait training Functional mobility
Group A will perform exercises via telerehabilitation platforms, while Group B will receive direct, in-person supervision.
Participants will attend scheduled follow-ups where the following outcomes will be assessed:
Primary Outcomes Pain (e.g., VAS) Range of Motion (goniometry) Gait performance Secondary Outcomes Functional performance Exercise adherence Kinesiophobia Quality of life Patient satisfaction
Standardized and validated assessment tools will be used for all measurements.
The study hypothesizes that:
The Modified Structured Telerehabilitation Intervention Protocol (MSTITP) will be equally or more effective than conventional physical therapy in improving patient-related outcomes following Total Knee Arthroplasty.
Study Significance
Osteoarthritis is an increasing public health concern in Pakistan, with prevalence rising substantially over recent decades, leading to a higher number of TKA procedures. This growing demand places a significant burden on healthcare systems and rehabilitation services.
Telerehabilitation offers a cost-effective, accessible, and scalable solution, particularly in regions with limited access to specialized physiotherapy services. By enabling patients to receive supervised care at home, it improves accessibility, continuity, and adherence to rehabilitation.
This study is expected to:
Provide locally relevant evidence for telerehabilitation in Pakistan Contribute to the development of a standardized rehabilitation protocol for post-TKA patients Improve functional recovery and quality of life Reduce the burden on healthcare facilities Support the integration of technology-based rehabilitation models into routine clinical practice This randomized controlled trial aims to strengthen evidence-based physiotherapy practice by comparing innovative and conventional rehabilitation approaches. The findings may guide future clinical protocols and policy-making, ultimately improving outcomes for patients undergoing Total Knee Arthroplasty.
Eligibility
Inclusion Criteria:
- Patients who have underwent a primary unilateral total knee arthroplasty due to osteoarthritis
- Able to participate in a rehabilitation program, either telerehabilitation or in-person, and demonstrate sufficient mobility with or without assistive devices (e.g., crutches, walker) as deemed appropriate for post-TKA therapy.
- Participants must have reliable access to a smartphone, tablet, or computer with internet connectivity and the ability to engage in video calls.
- Willing and able to provide informed consent, and to comply with all study protocols, including scheduled therapy sessions and follow-up assessments.
Exclusion Criteria:
- Presence of significant comorbidities or complications that could interfere with safe participation in rehabilitation, such as severe cardiovascular disease, or conditions causing significant immobility (e.g., severe osteoarthritis in other joints or Rheumatoid Arthritis.
- Previous knee replacement or other significant knee surgeries on the same knee, as this may impact the standardization of rehabilitation outcomes.
- Currently enrolled in another physical therapy or rehabilitation trial, or engaging in additional rehabilitation outside the study protocol.
- Cognitive impairment or severe visual or hearing impairments that would prevent them from following therapy instructions or engaging with telerehabilitation technology.
- Any other conditions or factors that, in the opinion of the investigators, could hinder compliance with the study procedures or put the participant at undue risk.
