Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls.

BACKGROUND: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. OBJECTIVE: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. METHODS: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. RESULTS: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales "function in sport and recreational activities" and "hip-related quality of life" of HOOS, and on the subscale "physical role limitations" of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes. CONCLUSIONS: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo.

Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty.

BACKGROUND: Recent developments in technology are promising for providing home-based exercise programs. OBJECTIVE: The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. METHODS: We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). RESULTS: Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25% (33/134) and work 15% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale "coaching" and the lowest for the subscale "sensor." CONCLUSIONS: A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed.

Low aerobic capacity and physical activity not associated with fatigue in patients with rheumatoid arthritis: a cross-sectional study.

OBJECTIVE: To explore whether low aerobic capacity and physical activity are associated with fatigue, when controlling for age, gender, pain and depressive symptoms in persons with rheumatoid arthritis. METHODS: In 60 individuals fatigue (Multidimensional Assessment of Fatigue scale; MAF), disease activity (Disease Activity Score-28; DAS 28), pain, physical and psychological status (Arthritis Impact Measurement Scales 2; AIMS 2), depression (Hospital Anxiety and Depression Scale; HADS), aerobic capacity and physical activity (Short Questionnaire to Assess Health-enhancing physical activity; SQUASH) were measured. Regression was performed to study the variance of fatigue explained by aerobic capacity and physical activity. RESULTS: Mean (standard deviation (SD)) age of participants was 51.8 (SD 10.4) years and 73.3% were women. Duration of disease was 10.2 (SD 0-41) years and mean disease activity score was 3.4 (SD 1.4). Mean Global Fatigue Index was 20.3 (SD 10.5). Physical function was 1.6 (SD 1.1) and psychological status 3.1 (SD 0-8) on the AIMS2. Pain score was 4.1 (SD 2.0) and median depression score was 3.2 (range 0-15). Total amount of physical activity was 176.9 (10.6-1,492.3) METhours/week and VO2max was 27.8 (SD 3.8) ml/kg/min. Backward multiple regression showed a statistically significant relationship with depressive symptoms only (t = 5.4, p < 0.001), which explained 33% of variance of fatigue in patients with RA. CONCLUSION: Depression, but not aerobic capacity or physical activity, contributed to fatigue. However, no relationship was found between aerobic capacity and fatigue.

Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity.

BACKGROUND: Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. METHODS: Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. RESULTS: In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. CONCLUSION: Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls.