Effects of telerehabilitation-implemented core stability exercises on patient-reported and performance-based outcomes in total knee arthroplasty patients: randomised controlled trial

Abstract

Background: Face-to-face access to exercise programs, including standard exercises (SE) and core stability exercises (CSE), can be challenging for many total knee arthroplasty (TKA) patients. Objectives: To investigate the effects of adding CSE to SE on patient-reported and performance-based outcomes in TKA patients using telerehabilitation (TR). Methods: Group 1 (SE, n = 21) and Group 2 (SE+CSE, n = 21). Follow-up included videoconferences (1-8 weeks) and telephone calls (9-12 weeks). Assessments (preoperatively and at 1st, 2nd, and 3rd postoperative months) included; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): functional level, Visual Analogue Scale (VAS): pain intensity, Copenhagen Knee Range of Motion (ROM) Scale (CKRS): knee ROM, Short Form-12 (SF-12) and World Health Organization Quality of Life Brief Version (WHOQOL-BREF): quality of life, 30-s Chair-Stand Test: muscle strength, and Stair Climb Test: locomotor performance. Results: All assessments showed a significant improvement after treatment in group 1 (p < .001, Cohen's d = 0.315 to 0.959) and group 2 (p < .001, d = 0.445 to 0.901). There was no significant difference between groups in knee flexion ROM (p > .05). Group 2 achieved better results in functional level (p = .001 to 0.003,d = -0.334 to 1.207), pain intensity (p = .030,d = -0.334), knee extension ROM (p = .015,d = -0.374), quality of life (p = .001 to 0.046,d = -0.308 to -1.366), muscle strength (p = .002 to 0.016,d = -0.779 to -1.030), and locomotor performance (p = .004 to 0.009, d = 0.404 to 0.954). Conclusion: SE and SE+CSE via TR enhance patient-reported and performance-based outcomes in post-operative TKA patients, with CSE providing additional benefits. These results support using CSE in TR programs for TKA and encourage further research on TR.