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Visualisation of total knee replacement rehabilitation exercises in the home

Ayoade, Mobolaji and Almustafa, M. and Dounavi, Myrto-Despoina and Deakin, Angela and Rowe, Philip and Howe, Tracey and Munro, Niall and Kellett, C. and Deep, Kamal and Baillie, Lynne (2013) Visualisation of total knee replacement rehabilitation exercises in the home. In: CAOS UK conference 2013, 2013-11-21 - 2013-11-22.

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Postoperative rehabilitation after total knee replacement (TKR) within the UK usually takes place within the home. Sometimes patients find it difficult to monitor the quality and quantity of their exercises, and it is important to achieve as good a range of movement as possible in the first few weeks. This work aimed to engage users in their rehabilitation through an innovative way of capturing and then visualising movement data. Primary unilateral TKR patients were recruited to a single centre randomised controlled pilot trial. The control group underwent normal post-operative rehabilitation with an exercise booklet and DVD. The intervention group were provided with the visualisation system to use in their homes. The system consisted of two wireless sensors, a remote control, bespoke software and a laptop. The patient wore one sensor above the knee and one below while performing the rehabilitation exercises. A colour coded interactive traffic light system and stickman figure was used to indicate the quality of movement and the number of repetitions of each exercise. The system tracked weekly progress (both quality and quantity of exercises completed) and allowed arthroplasty practitioners to hold video calls with patients. The outcome measures for the study were gait speed, timed up and go test, knee range of motion and Oxford Knee Score. These were collected immediately prior to discharge (baseline) and at six weeks follow up. As this was a pilot study only descriptive statistics (mean ± SD) were used. Twenty-four patients were recruited. Of these six withdrew and two were excluded (one readmit and one referral for outpatient physiotherapy). Seven control and nine intervention patient completed the study. The mean age was 69 years (47 to 85), 6 left and 10 right knees, 10 females and 6 males. All intervention patients who completed the study found the visualisation system and video call easy to use. There were similar improvements in both groups from baseline to six-week follow-up for the gait speed (Control = 0.6 m/s ± 0.2, Intervention = 0.6 m/s ± 0.3), the timed up and go test (Control = 16 s ± 12, Intervention = 16 s ± 12) and for the Oxford Knee Score (Control = 17 ± 8, Intervention = 20 ± 10). However, the intervention group had larger improvements in knee extension (Control = 1° ± 3, Intervention = 6° ± 5) and knee flexion (Control = 15° ± 14, Intervention = 22° ± 12). This pilot study shows that a home-based visualisation system using wireless sensors can be introduced into patients’ post-operative rehabilitation and can also be used to facilitate remote assessment sessions with trained professionals. This approach is generally acceptable and could potentially improve patients’ knee range of motion, most especially in reducing knee extension lag.