Comparison of voice call based and multimodal telerehabilitation after total knee arthroplasty: a randomized controlled trial

Background Telerehabilitation has emerged as a promising approach in postoperative care following total knee arthroplasty(TKA);nevertheless,the relative effectiveness of different telerehabilitation modules is still under discussion, leaving room for alternative and multimodal program approaches.Objectives This study aimed to compare the effectiveness of a multimodal telerehabilitation(MTR) and voice call based telerehabilitation(VTR) in patients undergoing TKA.Methods A two-arm randomized controlled trial was conducted with 24 patients (68.42 ± 9.28y) in the MTR group and 21(71.19 ± 7.26y) in the VTR group. The MTR group received weekly digital booklets containing asynchronous exercise videos, one voice call, one video call,and text messages,for a total of three contacts per week. The VTR group received weekly printed booklets and voice calls three times a week(on alternate days) over the 8-week intervention period. Outcomes were assessed face to face at discharge, and at the 4th and 8th postoperative weeks. Measures included Visual Analog Scale(VAS), active and passive range of motion(ROM), Knee Osteoarthritis Outcome Score-Physical Function(KOOS-PS), Five Repetition Sit to Stand Test(5xSST), Brief Fear of Movement(BFoM) Scale, isometric Quadriceps muscle strength, Forgotten Joint Score-12(FJS-12),Exercise Adherence Rating Scale(EARS). The primary outcome was active knee flexion ROM. Statistical significance was set at p < .05; effect sizes (r, W) were reported for the Mann – Whitney U and Wilcoxon tests.Results After 8 weeks, a statistically significant difference in pain during activity was observed between the MTR and VTR groups (p < .001, r = 0.62). Both groups showed significant gains in active and passive knee flexion ROM, 5xSST, and KOOS-PS scores (all p < .001), while the MTR group also improved in rest pain, knee extension, and BFoM (all p < .001). At week 8, statistically significant differences were observed between the MTR and VTR groups across all outcome measures (all p < .001).Conclusion Both telerehabilitation approaches were effective in improving pain, ROM, and functional outcomes after TKA.Although this study did not compare outcomes with conventional in-person rehabilitation, MTR showed greater overall improvements than VTR. Nevertheless, VTR remains a reasonable alternative when MTR cannot be implemented.