The goal of this clinical trial is to compare patient-reported and performance-based outcomes
of patients followed with a standard exercise program based on telerehabilitation and
patients followed with action observation therapy program added to a standard exercise
program based on telerehabilitation after total knee arthroplasty surgery.
The secondary aim is to investigate the effect of a telerehabilitation-based standard
exercise program added to the home program (information leaflet) on patient-reported and
performance-based outcomes.
The surgical operations of all patients participating in the study will be performed by the
same surgical team and a standard physiotherapy program will be applied to all patients until
discharge.
Participants will be divided into three groups by computer-assisted randomization method:
Group 1: home exercise with information leaflet group, Group 2: information leaflet +
telerehabilitation-based standard exercise program group, Group 3: information leaflet +
telerehabilitation-based standard exercise program + action observation therapy group.
Patients in the second and third groups will be followed up with the telerehabilitation
method accompanied by a physiotherapist for 30 minutes 3 days a week for 6 weeks after
discharge. The third group will receive a standard exercise program 3 days a week and 15
minutes of action observation therapy via video conferencing.
Telerehabilitation sessions will include information about the process and exercise training.
Action observation therapy will include showing videos of the exercises in the exercise
program. All patients will be evaluated before surgery and at the third, sixth, and twelfth
weeks after discharge.
Evaluations
Descriptive Data: Descriptive data of the patients will be recorded using an evaluation form.
Patient Reported Assessments:
Western Ontario McMaster University Osteoarthritis Index (WOMAC): This index questions
clinically significant problems in the areas of pain, stiffness and physical function in
patients with osteoarthritis of the hip and knee.
Pain intensity: Pain intensity will be assessed with the Visual Analog Scale (VAS).
Knee range of motion: Active and passive knee range of motion will be measured in the
sitting position with a digital goniometer (HALO Medical Devices, Australia)
Quality of Life Assessment: Knee Injury and Osteoarthritis Outcome Score - Activities of
Daily Livings Scale (KOOS-ADLS) and EuroQol Group (EQ-5D) scales will be used for
quality of life assessment.KOOS-ADLS is a scale used to detect symptoms and limitations
in daily life tasks.The EQ-5D index scale consists of a questionnaire with five
dimensions (movement, self-care, usual activities, pain/discomfort and
anxiety/depression).
Physical activity assessment: International Physical Activity Survey (IPAQ-Short Form)
and smart phone pedometer application (Samsung Health®) will be used for physical
activity assessment. The IPAQ-Short Form consists of 7 questions asking about various
degrees of physical activity and sedentary behaviors in the past 1 week.
Patient Satisfaction Assessments: Patient satisfaction with telerehabilitation sessions
will be assessed. Technical quality (such as reliability of technology, quality of
audio/video synchronization, quality of image, quality of sound), achievement of
treatment goals of the session and overall satisfaction with the session will be
questioned.
Performance Based Assessments:
The tests recommended by the research groups of 30 seconds of sit and stand, 40 meters fast
walking and stair climbing will be used.
Lower extremity muscle strength: Lower extremity muscle strength will be assessed by 30
seconds sit and stand test.
Walking speed: In the 40-meter walk test, the patient is asked to walk a distance of 40
meters as fast as possible and the time in seconds is recorded.
Locomotor performance: Locomotor performance will be assessed with the stair climbing
test. The patient will be asked to ascend and descend 9 steps 16-20 centimeters long
stairs as quickly but safely as possible.