Currently accepted at: Journal of Medical Internet Research
Date Submitted: May 13, 2026
Date Accepted: Oct 5, 2026
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/101277
The final accepted version (not copyedited yet) is in this tab.
Effectiveness of digital health interventions on rehabilitation outcomes in patients after total knee arthroplasty: A systematic review and network meta-analysis
ABSTRACT
Background:
Digital health interventions are increasingly used in rehabilitation after total knee arthroplasty (TKA), but their comparative effectiveness remains unclear.
Objective:
This study aimed to compare and rank different digital interventions using network meta-analysis.
Methods:
A systematic review and network meta-analysis of randomized controlled trials was conducted. Databases including PubMed, Embase, and China National Knowledge Infrastructure were searched. Outcomes included pain, range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital for Special Surgery (HSS) score, and Timed Up and Go (TUG). Effect sizes were estimated using standardized mean differences (SMDs), and treatments were ranked using the surface under the cumulative ranking curve (SUCRA).
Results:
Thirty-five studies involving 3002 patients were included. The results of the network meta-analysis showed that, compared with conventional rehabilitation, for pain score, rehabilitation robot (RR) demonstrated the most significant improvement effect (SMD = -0.72, 95% CI: -1.29 to -0.16, SUCRA = 86.0%). For knee ROM, virtual reality (VR) showed the most significant improvement effect (SMD = 1.45, 95% CI: 0.62 to 2.29, SUCRA = 91.9%). For the WOMAC score, although RR showed a better improvement effect, there was no statistically significant difference among the groups (P > 0.05). For the HSS, VR demonstrated the best improvement effect (SMD = 1.58, 95% CI: 1.13 to 2.03, SUCRA = 98.8%). For the TUG, mobile application-based telerehabilitation (MAT) demonstrated the best improvement effect (SMD = -1.24, 95% CI: -1.86 to -0.62, SUCRA = 92.0%).
Conclusions:
Digital health interventions effectively improve pain, knee ROM, and knee function in patients after TKA. Among them, RR, VR, and MAT demonstrate favorable overall effectiveness. Further high-quality studies are needed.
Citation
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