JMIR Publications

ABSTRACT

Background:

Persistent pain and functional limitations after total knee arthroplasty (TKA) remain a clinical challenge, with growing evidence highlighting the role of psychological factors such as coping strategies, treatment expectancy, and social support in postoperative recovery. Tele-rehabilitation represents a promising approach to enhance continuity of care and patient engagement, particularly when integrated with psychoeducational support.

Objective:

To compare the effectiveness of a personalized tele-rehabilitation program incorporating psychoeducational components and caregiver support with conventional outpatient rehabilitation following TKA, and to explore the relationship between coping strategies, treatment expectancy, and clinical outcomes.

Methods:

This single-blind randomized controlled trial enrolled 48 patients undergoing TKA for knee osteoarthritis, randomly assigned to an experimental group (tele-rehabilitation with psychoeducational support; n = 24) or a control group (conventional in-person outpatient rehabilitation; n = 24). Forty-four participants completed the study (22 per group). Both groups followed comparable rehabilitation protocols in terms of frequency and duration. Outcome measures – including pain (VAS), function (WOMAC, KOOS), autonomy (Barthel Index, Modified Rankin Scale), coping strategies (COPE-NIV), and treatment credibility/expectancy (CEQ) – were assessed at baseline (T0), after 4 weeks (T1), and at 3 months post-surgery (T2). Non-parametric mixed-effects models and correlation analyses were performed.

Results:

Both groups showed significant improvements over time in all clinical outcomes (p < 0.001). Significant group x time interactions were observed for pain-related outcomes, with the tele-rehabilitation group demonstrating greater reductions in VAS pain (p = 0.019), WOMAC Pain (p = 0.036), and KOOS Pain (p = 0.046). Crucially, correlation analyses revealed that the “Social Support” coping strategy at baseline was a significant predictor of clinical success; greater reliance on seeking social support was strongly associated with more pronounced improvements in pain intensity and functional disability scores. No significant between-group differences emerged for functional independence or quality of life measures. Baseline coping strategies and CEQ scores were comparable between groups. Greater reliance on social support coping strategies was significantly associated with larger improvements in pain and disability outcomes. No adverse events were reported.

Conclusions:

A personalized tele-rehabilitation program with psychoeducational components and caregiver support is a safe and effective alternative to conventional outpatient rehabilitation after TKA. Tele-rehabilitation was non-inferior in functional recovery and demonstrated superior pain reduction. The finding that social support coping strategies are significantly correlated with better clinical outcomes emphasizes the importance of a biopsychosocial approach to post-TKA rehabilitation. Clinical Trial: The trial was prospectively registered at ClinicalTrials.gov (“Pilot Study on Personalized Total Knee Arthroplasty (TKA) Rehabilitation Using Telemedicine and Psychoeducation (TKA)”; ClinicalTrials.gov ID: NCT07032805; Sponsor: Laura Belinda Rizzo; Information provided by Laura Belinda Rizzo, University of Bari “Aldo Moro” (Responsible Party); Last Update Posted: 2025-12-23).