Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jul 21, 2026
Open Peer Review Period: Jul 21, 2026 - Sep 15, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Mobile-Based Telerehabilitation with Sensors for Adherence and Efficacy in Chronic Patellofemoral Pain: A Randomized Controlled Trial
ABSTRACT
Background:
The Internet and mobile technologies offer promising platforms for delivering rehabilitation remotely, yet the optimal preparation strategy to maximize patient adherence and clinical outcomes in digital rehabilitation programs remains unclear.
Objective:
To compare the effects of 1, 3, or 6 face-to-face pre-telerehabilitation tutorial sessions on adherence and clinical outcomes in patients with patellofemoral pain (PFP) participating in an 8-week digital rehabilitation program.
Methods:
174 patients with PFP were randomized to one-session (OST; n=58), three-session (TST; n=58), or six-session (SST; n=58) face-to-face pre-telerehabilitation tutorial groups. All participants completed an 8-week digital health program comprising sensor-guided exercise therapy and self-care education. Primary outcome was device-recorded training adherence over 6 weeks. Secondary outcomes included self-reported adherence (Exercise Adherence Rating Scale [EARS]), pain intensity (Visual Analog Scale), quadriceps strength, Kujala Patellofemoral Score, Fatigue Severity Scale, and a closed-ended adherence survey. Primary and EARS analyses used one-way ANOVA with Tukey post-hoc tests. Secondary longitudinal analyses used linear mixed models.
Results:
Device-recorded total training time was greater in TST (12.4±2.3 h) and SST (12.6±2.5 h) versus OST (9.3±1.6 h; both P<.001), with no difference between TST and SST. Mean weekly training time showed a similar pattern (both P<.001). For engagement metrics, TST and SST groups had fewer Q&A visits and alert reminders than OST (all P<.001), and SST received fewer reminders than TST (P=.03). Self-reported adherence (EARS Part A) was higher in TST (18.9) and SST (19.1) versus OST (14.0; both P<.001); EARS Part B (barriers) was also higher in TST (13.1) and SST (14.2) versus OST (10.5), with SST higher than TST (P=.04). TST and SST showed greater improvements than OST in daily activity pain, squatting pain, and Kujala score (all adjusted P<.05), with no TST-SST differences. For concentric quadriceps strength, males in TST and SST had greater gains than OST; females showed TST superiority only. Eccentric strength improved more in males for TST and SST versus OST. Fatigue scores did not differ among groups (P=.63). Over 90% endorsed program features for adherence; 96.7% would recommend the program.
Conclusions:
Three face-to-face pre-rehabilitation sessions optimized adherence and short-term clinical outcomes for PFP telerehabilitation, with no added benefit from six sessions. This suggests a plateau effect, supporting a practical and efficient pre telerehabilitation preparation strategy. Clinical Trial: ClinicalTrials.gov NCT06651996; https://clinicaltrials.gov/ct2/show/NCT06651996
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