JMIR Publications

ABSTRACT

Background:

Achilles tendon rupture significantly affects patient mobility and quality of life. Postoperative rehabilitation is critical to regain ankle function, strength, and return to activity. Recently, home-based digital rehabilitation has emerged as an accessible alternative to traditional clinic-based physiotherapy, however, high-quality evidence comparing these approaches after Achilles tendon repair remains scarce.

Objective:

This randomized controlled trial aimed to evaluate whether a home-based digital exercise program is noninferior to clinic-based face-to-face physiotherapy for restoring ankle range of motion (ROM), strength, patient-reported outcomes, and cost-effectiveness following open Achilles tendon repair.

Methods:

Between August 2020 and June 2023, 200 adult patients (mean age, 36.5±5.0 years; 67.5% male) undergoing open Achilles tendon repair at two trauma centers were randomly assigned (1:1) to either a 12-week home-based digital exercise program (DEP group, n=100) or traditional 12-week clinic-based physiotherapy (CP group, n=100) in Shanghai. The digital program was delivered through an online app, providing instructional videos, real-time telecommunication, daily exercise tasks, and monitoring of adherence. The clinic-based group received weekly physiotherapist-supervised sessions. The primary outcome was ankle ROM at 12 weeks postoperatively. Secondary outcomes included plantarflexion strength at 0° and 12°, heel-rise index and height, Achilles Tendon Total Rupture Score (ATRS), Victorian Institute of Sport Assessment–Achilles (VISA-A) scores, adherence, patient satisfaction, cost-effectiveness, and adverse events assessed at 6, 12, and 24 weeks. Mixed-effects models were applied for intention-to-treat analyses, and sensitivity analyses were performed per protocol.

Results:

At 12 weeks postoperatively, the DEP group demonstrated noninferiority to the CP group regarding ankle ROM (mean difference -0.08°, 95% CI, -2.56° to 2.40°; p=0.949). Similarly, no significant differences were noted between groups for plantarflexion strength at 0° (mean difference -0.04, 95% CI, -3.14 to 3.06; p=0.980), plantarflexion strength at 12° (mean difference 0.21, 95% CI, -2.49 to 2.90; p=0.882), heel-rise tests, ATRS, or VISA-A scores across all follow-up points. Patients reported higher convenience (4.6 vs. 4.4; p=0.021) and ease of use/access (4.4 vs. 4.2; p=0.020) for the digital program. DEP reduced total rehabilitation costs significantly compared to CP (CNY 59,260.77 vs. CNY 68,432.80; difference: -9,172.03; p<0.001). Incremental cost-effectiveness analysis favored DEP for all outcomes, reflecting lower costs without sacrificing clinical outcomes. Adverse events and serious complications were rare and comparable between groups (DEP 18%, CP 22%; p>0.05).

Conclusions:

The home-based digital exercise program following Achilles tendon repair provided comparable clinical outcomes to traditional physiotherapy while significantly improving cost-effectiveness, convenience, and adherence. These findings support the broader adoption of tele-supervised digital rehabilitation as a safe, effective, and patient-preferred alternative. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR) (ChiCTR2400093415).