JMIR Publications

ABSTRACT

Background:

Exercise therapy is a cornerstone of rehabilitation for knee osteoarthritis (OA) and anterior cruciate ligament (ACL) reconstruction. However, maintaining adherence to prescribed exercise programs after clinical supervision often remains difficult. Digital rehabilitation interventions offer a promising avenue to support sustained engagement, yet their real-world use and the factors influencing adherence remain poorly understood.

Objective:

This study aimed to explore patient adherence to the Healthy Knees digital rehabilitation program in Hong Kong and to identify key barriers and facilitators influencing sustained engagement across different knee conditions and age groups.

Methods:

A qualitative design was adopted using reflective thematic analysis. Fifteen adults who had been prescribed the Healthy Knees web-based platform at the Prince of Wales Hospital participated in semi-structured, in-person interviews (30–45 min). Interviews were conducted in Cantonese or Mandarin, transcribed verbatim, translated to English, and analysed inductively. Ethical approval obtained from The Chinese University of Hong Kong and UNSW.

Results:

The study included 15 participants (9 with anterior cruciate ligament [ACL] injuries and 6 with knee osteoarthritis [OA]), aged 21–79 years, with most being male (11/15). Younger ACL participants were predominantly post-surgery, whereas older OA participants were mostly pre-surgery. Thematic analysis revealed three interrelated themes shaping adherence to the Healthy Knees digital intervention. First, the relevance of exercise to recovery and pain management influenced adherence, as many participants recognised exercise as essential for pain reduction and mobility improvement, though the perceived suitability varied—ACL patients often found exercises too simple, while OA patients struggled with their physical difficulty. Second, patient motivation and external support played key roles; some participants relied on self-motivation, while others required external reinforcement. Third, technology and accessibility affected engagement—users appreciated the platform’s convenience but encountered usability challenges, particularly older participants who reported limited digital literacy and preferred simpler tools.

Conclusions:

Digital knee rehabilitation adherence was shaped by the interplay between exercise relevance, motivational context, and technological usability. These findings underscore that while digital platforms can extend rehabilitation beyond clinical settings, their effectiveness depends on tailoring to user needs, ensuring accessibility, and embedding support mechanisms that sustain long-term exercise adherence.