JMIR Publications

ABSTRACT

Background:

With THA volumes rising worldwide, scalable home rehabilitation strategies are needed. Home-based digital physiotherapy can improve recovery after THA, and adding wearable motion sensor feedback may further enhance exercise performance and adherence. However, the impact of sensor-augmented digital rehabilitation on patient outcomes and cost-effectiveness remains unclear.

Objective:

To evaluate the clinical effectiveness (including adherence) and cost-effectiveness of adding wearable sensor feedback to a home-based digital THA rehabilitation program compared to the same digital program without sensors.

Methods:

We conducted a single-center randomized controlled trial in Shanghai from June 2023 to June 2024. A total of 240 primary THA patients were randomized (1:1) to a 12-week home exercise program delivered via mobile app either with wearable motion sensors for real-time feedback (intervention) or without sensors (control). Both groups received identical exercise content and weekly teleconsultations. Outcomes were assessed at 6, 12, and 24 weeks by blinded evaluators. The primary outcome was Hip Disability and Osteoarthritis Outcome Score (HOOS) at 24 weeks. Secondary outcomes included HOOS subscales, Timed Up-and-Go (TUG), Berg Balance, SF-36 physical and mental scores, HADS anxiety/depression, patient satisfaction, adherence metrics, and total 24-week costs. Analyses followed intention-to-treat. Mixed-effects models and chi-square tests were used for group comparisons. Cost-effectiveness was evaluated from a societal perspective.

Results:

The sensor-based rehabilitation group showed significantly greater improvement in HOOS than controls at all time points (P=.010). Early postoperative gains were larger: at 6 weeks, the sensor group had faster TUG times (P<.001) and greater HOOS subscale improvements (all P≤.011). By 24 weeks, most differences narrowed, but the sensor group still achieved better performance on TUG (P=.01) and had higher SF-36 Physical and Mental scores (both P<.001), with lower HADS anxiety/depression (both P<.001). Total 24-week costs were similar between groups (¥87,967 vs ¥94,396 per patient, P=.315). The sensor intervention was cost-saving on average (¥6,428.98 less per patient), yielding negative incremental cost-effectiveness ratios (better outcomes at lower cost). Adherence was high in both groups but higher with sensors: the intervention group completed more exercise sessions (P=.002) and showed greater participation in weekly assessments and follow-up calls (both P<.001). Adverse events were uncommon in both groups (5.8% vs 7.5%) and mostly minor, with no serious events reported.

Conclusions:

Augmenting home-based digital rehabilitation with wearable sensor feedback modestly improved early post-THA functional outcomes and patient-reported outcomes, and significantly increased exercise adherence, compared to the program without sensors. These benefits were achieved with no increase in cost, suggesting the sensor-enhanced program is a safe, efficient, and cost-effective approach to THA rehabilitation. Clinical Trial: ChiCTR2500103894. (Chinese Clinical Trial Registry, https://www.chictr.org.cn/)