JMIR Publications

ABSTRACT

Background:

Digital technologies have become common in postoperative orthopaedic rehabilitation. The tendency towards this adoption appeared in the past decade. However, no standard method exists to evaluate their functional capabilities. This absence hinders practical implementation. Clinicians struggle to compare different technologies effectively. This systematic review proposes the Coordination, Alignment, Motivation, and Strength (CAMS) framework to classify existing digital interventions and to highlight key technological gaps within the current literature.

Objective:

This systematic review aims to map digital interventions used in post-surgical orthopaedic rehabilitation to the Coordination, Alignment, Motivation, and Strength (CAMS) framework and to identify technological trends, functional coverage, and gaps in current evidence.

Methods:

A systematic search was performed in six databases, such as medical (PubMed/EMBASE), and technical (IEEE/ACM), using the PRISMA 2020 guidelines (2020-2025). Research papers undergoing digital interventions in post-surgical orthopaedic recovery were mapped to four CAMS pillars. The Cochrane Risk of Bias 2 (RoB 2) tool and PEDro scale were used to evaluate the methodological quality.

Results:

Twenty-five studies (n=25) met the inclusion criteria. The most common pillar was motivation (M), which became most active due to the spread of immersive VR and gamification (96%, n=24). Coordination (C) studies using sensor fusion to provide real-time neuromuscular feedback contributed 88% (n=22) to the collection. Alignment (A) (36%, n=9) has recently experienced a surge due to the development of markerless computer vision. Nevertheless Strength (S) is a major deficit, only covered in 32% (n=8) of the corpus. Although 64% (n=16) of the studies attained the status of Low Risk, performance bias is a problem. The model of delivery has moved firmly to the hybrid (60%, n=15) and home-based care (32%, n=8), with only 8% (n=2) remaining exclusively clinical.

Conclusions:

Digital health has shown significant advancement in the kinematic monitoring feature, offering effective solutions to psychological engagement (Motivation) and movement quality (Coordination/Alignment). Nevertheless, there is a consistent gap in strength-related studies, as current decentralized tools lack the capability to quantify physiological load. The next phase of innovations should be a shift to integrated 4-pillar solutions that would coordinate resistance-based training with high-precision biomechanical monitoring. The CAMS framework is a roadmap for the next generation of holistic orthopaedic recovery. Clinical Trial: This systematic review was registered with the PROSPERO (International Prospective Register of Systematic Reviews), registration number CRD420251062131.