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J Knee Surg
DOI: 10.1055/a-2315-8110
Original Article

Stepping Up Recovery: Integrating Patient Reported Outcome Measures and Wearable Technology for Rehabilitation Following Knee Arthroplasty

Ignacio Pasqualini
1   Orthopedic Surgery, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Nickelas Huffman 
2   Orthopaedic Surgery, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Alison K Klika
2   Orthopaedic Surgery, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Atul F kamath
2   Orthopaedic Surgery, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Carlos A Higuera
3   Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, United States (Ringgold ID: RIN219819)
,
Matthew Deren
4   Orthopaedic Surgery, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Trevor Murray
1   Orthopedic Surgery, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Nicolas S Piuzzi 
5   Orthopedics, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
6   Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Ringgold ID: RIN148357)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT03737149, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective
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Background: Improvement after knee arthroplasty (KA) is often measured using patient-reported outcome measures (PROMs). However, PROMs are limited due to their subjectivity. Therefore, wearable technology is becoming commonly utilized to objectively assess physical activity and function. We assessed the correlation between PROMs and step/stair flight counts in total (TKA) and partial knee arthroplasty (PKA) patients. Methods: Analysis of a multicenter prospective longitudinal cohort study investigating the collection of average daily step and stair flight counts, was performed. Subjects (N=1,844 TKA patients and N=489 PKA patients) completed the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and provided numerical rating scale pain scores pre- and postoperatively. Only patients who reported living in a multi-level home environment (N=896 TKA patients and N=258 PKA patients) were included in analysis of stair flight counts Pearson correlation coefficients were calculated to determine correlations between variables. Results: Among TKA patients, pain scores demonstrated a negative correlation to mean step counts at preoperative (r=-0.14, p<0.0001) and 1-month follow-up (r=-0.14, p<0.0001). Similar negative correlations were true for pain and stair flight counts at preoperative (r=-0.16, p<0.0001) and 1-month follow-up (r=-0.11, p=0.006). KOOS JR scores demonstrated weak positive correlations with mean step counts at preoperative (r=0.19, p<0.0001) and 1-month postoperative (r=0.17, p<0.0001). Similar positive correlations were true for KOOS JR scores and stair flight counts preoperatively (r=0.13, p=0.0002) and at 1-month postoperatively (r=0.10, p=0.0048). For PKA patients, correlations between pain and KOOS JR with step/stair counts demonstrated similar directionality. Conclusion: Given the correlation between wearable-generated data and PROMs, wearable technology may be beneficial in evaluating patient outcomes following KA. By combining subjective feedback with the objective data, healthcare providers can gain a holistic view of patients’ progress and tailor treatment plans accordingly.



Publication History

Received: 12 March 2024

Accepted after revision: 23 April 2024

Accepted Manuscript online:
27 April 2024

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