A chatbot tool on a smart mobile device to promote adherence to home rehabilitation after total knee replacement: A randomized controlled trial

Autores de IIS La Fe

• Ignacio Martínez Garrido

  Autor

Participantes ajenos a IIS La Fe

• Pérez-Maletzki J.
• Roig-Casasús S.
• Díaz-Díaz B.
• Hernández-Guillén D.
• Blasco J.-M.

Grupos

• Cirugía Ortopédica y Traumatología

Abstract

Objectives: To determine the effectiveness of using an automated chatbot to promote adherence to home rehabilitation following total knee replacement surgery. Additionally, exploring the impact on functionality, pain, and physical activity. Design: Two-armed randomized controlled trial. Setting: University hospital in Valencia, Spain. Patients: Ninety-one participants following total knee replacement surgery. Interventions: Participants were randomly assigned to standard care or an experimental group (home rehabilitation supervised via chatbot). Main outcome measures: The primary outcome measure was adherence to the intervention, defined as completing at least 80 % of the prescribed sessions within three months after surgery. Secondary outcomes included functionality, pain, and physical activity. Additionally, the system's usability, safety, and feasibility were evaluated. Results: Adherence rate was 89 % (SD 31 %) in the experimental group compared to 74 % (SD 52 %) in the control group. The usability, safety, and feasibility scores, as measured by the System Usability Scale, were 80.4 (SD 36.6; range 49–100). Significant between-group differences were identified in functionality, as measured by the Western Ontario and McMaster University Osteoarthritis Index (-2; IQR - 7 to 4) and the Five Times Sit-to-Stand Test (-0.6; IQR - 2.9 to 1.7). No significant differences were observed for the Knee Range of Motion or Visual Analogue Scale of Pain. Conclusions: An automated chatbot tool effectively promotes adherence to early postoperative home rehabilitation in patients undergoing total knee replacement surgery. This approach has increased functional benefits, although it did not provide any benefits in terms of pain relief. Clinical Trial Registration number: NCT05363137. Contribution of the Paper: • This study provides evidence that using an automated chatbot improves adherence to postoperative home rehabilitation in patients who have undergone total knee replacement surgery, resulting in enhanced functional outcomes. • Chatbot-based rehabilitation enhances functionality in patients undergoing total knee replacement surgery but does not yield additional pain relief benefits. © 2025

Keywords

• aged; analgesia; Article; clinical effectiveness; clinical evaluation; controlled study; demographics; feasibility study; female; functional status; health promotion; home rehabilitation; human; major clinical study; male; multicenter study; outcome assessment; pain; patient compliance; patient participation; physical activity; prescription; randomized controlled trial; range of motion; safety assessment; sample size; scoring system; sit-to-stand test; Spain; System Usability Scale score; total knee arthroplasty; treatment outcome; university hospital; usability; visual analog scale; Western Ontario and McMaster Universities Osteoarthritis Index