Home-based digital rehab after knee replacement

Study overview

Rehabilitation after total knee replacement can help people regain mobility, improve function, and return to daily activities. But conventional home-based rehabilitation often requires significant logistics and clinician time, while many telerehabilitation approaches still depend on real-time supervision.  

This study evaluated whether a home-based digital biofeedback system could support rehabilitation after total knee replacement with less reliance on in-person supervision. The system used inertial motion trackers to digitize patient movement, provide real-time feedback through a mobile app, and allow the clinical team to prescribe, monitor, and adapt the rehabilitation program remotely.  

The study compared an 8-week SWORD digital rehabilitation program with conventional in-person home rehabilitation after total knee replacement. Fifty-nine patients completed the study: 30 in the digital rehabilitation group and 29 in the conventional rehabilitation group. The primary outcome was change in Timed Up and Go score from baseline to the end of the program.

Key findings

Digital rehabilitation improved functional mobility

Patients in the digital rehabilitation group improved more on the Timed Up and Go test than patients receiving conventional in-person home rehabilitation.

At the 8-week assessment, patients in the digital rehabilitation group completed the test faster than those in the conventional rehabilitation group, with median scores of 7.8 seconds compared with 10.1 seconds.  

Improvements exceeded clinically meaningful thresholds

Both groups improved over the 8-week program, but the difference between groups favored digital rehabilitation. The difference between median changes in Timed Up and Go scores was 4.9 seconds, more than twice the reported minimal clinically important difference for this measure.  

Patient-reported knee outcomes improved more with digital rehabilitation

Patients in the digital rehabilitation group showed greater improvement across Knee injury and Osteoarthritis Outcome Score subscales, including symptoms, pain, activities of daily living, and quality of life. The study reported that the difference between groups was greater than 20 points in all KOOS subscales except sports, favoring the digital rehabilitation group.  

Range of motion improved more in the digital rehabilitation group

The study found significant improvements in knee range of motion only in the digital rehabilitation group. At 8 weeks, range of motion was higher in the digital rehabilitation group for lying knee flexion, standing knee flexion, and sitting knee extension.  

Safety outcomes were similar between groups

Adverse events were similar between groups. The digital rehabilitation group reported one adverse event among initially enrolled patients, while the conventional rehabilitation group reported a higher adverse event rate, though the difference was not statistically significant.   

Why this study matters

This study is an early example of Sword’s work in bringing clinically guided rehabilitation into the home.

After total knee replacement, patients need structured rehabilitation to rebuild mobility and function. Traditional home-based rehab can be effective, but it depends heavily on clinician availability and in-person logistics. This study tested whether a digital biofeedback system could deliver high-quality rehabilitation at home while allowing clinicians to monitor and adjust care remotely.

The findings suggest that home-based digital rehabilitation can improve functional mobility, patient-reported knee outcomes, and range of motion after total knee replacement. The study also showed that the digital program required far fewer in-person therapist visits: patients in the conventional group received 24 face-to-face sessions, while patients in the digital group had three scheduled face-to-face contacts, plus remote monitoring and support.  

The study should be understood as a feasibility study, not a large randomized trial. Patient allocation was based on geography rather than randomization, and the authors noted that unmeasured factors could have influenced the results. Still, the study provides an important early signal that digital rehabilitation can support meaningful recovery after major orthopedic surgery.

Read the full study