Examining the effect of action observation therapy added to the telerehabilitation-based standard exercise program on patient-reported and performance-based outcomes in patients undergoing total knee arthroplasty surgery

Aim: The aim of this study was to investigate the effect of action observation therapy (AOT) added to a telerehabilitation (TR)-based standard exercise program and TR-based standard exercise program added to a home program on patient-reported and performance-based outcomes after total knee arthroplasty (TKA). Materials and Methods: After TKA, 40 participants completed the treatment process in 3 groups and were included in the analysis (Group 1: (n=13), Group 2: (n=14), Group 3: (n=13)). Group 1 received AOT plus TR-based standard exercise program (AOT+TR), Group 2 received TR-based standard exercise program (TR), and Group 3 received home program. Participants received standard hospital-based physiotherapy and information brochures until discharge (1 day). In TR, a total of 6 weeks of videoconference-based rehabilitation of 30 minutes 3 days a week for a total of 6 weeks, and in AOT+TR, 15 minutes of exercise videos were added to each session. After the 6th postoperative week, patients in the TR groups were followed up by phone call until the 12th postoperative week. All participants were evaluated 4 times: preoperatively, 3, 6 and 12 weeks after surgery. Participants' functional status was assessed by Western Ontario McMaster University Osteoarthritis Index (WOMAC); pain intensity by Visual Analog Scale (VAS); range of motion (ROM) by digital goniometer; quality of life by EuroQol-5D-3L (EQ-5D-3L); symptoms and limitations in activities of daily living were assessed by Knee Injury and Osteoarthritis Outcome Score Activities of Daily Living Score (KOOS-ADLS); physical activity levels were assessed by International Physical Activity Questionnaire - Short (IPAQ-Short Form); lower extremity muscle strength was assessed by 30 seconds sit to stand test; locomotor performance was assessed by stair climbing test and 40 meter walk test. Results: Statistically, improvement in the functional levels of the participants in all three groups in certain weeks after treatment; decrease in pain intensity, symptoms and limitations in activities of daily living; increase in affected and unaffected knee ROM values, physical activity levels, quality of life and performance test scores were found. AOT+TR statistically contributed to an increase in the degrees of active/passive flexion of the affected knee and an increase in lower extremity strength in the early period (3rd week after surgery) compared to TR. TR made an additional contribution to the reduction of pain at rest and during walking compared to the home program. It was observed that the improvement in the participants' quality of life, physical activity levels and performance test scores increased more when AOT+TR was applied compared to the home program and TR (p<0.05). TR and AOT+TR did not provide additional contributions to the improvement of functional outcomes, reduction of night pain and symptoms and limitations in activities of daily living compared to the home program (p>0.05). Conclusion: We believe that AOT+TR, TR and home program methods improved the functional levels of patients after TKA; decreased pain intensity, symptoms and limitations in activities of daily living; and increased affected and unaffected knee ROM values, physical activity levels, quality of life and performance test scores. AOT+TR resulted in increased active/passive flexion degrees of the affected knee and increased lower extremity strength in the early period compared to TR, and improved quality of life compared to the home program, AOT+TR and TR contributed to an increase in physical activity levels and performance test scores and TR contributed to a reduction in pain at rest and during walking compared to the home program, but AOT+TR and TR did not contribute to the improvement of functional outcomes and reduction of symptoms and limitations in night pain and activities of daily living compared to the home program. We think that AOT+TR and TR are feasible methods in rehabilitation after TKA and more publications are needed to investigate the effects of AOT, TR and AOT+TR on patients after TKA. Keywords: Action observation therapy; Exercise; Home program; Physiotherapy; Telerehabilitation; Total knee arthroplasty