Integrated Telehealth and Extended Reality to Enhance Home Exercise Adherence Following Total Hip and Knee Arthroplasty

TL;DR

This study introduces Tele-PhyT, an XR-based telehealth system designed to improve adherence and performance in home exercises after hip and knee replacements, showing promising user preferences and potential benefits.

Contribution

The paper presents a novel XR and telehealth system, Tele-PhyT, that combines real-time feedback and marker-less tracking to enhance home exercise adherence post-arthroplasty.

Findings

Participants preferred Tele-PhyT for feedback and usability.

Tele-PhyT showed potential to improve exercise accuracy.

System demonstrated feasibility in a pilot study.

Abstract

Nearly one million total hip and knee arthroplasties (THA/TKA) are performed annually in the United States, with most patients discharged home and prescribed home exercise programs (HEPs) to enhance lower extremity function. Traditional paper-based HEPs, while accessible and low-cost, often lack engagement and real-time feedback, which are critical for adherence and performance optimization. Extended reality (XR) and telehealth (TH) systems offer promising solutions, combining engagement and feedback, though each has limitations. To address these gaps, we designed and executed a pilot study that compared exercise performance in individuals with THA/TKA using a conventional paper-based HEP versus a proof-of-concept system, dubbed Tele-PhyT, that included the ideal characteristics of a future XR technology that would enable seamless HEP-TH systems, with robust marker-less full body tracking, real-time visual feedback, and performance quantification. The pilot study used a randomized cross-over design and targeted two types of users: therapists and patients. Participants favored Tele- PhyT for its real-time feedback and ease of use, and noted its potential to improve HEP adherence and exercise accuracy.