Integrated Telehealth and Extended Reality to Enhance Home Exercise Adherence Following Total Hip and Knee Arthroplasty
Christy L. Conroy, Gina M. Brunetti, Angelos Barmpoutis, Emily J. Fox
TL;DR
This study tackles low adherence and suboptimal performance in home-based hip and knee arthroplasty rehabilitation. It assesses an integrated XR–telehealth system, Tele-PhyT, against conventional paper-based HEP in a randomized cross-over pilot with patients and therapists, using marker-less full-body tracking and real-time feedback. Results show similar movement magnitudes between Tele-PhyT and traditional HEP, but Tele-PhyT yields slower velocities under remote guidance; nonetheless, participants perceived Tele-PhyT as easy to use and more engaging, with real-time feedback ranked highly. The work demonstrates the feasibility and potential of XR–TH approaches to enhance home exercise adherence and remote monitoring, informing design considerations for scalable, group-enabled rehabilitation solutions.
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.