Development and Feasibility Evaluation of a Telerehabilitation Program After Total Knee Arthroplasty: A Cross-sectional Study of Surgeons and Patients

Development and Feasibility Evaluation of a Telerehabilitation Program After Total Knee Arthroplasty: A Cross-sectional Study of Surgeons and Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Feasibility Evaluation of a Telerehabilitation Program After Total Knee Arthroplasty: A Cross-sectional Study of Surgeons and Patients Chengyuan Ma, Guanghui Zhao, Jianbing Ma, Jianpeng Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8886676/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Total knee arthroplasty (TKA) is a common surgical procedure that requires structured postoperative rehabilitation to optimize functional recovery. Conventional supervised rehabilitation is associated with high costs, transportation barriers, and limited patient adherence. Telerehabilitation may provide a scalable alternative; however, the clinical reasonableness of structured programs and their feasibility and acceptability among both clinicians and patients remain unclear. This study aimed to evaluate a newly developed telerehabilitation program for patients undergoing TKA from both surgeon and patient perspectives. Methods A cross-sectional study was conducted. A nationwide questionnaire survey was distributed to orthopedic surgeons in China to evaluate the clinical reasonableness of a structured telerehabilitation program consisting of 30 exercises across four postoperative phases. In addition, patients scheduled for TKA between March and April 2023 were invited to complete practical assessments of five representative exercises after watching instructional videos. Patient understanding, ability to perform the exercises, acceptance of telerehabilitation, and factors influencing comprehension and acceptance were analyzed. Results A total of 148 orthopedic surgeons and 152 patients participated. Most surgeons considered postoperative rehabilitation essential and supported home-based rehabilitation after discharge. Over 80% of surgeons rated most exercises in the program as clinically reasonable, although approximately one quarter expressed concerns regarding wall squat exercises in later rehabilitation phases. Among patients, 84.21% reported understanding the exercise instructions and successfully performing the recommended movements, and 92.11% expressed willingness to participate in telerehabilitation. Lower education level and shorter daily smartphone use were associated with reduced understanding of the rehabilitation program, while limited smartphone use was the main factor associated with lower acceptance. Conclusions The proposed telerehabilitation program for patients undergoing TKA was considered clinically reasonable by surgeons and was feasible and acceptable to most patients. This program may provide a scalable and resource-efficient rehabilitation pathway and supports the integration of digital rehabilitation into routine orthopaedic care. Telerehabilitation Total Knee Arthroplasty Postoperative Rehabilitation Digital health Home-based rehabilitation Figures Figure 1 Background Total knee arthroplasty (TKA) is an established treatment for end-stage knee arthritis that improves pain, function, and quality of life. Although most patients regain daily activity after surgery [ 1 ], a considerable proportion remain dissatisfied, highlighting the importance of effective postoperative rehabilitation [ 2 – 4 ]. The number of TKA procedures continues to rise worldwide, placing increasing pressure on postoperative rehabilitation services. Projections suggest a substantial growth in joint arthroplasty demand over the coming decades, emphasizing the need for scalable and cost-efficient rehabilitation strategies [ 5 , 6 ]. However, access to supervised rehabilitation is often limited by cost, travel burden, and poor patient adherence. Supervised physical therapy (PT) remains the standard rehabilitation approach after TKA [ 7 ], but home-based programs have shown comparable outcomes in several randomized controlled trials [ 8 – 10 ]. In this context, telerehabilitation has emerged as a potential solution to deliver structured rehabilitation while reducing healthcare utilization. Early evidence suggests that virtual rehabilitation can achieve outcomes similar to conventional therapy while lowering costs [ 11 ]. In China, most research still focuses on traditional rehabilitation models [ 12 – 14 ], and the implementation of telerehabilitation in routine orthopaedic care remains limited. Although evidence-based exercise frameworks have been proposed by professional societies [ 15 , 16 ], it is unclear whether structured telerehabilitation programs are considered clinically appropriate by surgeons or whether patients can understand and accept them in practice. Methods Study design This study was designed as a cross-sectional study evaluating the clinical reasonableness, feasibility, and acceptability of a telerehabilitation program for patients undergoing TKA. The study was conducted at a high-volume tertiary orthopaedic center. The present study was approved by the hospital research committee and the Institutional Review Board of Honghui Hospital, Xi’an Jiaotong University (Approval No. 202212008). Telerehabilitation program The telerehabilitation program consisted of 30 exercises divided into four postoperative phases: weeks 1–2, weeks 3–4, weeks 5–6, and weeks 7–12 after surgery. The program was delivered through a smartphone-based platform and included joint mobility, muscle strengthening, balance training, and pain and swelling management exercises. Details of the rehabilitation program are provided separately (Table 1 ). Surgeon survey and evaluation of clinical reasonableness A nationwide questionnaire survey was distributed to orthopedic surgeons in China via WeChat (Tencent Inc., Shenzhen, China). The questionnaire collected demographic and professional information and evaluated surgeons’ knowledge and current practices regarding postoperative rehabilitation after total knee arthroplasty. Surgeons were asked to assess the clinical appropriateness of each exercise included in the telerehabilitation program. The full questionnaire is available as supplementary material (Appendix 1). Patient recruitment and feasibility assessment Patients scheduled for primary total knee arthroplasty between March and April 2023 were invited to participate. Patients who were unable to use smartphones, declined participation, had severe cognitive impairment, or were unable to understand instructional content were excluded. Participants were asked to watch instructional videos and perform five representative rehabilitation exercises. They were allowed to replay the videos as needed until they successfully completed the exercises or chose to discontinue. Patient survey and acceptability assessment After completing the practical assessment, participants completed a questionnaire that collected demographic information, education level, daily smartphone usage time, and perceptions of telerehabilitation. Patient understanding, ability to perform exercises, and willingness to participate in telerehabilitation were recorded. The patient questionnaire is available as supplementary material (Appendix 2). Statistical analysis Statistical analyses were performed using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were presented as numbers and percentages and analyzed using the chi-square test. Continuous variables were expressed as mean ± standard deviation and analyzed using the independent t-test. A p value < 0.05 was considered statistically significant. Results Surgeon characteristics and current rehabilitation practice A total of 148 orthopedic surgeons participated in the survey. Among them, 65.54% had more than five years of experience in TKA, and 31.19% had more than ten years of experience. The majority of surgeons (80.41%) performed more than 50 TKA procedures annually, with the largest proportion (36.49%) performing between 100 and 300 procedures per year. Most surgeons reported good knowledge of postoperative rehabilitation (95.27%) and recognized its importance (95.94%). Furthermore, 97.30% of surgeons allowed patients to perform home-based rehabilitation after discharge, whereas 39.86% relied primarily on verbal instructions to guide postoperative rehabilitation (Table 2 ). Table 2 General information of Surgeons Evaluation index Number (Percentage) Number of knee arthroplasty per year 300 27(18.24%) Years of knee arthroplasty performed 10 years 58(39.19%) Main rehabilitation methods of patients after discharge Self-rehabilitation at home + outpatient guidance 144(97.30%) Out-of-hospital rehabilitation facility 1(0.68%) Rehabilitation outpatient clinic 3(2.03%) Patient's post-discharge rehabilitation guidance method Verbal explanation 59(39.86%) paper materials 43(29.05%) Video materials 19(12.84%) Online instruction (Internet) 25(16.89%) Other 2(1.35%) Whether postoperative rehabilitation is necessary for TKA patients Necessary and in recovery 88(59.46%) Necessary, but difficult to implement 54(36.49%) Necessary for special patients 5(3.38%) Unnecessary 1(0.68%) Level of understanding of postoperative rehabilitation after TKA Very well understood 28(18.92%) Better informed 89(60.14%) Understood 24(16.22%) Don't know much 7(4.73%) Rehabilitation guidance across different hospital settings Participating surgeons were from multiple provinces and municipalities across China, and approximately half worked in first-tier cities or provincial capitals. The perceived importance of postoperative rehabilitation was consistently high across hospital levels (95.94%). Nevertheless, verbal instruction remained the most common method of rehabilitation guidance after discharge, even in provincial hospitals, indicating that out-of-hospital self-rehabilitation remains the dominant recovery pathway (Table 3 ). Table 3 General information of Surgeons in different level of hospital Evaluation index Hospital Level Provincial hospital (n = 72) Municipal hospital (n = 76) Main rehabilitation methods of patients after discharge Self-rehabilitation at home + outpatient guidance 68(94.44%) 76(100.00%) Out-of-hospital rehabilitation facility 1(1.39%) 0(0.00%) Rehabilitation outpatient clinic 3(4.17%) 0(0.00%) Patient's post-discharge rehabilitation guidance method Verbal explanation 24(33.33%) 35(46.05%) paper materials 21(29.17%) 22(28.95%) Video materials 14(19.44%) 5(6.58%) Online instruction (Internet) 15(20.83%) 10(13.16%) Other 1(1.39%) 1(1.32%) Whether postoperative rehabilitation is necessary for TKA patients Necessary and in recovery 41(56.94%) 47(61.84%) Necessary, but difficult to implement 28(38.89%) 26(34.21%) Necessary for special patients 3(4.17%) 2(2.63%) Unnecessary 0(0.00%) 1(1.32%) Level of understanding of postoperative rehabilitation after TKA Very well known 16(22.22) 12(15.79%) Better understanding 41(56.94) 48(63.16%) Understand 13(18.06%) 11(14.47%) Don't know 2(2.78%) 5(6.58%) Surgeon evaluation of rehabilitation exercises Surgeons evaluated the appropriateness of the proposed exercises across the different rehabilitation phases (Table 4 ). During postoperative weeks 1–2 and 3–4, more than 80% of surgeons considered all recommended exercises to be appropriate. However, during weeks 5–6, a proportion of surgeons considered the 30° wall squat to be inappropriate. Similarly, during weeks 7–12, concerns were raised regarding the 45° wall squat exercise. Table 4 Surgeons' perceptions of different stages of postoperative rehabilitation programs Rehabilitation Programs Reasonable Unreasonable 1 ~ 2 weeks postoperative The sandbag presses down on the leg for 5–10 minutes 120(81.08%) 28(18.92%) Quadriceps static contraction 145(97.97%) 3(2.03%) Hamstring pulling 130(87.84%) 18(12.16%) Supine heel slide training 140(94.59%) 8(5.41%) Seated bedside assisted knee flexion 141(95.27%) 7(4.73%) Seated elastic band assisted knee flexion 123(83.11%) 25(16.89%) Ankle pump training 144(97.30%) 4(2.70%) Walker-assisted leg lift training 144(97.30%) 4(2.70%) Straight leg raises (contralateral knee flexion) 128(86.49%) 20(13.51%) Supine hip abduction 115(77.70%) 33(22.30%) Gluteal contraction training 128(86.49%) 20(13.51%) Breathing and abdominal exercises 124(83.78%) 24(16.22%) Cold compresses (10–15 minutes, 3–5 times/day) 133(89.86%) 15(10.14%) 3 ~ 4 weeks postoperative Straight leg raises (contralateral knee extension) 127(85.81%) 21(14.19%) Standing hip abduction 132(89.19%) 16(10.81%) Seated knee extension 136(91.89%) 12(8.11%) Seated knee flexion hamstring static contraction training 90°-0° 133(89.86%) 15(10.14%) Sit-to-stand training 131(88.51%) 17(11.49%) Walker-assisted left-right weight shift training 136(91.89%) 12(8.11%) Walker-assisted standing tiptoe 138(93.24%) 10(6.76%) Walker-assisted alternating single-leg standing 132(89.19%) 16(10.81%) 5 ~ 6 weeks postoperative 30° static squat against the wall 108(72.97%) 40(27.03%) Standing rear leg hook 127(85.81%) 21(14.19%) Calf triceps pulling 131(88.51%) 17(11.49%) Patellar mobility training 120(81.08%) 28(18.92%) 7 ~ 12 weeks postoperative 45° static squat against the wall 114(77.03%) 34(22.97%) Standing weight-bearing hip flexion 125(84.46%) 23(15.54%) Standing weight-bearing hip abduction 125(84.46%) 23(15.54%) Seated weight-bearing knee extension 128(86.49%) 20(13.51%) Squat training 138(93.24%) 10(6.76%) Patient characteristics and feasibility assessment A total of 152 patients scheduled for TKA between March and April 2023 were included. The cohort consisted of 42 men and 110 women, with a mean age of 66.97 ± 6.33 years. Most patients had received formal education (82.89%), and 61.84% reported using smartphones for more than 30 minutes per day (Table 5 ). After viewing the instructional videos, more than 95% of patients reported understanding the exercises, and over 85% successfully completed the movements (Fig. 1 ). Overall, 92.11% of patients expressed willingness to participate in telerehabilitation. Concerns were mainly related to equipment cost and smartphone proficiency. Table 5 General information of patients Age (y) 66.97 ± 6.33 Gender (F/M) 110/42 Evaluation index Number (Percentage) Education level Never went to school 26(17.11%) Elementary school 53(34.87%) Middle School 49(32.24%) High School and above 24(15.73%) Daily smartphone use time 3 hours 37(24.34) Ability to receive telerehabilitation guidance Accept 140(92.11%) Unacceptable but can try 10(6.58%) Unacceptable 2(1.32%) Perceptions of telerehabilitation Whether to charge 87(57.24%) Can't operate the phone 78(51.32%) Too much trouble to wear 69(45.39%) Is it safe? 17(11.18%) Feel no benefit 16(10.53%) Other 21(13.82%) Factors influencing understanding and acceptance of telerehabilitation No significant associations were found between patient age or gender and understanding of the rehabilitation program. In contrast, educational level and daily smartphone use were significantly associated with patient comprehension and learning. Patients with higher education levels and longer smartphone usage demonstrated better understanding and performance of the exercises. Regarding acceptance, daily smartphone use was the only significant influencing factor and was not affected by age, gender, or education level (Table 6 ). Table 6 The influencing factors of patients' understanding, learning and acceptance Patients Understanding and Learning χ2 p Status of acceptance χ2 p Accomplish Give up Acceptable Unacceptable Age (y) 70 41(83.67%) 8(16.33%) 43(87.76%) 6(12.24%) Gender (F/M) Male 38(90.48%) 4(9.52%) 1.714 0.191 38(90.48%) 4(9.52%) 0.015 0.901 Female 90(81.82%) 20(18.18%) 102(92.73%) 8(7.27%) Education level Never went to school 18(69.23%) a 8(30.77%) a 10.342 0.016* 22(84.62%) 4(15.38%) 3.996 0.262 Elementary school 42(79.25%) ab 11(20.75%) ab 51(96.23%) 2(3.77%) Middle School 45(91.84%) b 4(8.16%) b 44(89.80%) 5(10.20%) High School and above 23(95.83%) b 1(4.17%) b 23(95.83%) 1(4.17%) Daily smartphone use time < 30min 42(72.41%) a 16(27.59%) a 23.581 3 hours 35(94.59%) b 2(5.41%) b 36(97.30%) b 1(2.70%) b “ a ” and “ b ” means that there was a significant statistical difference. “ ab ” means that the results were not statistically significantly different from either “ a ” or “ b ”. Discussion Regular exercise is essential for post-TKA patients to restore mobility and activity levels. With rising demand for rehabilitation services and advances in telerehabilitation, it is crucial to develop effective programs to meet patient needs. This study evaluated the clinical reasonableness, feasibility, and acceptability of a structured telerehabilitation program for TKA patients. We found that while over 90% of surgeons believe rehabilitation after TKA is necessary, limited attention has been paid to patients’ understanding and acceptance of rehabilitation materials. Our results indicate that most exercises in our telerehab program were considered clinically reasonable by surgeons and were easily understood by patients. This supports telerehabilitation as a viable alternative to traditional in-person rehabilitation sessions. Growing evidence supports home-based rehabilitation as an effective alternative to formal outpatient physical therapy for TKA. For example, Fleischman et al. [ 17 ] found that unsupervised home exercise was non-inferior to standard outpatient PT in appropriately selected patients after primary TKA, suggesting that routine referrals to outpatient PT could be reconsidered. Similarly, Crawford et al. [ 18 ] reported that a smartphone-based exercise care system yielded outcomes comparable to in-person PT while significantly reducing postoperative visits. Home-based programs have also been shown to save time and reduce costs [ 19 ], and even for higher-risk patients, additional outpatient PT did not significantly improve outcomes over a single postoperative review combined with home exercise [ 20 ]. Overall, these findings reinforce that digitally delivered, home-based rehabilitation can be both effective and resource-efficient in the post-TKA population. Effective exercise programming is key to successful rehabilitation after TKA, yet existing guidelines often provide only general recommendations without specific timing or progression of exercises. Notably, the American Association of Hip and Knee Surgeons (AAHKS) guideline offers a phased program with detailed stretching, strengthening, endurance [ 16 ], and balance exercises—more specific than the broader American Academy of Orthopaedic Surgeons (AAOS) guidance [ 15 ]. To bridge the gap between generalized guidelines and individual patient needs, our team developed a tailored multi-phase rehabilitation program based on evidence and expert consensus. We evaluated this program from both the surgeon’s and patient’s perspectives to ensure its feasibility and effectiveness in early recovery. While surgeons deemed most of the exercises reasonable, some expressed concerns about squatting exercises due to potential patellofemoral stress. This is supported by the literature: a retrospective study found that preoperative anterior knee pain was associated with a higher risk of postoperative anterior knee pain [ 21 ], and a systematic review noted that deep squats (knee flexion 60°–90°) can overload the joint [ 22 ]. Meanwhile, recent research has increasingly focused on the patient’s perspective in rehabilitation to improve engagement and outcomes [ 23 , 24 ]. In our study, patient feedback was overwhelmingly positive—most participants found the telerehabilitation program acceptable and helpful for regaining mobility and independence. This high level of satisfaction underscores the importance of incorporating patient perspectives when developing rehabilitation protocols. Technological advancements have paved the way for telerehabilitation, which offers several advantages over traditional outpatient care. It can significantly reduce costs and travel burdens for patients. For instance, an 8-week outpatient PT regimen is estimated at around USD 2,500 per patient, whereas a comparable telerehabilitation program costs roughly USD 500 [ 9 ]. Patients also value the convenience of completing therapy at home on their own schedule, especially when travel is difficult in the early postoperative period. Importantly, telerehabilitation is highly scalable, enabling providers to extend care to more patients by overcoming geographic and resource constraints and delivering rehabilitation services efficiently to broad populations, thereby expanding access and reducing strain on healthcare systems [ 25 ]. However, successful digital rehabilitation delivery must account for patient digital literacy and access barriers. A significant proportion of our patients had minimal formal education (with 16.7% never attending school) or very limited smartphone use. Such characteristics reflect limited eHealth literacy and technological access, which have been identified as major barriers to telehealth adoption among older adults [ 26 , 27 ]. In our program, patients with lower education levels and shorter daily smartphone use had more difficulty understanding and accepting the exercises. Some may require additional support or a hybrid approach (combining remote rehabilitation with occasional in-person guidance) to ensure proper participation. Indeed, older patients or those with cognitive impairment often need extra assistance to engage effectively in telerehabilitation despite its benefits [ 28 ]. Providing user-friendly platforms, training, or caregiver support can help bridge this digital divide. It is increasingly recognized that telerehabilitation services must be designed to be inclusive and accessible, addressing issues like internet access and digital literacy to maximize their reach and equity [ 29 ]. Several limitations of this study should be acknowledged. First, our sample was drawn from a single geographic region in China, which may limit the generalizability of the findings. Second, the questionnaire-based design constrained the depth of data on certain factors (for example, detailed surgeon opinions on telerehabilitation devices and patients’ financial willingness to pay for rehabilitation were not fully captured). Third, the exercises selected for patient assessment might not represent all possible rehabilitation activities, potentially limiting the scope of our evaluation. Lastly, the fixed response options for surgeons could have restricted the expression of nuanced opinions. Future studies should include more diverse populations, employ more comprehensive data collection (including technology usability and socioeconomic factors), and evaluate how structured telerehabilitation programs perform across different patient demographics and settings. Conclusion Telerehabilitation is a promising intervention for improving postoperative outcomes among TKA patients. Our study found that the program was both reasonable, feasible and acceptable to patients after TKA. However, further investigations are needed to confirm its clinical value and potential benefits, and to develop an individualized rehabilitation program that meets the specific needs and preferences of each patient. Abbreviations TKA total knee arthroplasty PT physical therapy AAHKS American Association of Hip and Knee Surgeons AAOS American Academy of Orthopaedic Surgeons Declarations Ethics approval and consent to participate This study was reviewed and approved by the Institutional Review Board and the Human Research Ethics Committee of Honghui Hospital, Xi’an Jiaotong University (Approval No. 202212008). Written informed consent was obtained from all participants prior to enrollment. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and national research committees and complied with the principles of the Declaration of Helsinki and its subsequent amendments. Consent for publication Not applicable. Clinical trial number Not applicable. Availability of data and materials The datasets generated and analyzed during the current study are included in this published article. Additional information is available from the corresponding author on reasonable request. Competing interests The authors declare that there is no conflict of interest regarding the publication of this article. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Authorship contribution statement: Author contributions JPW and JBM conceived and designed the experiment. CYM, GHZ collected data. CYM, GHZ, and JBM analyzed and interpreted the data. 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Prvu Bettger J, Green CL, Holmes DN, Chokshi A, Mather RC, Hoch BT, et al. Effects of virtual exercise rehabilitation in-home therapy compared with traditional care after total knee arthroplasty: VERITAS randomized controlled trial. J Bone Joint Surg Am. 2020;102(2):101–9. Liang Z, Fu Y, Zhao Y, Zhang J, Xu X, Wang L, et al. Home-based telerehabilitation after total knee arthroplasty: a systematic review and meta-analysis. J Telemed Telecare. 2024;30(2):94–103. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Appendix2.docx Table1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8886676","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593634369,"identity":"642aedca-cb97-40ee-981b-3df20d778847","order_by":0,"name":"Chengyuan Ma","email":"","orcid":"","institution":"Honghui Hospital, Xi’An Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Chengyuan","middleName":"","lastName":"Ma","suffix":""},{"id":593634370,"identity":"24f97d97-6674-43f8-bfd9-4b543833c748","order_by":1,"name":"Guanghui Zhao","email":"","orcid":"","institution":"Honghui Hospital, Xi’An Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Guanghui","middleName":"","lastName":"Zhao","suffix":""},{"id":593634373,"identity":"f427a3b8-8515-4e82-becd-ad115bf61b12","order_by":2,"name":"Jianbing Ma","email":"","orcid":"","institution":"Honghui Hospital, Xi’An Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Jianbing","middleName":"","lastName":"Ma","suffix":""},{"id":593634376,"identity":"db4772d7-b550-4d63-80f3-f6aed86707b3","order_by":3,"name":"Jianpeng Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIie3PPQrCMBjG8YRAuwRc3+IlHhc/sODgMVwCQlwUBNeC6WKXgqviJfQGhYAuPUCdvYC7HRRc3Bo3wfzn9wfvw5jP94O1wjR71IjX29A4kii3Bcml5vu8cCSotCJ5t/y4U66flSVAsALR7VSxJJ40Cp7lUMAs6LX1qs/OemGaiJAlCoWhHBzmXeLGNpOA5h1TQBCupSORpKfcYAxU0pGQtGfBoFWUv7Yoly2jS7oRrI5VK7Sn6p7EzeQzkPrm/E2+FT6fz/cfPQG/VT8rYUJTyQAAAABJRU5ErkJggg==","orcid":"","institution":"Honghui Hospital, Xi’An Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Jianpeng","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-02-15 14:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8886676/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8886676/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103178481,"identity":"3551dc55-22a5-45bd-8e76-ca377a3eaa77","added_by":"auto","created_at":"2026-02-22 17:01:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1079256,"visible":true,"origin":"","legend":"\u003cp\u003ePatients' understanding and exercise of the five selected actions.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8886676/v1/0eaaf259d531870137075a40.png"},{"id":109055409,"identity":"11e24c1e-a00a-4221-b0ee-3b7273f8badb","added_by":"auto","created_at":"2026-05-12 07:31:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1281414,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8886676/v1/18af3569-a162-46f5-9ada-4ba6023201c6.pdf"},{"id":103178482,"identity":"8a80b38a-922d-43bd-b406-0e8aa0e708e6","added_by":"auto","created_at":"2026-02-22 17:01:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18446,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8886676/v1/72380476db4139df2901ba9e.docx"},{"id":103178479,"identity":"8c6f6e85-2482-4c60-98f6-61a8b3cacadc","added_by":"auto","created_at":"2026-02-22 17:01:40","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16613,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8886676/v1/fd23ad56f266deeb814e9534.docx"},{"id":103178480,"identity":"9b6bf7fd-5a09-4919-b92c-8991df13cefa","added_by":"auto","created_at":"2026-02-22 17:01:40","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":19001,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8886676/v1/35cb491810ee2eaa9c3f9b21.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Feasibility Evaluation of a Telerehabilitation Program After Total Knee Arthroplasty: A Cross-sectional Study of Surgeons and Patients","fulltext":[{"header":"Background","content":"\u003cp\u003eTotal knee arthroplasty (TKA) is an established treatment for end-stage knee arthritis that improves pain, function, and quality of life. Although most patients regain daily activity after surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], a considerable proportion remain dissatisfied, highlighting the importance of effective postoperative rehabilitation [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe number of TKA procedures continues to rise worldwide, placing increasing pressure on postoperative rehabilitation services. Projections suggest a substantial growth in joint arthroplasty demand over the coming decades, emphasizing the need for scalable and cost-efficient rehabilitation strategies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, access to supervised rehabilitation is often limited by cost, travel burden, and poor patient adherence.\u003c/p\u003e \u003cp\u003eSupervised physical therapy (PT) remains the standard rehabilitation approach after TKA [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], but home-based programs have shown comparable outcomes in several randomized controlled trials [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this context, telerehabilitation has emerged as a potential solution to deliver structured rehabilitation while reducing healthcare utilization. Early evidence suggests that virtual rehabilitation can achieve outcomes similar to conventional therapy while lowering costs [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn China, most research still focuses on traditional rehabilitation models [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and the implementation of telerehabilitation in routine orthopaedic care remains limited. Although evidence-based exercise frameworks have been proposed by professional societies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], it is unclear whether structured telerehabilitation programs are considered clinically appropriate by surgeons or whether patients can understand and accept them in practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design\u003c/h2\u003e\n \u003cp\u003eThis study was designed as a cross-sectional study evaluating the clinical reasonableness, feasibility, and acceptability of a telerehabilitation program for patients undergoing TKA. The study was conducted at a high-volume tertiary orthopaedic center. The present study was approved by the hospital research committee and the Institutional Review Board of Honghui Hospital, Xi\u0026rsquo;an Jiaotong University (Approval No. 202212008).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eTelerehabilitation program\u003c/h3\u003e\n\u003cp\u003eThe telerehabilitation program consisted of 30 exercises divided into four postoperative phases: weeks 1\u0026ndash;2, weeks 3\u0026ndash;4, weeks 5\u0026ndash;6, and weeks 7\u0026ndash;12 after surgery. The program was delivered through a smartphone-based platform and included joint mobility, muscle strengthening, balance training, and pain and swelling management exercises. Details of the rehabilitation program are provided separately (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eSurgeon survey and evaluation of clinical reasonableness\u003c/h3\u003e\n\u003cp\u003eA nationwide questionnaire survey was distributed to orthopedic surgeons in China via WeChat (Tencent Inc., Shenzhen, China). The questionnaire collected demographic and professional information and evaluated surgeons\u0026rsquo; knowledge and current practices regarding postoperative rehabilitation after total knee arthroplasty. Surgeons were asked to assess the clinical appropriateness of each exercise included in the telerehabilitation program. The full questionnaire is available as supplementary material (Appendix 1).\u003c/p\u003e\n\u003ch3\u003ePatient recruitment and feasibility assessment\u003c/h3\u003e\n\u003cp\u003ePatients scheduled for primary total knee arthroplasty between March and April 2023 were invited to participate. Patients who were unable to use smartphones, declined participation, had severe cognitive impairment, or were unable to understand instructional content were excluded. Participants were asked to watch instructional videos and perform five representative rehabilitation exercises. They were allowed to replay the videos as needed until they successfully completed the exercises or chose to discontinue.\u003c/p\u003e\n\u003ch3\u003ePatient survey and acceptability assessment\u003c/h3\u003e\n\u003cp\u003eAfter completing the practical assessment, participants completed a questionnaire that collected demographic information, education level, daily smartphone usage time, and perceptions of telerehabilitation. Patient understanding, ability to perform exercises, and willingness to participate in telerehabilitation were recorded. The patient questionnaire is available as supplementary material (Appendix 2).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eStatistical analyses were performed using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were presented as numbers and percentages and analyzed using the chi-square test. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and analyzed using the independent t-test. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSurgeon characteristics and current rehabilitation practice\u003c/h2\u003e \u003cp\u003eA total of 148 orthopedic surgeons participated in the survey. Among them, 65.54% had more than five years of experience in TKA, and 31.19% had more than ten years of experience. The majority of surgeons (80.41%) performed more than 50 TKA procedures annually, with the largest proportion (36.49%) performing between 100 and 300 procedures per year. Most surgeons reported good knowledge of postoperative rehabilitation (95.27%) and recognized its importance (95.94%). Furthermore, 97.30% of surgeons allowed patients to perform home-based rehabilitation after discharge, whereas 39.86% relied primarily on verbal instructions to guide postoperative rehabilitation (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral information of Surgeons\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (Percentage)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eNumber of knee arthroplasty per year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(19.59%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026thinsp;~\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(25.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101\u0026thinsp;~\u0026thinsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(36.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(18.24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eYears of knee arthroplasty performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(7.43%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026thinsp;~\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(27.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026thinsp;~\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(26.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58(39.19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMain rehabilitation methods of patients after discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-rehabilitation at home\u0026thinsp;+\u0026thinsp;outpatient guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144(97.30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOut-of-hospital rehabilitation facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation outpatient clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(2.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePatient's post-discharge rehabilitation guidance method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal explanation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59(39.86%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epaper materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(29.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVideo materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(12.84%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnline instruction (Internet)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(16.89%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWhether postoperative rehabilitation is necessary for TKA patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNecessary and in recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88(59.46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNecessary, but difficult to implement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(36.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNecessary for special patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(3.38%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnnecessary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLevel of understanding of postoperative rehabilitation after TKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery well understood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(18.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBetter informed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(60.14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderstood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(16.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDon't know much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(4.73%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRehabilitation guidance across different hospital settings\u003c/h2\u003e \u003cp\u003eParticipating surgeons were from multiple provinces and municipalities across China, and approximately half worked in first-tier cities or provincial capitals. The perceived importance of postoperative rehabilitation was consistently high across hospital levels (95.94%). Nevertheless, verbal instruction remained the most common method of rehabilitation guidance after discharge, even in provincial hospitals, indicating that out-of-hospital self-rehabilitation remains the dominant recovery pathway (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral information of Surgeons in different level of hospital\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eEvaluation index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eHospital Level\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProvincial hospital (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMunicipal hospital\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMain rehabilitation methods of patients after discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-rehabilitation at home\u0026thinsp;+\u0026thinsp;outpatient guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(94.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76(100.00%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOut-of-hospital rehabilitation facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation outpatient clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(4.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePatient's post-discharge rehabilitation guidance method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal explanation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(46.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epaper materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(29.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(28.95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVideo materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(19.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(6.58%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnline instruction (Internet)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(20.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(13.16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWhether postoperative rehabilitation is necessary for TKA patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNecessary and in recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(56.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47(61.84%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNecessary, but difficult to implement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(38.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26(34.21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNecessary for special patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(4.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(2.63%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnnecessary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLevel of understanding of postoperative rehabilitation after TKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery well known\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(22.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(15.79%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBetter understanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(56.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48(63.16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderstand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(18.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(14.47%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDon't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(6.58%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSurgeon evaluation of rehabilitation exercises\u003c/h2\u003e \u003cp\u003eSurgeons evaluated the appropriateness of the proposed exercises across the different rehabilitation phases (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). During postoperative weeks 1\u0026ndash;2 and 3\u0026ndash;4, more than 80% of surgeons considered all recommended exercises to be appropriate. However, during weeks 5\u0026ndash;6, a proportion of surgeons considered the 30\u0026deg; wall squat to be inappropriate. Similarly, during weeks 7\u0026ndash;12, concerns were raised regarding the 45\u0026deg; wall squat exercise.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgeons' perceptions of different stages of postoperative rehabilitation programs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRehabilitation Programs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReasonable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnreasonable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;2 weeks postoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe sandbag presses down on the leg for 5\u0026ndash;10 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120(81.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28(18.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuadriceps static contraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145(97.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(2.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHamstring pulling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130(87.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(12.16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupine heel slide training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140(94.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(5.41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeated bedside assisted knee flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141(95.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(4.73%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeated elastic band assisted knee flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123(83.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(16.89%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnkle pump training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144(97.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(2.70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalker-assisted leg lift training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144(97.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(2.70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStraight leg raises (contralateral knee flexion)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128(86.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(13.51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupine hip abduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115(77.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33(22.30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGluteal contraction training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128(86.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(13.51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreathing and abdominal exercises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124(83.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(16.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCold compresses (10\u0026ndash;15 minutes, 3\u0026ndash;5 times/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133(89.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(10.14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e3\u0026thinsp;~\u0026thinsp;4 weeks postoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStraight leg raises (contralateral knee extension)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127(85.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(14.19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStanding hip abduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132(89.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(10.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeated knee extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136(91.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(8.11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeated knee flexion hamstring static contraction training 90\u0026deg;-0\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133(89.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(10.14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSit-to-stand training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131(88.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(11.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalker-assisted left-right weight shift training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136(91.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(8.11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalker-assisted standing tiptoe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138(93.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(6.76%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalker-assisted alternating single-leg standing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132(89.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(10.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e5\u0026thinsp;~\u0026thinsp;6 weeks postoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026deg; static squat against the wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108(72.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40(27.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStanding rear leg hook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127(85.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(14.19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalf triceps pulling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131(88.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(11.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatellar mobility training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120(81.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28(18.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e7\u0026thinsp;~\u0026thinsp;12 weeks postoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026deg; static squat against the wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114(77.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34(22.97%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStanding weight-bearing hip flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125(84.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(15.54%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStanding weight-bearing hip abduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125(84.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(15.54%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeated weight-bearing knee extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128(86.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(13.51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSquat training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138(93.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(6.76%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics and feasibility assessment\u003c/h2\u003e \u003cp\u003eA total of 152 patients scheduled for TKA between March and April 2023 were included. The cohort consisted of 42 men and 110 women, with a mean age of 66.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33 years. Most patients had received formal education (82.89%), and 61.84% reported using smartphones for more than 30 minutes per day (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). After viewing the instructional videos, more than 95% of patients reported understanding the exercises, and over 85% successfully completed the movements (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall, 92.11% of patients expressed willingness to participate in telerehabilitation. Concerns were mainly related to equipment cost and smartphone proficiency.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral information of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender (F/M)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110/42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEvaluation index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (Percentage)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever went to school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(17.11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53(34.87%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49(32.24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(15.73%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDaily smartphone use time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58(38.16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026thinsp;~\u0026thinsp;60min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(13.82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;3 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(23.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37(24.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAbility to receive telerehabilitation guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140(92.11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnacceptable but can try\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(6.58%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnacceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003ePerceptions of telerehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhether to charge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87(57.24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCan't operate the phone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78(51.32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eToo much trouble to wear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69(45.39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs it safe?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(11.18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeel no benefit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(10.53%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(13.82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors influencing understanding and acceptance of telerehabilitation\u003c/h2\u003e \u003cp\u003eNo significant associations were found between patient age or gender and understanding of the rehabilitation program. In contrast, educational level and daily smartphone use were significantly associated with patient comprehension and learning. Patients with higher education levels and longer smartphone usage demonstrated better understanding and performance of the exercises. Regarding acceptance, daily smartphone use was the only significant influencing factor and was not affected by age, gender, or education level (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe influencing factors of patients' understanding, learning and acceptance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnderstanding and Learning\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eStatus of acceptance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccomplish\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGive up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAcceptable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUnacceptable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(88.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(12.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23(92.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(8.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026thinsp;~\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(83.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(16.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74(94.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4(5.13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(83.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(16.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43(87.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6(12.24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender (F/M)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(90.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(9.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38(90.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4(9.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(81.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(18.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e102(92.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(7.27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever went to school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(69.23%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(30.77%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e10.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22(84.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4(15.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(79.25%)\u003csub\u003eab\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(20.75%)\u003csub\u003eab\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51(96.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(3.77%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(91.84%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(8.16%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44(89.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(10.20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(95.83%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(4.17%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23(95.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(4.17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDaily smartphone use time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(72.41%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(27.59%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e23.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48(82.76%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10(17.24%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e13.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026thinsp;~\u0026thinsp;60min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(71.43%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(28.57%)\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20(95.24%)\u003csub\u003eab\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(4.76%)\u003csub\u003eab\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;3 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(100.00%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36(100.00%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.00%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(94.59%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(5.41%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36(97.30%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(2.70%)\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003e\u0026ldquo;\u003csub\u003ea\u003c/sub\u003e\u0026rdquo; and \u0026ldquo;\u003csub\u003eb\u003c/sub\u003e\u0026rdquo; means that there was a significant statistical difference. \u0026ldquo;\u003csub\u003eab\u003c/sub\u003e\u0026rdquo; means that the results were not statistically significantly different from either \u0026ldquo;\u003csub\u003ea\u003c/sub\u003e\u0026rdquo; or \u0026ldquo;\u003csub\u003eb\u003c/sub\u003e\u0026rdquo;.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eRegular exercise is essential for post-TKA patients to restore mobility and activity levels. With rising demand for rehabilitation services and advances in telerehabilitation, it is crucial to develop effective programs to meet patient needs. This study evaluated the clinical reasonableness, feasibility, and acceptability of a structured telerehabilitation program for TKA patients. We found that while over 90% of surgeons believe rehabilitation after TKA is necessary, limited attention has been paid to patients\u0026rsquo; understanding and acceptance of rehabilitation materials. Our results indicate that most exercises in our telerehab program were considered clinically reasonable by surgeons and were easily understood by patients. This supports telerehabilitation as a viable alternative to traditional in-person rehabilitation sessions.\u003c/p\u003e \u003cp\u003eGrowing evidence supports home-based rehabilitation as an effective alternative to formal outpatient physical therapy for TKA. For example, Fleischman et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found that unsupervised home exercise was non-inferior to standard outpatient PT in appropriately selected patients after primary TKA, suggesting that routine referrals to outpatient PT could be reconsidered. Similarly, Crawford et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported that a smartphone-based exercise care system yielded outcomes comparable to in-person PT while significantly reducing postoperative visits. Home-based programs have also been shown to save time and reduce costs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and even for higher-risk patients, additional outpatient PT did not significantly improve outcomes over a single postoperative review combined with home exercise [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Overall, these findings reinforce that digitally delivered, home-based rehabilitation can be both effective and resource-efficient in the post-TKA population.\u003c/p\u003e \u003cp\u003e Effective exercise programming is key to successful rehabilitation after TKA, yet existing guidelines often provide only general recommendations without specific timing or progression of exercises. Notably, the American Association of Hip and Knee Surgeons (AAHKS) guideline offers a phased program with detailed stretching, strengthening, endurance [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and balance exercises\u0026mdash;more specific than the broader American Academy of Orthopaedic Surgeons (AAOS) guidance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To bridge the gap between generalized guidelines and individual patient needs, our team developed a tailored multi-phase rehabilitation program based on evidence and expert consensus. We evaluated this program from both the surgeon\u0026rsquo;s and patient\u0026rsquo;s perspectives to ensure its feasibility and effectiveness in early recovery.\u003c/p\u003e \u003cp\u003eWhile surgeons deemed most of the exercises reasonable, some expressed concerns about squatting exercises due to potential patellofemoral stress. This is supported by the literature: a retrospective study found that preoperative anterior knee pain was associated with a higher risk of postoperative anterior knee pain [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and a systematic review noted that deep squats (knee flexion 60\u0026deg;\u0026ndash;90\u0026deg;) can overload the joint [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Meanwhile, recent research has increasingly focused on the patient\u0026rsquo;s perspective in rehabilitation to improve engagement and outcomes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In our study, patient feedback was overwhelmingly positive\u0026mdash;most participants found the telerehabilitation program acceptable and helpful for regaining mobility and independence. This high level of satisfaction underscores the importance of incorporating patient perspectives when developing rehabilitation protocols.\u003c/p\u003e \u003cp\u003eTechnological advancements have paved the way for telerehabilitation, which offers several advantages over traditional outpatient care. It can significantly reduce costs and travel burdens for patients. For instance, an 8-week outpatient PT regimen is estimated at around USD 2,500 per patient, whereas a comparable telerehabilitation program costs roughly USD 500 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Patients also value the convenience of completing therapy at home on their own schedule, especially when travel is difficult in the early postoperative period. Importantly, telerehabilitation is highly scalable, enabling providers to extend care to more patients by overcoming geographic and resource constraints and delivering rehabilitation services efficiently to broad populations, thereby expanding access and reducing strain on healthcare systems [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, successful digital rehabilitation delivery must account for patient digital literacy and access barriers. A significant proportion of our patients had minimal formal education (with 16.7% never attending school) or very limited smartphone use. Such characteristics reflect limited eHealth literacy and technological access, which have been identified as major barriers to telehealth adoption among older adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In our program, patients with lower education levels and shorter daily smartphone use had more difficulty understanding and accepting the exercises. Some may require additional support or a hybrid approach (combining remote rehabilitation with occasional in-person guidance) to ensure proper participation. Indeed, older patients or those with cognitive impairment often need extra assistance to engage effectively in telerehabilitation despite its benefits [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Providing user-friendly platforms, training, or caregiver support can help bridge this digital divide. It is increasingly recognized that telerehabilitation services must be designed to be inclusive and accessible, addressing issues like internet access and digital literacy to maximize their reach and equity [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral limitations of this study should be acknowledged. First, our sample was drawn from a single geographic region in China, which may limit the generalizability of the findings. Second, the questionnaire-based design constrained the depth of data on certain factors (for example, detailed surgeon opinions on telerehabilitation devices and patients\u0026rsquo; financial willingness to pay for rehabilitation were not fully captured). Third, the exercises selected for patient assessment might not represent all possible rehabilitation activities, potentially limiting the scope of our evaluation. Lastly, the fixed response options for surgeons could have restricted the expression of nuanced opinions. Future studies should include more diverse populations, employ more comprehensive data collection (including technology usability and socioeconomic factors), and evaluate how structured telerehabilitation programs perform across different patient demographics and settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTelerehabilitation is a promising intervention for improving postoperative outcomes among TKA patients. Our study found that the program was both reasonable, feasible and acceptable to patients after TKA. However, further investigations are needed to confirm its clinical value and potential benefits, and to develop an individualized rehabilitation program that meets the specific needs and preferences of each patient.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTKA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etotal knee arthroplasty\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ephysical therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAHKS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Association of Hip and Knee Surgeons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Academy of Orthopaedic Surgeons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Institutional Review Board and the Human Research Ethics Committee of Honghui Hospital, Xi\u0026rsquo;an Jiaotong University (Approval No. 202212008). Written informed consent was obtained from all participants prior to enrollment. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and national research committees and complied with the principles of the Declaration of Helsinki and its subsequent amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are included in this published article. Additional information is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship contribution statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor contributions JPW and JBM conceived and designed the experiment. CYM, GHZ collected data. CYM, GHZ, and JBM analyzed and interpreted the data. CYM and JPW wrote the manuscript. JPW and JBM modifed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge all the participants enrolled in the current study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRanawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplasty: a 15-year survivorship study. Clin Orthop Relat Res. 1993;286:94\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoble PC, Conditt MA, Cook KF, Mathis KB. I can\u0026rsquo;t get no satisfaction after my total knee replacement: rhymes and reasons. Clin Orthop Relat Res. 2006;452:175\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFortier LM, Rockov ZA, Chen AF, Rajaee SS. Activity recommendations after total hip and total knee arthroplasty. J Bone Joint Surg Am. 2021;103(5):446\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWylde V, Blom AW, Whitehouse SL, Taylor AH, Pattison GT, Bannister GC. Patient-reported outcomes after total knee arthroplasty: comparison of the Oxford Knee Score and the Knee Society Score. J Bone Joint Surg Br. 2009;91(3):337\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScott CEH, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee arthroplasty: a prospective study of 1217 patients. J Bone Joint Surg Am. 2010;92(6):1253\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma L, Hurwitz DE, Thonar EJ, Sum JA, Lenz ME, Dunlop DD, et al. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum. 1998;41(7):1233\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunze KN, Polce EM, Nwachukwu BU, et al. What is the risk of dissatisfaction after total knee arthroplasty? A systematic review. Clin Orthop Relat Res. 2019;477(7):1452\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J. 2014;96-B(11 Suppl A):96\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty. 2017;32(12):3854\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br. 2007;89(7):893\u0026ndash;900.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian X, Sun Y, Xu T, Wu Y. Observation on the effect of compression training and low load resistance training in postoperative rehabilitation of total knee replacement. Chin J Bone Joint Injury. 2021;36(12):1312\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang M, Liu Q, Xiong S, et al. Effect of rehabilitation therapy combined with isometric muscle training on knee function in patients after total knee arthroplasty. J Xinxiang Med Univ. 2023;40(3):230\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong SX, Gao ZY, Wang JJ. Application effect of proprioception enhancement training in rehabilitation treatment of patients with knee osteoarthritis after total knee arthroplasty. Clin Med Res Pract. 2023;8(11):23\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Orthopaedic Surgeons. Management of osteoarthritis of the hip: evidence-based clinical practice guideline. 2017. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://aaos.org/globalassets/quality-and-practice-resources/osteoarthritisof-the-hip/oa-hip-cpg_6-11-19.pdf\u003c/span\u003e\u003cspan address=\"https://aaos.org/globalassets/quality-and-practice-resources/osteoarthritisof-the-hip/oa-hip-cpg_6-11-19.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 2020 Oct 30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Association of Hip and Knee Surgeons. Exercises you can do at home after knee replacement surgery. 2018. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hip-knee.aahks.org/physical-therapy-after-knee-replacement-video/\u003c/span\u003e\u003cspan address=\"https://hip-knee.aahks.org/physical-therapy-after-knee-replacement-video/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 2020 Oct 30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSloan M, Sheth NP, Lee GC. Is obesity associated with increased risk of complications after total knee arthroplasty? A systematic review and meta-analysis. J Arthroplasty. 2018;33(7):2290\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved outcomes after total knee arthroplasty with a kinematic alignment technique: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29(6):1749\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmin AK, Patton JT, Cook RE, Brenkel IJ. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br. 2006;88(3):335\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatailler C, Swan J, Sappey-Marinier E, Neyret P, Servien E, Lustig S. Kinematic alignment versus mechanical alignment in total knee arthroplasty: a meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res. 2020;106(6):1225\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatailler C, Fernandez A, Swan J, Sappey-Marinier E, Neyret P, Servien E, Lustig S. Kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2022;30(11):3566\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026uuml;tzner J, Kasten P, G\u0026uuml;nther KP, Kirschner S. Surgical options for patients with osteoarthritis of the knee. Nat Rev Rheumatol. 2009;5(6):309\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatailler C, Swan J, Neyret P, Servien E, Lustig S. Kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2200\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirschmann MT, Becker R. The unhappy total knee arthroplasty (TKA) patient: higher incidence and increased risk factors. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2779\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaeemabadi MR, Dinesen B, Andersen OK, Hansen J. Telerehabilitation for patients with knee osteoarthritis: a systematic review. JMIR Biomed Eng. 2020;5(1):e16991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCottrell MA, Galea OA, O\u0026rsquo;Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31(5):625\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBini SA, Mahajan J. Digital orthopaedics: a glimpse into the future in the midst of a pandemic. J Arthroplasty. 2020;35(7S):S1\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrvu Bettger J, Green CL, Holmes DN, Chokshi A, Mather RC, Hoch BT, et al. Effects of virtual exercise rehabilitation in-home therapy compared with traditional care after total knee arthroplasty: VERITAS randomized controlled trial. J Bone Joint Surg Am. 2020;102(2):101\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang Z, Fu Y, Zhao Y, Zhang J, Xu X, Wang L, et al. Home-based telerehabilitation after total knee arthroplasty: a systematic review and meta-analysis. J Telemed Telecare. 2024;30(2):94\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Telerehabilitation, Total Knee Arthroplasty, Postoperative Rehabilitation, Digital health, Home-based rehabilitation","lastPublishedDoi":"10.21203/rs.3.rs-8886676/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8886676/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTotal knee arthroplasty (TKA) is a common surgical procedure that requires structured postoperative rehabilitation to optimize functional recovery. Conventional supervised rehabilitation is associated with high costs, transportation barriers, and limited patient adherence. Telerehabilitation may provide a scalable alternative; however, the clinical reasonableness of structured programs and their feasibility and acceptability among both clinicians and patients remain unclear. This study aimed to evaluate a newly developed telerehabilitation program for patients undergoing TKA from both surgeon and patient perspectives.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted. A nationwide questionnaire survey was distributed to orthopedic surgeons in China to evaluate the clinical reasonableness of a structured telerehabilitation program consisting of 30 exercises across four postoperative phases. In addition, patients scheduled for TKA between March and April 2023 were invited to complete practical assessments of five representative exercises after watching instructional videos. Patient understanding, ability to perform the exercises, acceptance of telerehabilitation, and factors influencing comprehension and acceptance were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 148 orthopedic surgeons and 152 patients participated. Most surgeons considered postoperative rehabilitation essential and supported home-based rehabilitation after discharge. Over 80% of surgeons rated most exercises in the program as clinically reasonable, although approximately one quarter expressed concerns regarding wall squat exercises in later rehabilitation phases. Among patients, 84.21% reported understanding the exercise instructions and successfully performing the recommended movements, and 92.11% expressed willingness to participate in telerehabilitation. Lower education level and shorter daily smartphone use were associated with reduced understanding of the rehabilitation program, while limited smartphone use was the main factor associated with lower acceptance.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe proposed telerehabilitation program for patients undergoing TKA was considered clinically reasonable by surgeons and was feasible and acceptable to most patients. This program may provide a scalable and resource-efficient rehabilitation pathway and supports the integration of digital rehabilitation into routine orthopaedic care.\u003c/p\u003e","manuscriptTitle":"Development and Feasibility Evaluation of a Telerehabilitation Program After Total Knee Arthroplasty: A Cross-sectional Study of Surgeons and Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-22 17:01:35","doi":"10.21203/rs.3.rs-8886676/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3a89e334-0c9a-4aad-81ec-df5a260ca4fd","owner":[],"postedDate":"February 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-12T07:14:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T16:08:55+00:00","index":138,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T20:06:35+00:00","index":136,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T07:30:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-22 17:01:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8886676","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8886676","identity":"rs-8886676","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}