TITLE:
Assessment of a Downloadable Application with Avatar Guidance for PT-Prescribed Home Exercise after Total Knee Arthroplasty: A 30-Day Usability and Feasibility Study
AUTHORS:
Joel Carmichael, Sheryl Flynn, Tamara Struessel, Stefano Bini, Michael Bade, Jennifer Stevens-Lapsley
KEYWORDS:
Mobile Health Technology, Feasibility, Usability, Total Knee Replacement, System Usability Scale
JOURNAL NAME:
Advances in Aging Research,
Vol.11 No.4,
July
14,
2022
ABSTRACT: Objective: To explore the usability and feasibility of a downloadable application
(APP) compared to paper handouts (CONTROL) in guiding 30 days of PT-prescribed
home exercise after total knee arthroplasty (TKA), and to compare functional
outcomes at 30 days postoperatively between APP and CONTROL. Design: Randomized controlled usability and feasibility study. Setting: Rehabilitation laboratories at two regional medical centers. Participants: Individuals with knee osteoarthritis undergoing unilateral TKA (APP group: N =
26; mean age, 67.0 ± 8.2 y; CONTROL group: N = 31; mean age, 64.7 ± 7.7 y). Interventions: This study assessed the user experience of a downloadable app to guide 30 days
of home exercises and instruction after TKA and compared exploratory outcomes
to a group using paper handouts. Main Outcome Measures: The System Usability Scale (SUS) score was used to assess patient usability
experience. Raw SUS scores were dichotomized (≥72% or a priori criterion for mean APP group score. Feasibility for app use was similarly
evaluated in the APP group only through a priori criteria applied to computing device ownership
and study use, to the absence of technology-based barriers to participation,
and to completion of app-based testing. Exploratory measures compared change from baseline to 30 days for
functional and patient-reported outcomes between APP and CONTROL. Results: The APP group’s mean SUS score of 79.2% at 30 days exceeded the 75% threshold
for good usability. The app met the predetermined a priori feasibility
criteria for absence of technology-based barriers to participation (75% of
participants) and completion of app-based testing (91.3% of participants).
Personal computing devices were used by 71.4% of APP participants, which was
below the 75% a priori feasibility criterion. No differences between the APP and CONTROL groups were
observed for functional or patient-reported outcomes. Conclusions: The app-based platform met the a priori criteria for usability
for 79% of APP participants. Our findings suggest that app-based, avatar-guided
home exercise after TKA has acceptable usability and feasibility. The
app-guided patient assessment capability also demonstrates preliminary
feasibility for guiding and administering functional and self-reported outcomes
assessments.