Assessment of a Downloadable Application with Avatar Guidance for PT-Prescribed Home Exercise after Total Knee Arthroplasty: A 30-Day Usability and Feasibility Study
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. MainOutcomeMeasures: The System Usability Scale (SUS) score was used to assess patient usability
experience. Raw SUS scores were dichotomized (≥72% or <72%) to determine app
usability against a 75% apriori criterion for mean APP group score. Feasibility for app use was similarly
evaluated in the APP group only through apriori 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% apriori 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 apriori 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.
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