Abstract
BACKGROUND: Total knee arthroplasty (TKA) remains the definitive treatment for end-stage knee osteoarthritis (OA). Despite its success, post-operative rehabilitation continues to be challenged by limited access to care, inconsistent patient compliance, and a lack of standardized protocols. In response, smart device-assisted telerehabilitation has gained attention for its capacity to deliver real-time monitoring and individualized feedback. However, its comparative effectiveness relative to traditional rehabilitation approaches remains inconclusive. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing smart device-assisted telerehabilitation to conventional rehabilitation following TKA. Databases searched included PubMed, Web of Science, EMBASE, and Cochrane Library. Key outcomes assessed were pain (Visual Analog Scale (VAS)), functional recovery (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), and range of motion (ROM) (knee flexion and extension angles). Meta-analysis was performed using Stata 16.0, with heterogeneity evaluated via the I(2) statistic. Subgroup and sensitivity analyses were also conducted. RESULTS: A total of 22 RCTs encompassing 2,181 participants were included. Overall, there were no significant differences between smart and conventional rehabilitation regarding VAS (SMD = 0.02, 95% CI: - 0.24 to 0.28) and WOMAC scores (SMD = - 0.27, 95% CI: - 0.60 to 0.06). Subgroup analyses revealed that augmented reality (AR) interventions were associated with greater pain reduction (VAS: SMD = - 1.12, 95% CI: - 1.98 to - 0.25), and virtual reality (VR) interventions led to significant functional improvement (WOMAC: SMD = - 0.47, 95% CI: - 0.82 to - 0.13). Furthermore, smart rehabilitation yielded superior outcomes in knee extension angle (SMD = - 0.15, 95% CI: - 0.28 to - 0.02). Sensitivity and publication bias analyses confirmed the stability of the results. CONCLUSION: Smart device-assisted telerehabilitation is comparable to conventional rehabilitation in overall outcomes after TKA. However, AR and VR technologies demonstrate added value in specific domains of recovery, suggesting that future rehabilitation programs should consider integrating these modalities to enhance effectiveness and personalization of care.