Mobile-Based Telerehabilitation with Sensors for Adherence and Efficacy in Chronic Patellofemoral Pain: A Randomized Controlled Trial (Preprint)

<sec> <title>BACKGROUND</title> <p>The Internet and mobile technologies offer promising platforms for delivering rehabilitation remotely, yet the optimal preparation strategy to maximize patient adherence and clinical outcomes in digital rehabilitation programs remains unclear.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To compare the effects of 1, 3, or 6 face-to-face pre-telerehabilitation tutorial sessions on adherence and clinical outcomes in patients with patellofemoral pain (PFP) participating in an 8-week digital rehabilitation program.</p> </sec> <sec> <title>METHODS</title> <p>174 patients with PFP were randomized to one-session (OST; n=58), three-session (TST; n=58), or six-session (SST; n=58) face-to-face pre-telerehabilitation tutorial groups. All participants completed an 8-week digital health program comprising sensor-guided exercise therapy and self-care education. Primary outcome was device-recorded training adherence over 6 weeks. Secondary outcomes included self-reported adherence (Exercise Adherence Rating Scale [EARS]), pain intensity (Visual Analog Scale), quadriceps strength, Kujala Patellofemoral Score, Fatigue Severity Scale, and a closed-ended adherence survey. Primary and EARS analyses used one-way ANOVA with Tukey post-hoc tests. Secondary longitudinal analyses used linear mixed models.</p> </sec> <sec> <title>RESULTS</title> <p>Device-recorded total training time was greater in TST (12.4±2.3 h) and SST (12.6±2.5 h) versus OST (9.3±1.6 h; both P&lt;.001), with no difference between TST and SST. Mean weekly training time showed a similar pattern (both P&lt;.001). For engagement metrics, TST and SST groups had fewer Q&amp;A visits and alert reminders than OST (all P&lt;.001), and SST received fewer reminders than TST (P=.03). Self-reported adherence (EARS Part A) was higher in TST (18.9) and SST (19.1) versus OST (14.0; both P&lt;.001); EARS Part B (barriers) was also higher in TST (13.1) and SST (14.2) versus OST (10.5), with SST higher than TST (P=.04). TST and SST showed greater improvements than OST in daily activity pain, squatting pain, and Kujala score (all adjusted P&lt;.05), with no TST-SST differences. For concentric quadriceps strength, males in TST and SST had greater gains than OST; females showed TST superiority only. Eccentric strength improved more in males for TST and SST versus OST. Fatigue scores did not differ among groups (P=.63). Over 90% endorsed program features for adherence; 96.7% would recommend the program.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Three face-to-face pre-rehabilitation sessions optimized adherence and short-term clinical outcomes for PFP telerehabilitation, with no added benefit from six sessions. This suggests a plateau effect, supporting a practical and efficient pre telerehabilitation preparation strategy.</p> </sec> <sec> <title>CLINICALTRIAL</title> <p>ClinicalTrials.gov NCT06651996; https://clinicaltrials.gov/ct2/show/NCT06651996</p> </sec>