Beyond the Step Count: A Qualitative Study of Patient and Clinician Experiences with Wearable-Supported Rehabilitation After Major Orthopedic Surgery

Wang Haoyu; Alexander Angkasa; Linda Chiuman

doi:10.61919/d8xkar10

Authors

Wang Haoyu Universitas Prima Indonesia, Medan, Indonesia Author
Alexander Angkasa Universitas Prima Indonesia, Medan, Indonesia Author
Linda Chiuman Universitas Prima Indonesia, Medan, Indonesia Author

DOI:

https://doi.org/10.61919/d8xkar10

Keywords:

wearable technology; orthopedic rehabilitation; total knee arthroplasty; total hip arthroplasty; qualitative research; remote monitoring.

Abstract

Background: Wearable technologies can make recovery after major lower-limb orthopedic surgery more visible, but their clinical value depends on how patients and clinicians interpret and act on the data they produce. Qualitative inquiry is needed to understand motivation, reassurance, anxiety, clinical meaning, workload, and digital exclusion. Objective: To explore patient and clinician experiences of wearable-supported rehabilitation and identify conditions under which wearable data are perceived as supportive, clinically meaningful, and feasible. Methods: An interpretive qualitative descriptive interview study included 14 purposively selected participants: nine postoperative patients and five clinicians involved in orthopedic rehabilitation. Semi-structured interviews were analyzed using reflexive thematic analysis. Results: Four themes were developed: numbers as reassurance and momentum; quantified recovery as pressure; data requiring clinical context; and remote visibility creating new work and inequities. Personal trends could make progress tangible, whereas inflexible targets could be experienced as judgment. Clinicians interpreted longitudinal patterns alongside symptoms, function, and circumstances. Remote monitoring was perceived as useful only when review responsibilities, escalation pathways, technical support, and non-digital alternatives were clear. Conclusion: Participants perceived wearables as most acceptable when they supported conversation rather than replaced it. Personalized goals, contextualized feedback, defined monitoring responsibilities, and equitable access are important sustainability conditions

References

1. Gordon AM, Nian P, Baidya J, Scuderi GR, Mont MA. Randomized controlled studies on smartphone applications and wearable devices for postoperative rehabilitation after total knee arthroplasty: a systematic review. J Arthroplasty. 2025;40(8):2204-2213.e1. doi: 10.1016/j.arth.2025.01.034.

2. Tripuraneni KR, Foran JRH, Munson NR, Racca NE, Carothers JT. A smartwatch paired with a mobile application provides postoperative self-directed rehabilitation without compromising total knee arthroplasty outcomes: a randomized controlled trial. J Arthroplasty. 2021;36(12):3888-3893. doi: 10.1016/j.arth.2021.08.007.

3. Van der Walt N, Salmon LJ, Gooden B, Lyons MC, O'Sullivan M, Martina K, et al. Feedback from activity trackers improves daily step count after knee and hip arthroplasty: a randomized controlled trial. J Arthroplasty. 2018;33(11):3422-3428. doi: 10.1016/j.arth.2018.06.024.

4. Bradbury TL, McConnell MJ, Whitacre D, Naylor BH, Gibson BT, DeCook CA. A remote physical therapy program demonstrates similar outcomes compared to in-person, supervised physical therapy after same-day discharge total knee arthroplasty: a randomized clinical trial. J Arthroplasty. 2024;39(11):2725-2730.e4. doi: 10.1016/j.arth.2024.05.040.

5. Booth MW, Riegler V, King JS, Barrack RL, Hannon CP. Patients' perceptions of remote monitoring and app-based rehabilitation programs: a comparison of total hip and knee arthroplasty. J Arthroplasty. 2023;38(7 Suppl):S39-S43. doi: 10.1016/j.arth.2023.04.032.

6. Kurtz SM, Higgs GB, Chen Z, et al. Patient perceptions of wearable and smartphone technologies for remote outcome monitoring in patients who have hip osteoarthritis or arthroplasties. J Arthroplasty. 2022;37(7 Suppl):S488-S492.e2. doi: 10.1016/j.arth.2022.02.026.

7. Zhang W, Ji H, Wu Y, Xu Z, Li J, Sun Q, et al. Patients' needs and experiences of telerehabilitation after total hip and knee arthroplasty: a qualitative systematic review and meta-synthesis. Digit Health. 2024;10:20552076241256756. doi: 10.1177/20552076241256756.

8. Chew ES, Scully AE, Koh SSM, Woon EL, Low JKMS, Kwan YH, et al. Understanding patient and physiotherapist requirements for a personalized automated smartphone telemonitored app for posttotal knee arthroplasty rehabilitation: qualitative study. JMIR Rehabil Assist Technol. 2025;12:e59688. doi: 10.2196/59688.

9. Gianzina E, Kalinterakis G, Delis S, Vlastos I, Sachinis NP, Yiannakopoulos CK. Evaluation of gait recovery after total knee arthroplasty using wearable inertial sensors: a systematic review. Knee. 2023;41:190-203. doi: 10.1016/j.knee.2023.01.006.

10. Wu KA, Kugelman DN, Goel RK, Dilbone ES, Ryan SP, Wellman SS, et al. How do patient-reported outcomes correlate with real-time objective measures of function after total knee arthroplasty? A prospective study using daily gait metrics. J Arthroplasty. 2025;40(7):1711-1718. doi: 10.1016/j.arth.2024.12.007.

11. Boekesteijn R, Smolders J, Busch V, Keijsers N, Geurts A, Smulders K. Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures. PeerJ. 2022;10:e14054. doi: 10.7717/peerj.14054.

12. Small SR, Bullock GS, Khalid S, Barker K, Trivella M, Price AJ. Current clinical utilisation of wearable motion sensors for the assessment of outcome following knee arthroplasty: a scoping review. BMJ Open. 2019;9(12):e033832. doi: 10.1136/bmjopen-2019-033832.

13. Mehta SP, Ventura LM, Boone JD, Oliashirazi A. A qualitative study to explore patient expectations of recovery after total knee replacement surgery. Musculoskelet Care. 2025;23(3):e70178. doi: 10.1002/msc.70178.

14. Oh SS, Kim KA, Kim M, Oh J, Chu SH, Choi J. Measurement of digital literacy among older adults: systematic review. J Med Internet Res. 2021;23(2):e26145. doi: 10.2196/26145.

15. Wang X, Luan W. Research progress on digital health literacy of older adults: a scoping review. Front Public Health. 2022;10:906089. doi: 10.3389/fpubh.2022.906089.

16. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi: 10.1191/1478088706qp063oa.

17. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2021;18(3):328-352. doi: 10.1080/14780887.2020.1769238.

18. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi: 10.1093/intqhc/mzm042.

19. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251. doi: 10.1097/ACM.0000000000000388.

20. Redfern RE, Khan ST, Archibeck MJ, Peters CL, Anderson MB, Piuzzi NS. Establishing minimal clinically important difference and substantial clinical benefit thresholds for objective gait metrics after total knee arthroplasty. J Arthroplasty. Published online April 9, 2026. doi: 10.1016/j.arth.2026.03.101.