Understanding Patient and Physiotherapist Requirements for an Automated Smartphone Application for Post-Total Knee Arthroplasty Rehabilitation in Singapore: A Qualitative Study Informing User-Centred Design (Preprint)

UNSTRUCTURED Background: Total knee arthroplasty (TKA) is cost-effective surgical intervention for painful knee osteoarthritis in older adults, but post-surgery rehabilitation access is limited. Tele-rehabilitation offers a solution, but existing models require significant therapist involvement and costly setup. A smartphone-based automated program could be a cost-effective alternative. Objective: To ensure uptake and long-term sustainability, our study adopted a user-centred approach. This study aimed to understand the requirements of both patients and physiotherapists in developing an automated tele-monitored rehabilitation smartphone application for individuals undergoing TKA. Methods: A multistakeholder qualitative study of user needs was conducted. Physiotherapists and patients who underwent TKA were recruited via purposive sampling. Individual in-depth interviews, lasting about an hour each, were conducted via zoom by an experienced, trained female interviewer with a Master of Arts in Sociology. Data were audio-recorded and transcribed by the same interviewer. Two reviewers (ESC, SSK) independently analysed the data using thematic analysis, with data triangulation achieved through cross-checking of data sources by three reviewers (ESC, SSK, AES). Interviews were conducted to data saturation. Results: Among the four eligible physiotherapists and 11 eligible patients invited, four physiotherapists (100%) and six patients (54.5%) consented and completed interviews. The median age of physiotherapists and patients were 27- and 65-years-old respectively. The majority of patients were Chinese (83%) and employed (67%). Common themes that emerged from both groups were that the application should be informative and provide reassurance. Additional themes from the patient group were: ease of use, and enhancing motivation and compliance. Conclusion: This study provided insights into the requirements of potential end-users of a smartphone application for automated tele-monitored rehabilitation following TKA. This is useful for steering the development of a user-centric smartphone application.