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Introduction: After knee arthroplasty, there is little guidance on return to daily life activities including work and sport, despite the importance of these outcomes for patients in working-age. Personal eHealth programs could provide perioperative guidance to patients, facilitating an earlier recovery. This study evaluated whether an additional personalized eHealth care program enhances return to daily life activities, including work and sports, compared to usual care among working-age knee arthroplasty patients in the Netherlands.

Methods: The multicenter randomized controlled ACTIVE trial was conducted across eleven Dutch medical centers. Eligible patients were working-age patients on the waiting list for a primary total- or unicompartmental knee arthroplasty, employed at least eight hours a week, and willing to return to work. Patients were randomized 1:1 into the intervention or control group. The intervention group received an eHealth care program in addition to usual care, including an eHealth application with activity tracker, goal attainment scaling and a one-time case-manager consultation. The control group received usual care. The primary outcome was the self-reported PROMIS-Physical Functioning, assessing time from surgery to return to six out of eight self-selected daily life activities. Kaplan-Meier curves and a multi-level longitudinal Cox proportional hazard model were used for analysis. Using a forward stepwise selection procedure, nine variables were assessed as potential confounders or effect-modifiers, including body mass index, knee demanding work, and work absenteeism prior to surgery.

Results: From October 2020 through January 2023, 145 patients were randomized in the intervention group (54% female, mean age 58 years) and 142 in the control group (51% female, mean age 59 years). Median time to resume the self-selected six out of eight daily life activities was 52 days (IQR 32–84) in the intervention group, compared to 75 days (IQR 36-137) in the control group (HR 1.6, 95%CI 1.3–2.0). No confounders or effect-modifiers were found.

Discussion: The personalized eHealth care program reduced the time to return to self-selected daily life activities by 23 days compared to usual care. Given the worldwide rising prevalence of knee osteoarthritis, especially among working-age patients with high expectations regarding performance of knee-demanding activities, this intervention could enhance perioperative care to support personalized medicine.

Conclusion: The personalized eHealth care program reduced the median time to resume self-selected daily life activities by 23 days compared to usual care.