{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:59:19Z","timestamp":1760057959785,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background\/Objectives: Total knee Arthroplasty (TKA) is a prevalent treatment modality for degenerative knee diseases. Nevertheless, the success of the intervention is contingent on effective rehabilitation. The +PERTO\u00ae program (a Technological Rehabilitation Nursing Program) was developed as a mobile application comprising three phases to support patients during the perioperative period by providing exercises, information, and direct communication with healthcare professionals. The present study aims to evaluate the effects and usability of the +PERTO\u00ae program in patients undergoing total knee arthroplasty. Methods: In 2024, a hospital in northern Portugal conducted a pilot trial with eleven patients undergoing elective total knee arthroplasty. Researchers collected data both before surgery and six weeks after discharge. To evaluate effectiveness, software satisfaction, and usability, they used several assessment tools, including the Oxford Knee Score (OKS), SF-36v2, Visual Analog Scale (VAS), Short Physical Performance Battery (SPPB), QSEnf-10, and System Usability Scale (SUS). Researchers analyzed the data using both descriptive and inferential statistics. The hospital\u2019s ethics committee and board of directors approved the study. Results: There was a significant reduction in pain (p = 0.041) and improvement in knee functionality (p = 0.010), physical performance (p = 0.038), and quality of life (p &lt; 0.05). Patient satisfaction was high (QSEnf-10: 3.8\/4), and the usability of +PERTO\u00ae was considered excellent (SUS: 96.6\/100). Conclusions: The +PERTO\u00ae program proved to be an effective and innovative solution to support rehabilitation after TKA, promoting improvements in pain, functionality, and quality of life. This digital program stands out for its high rate of usability and its ability to modernize healthcare by providing a patient-centered approach.<\/jats:p>","DOI":"10.3390\/healthcare13060605","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T08:59:52Z","timestamp":1741683592000},"page":"605","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of +PERTO\u00ae in Rehabilitation for Total Knee Arthroplasty: A Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7004-9139","authenticated-orcid":false,"given":"Tiago Emanuel Soares de","family":"Ara\u00fajo","sequence":"first","affiliation":[{"name":"Abel Salazar Institute of Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"},{"name":"T\u00e2mega e Sousa Local Health Unit, 4560-136 Penafiel, Portugal"},{"name":"RISE@Health, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8786-3025","authenticated-orcid":false,"given":"Elsa Paula Santos","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"T\u00e2mega e Sousa Local Health Unit, 4560-136 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9021-5683","authenticated-orcid":false,"given":"Ana Raquel Varej\u00e3o","family":"Files","sequence":"additional","affiliation":[{"name":"T\u00e2mega e Sousa Local Health Unit, 4560-136 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8794-528X","authenticated-orcid":false,"given":"Jo\u00e3o Miguel Almeida","family":"Ventura-Silva","sequence":"additional","affiliation":[{"name":"RISE@Health, 4200-319 Porto, Portugal"},{"name":"Northern Health School of the Portuguese Red Cross, 3720-126 Oliveira de Azem\u00e9is, Portugal"}]},{"given":"Jorge Eduardo Ferreira","family":"Mendes","sequence":"additional","affiliation":[{"name":"T\u00e2mega e Sousa Local Health Unit, 4560-136 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-0406","authenticated-orcid":false,"given":"Andr\u00e9 Filipe Morais Pinto","family":"Novo","sequence":"additional","affiliation":[{"name":"Research Center for Active Living and Wellbeing\u2013LiveWell, 5300-253 Bragan\u00e7a, Portugal"},{"name":"School of Health, Polytechnic Institute of Bragan\u00e7a, 5300-253 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9982-9537","authenticated-orcid":false,"given":"Olga Maria Pimenta Lopes","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"RISE@Health, 4200-319 Porto, Portugal"},{"name":"Porto Nursing School, 4200-072 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13690-024-01243-2","article-title":"Chronic Disease and Multimorbidity in the Chinese Older Adults\u2019 Population and Their Impact on Daily Living Ability: A Cross-Sectional Study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)","volume":"82","author":"Chen","year":"2024","journal-title":"Arch. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.12707\/RIII12162","article-title":"People dependent in self-care: Implications for Nursing","volume":"4","author":"Ribeiro","year":"2014","journal-title":"Rev. Enf. Ref."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1136\/ard-2023-225041","article-title":"EULAR Recommendations for the Non-Pharmacological Core Management of Hip and Knee Osteoarthritis: 2023 Update","volume":"83","author":"Moseng","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00264-018-4116-3","article-title":"Total Knee Arthroplasty in the Varus Knee: Tips and Tricks","volume":"43","author":"Rossi","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_5","first-page":"1069","article-title":"The Combination of Exercise and Manual Therapy versus Exercise Alone in Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Clinical Trial","volume":"13","author":"Celik","year":"2021","journal-title":"PMR"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3643","DOI":"10.3233\/THC-240628","article-title":"What are the novel rehabilitation methods in knee arthroplasty? A bibliographic review","volume":"32","author":"Kara","year":"2024","journal-title":"Technol. Health Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3287","DOI":"10.1007\/s00167-020-06154-7","article-title":"The Projected Volume of Primary and Revision Total Knee Arthroplasty Will Place an Immense Burden on Future Health Care Systems over the Next 30 Years","volume":"29","author":"Klug","year":"2021","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lamplot, J.D., Pinnamaneni, S., Swensen-Buza, S., Lawton, C.D., Dines, J.S., Nawabi, D.H., and McLawhorn, A.S. (2020). The Virtual Shoulder and Knee Physical Examination. Orthop. J. Sports Med., 8.","DOI":"10.1177\/2325967120962869"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"van Dijk-Huisman, H.C., Weemaes, A.T.R., Boymans, T.A.E.J., Lenssen, A.F., and Bie, R.A. (2020). Smartphone App with an Accelerometer Enhances Patients\u2019 Physical Activity Following Elective Orthopedic Surgery: A Pilot Study. Sensors, 20.","DOI":"10.3390\/s20154317"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1016\/j.arth.2020.04.061","article-title":"Web-Based Self-Directed Exercise Program Is Cost-Effective Compared to Formal Physical Therapy after Primary Total Knee Arthroplasty","volume":"35","author":"Zachwieja","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mohammadi, S., Miller, W.C., Wu, J., Pawliuk, C., and Robillard, J.M. (2021). Effectiveness of eHealth Tools for Hip and Knee Arthroplasty: A Systematic Review. Front. Rehabil. Sci., 2.","DOI":"10.3389\/fresc.2021.696019"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pritwani, S., Shrivastava, P., Pandey, S., Kumar, A., Malhotra, R., Maddison, R., and Devasenapathy, N. (2024). Mobile and Computer-Based Applications for Rehabilitation Monitoring and Self-Management after Knee Arthroplasty: Scoping Review. JMIR Mhealth Uhealth, 12.","DOI":"10.2196\/47843"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Correia, F.D., Nogueira, A., Magalh\u00e3es, I., Guimar\u00e3es, J., Moreira, M., Barradas, I., Molinos, M., Teixeira, L., Tulha, J., and Seabra, R. (2019). Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study. JMIR Rehabil. Assist. Technol., 6.","DOI":"10.2196\/13111"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Han, S.H., and Kong, S.H. (2024). A Pilot Study on the Efficacy of an App-Based Rehabilitation Counselling Program after Total Knee Arthroplasty. Healthcare, 12.","DOI":"10.3390\/healthcare12131329"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mansoubi, M., Leveridge, P., Smith, M., Fox, A., Massey, G., Lamb, S.E., Keene, D.J., Newell, P., Jacobs, E., and Kalson, N.S. (2024). Knee4Life: Empowering Knee Recovery After Total Knee Replacement Through Digital Health Protocol. Sensors, 24.","DOI":"10.3390\/s24227334"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ara\u00fajo, T., Rodrigues, E., Nunes, J.R., Mendes, M., Novo, A., and Ribeiro, O.M.P.L. (2023). Validity of a Technological Rehabilitation Nursing Program for People Undergoing Knee Arthroplasty. Texto Contexto Enferm., 32.","DOI":"10.1590\/1980-265x-tce-2023-0151pt"},{"key":"ref_17","unstructured":"World Health Organization (2019). WHO Guideline Recommendations on Digital Interventions for Health System Strengthening, World Health Organization."},{"key":"ref_18","first-page":"376","article-title":"Cross-Cultural Adaptation and Validation of the Portuguese Version of the Oxford Knee Score (OKS)","volume":"18","author":"Martins","year":"2011","journal-title":"Knee"},{"key":"ref_19","unstructured":"(2025, January 15). Oxford University Innovation. Available online: https:\/\/innovation.ox.ac.uk\/outcome-measures\/oxford-knee-score-oks\/."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Silva, C.F.R., Ohara, D.G., Matos, A.P., Pinto, A.C., and Pegorari, M.S. (2021). Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010612"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.rpsp.2012.12.007","article-title":"Medidas Sum\u00e1rio F\u00edsica e Mental de Estado de Sa\u00fade para a Popula\u00e7\u00e3o Portuguesa","volume":"30","author":"Ferreira","year":"2012","journal-title":"Rev. Port. Sa\u00fade P\u00fablica"},{"key":"ref_22","unstructured":"Lopes, J. (2012). Satisfa\u00e7\u00e3o dos Clientes com os Cuidados de Enfermagem de Reabilita\u00e7\u00e3o: Contributo para a Adapta\u00e7\u00e3o e Valida\u00e7\u00e3o do Question\u00e1rio de Satisfa\u00e7\u00e3o SNQ-10. [Master\u2019s Thesis, Escola Superior de Enfermagem de Coimbra]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1080\/10447310802205776","article-title":"An Empirical Evaluation of the System Usability Scale","volume":"24","author":"Bangor","year":"2008","journal-title":"Int. J. Hum. Comput. Interact."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.procs.2015.09.273","article-title":"European Portuguese Validation of the System Usability Scale (SUS)","volume":"67","author":"Martins","year":"2015","journal-title":"Procedia Comput. Sci."},{"key":"ref_25","first-page":"158","article-title":"Item Benchmarks for the System Usability Scale","volume":"13","author":"Lewis","year":"2018","journal-title":"J. Usability Stud."},{"key":"ref_26","first-page":"94","article-title":"The Factor Structure of the System Usability Scale","volume":"Volume 5619","author":"Kurosu","year":"2009","journal-title":"Human-Centered Design, Proceedings of the First International Conference, HCD 2009, Held as Part of HCI International, San Diego, CA, USA, 19\u201324 July 2009"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Stauber, A., Sch\u00fc\u00dfler, N., Palmdorf, S., Sch\u00fcrholz, N., Bruns, D., Osterbrink, J., and Nestler, N. (2020). RECOVER-E\u2014A Mobile App for Patients Undergoing Total Knee or Hip Replacement: Study Protocol. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-3090-2"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Hong, Y., Wang, J., Zhang, X., Zhao, D., He, H., and Sun, M. (2024). The Effectiveness of Home Rehabilitation Based on BPMpathway Exercise Rehabilitation System for Patients after Total Knee Arthroplasty in China. Int. J. Orthop. Trauma Nurs., 53.","DOI":"10.1016\/j.ijotn.2023.101062"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wang, Q., Hunter, S., Lee, R.L., and Chan, S.W. (2023). The Effectiveness of a Mobile Application-Based Programme for Rehabilitation after Total Hip or Knee Arthroplasty: A Randomised Controlled Trial. Int. J. Nurs. Stud., 140.","DOI":"10.1016\/j.ijnurstu.2023.104455"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Straat, A.C., Maarleveld, J.M., Smit, D.J.M., Visch, L., Hulsegge, G., Huirne, J.A.F., van Dongen, J.M., van Geenen, R.C., Kerkhoffs, G.M.M.J., and Anema, J.R. (2023). (Cost-)Effectiveness of a Personalized Multidisciplinary eHealth Intervention for Knee Arthroplasty Patients to Enhance Return to Activities of Daily Life, Work and Sports\u2014Rationale and Protocol of the Multicentre ACTIVE Randomized Controlled Trial. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06236-w"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Timmers, T., Janssen, L., van der Weegen, W., Das, D., Marijnissen, W.J., Hannink, G., van der Zwaard, B.C., Plat, A., Thomassen, B., and Swen, J.W. (2019). The Effect of an App for Day-to-Day Postoperative Care Education on Patients with Total Knee Replacement: Randomized Controlled Trial. JMIR Mhealth Uhealth, 7.","DOI":"10.2196\/preprints.15323"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1016\/j.arth.2023.04.032","article-title":"Patients\u2019 Perceptions of Remote Monitoring and App-Based Rehabilitation Programs: A Comparison of Total Hip and Knee Arthroplasty","volume":"38","author":"Booth","year":"2023","journal-title":"J. Arthroplasty"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Mon\u00e1rrez, R., Mohamadi, A., Drew, J.M., and Abdeen, A. (2023). Mobile Application\u2019s Effect on Patient Satisfaction and Compliance in Total Joint Arthroplasty: A Systematic Review and Meta-analysis. J. Am. Acad. Orthop. Surg. Glob. Res. Rev., 7.","DOI":"10.5435\/JAAOSGlobal-D-22-00200"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1186\/s13018-023-03907-1","article-title":"Study on the Effect of Internet Plus Continuous Nursing on Functional Recovery and Medication Adherence in Patients Undergoing Knee Arthroplasty","volume":"18","author":"Li","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1146\/annurev-publhealth-052020-103738","article-title":"A Review of the Quality and Impact of Mobile Health Apps","volume":"43","author":"Grundy","year":"2022","journal-title":"Annu. Rev. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00590-019-02548-7","article-title":"Does Face-to-Face Pre-Operative Joint Replacement Education Reduce Hospital Costs in a Regional Australian Hospital? A Descriptive Retrospective Clinical Audit","volume":"30","author":"Lewis","year":"2020","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Sniderman, J., Monarrez, R., Drew, J., and Abdeen, A. (2024). Mobile Application Use and Patient Engagement in Total Hip and Knee Arthroplasty. JBJS Rev., 12.","DOI":"10.2106\/JBJS.RVW.23.00208"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/6\/605\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:50:26Z","timestamp":1760028626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/6\/605"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,11]]},"references-count":37,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["healthcare13060605"],"URL":"https:\/\/doi.org\/10.3390\/healthcare13060605","relation":{},"ISSN":["2227-9032"],"issn-type":[{"type":"electronic","value":"2227-9032"}],"subject":[],"published":{"date-parts":[[2025,3,11]]}}}