A Sensor-Augmented Telerehabilitation System for Knee Osteoarthritis: A Randomized Controlled Trial of Neuromuscular, Functional, and Psychosocial Outcomes.

BACKGROUND: Knee osteoarthritis (OA) is a prevalent musculoskeletal condition associated with pain, functional limitation, and reduced quality of life. Telerehabilitation has emerged as a scalable intervention, yet many platforms lack neuromuscular feedback or objective-monitoring capabilities. The KneE-PAD system uniquely integrates electromyographic and inertial sensing to provide personalized feedback and remote performance tracking. OBJECTIVE: To evaluate the clinical effectiveness of a sensor-augmented telerehabilitation system (KneE-PAD) compared to conventional face-to-face physiotherapy in older adults with mild-to-moderate knee OA. METHODS: In this single-blind randomized controlled trial, 42 older adults (mean age 68.4 ± 5.7 years) were randomly assigned to either KneE-PAD telerehabilitation or conventional physiotherapy for eight weeks. KneE-PAD sessions incorporated real-time electromyographic and motion feedback, while physiotherapists remotely supervised training. Assessments were performed at baseline, post-intervention, and 12-week follow-up. Primary outcomes included quadriceps strength, neuromuscular activation, and WOMAC scores. Secondary outcomes covered functional mobility, psychological distress, self-efficacy, and fear of movement. RESULTS: The telerehabilitation group demonstrated notable improvements in neuromuscular activation, quadriceps strength, and functional capacity, all exceeding clinically meaningful thresholds. Functional mobility and pain outcomes showed substantial gains compared with the control group, while psychological indicators (self-efficacy and depressive symptoms) exhibited modest but positive trends. Between-group comparisons consistently favored KneE-PAD, with effects maintained at the 12-week follow-up, confirming both clinical and functional robustness. CONCLUSIONS: Sensor-augmented telerehabilitation using the KneE-PAD platform appears to be a feasible and potentially effective alternative to conventional physiotherapy for knee OA. By combining real-time feedback, motor learning reinforcement, and remote monitoring, the system may enhance neuromuscular and functional recovery. These findings should be confirmed in larger and longer-term trials. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06416332.