Abstract Background Achilles tendon rupture significantly affects patient mobility and quality of life. Postoperative rehabilitation is critical to regain ankle function, strength, and return to activity. Home-based digital rehabilitation has emerged as an accessible alternative to traditional clinic-based physiotherapy; however, high-quality evidence comparing these approaches after Achilles tendon repair remains scarce. Objective This randomized controlled trial aimed to evaluate whether a home-based digital exercise program (DEP) is noninferior to clinic-based face-to-face physiotherapy for restoring ankle range of motion (ROM), strength, patient-reported outcomes, and cost-effectiveness following open Achilles tendon repair. Methods Between August 2020 and June 2023, 200 adult patients (mean age 36. 5, SD 5. 0 years; n=135, 67. 5% male) undergoing open Achilles tendon repair at 2 trauma centers were randomly assigned (1: 1) to either a 12-week home-based DEP group (n=100) or traditional 12-week clinic-based physiotherapy (CP group, n=100) in Shanghai. The digital program was delivered through an online app, providing instructional videos, real-time telecommunication, daily exercise tasks, and monitoring of adherence. The clinic-based group received weekly physiotherapist-supervised sessions. The primary outcome was ankle ROM at 12 weeks postoperatively. Secondary outcomes included plantarflexion strength at 0° and 12°, heel-rise index and height, Achilles Tendon Total Rupture Score (ATRS), Victorian Institute of Sport Assessment–Achilles scores, adherence, patient satisfaction, cost-effectiveness, and adverse events assessed at 6, 12, and 24 weeks. Mixed-effects models were applied for intention-to-treat analyses, and sensitivity analyses were performed in the per-protocol population. Results At 12 weeks postoperatively, the DEP group was noninferior to the CP group for ankle ROM: mean difference (DEP–CP=−0. 08°) with a 1-sided 95% CI lower bound of −2. 16°, exceeding the noninferiority margin of −5° (P. 05). The exchange rate used in this study was 1 US =6. 90 Chinese Yuan. Conclusions The home-based DEP following Achilles tendon repair provided comparable clinical outcomes to traditional physiotherapy while significantly improving cost-effectiveness. These findings support the broader adoption of tele-supervised digital rehabilitation as a safe and effective alternative.
Wang et al. (Thu,) studied this question.
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