Coping to move again: the psychological dimension of tele-supported rehabilitation after knee arthroplasty—A randomized controlled trial

Teresa Paolucci, Laura Rizzo, Alice Cichelli, Federica Bressi, Andrea Bernetti, Giacomo Farì, Marisa Megna, Marco Bonerba, Annalisa Marotta, Marta Di Nicola

Introduction Persistent pain and functional limitations after total knee arthroplasty (TKA) remain clinical challenges, influenced heavily by psychological factors like coping strategies and treatment expectancy. Tele-rehabilitation offers a promising approach to enhance continuity of care and patient engagement when integrated with psychoeducational support. This study compared the effectiveness of a personalized tele-rehabilitation program incorporating psychoeducational components and caregiver support with conventional outpatient rehabilitation following TKA, exploring the relationships between coping strategies, treatment expectancy, and clinical outcomes. Methods This single-blind randomized controlled trial enrolled 48 patients undergoing TKA for knee osteoarthritis, randomly assigned to an experimental group (tele-rehabilitation with psychoeducational support; n = 24) or a control group (conventional outpatient rehabilitation; n = 24). Forty-four participants completed the study (22 per group) following comparable protocols in frequency and duration. Outcomes—pain (VAS), function (WOMAC, KOOS), autonomy (Barthel Index, Modified Rankin Scale), coping strategies (COPE-NIV), and treatment credibility/expectancy (CEQ)—were assessed at baseline (T0), 4 weeks (T1), and 3 months post-surgery (T2). Non-parametric mixed-effects models and correlation analyses were performed. Results Both groups showed significant improvements over time in all clinical outcomes ( p < 0.001). Significant group time interactions were observed for pain, with the tele-rehabilitation group demonstrating greater reductions in VAS pain ( p = 0.019), WOMAC Pain ( p = 0.036), and KOOS Pain ( p = 0.046). Baseline coping strategies and CEQ scores were comparable between groups. Higher baseline “Social Support” coping was exploratorily associated with greater improvement in selected pain-related outcomes. No significant between-group differences emerged for functional independence or quality of life. No adverse events occurred. Discussion A personalized tele-rehabilitation program with psychoeducational components and caregiver support was implemented without adverse events in this sample. No statistically significant between-group differences were observed for functional outcomes, whereas greater reductions in pain were observed in the experimental group. The significant correlation between social support coping and better clinical outcomes suggests the potential importance of a biopsychosocial approach to post-TKA care. Clinical Trial Registration ClinicalTrials.gov ID Identifier: NCT07032805.