Effectiveness of Combined High-Intensity Laser Therapy (HILT) and Telerehabilitation in Patients with Primary Knee Osteoarthritis Following Total Knee Replacement Surgery: A Randomized Controlled Study
DOI:
https://doi.org/10.56929/jseaortho-2026-0322Keywords:
High-intensity laser therapy (HILT), tele-rehabilitation, total knee replacement, primary knee osteoarthritisAbstract
Purpose: This study evaluated the effectiveness of combined High-intensity laser therapy (HILT) and telerehabilitation in patients with primary knee osteoarthritis undergoing total knee replacement at Buriram Hospital. Outcomes included pain intensity, knee range of motion, knee circumference, functional mobility, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 6-Minute Walk Test (6MWT).
Methods: In this randomized controlled trial 88 participants were equally assigned to an experimental group receiving HILT combined with telerehabilitation or a control group receiving standard care. Assessments were performed at baseline and at 1, 3, and 6 months postoperatively and included knee flexion and extension, circumference, Timed Up and Go (TUG), 6MWT, Visual Analog Scale (VAS), and KOOS domains. Data were statistically analyzed using independent t-test, Mann–Whitney test, Chi-square test, Fisher’s exact test, and a mixed-effects linear regression for repeated measures, with significance set at p < 0.05.
Results: The experimental group demonstrated significantly greater improvement in knee flexion at Month 3 compared with the control group. Knee circumference and VAS pain scores decreased in both groups. Functional performance (6MWT) improved over time, with earlier gains in the experimental group. All KOOS domains improved significantly, with consistently higher scores in the experimental group from Month 1 onward. The greatest between-group difference was observed in quality of life at Months 3 and 6 (98.72 vs. 68.89 at Month 6).
Conclusions: Combined HILT and telerehabilitation significantly improved postoperative recovery, particularly in functional outcomes and quality of life, and may be an effective adjunct to standard care in knee osteoarthritis patients after total knee replacement.
Metrics
References
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204-22.
Long H, Liu Q, Yin H, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: Findings from the global burden of disease study 2019. Arthritis Rheumatol 2022;74:1172-83.
Cieza A, Causey K, Kamenow K, et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021;396:2006-17.
The Thai Rheumatism Association. Guideline for the treatment of osteoarthritis of the knee. Bangkok: The Thai Rheumatism Association; 2010.
Sroisong S, Ruenkon A, Fuengthong P, et al. Nursing care for elderly patients with knee osteoarthritis. Reg 11 Med J 2019;33:197-210.
Charoencholwanich K. Let us have only good joints. 4th ed. Bangkok: Banlue Books Publishing; 2013.
Rattanathongkham S. Physical therapy laser [Internet]. Khon Kaen: Khon Kaen University; [cited 2024 Jul 15]. Available from: https://ams.kku.ac.th/aalearn/resource/edoc/heatcold/lasertx.pdf
Apichantrametakul W, Sroisong S, Eawsiyok B. Nursing care for patients with knee osteoarthritis undergoing total knee arthroplasty. JPNC 2018;29:223-38.
Trakarnchan N, Yospitak P. Rehabilitation after total knee arthroplasty. RHPC9Journal 2020;14:271-84.
Saechin W. Effects of an 8-week continuous telerehabilitation program in patients recovered from coronavirus disease 2019 pneumonia [dissertation]. Bangkok: Chulalongkorn University; 2022.
Phanthi J, Kliangda C, Wannathoob T. Range of motion in extremity injuries: assessment and nursing care. J Thai Nurse Midwife Counc 2022;37:30-41.
Ungpinijpong W, Chaipinyo K, Jamnongkit S. Physical Therapy Association of Thailand, editor. Rehabilitation manual for the elderly after total knee arthroplasty. Bangkok: Samanmit Printing 2003; 2015.
Queen Sirikit Heart Center of the Northeast. Physical fitness test [Internet]. Khon Kaen: Queen Sirikit Heart Center of the Northeast; [cited 2024 Jul 17]. Available from: https://heart.kku.ac.th/index.php?option=com_k2&view=item&id=49:rehap-physicl-fitness-test.
Ongsantipap P, Pirunsan U, Puangmali A. Reliability of measurement variables used in knee osteoarthritis assessment. Chiang Mai Med J 2015;48:53-9.
Ciplak ED, Akturk S, Buyukavci R, et al. Efficiency of high intensity laser therapy in patients with knee osteoarthritis. Medicine Science Int Med J 2018;7:724-7.
Osifo SE, Shobode MA. Telerehabilitation after total knee arthroplasty: a narrative review of its effectiveness, safety, and access in the post-COVID era. Cureus 2025;17:e94102.
BBade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 2010;40:559-67.
Dubljanin Raspopović E, Meissner W, Zaslansky R, et al. Associations between early postoperative pain outcome measures and late functional outcomes in patients after knee arthroplasty. PLoS One 2021;16:e0253147.
Kim JH, Kim BR, Kim SR, et al. Functional outcomes after critical pathway for inpatient rehabilitation of total knee arthroplasty. Ann Rehabil Med 2019;43:650-61.
Russell TG, Buttrum P, Wootton R, et al. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2011;93:113-20.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The Royal College of Orthopaedic Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
