Adherence to Home-Based Physiotherapy and Music-Assisted Relaxation After Total Knee Arthroplasty

Patients undergoing primary total knee arthroplasty for knee osteoarthritis were enrolledand randomly assigned in a 1:1 ratio to an intervention group or a control group using acomputer‐generated random allocation sequence.All participants received standard postoperative physiotherapy during hospitalization. Atdischarge, both groups received a structured home‐based physiotherapy program andindividual instruction on correct exercise performance. The physiotherapy program wasprescribed for 6 weeks, 5 days per week, twice daily. Participants recorded completedsessions in an activity diary.In addition to home‐based physiotherapy, participants in the intervention group receivedan audio‐guided, music‐assisted progressive muscle relaxation program. The approximately27‐minute audio recording included verbal instructions for diaphragmatic breathing andthe sequential contraction and relaxation of major muscle groups, accompanied byinstrumental background music. Participants were instructed to complete one relaxationsession before bedtime, 5 days per week, for 6 weeks, and to record each completedsession in an activity diary.At the end of the first postoperative week, participants were contacted individually toreview program performance, correct potential errors, answer questions, and addressdifficulties related to home practice.The primary feasibility outcome was adherence to the prescribed home‐based programs.Physiotherapy adherence was calculated as the percentage of completed sessions out of 60prescribed sessions. Progressive muscle relaxation adherence was calculated as thepercentage of completed sessions out of 30 prescribed sessions. Participants completingat least 80% of the prescribed sessions were classified as adherent. Participants who didnot meet the adherence criterion for progressive muscle relaxation were asked structuredquestions about the reasons for non‐adherence.Exploratory clinical assessments were performed preoperatively and at postoperative week6. These assessments included pain intensity at rest, during walking, and at night;osteoarthritis‐related pain, stiffness, and physical function; sleep quality; depression,anxiety, and stress symptoms; operated‐side knee flexion and extension range of motion;lower‐extremity functional performance; functional mobility; and health‐related qualityof life. Because the study primarily focused on adherence and feasibility, analyses ofclinical outcomes were considered exploratory rather than confirmatory.