Adaptive, Stepped-Care for Cancer-Related PTSD Symptoms in HCT Survivors: Results From a SMART Trial.

Total knee arthroplasty (TKA) is a well-established surgical intervention for end-stage knee osteoarthritis and is widely recognized for its ability to relieve pain and improve joint function []. However, optimal postoperative recovery does not depend on surgery alone []. Rehabilitation after TKA is essential for reducing pain, restoring range of motion (ROM), rebuilding lower-limb strength, improving mobility, and facilitating return to daily activities and social participation [,]. This recovery process usually extends beyond the inpatient period and requires sustained exercise participation, appropriate progression of training intensity, and timely correction of movement patterns []. In routine care, however, access to structured rehabilitation may be constrained by travel distance, uneven distribution of rehabilitation resources, financial and time burdens, and difficulty maintaining adherence once patients return home [,]. These barriers have stimulated interest in alternative models that can extend rehabilitation support beyond conventional face-to-face settings []. The rapid development of telecommunication technologies has created new opportunities for delivering postoperative rehabilitation remotely []. Remote rehabilitation may be implemented through videoconferencing, mobile apps, wearable sensors, web-based platforms, or combinations of these approaches []. In principle, such systems can reduce geographical barriers, support home-based recovery, and facilitate more flexible care delivery while maintaining some degree of professional oversight []. Importantly, remote rehabilitation is not a single uniform intervention. Some programs merely provide exercise instructions or educational materials for independent completion, whereas others incorporate real-time supervision, asynchronous feedback, data monitoring, goal adjustment, or repeated patient-clinician communication []. These differences are clinically meaningful because the therapeutic value of a remote program may depend not only on where care is delivered, but also on whether patients receive timely guidance, corrective feedback, and individualized reinforcement during recovery []. Several systematic reviews and meta-analyses have evaluated the effectiveness of remote rehabilitation or telerehabilitation following TKA [-]. Overall, these studies have generally suggested that remote rehabilitation may achieve outcomes comparable to conventional in-person rehabilitation for pain and functional recovery, with potential advantages related to convenience, accessibility, and cost. Other reviews have focused on more specific digital modalities, such as virtual reality–based rehabilitation or smart device–assisted telerehabilitation, and have reported possible benefits in selected outcomes [,]. Nevertheless, the existing literature remains difficult to interpret from an intervention-design perspective. Most prior reviews have classified interventions according to their mode of delivery, such as telerehabilitation, remote rehabilitation, or home-based digital rehabilitation, or according to the technological platform used, rather than using therapeutic interactivity as the primary conceptual criterion for intervention definition.