Feasibility and usability of a wearable sensor-based telerehabilitation program for home-based exercise in patients with lower limb amputation: a pilot study.

Abstract

Background: Lower limb amputation (LLA) presents significant rehabilitation challenges, with patients requiring comprehensive multidisciplinary care to achieve optimal functional outcomes. Telerehabilitation using wearable sensor technology offers a promising solution to improve therapy accessibility and exercise adherence among this population. This pilot study evaluated the feasibility, usability, and preliminary effects on hip strength, and user acceptability of a home-based telerehabilitation program using the Rebee wearable sensor system for patients with major lower extremity amputation.

Methods: A prospective single-arm feasibility study was conducted at the Foot Care and Limb Design Centre, Tan Tock Seng Hospital, Singapore. Ten participants with unilateral major amputations (5 transtibial, 5 transfemoral) were enrolled. Participants performed daily home exercises using the Rebee inertial measurement unit (IMU) sensor system for 30 days, with remote monitoring and biweekly adjustments. Primary outcomes included hip extensor and abductor strength assessed using dynamometry at baseline (Week 0), Week 4, and Week 8. Secondary outcomes included quality of life (EQ-5D-5L), exercise compliance, patient satisfaction, and system usability (System Usability Scale).

Results: All ten participants (80% male; median age 51.5 years, IQR 11) completed the intervention. Median hip extensor strength improved significantly from 8.43 kg at baseline to 9.87 kg at Week 4 (p < 0.05) and 10.88 kg at Week 8 (p < 0.05). Median hip abductor strength increased from 8.01 to 9.45 kg (Week 4) and 9.70 kg (Week 8), with statistically significant improvements (p < 0.05). Mean exercise compliance was 68%. The mean System Usability Scale score was 75.8, indicating favorable usability. Health-related quality of life showed mixed patterns: median self-rated health (EQ-VAS) increased from 80 at baseline to 87.5 by Week 8, whereas the proportion of participants reporting problems in several EQ-5D-5L dimensions did not improve and slightly increased. No adverse events were reported.

Conclusions: Home-based telerehabilitation using the Rebee wearable sensor system is feasible, safe, and acceptable for patients with lower limb amputation, with preliminary improvements in hip strength. High user satisfaction and favorable usability support its potential. However, as a single-arm pilot without a control group, findings remain preliminary and not generalizable. Future RCTs are needed to confirm effectiveness and cost-effectiveness for clinical integration.