Determination of Nurses’ Knowledge and Practice about Post-Cesarean Wound Infection in a Tertiary-Care Hospital, Lahore: A Cross-Sectional Study

Abstract

Background: Access to postoperative rehabilitation after total knee arthroplasty (TKA) is limited in many middleincome countries. Telerehabilitation has emerged as a promising alternative, yet evidence from South Asian populations remains sparse. Objective: To compare the effectiveness of a 12-week synchronous telerehabilitation programme versus standard outpatient physiotherapy on functional recovery and quality of life after TKA. Methods: Assessor-blinded, two-arm randomised controlled trial involving 90 patients (45 per group) 2 weeks post-unilateral primary TKA in Lahore, Pakistan. The intervention group received live videoconferencing-guided physiotherapy three times weekly plus daily home exercises; controls attended in-person hospital sessions with identical content. Primary outcome was change in Knee Injury and Osteoarthritis Outcome Score (KOOS) total at 12 weeks. ANCOVA adjusted for baseline values was used for between-group comparisons. Results: Telerehabilitation produced significantly greater improvements in KOOS total score (adjusted mean difference 4.0 points, 95% CI 0.2–7.8; p=0.038), knee flexion ROM (+6°), pain reduction, TUG (−1.4 s), gait speed, quadriceps strength, SF-12 physical component, and patient satisfaction (all p<0.05). Allocation to telerehabilitation independently predicted higher final KOOS score (β=3.68, p=0.011). Conclusion: Telerehabilitation is at least as effective as, and in several domains superior to, conventional rehabilitation after TKA, offering a highly accessible alternative in resource-constrained settings.