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

Participants recorded each completed home-based physiotherapy session in weekly activity diaries. Adherence was calculated as the percentage of completed sessions out of 60 prescribed sessions over 6 weeks. Participants who completed at least 48 of 60 sessions, corresponding to at least 80% of the prescribed program, were classified as adherent. The number and percentage of adherent participants were determined for each study arm.

Participants assigned to the experimental arm recorded each completed progressive muscle relaxation session in weekly activity diaries. Adherence was calculated as the percentage of completed sessions out of 30 prescribed sessions over 6 weeks. Participants who completed at least 24 of 30 sessions, corresponding to at least 80% of the prescribed program, were classified as adherent. The number and percentage of adherent participants were determined.

Pain intensity at rest was assessed using a 10-cm Visual Analog Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain. Higher scores indicate greater pain intensity.

Pain intensity during walking was assessed using a 10-cm Visual Analog Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain. Higher scores indicate greater pain intensity.

Pain intensity at night was assessed using a 10-cm Visual Analog Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain. Higher scores indicate greater pain intensity.

Knee osteoarthritis-related pain, stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The index consists of 24 items: 5 pain items, 2 stiffness items, and 17 physical function items. Each item is scored from 0 to 4. The pain score ranges from 0 to 20, the stiffness score from 0 to 8, the physical function score from 0 to 68, and the total score from 0 to 96. Higher scores indicate greater pain and stiffness, greater functional limitation, and poorer overall functional status.

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), which evaluates subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. The seven component scores were summed to obtain a global score ranging from 0 to 21. Higher scores indicate poorer sleep quality.

Depression, anxiety, and stress symptoms were assessed using the 21-item Depression Anxiety Stress Scale (DASS-21). The scale includes three 7-item subscales: depression, anxiety, and stress. Each item is scored from 0 to 3. Each subscale sum was multiplied by 2, yielding a final score ranging from 0 to 42. Higher scores indicate greater symptom severity.

Active knee flexion and extension range of motion of the operated limb were measured separately in degrees using a universal goniometer. Greater knee flexion and a smaller extension deficit, represented by values closer to 0 degrees, indicate better operated-side knee range of motion.

Lower-extremity functional performance was assessed using the 30-Second Chair Stand Test. Participants were instructed to rise fully from and return to sitting on a standard chair as many times as possible within 30 seconds. The number of correctly completed repetitions was recorded. A higher number of repetitions indicates better lower-extremity functional performance.

Functional mobility was assessed using the Timed Up and Go Test. Participants were instructed to stand up from a chair, walk 3 meters, turn, return to the chair, and sit down. The time required to complete the test was recorded in seconds. A shorter completion time indicates better functional mobility.

Health-related quality of life was assessed using Part I of the Nottingham Health Profile (NHP). Part I consists of 38 items across six domains: energy level, pain, emotional reactions, sleep, social isolation, and physical mobility. Each domain score ranges from 0 to 100, and the Part I total score ranges from 0 to 600. Domain scores and the Part I total score were calculated. Higher scores indicate poorer perceived health status.

Participants who did not meet the adherence criterion for progressive muscle relaxation were asked structured questions at the final assessment to identify reasons for non-adherence. Responses were categorized and reported as the number and percentage of participants in each category.