Digital home-based rehabilitation and functional independence after orthopedic surgery interpreted through Orem's self-care lens: a systematic review
(1) Master of Nursing Program, Universitas Ngudi Waluyo
(2) Master of Nursing Program, Universitas Ngudi Waluyo
(*) Corresponding Author
Abstract
Digital home-based rehabilitation may support functional recovery after orthopedic surgery, although its effectiveness and alignment with Orem's Self-Care Deficit Nursing Theory remain unclear. This systematic review aimed to synthesize the effects of digital home-based rehabilitation on functional independence by comparator type and evaluate its alignment with Orem's theoretical constructs. Comparative studies published between 2015 and 2026 were reviewed following PRISMA 2020 guidelines. Risk of bias was assessed using RoB 2 and ROBINS-I, evidence certainty was evaluated using GRADE, and findings were synthesized narratively following SWiM principles. Sixteen studies involving 1,900 participants, including 14 randomized trials, were included. Compared with usual or minimal care, six of 12 comparisons favored digital rehabilitation, although improvements were generally below clinically important thresholds. Compared with active professional rehabilitation, four randomized comparisons showed no difference, while two non-randomized studies favored digital interventions. None of the interventions explicitly applied Orem's theory or assessed self-care deficits. Digital home-based rehabilitation probably provides little or no additional functional benefit compared with active professional care (moderate-certainty evidence) but may slightly improve short-term function compared with usual or minimal care (low-certainty evidence). Future nursing interventions should explicitly incorporate Orem's theoretical constructs and evaluate self-care agency alongside functional outcomes.
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DOI: https://doi.org/10.26714/mki.9.4.2026.428-436
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