Assessing Digital Health Equity in Implementation of Virtual Rehabilitation After Total Knee Arthroplasty Among Older Adults in the U.S.: A Case Example

Abstract

Background: Digital divide among elderly people is an emerging problem. With more adoption of technology in the health care field, we should be aware of the health inequity generated by the adoption of digital health as the norm after COVID-19 crisis. Objectives: The primary aim of this study is to evaluate the participants’ comfort with technology (self-reported digital literacy) prior to using VERA, a digital health platform for exercise therapy. The secondary aim is to examine the association of patient characteristics and digital literacy with the acceptability, treatment adherence, accuracy of exercises performed, and change in exercise over 90-day intervention. Methods: This cohort study used secondary data from the VERITAS clinical trial (clinicaltrials.gov identifier: NCT02914210). The research analyzed socio-demographics, digital health determinants, and process outcomes at 90-days. Descriptive statistics were conducted, Prevalence Ratio (PR) was used as a measure of association. Results: Participants who were older in age and had less than 16 years of education were less comfortable with technology. Less comfort with technology prior to starting therapy was not associated with lower acceptability, adherence, accuracy, nor change in days per week exercised over 90 days. We found that having a preexisting condition of neurological disorders was associated with lower self-reported adherence. Conclusion: Age and education are related to comfort using technology. We should take them into consideration at the digital health design stage. Besides, we didn’t find unequal use of VERA with the process outcomes among different strata, which means by personalized health intervention and improved usability, people who have disadvantages can also adopt technology to achieve better health. By advocating the human-centered design, digital health can benefit more people to achieve health equity on a large scale.