Digitally Driven Lifestyle Modification Programs Incorporating Exercise, Patient Education, and Dietary Interventions After Total Knee Arthroplasty: Protocol for a Systematic Review and Network Meta-Analysis (Preprint)

BACKGROUND Total knee arthroplasty (TKA) is an orthopedic surgery that is highly prevalent in treating end-stage knee osteoarthritis. Though the results of the surgery are usually positive, postoperative recovery rates rely much on intensive rehabilitation interventions. Conventional rehabilitation interventions have mostly targeted exercise-oriented interventions. However, an increasing number of studies indicate that multicomponent lifestyle change interventions that include patient education, dietary programs, and digital health technologies could be better. Although the benefit of digitally assisted rehabilitation is increasing, the comparative effectiveness of different lifestyle alteration strategies in the aftermath of TKA is not known, and no network meta-analysis has been performed to synthesize this evidence. OBJECTIVE The proposed systematic review and network meta-analysis will evaluate and compare the effectiveness of different exercise-based lifestyle modification interventions, including dietary interventions and digitally aided education, on reducing pain, physical functionality, and health-related quality of life among adults undergoing total knee arthroplasty. METHODS The protocol is prepared as per the PRISMA-P guidelines. Randomized controlled trials on adults aged greater than 45 years who have received primary TKA due to osteoarthritis or degenerative joint disease will be included. Interventions of interest are exercise-only rehabilitation, exercise and patient education or self-management, exercise and dietary interventions, exercise and psychosocial support, digitally supported exercise programs, and multicomponent lifestyle modifications. The network will include comparators such as conventional postoperative treatment, conventional physiotherapy, and other lifestyle change methods. Primary outcomes are pain intensity, physical functioning, and health-related quality of life, while secondary outcomes include range of motion, muscle strength, body weight/BMI, adherence, patient satisfaction, psychological well-being, and adverse events. Searches will be conducted in MEDLINE, Embase, Cochrane CENTRAL, CINAHL Plus, Web of Science, Scopus, ClinicalTrials.gov, and WHO ICTRP without language or publication year restrictions. Two independent reviewers will screen studies, extract data using standardized forms, and assess risk of bias using RoB 2 and ROBINS-I. Direct and indirect evidence will be synthesized using random-effects network meta-analysis, with evaluation of transitivity, inconsistency, and treatment rankings. Certainty of evidence will be assessed using the GRADE approach. RESULTS A scoping search shows relevant studies are available, and no previous network meta-analysis has been conducted. Formal searching is planned from September 2025 to May 2026. CONCLUSIONS This review will systematically compare lifestyle modification strategies after TKA and guide clinical decision-making on postoperative rehabilitation, with particular relevance to integrating digital health technologies into orthopedic care. CLINICALTRIAL Prospero ID: CRD420251272615