3D Patient Education and Exercise for Safer Recovery

Customized and Branded to Your Practice

Keith Krugh MS

Exercise Science and Health Promotion

Web & Mobile App Development

3D Animation

3D Animations Now Available in 32 Languages

Reducing Complications & Re-hospitalizations

"1 in 5 Medicare patients readmitted within 30 days, costing $17.5 billion annually."

Sample Patient Program

Mastering Orthopedic Brace Use at Home

"Brace misuse has led to an 18% increase in 30-day re-hospitalizations."

Simplifying complex information with Anatomy visuals

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Data Sources

1. Heusdens, C. H. W., Roelant, E., & De Wachter, J. (2021). *Non-compliance with knee brace usage after anterior cruciate ligament reconstruction: A prospective study.* Knee Surgery, Sports Traumatology, Arthroscopy, 29(8), 2543-2550.
- Summary: This study tracked 120 patients post-ACL reconstruction and found a 25% non-compliance rate, often due to improper positioning, discomfort, or misunderstanding of brace instructions. Patients who removed their braces early or wore them incorrectly had an increased risk of delayed healing and instability.
- Relevance: Many patients struggle with brace adherence simply because they don’t fully understand how to wear and adjust them properly. A clear, visual demonstration—such as a 3D animation—can prevent these mistakes, ensuring patients follow post-op protocols correctly.
2. Van der Weegen, W., Kornuijt, A., & Das, D. (2019). *Patient adherence to shoulder braces after rotator cuff repair: A multicenter study.* Journal of Shoulder and Elbow Surgery, 28(6), 1120-1127.
- Summary: A multicenter study examining post-rotator cuff repair brace adherence found a 20-30% misuse or failure rate. The primary reasons cited were poor patient understanding of fit and function, as well as discomfort due to incorrect positioning.
- Relevance: When patients don’t understand how to properly wear a brace, adherence drops dramatically. Using 3D animation to illustrate the correct fit and adjustments ensures they have a reliable visual reference to follow at home, improving compliance.
3. Rossi, M. J., & Lubowitz, J. H. (2020). *Elbow brace compliance and recovery outcomes following ulnar collateral ligament reconstruction.* Orthopedic Journal of Sports Medicine, 8(5), 2325967120918945.
- Summary: This study found that 15-20% of patients experienced prolonged recovery times due to improper elbow brace use after surgery. Misuse often resulted in reduced range of motion, increased stiffness, and longer rehabilitation times.
- Relevance: A delayed recovery due to improper brace use is entirely preventable with the right education. 3D animations provide an easy-to-follow, step-by-step guide that makes brace instructions clear and actionable, reducing unnecessary complications.
4. Dekker, A. E., Davis, D. E., & Abboud, J. A. (2022). *Brace adherence and readmission rates after foot and ankle surgery: A retrospective analysis.* Foot & Ankle International, 43(3), 412-419.
- Summary: A retrospective analysis found that brace misuse led to an 18% increase in 30-day hospital readmissions after foot and ankle surgeries. Non-compliance rates were between 20-30%, and complications from improper brace usage resulted in delayed healing and increased healthcare costs.
- Relevance: Readmissions due to preventable brace misuse put an unnecessary burden on both patients and the healthcare system. A visually engaging, easy-to-understand 3D animation can significantly improve patient adherence and reduce avoidable hospital visits.
5. Van der List, J. P., & DiFelice, G. S. (2018). *Web-based patient education in orthopedics: A systematic review.* Journal of Medical Internet Research, 20(4), e143.
- Summary: This systematic review analyzed 10 trials with 4,172 patients, concluding that digital education tools improved patient knowledge and satisfaction. However, while knowledge retention improved, anxiety and clinical outcomes remained unchanged.
- Relevance: Digital education is already proven to increase patient knowledge and satisfaction. Adding 3D animation takes it further, making instructions even more engaging and effective than static web-based content or printed materials.
6. McDonald, S., & Jones, A. R. (2020). *Improving resource utilization and outcomes after total knee arthroplasty through technology-enabled patient engagement.* Journal of Orthopaedics, 17, 156-162.
- Summary: This study found that technology-enabled education reduced hospital stays by 2 days following total knee arthroplasty. Patients who received visual and interactive education showed higher adherence to recovery protocols, leading to better outcomes and lower costs.
- Relevance: A stronger, more engaging education approach translates to better patient adherence and faster recovery times. 3D animations simplify complex instructions, giving patients the tools they need to follow their recovery plan successfully.
7. Bernatz, J. T., & Anderson, P. A. (2015). *Thirty-day readmission rates in orthopedics: A systematic review and meta-analysis.* PLOS ONE, 10(4), e0123593.
- Summary: This systematic review found that 30-day readmission rates in orthopedic procedures ranged from 4.8% to 6.0%. Common causes included poor adherence to post-op protocols, improper use of medical devices like braces, and preventable complications.
- Relevance: When patients don’t follow their recovery plan correctly, they are at a higher risk of readmission. 3D animations ensure they fully understand how to manage their brace and reduce the chances of complications that lead to hospital visits.
8. Wilson, E. A., et al. (2010). *Media and memory: The efficacy of video and print materials for promoting patient education about asthma.* Patient Education and Counseling, 80(3), 393-398.
- Summary: This study found that patients who watched animated videos retained more health information than those who received printed materials alone. The results demonstrated the superiority of visual learning in patient education.
- Relevance: Patients learn and retain information better when it’s presented visually. 3D animations make complex post-op instructions clear, ensuring patients follow them correctly.
9. Seymour, N. E., et al. (2002). *Virtual reality training improves operating room performance: Results of a randomized, double-blinded study.* Annals of Surgery, 236(4), 458-464.
- Summary: This randomized controlled trial found that surgical residents who trained with virtual reality (VR) performed significantly better than those using traditional methods. VR-trained surgeons made fewer errors and completed procedures more efficiently.
- Relevance: Just as VR enhances surgical precision, 3D animations improve patient adherence by making brace instructions clear, visual, and easy to follow.
10. American Institutes for Research (AIR). (n.d.). *The Revolving Door: U.S. Hospital Readmissions by Diagnosis and Procedure.* [Report].
- Summary: This report examines hospital readmissions in the U.S., particularly for Medicare patients, revealing that unplanned readmissions cost Medicare over $17 billion annually. Common causes include poor discharge planning, lack of patient understanding, and preventable complications such as falls.
- Relevance: Many of these costly readmissions could be prevented with clearer discharge instructions and better patient education. 3D animations provide an effective way to reinforce post-op care, reducing errors and ensuring patients properly use medical devices like braces.
11. Office of Information Products and Data Analytics. (2012). *Medicare hospital readmissions statistics.* U.S. Department of Health and Human Services.
- Summary: This report found that 19.2% of Medicare patients are readmitted within 30 days of discharge, costing the U.S. healthcare system approximately $17.5 billion annually. Many readmissions stem from inadequate discharge instructions and poor patient preparation, particularly after orthopedic surgeries.
- Relevance: When patients lack clear post-op instructions, the likelihood of readmission increases. Providing 3D visual demonstrations at discharge can improve understanding, helping patients correctly manage their recovery and significantly lowering preventable readmissions.
12. Auerbach, A. D., et al. (2016). *Preventability and causes of readmissions in a national cohort of general medicine patients.* JAMA Internal Medicine, 176(4), 484–493. https://doi.org/10.1001/jamainternmed.2015.7863
- Summary: This study found that 27% of 30-day readmissions were potentially preventable, with inadequate discharge instructions and poor follow-up care being leading causes. While the study focused on general medicine, it applies to orthopedics, where brace misuse—due to poor patient education—can result in avoidable complications and hospital returns.
- Relevance: Readmissions often stem from poor patient education and follow-up care. A clear, engaging, and easily accessible 3D animation can reinforce post-op brace instructions, reducing confusion and supporting patient adherence.
13. Dailey, E. A., et al. (2013). *Risk factors for readmission of orthopedic surgical patients.* The Journal of Bone and Joint Surgery, 95(11), 1012–1019. https://doi.org/10.2106/JBJS.K.01569
- Summary: This study identifies common risk factors for readmission after orthopedic surgeries, including discharge to skilled nursing facilities and poor post-discharge care coordination. While it doesn’t focus specifically on brace misuse, it highlights patient-related factors, such as misunderstanding post-op protocols, which can contribute to readmissions.
- Relevance: Patients who forget or misunderstand their recovery instructions are more likely to experience complications. 3D animations provide a clear, consistent educational tool that ensures patients have ongoing access to correct information about brace use, reducing their risk of readmission.
14. Weiss, A. J., Elixhauser, A., & Steiner, C. (2014). *Readmissions to U.S. hospitals by procedure, 2010.* Healthcare Cost and Utilization Project (HCUP) Statistical Brief #154. Agency for Healthcare Research and Quality.
- Summary: This report found that hospital readmissions cost the U.S. $41.3 billion in 2010, with orthopedic procedures like joint replacements contributing significantly. Studies suggest that 10-20% of orthopedic readmissions are preventable, reinforcing the need for better post-op education.
- Relevance: Preventable readmissions place a massive financial burden on healthcare systems. Using 3D animations to educate patients on proper brace use can reduce errors, complications, and unnecessary hospital returns—helping lower overall healthcare costs.
15. Brown, M. M., et al. (2019). *Preoperative education for hip and knee replacement: A systematic review.* Current Reviews in Musculoskeletal Medicine, 12(3), 302–310. https://doi.org/10.1007/s12178-019-09565-2
- Summary: This review found that preoperative education improves outcomes and reduces readmissions for hip and knee replacement patients by clarifying expectations and post-surgical self-care. While not brace-specific, it emphasizes the role of effective patient education in preventing complications.
- Relevance: When patients fully understand what to expect after surgery, they are more likely to follow their recovery plan correctly. 3D animations provide a powerful way to deliver clear, engaging pre- and post-operative education, reducing readmissions and improving outcomes.
16. Greysen, S. R., et al. (2020). *Digital health interventions to reduce hospital readmissions: A systematic review.* Journal of General Internal Medicine, 35(5), 1538–1545. https://doi.org/10.1007/s11606-019-05519-8
- Summary: This review examined various digital tools—such as mobile apps and educational videos—in reducing hospital readmissions. It found that well-designed digital resources significantly improved patient adherence and self-care when they were tailored and accessible post-discharge.
- Relevance: Digital education is most effective when it’s engaging and easy to understand. 3D animations are an ideal tool, offering patients clear, visual guidance on brace application and adjustments, available whenever they need a refresher.
17. Krumholz, H. M., et al. (2014). *Post-hospital syndrome—An acquired, transient condition of generalized risk.* New England Journal of Medicine, 370(11), 1004–1006. https://doi.org/10.1056/NEJMp1315678
- Summary: This article describes how patients are especially vulnerable post-discharge due to poor care transitions. It highlights that many patients forget key aspects of their recovery plan, leading to avoidable complications and readmissions.
- Relevance: Patients need simple, accessible tools to reinforce recovery steps once they leave the hospital. 3D animations provide ongoing support, ensuring patients correctly follow brace usage instructions long after discharge.
18. Centers for Medicare & Medicaid Services. (2023). *Hospital Readmissions Reduction Program (HRRP).* CMS.gov. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp
- Summary: This program ties hospital reimbursements to readmission rates for procedures like hip and knee replacements, pushing hospitals to reduce preventable complications.
- Relevance: Hospitals have a strong incentive to prevent readmissions. 3D animations offer a practical, scalable solution for improving patient understanding and adherence, reducing costly complications.

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3D Guided Total Knee Replacement (TKA) Recovery Exercises—Left Side

This demo showcases sample exercises. It is not a complete program

Week 1: Foundational Movement and Exercise

How To—Toilet Sit Stand with Walker

Week 4: Stability Building

Side Lying Straight Leg Raise: 10 Reps. 2 second hold on each rep.

Week 6: Strength Development

Chair Squat: 10 reps. 2 sets. 2 sec hold at top. 2 times per day.

Data Sources

Bade, M. J., Struessel, T., Dayton, M., Foran, J., Kim, R. H., Miner, T., Wolfe, P., Kohrt, W. M., Dennis, D., & Stevens-Lapsley, J. E. (2017).Early high-intensity versus low-intensity rehabilitation after total knee arthroplasty: A randomized controlled trial. Arthritis Care & Research, 69(9), 1360–1368. https://doi.org/10.1002/acr.23139
- Summary: This randomized trial found that introducing functional exercises like chair squats around Week 6, after early mobility work, improved strength and recovery outcomes post-TKR.
Meier, W., Mizner, R. L., Marcus, R. L., Dibble, L. E., Peters, C., & Lastayo, P. C. (2008).Total knee arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches. Journal of Orthopaedic & Sports Physical Therapy, 38(5), 246–256. https://doi.org/10.2519/jospt.2008.2715
- Summary: This study suggests adding hip-strengthening exercises like side-lying leg raises around Week 4–6 to enhance stability and knee function after TKR surgery.
Mizner, R. L., Petterson, S. C., & Snyder-Mackler, L. (2005).Quadriceps strength and the time course of functional recovery after total knee arthroplasty. Journal of Orthopaedic & Sports Physical Therapy, 35(7), 424–436. https://doi.org/10.2519/jospt.2005.35.7.424
- Summary: This research showed that early Week 1 exercises like ankle pumps help reduce swelling and improve circulation, aiding initial TKR recovery.
Stevens-Lapsley, J. E., Balter, J. E., Kohrt, W. M., & Eckhoff, D. G. (2012).Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. Journal of Orthopaedic Research, 30(9), 1377–1383. https://doi.org/10.1002/jor.22108
- Summary: This study highlights the importance of quad sets in Week 1 to address muscle weakness and support early recovery after TKR.
Bade, M. J., & Stevens-Lapsley, J. E. (2011).Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. Journal of Orthopaedic & Sports Physical Therapy, 41(12), 932–941. https://doi.org/10.2519/jospt.2011.3734
- Summary: This study found that heel slides in Week 1 are essential for restoring knee flexion early, contributing to better overall TKR recovery.

Hi Fred. Please see below for your right hip exercises—program no. 1. Implement 1 - 2 times per day. Thanks! Keith

Right Hip Exercises—Program No. 1

1 — Foam Roller Front of Thigh Right

Roll slowly from Hip to just above your Knee for 1 - 2 minutes.

2 — Foam Roller Front Outside Thigh Right

Roll slowly from Hip to just above your Knee for 1 - 2 minutes.

3 — Foam Roller TFL Right

Roll slowly from Hip to just above your Knee for 1 - 2 minutes.

4 — Foam Roller Hamstring Right

Roll slowly from Hip to just above your Knee for 1 - 2 minutes.

5 — Myo-Ball Glute Right

Roll forward, back, and side to side stopping on sensitive spots up to 2 minutes or until a feeling of sensitivity decrease occurs.

TextHi Fred. Please see below for your right hip exercises—program no. 1. Implement 1 - 2 times per day. Thanks! Keith

3D Patient Education and Exercise for Safer Recovery

Keith Krugh MS

Exercise Science and Health Promotion

Web & Mobile App Development

3D Animation

Enhancing Patient Care with 3D Innovation

Bridging technology and patient education with immersive 3D animations and digital tools that empower patients, support providers, and enhance care outcomes.