Background: Knee osteoarthritis (OA) is a prevalent musculoskeletal condition associated with pain, functional limitation, and reduced quality of life. Telerehabilitation has emerged as a scalable intervention, yet many platforms lack neuromuscular feedback or objective-monitoring capabilities. The KneE-PAD system uniquely integrates electromyographic and inertial sensing to provide personalized feedback and remote performance tracking. Objective: To evaluate the clinical effectiveness of a sensor-augmented telerehabilitation system (KneE-PAD) compared to conventional face-to-face physiotherapy in older adults with mild-to-moderate knee OA. Methods: In this single-blind randomized controlled trial, 42 older adults (mean age 68.4 ± 5.7 years) were randomly assigned to either KneE-PAD telerehabilitation or conventional physiotherapy for eight weeks. KneE-PAD sessions incorporated real-time electromyographic and motion feedback, while physiotherapists remotely supervised training. Assessments were performed at baseline, post-intervention, and 12-week follow-up. Primary outcomes included quadriceps strength, neuromuscular activation, and WOMAC scores. Secondary outcomes covered functional mobility, psychological distress, self-efficacy, and fear of movement. Results: The telerehabilitation group demonstrated notable improvements in neuromuscular activation, quadriceps strength, and functional capacity, all exceeding clinically meaningful thresholds. Functional mobility and pain outcomes showed substantial gains compared with the control group, while psychological indicators (self-efficacy and depressive symptoms) exhibited modest but positive trends. Between-group comparisons consistently favored KneE-PAD, with effects maintained at the 12-week follow-up, confirming both clinical and functional robustness. Conclusions: Sensor-augmented telerehabilitation using the KneE-PAD platform appears to be a feasible and potentially effective alternative to conventional physiotherapy for knee OA. By combining real-time feedback, motor learning reinforcement, and remote monitoring, the system may enhance neuromuscular and functional recovery. These findings should be confirmed in larger and longer-term trials. Trial Registration: ClinicalTrials.gov: NCT06416332.

Background: Knee osteoarthritis (OA) is a leading cause of disability globally. Conventional physiotherapy, while effective, faces barriers including accessibility and adherence. Telerehabilitation augmented by wearable sensor technology and AI-driven feedback offers a scalable alternative. Objective: This pilot randomized controlled trial compared the feasibility, safety, and preliminary clinical effectiveness of a sensor-based telerehabilitation protocol using the KneE-PAD patient monitoring approach which was also combined with an avatar-guided visual feedback add-on tool. Although this approach is capable of AI-driven postural error detection, this feature was not enabled during the current study, and feedback was provided solely through visual cues. Methods: Twenty adults with radiographically confirmed Kellgren–Lawrence grade 1 to 3 knee OA were randomized into two groups (Control/Intervention groups, n = 10 in each). The control group received in-person physiotherapy, while the intervention group engaged in remote rehabilitation supported by wearable sEMG and IMU sensors. The 8-week program included supervised and home-based sessions. Primary outcomes were WOMAC scores (Functionality/Pain), quadriceps strength, and sEMG-derived neuromuscular activation. Secondary outcomes included Timed Up and Go test (TUG), psychological measures (HADS, TSK), and self-efficacy measure (ASES). Analyses employed both parametric and non-parametric statistics including an effect size estimation. Results: Both groups demonstrated significant improvements in WOMAC total scores (Intervention: −11.8 points; Control: −6.4 points), exceeding the minimal clinically important difference (MCID) for knee OA. Strength and mobility also improved significantly in both groups, with the Intervention group showing superior gains in sEMG measures (RMS: p = 0.0077; Peak-to-Peak: p < 0.005), indicating enhanced neuromuscular adaptation. TUG performance improved more in the intervention group (–3.17 s vs. –2.57 s, p = 0.037). Psychological outcomes favored the control group, particularly in depression scores (HADS-D, t(18) = 2.37, p = 0.03). Adherence was high (94.8%), with zero attrition and no adverse events. Conclusions: The KneE-PAD monitoring approach offers a feasible and clinically effective alternative to conventional physiotherapy, enhancing neuromuscular outcomes through real-time sensor feedback. These findings support the viability of intelligent telerehabilitation for scalable OA care and inform the design of future large-scale trials.