A Psycholgical Intervention Delivered by Automated Mobile Phone Messaging Stabilized Hip and Knee Function During the COVID-19 Pandemic: A Randomized Controlled Trial

Abstract

Background We conducted a randomized controlled trial to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) delivered via a mobile phone messaging robot to patients who had their total hip (THA) or total knee arthroplasty (TKA) procedures postponed due to the Covid-19 pandemic. Methods Ninety patients scheduled for THA or TKA who experienced surgical delay due to the Covid-19 pandemic were randomized to the ACT group, receiving 14 days of twice daily automated mobile phone messages, or the control group, who received no messages. Minimally clinical important differences (MCIDs) in pre and post intervention patient reported outcome measures (PROMs) were utilized to evaluate the intervention. Results Thirty-eight percent of ACT group participants improved and achieved MCID on the Patient-Reported Outcome Measure Information System (PROMIS) Physical Health compared to 17.5% in the control group (p=0.038; Number needed to treat [NNT]:5). For the joint specific Hip Disability and Osteoarthritis Outcome Score (HOOS-Jr) and Knee Disability and Osteoarthritis Outcome Score (KOOS-Jr), 24% of ACT group achieved MCID compared to 2.5% in the control group (p=0.004; NNT:5). An improvement in the KOOS-Jr was found in 29% of the ACT group compared to 4.2% in the control group (p=0.028; NNT:5). Fourteen percent of the ACT group participants experienced a clinical important decline in the KOOS-Jr compared to 41.7% in the control group (p=0.027; NNT: 4). Conclusions Psychotherapy delivered via a text messaging robot improved physical function and prevented decline of PROMs in patients who experienced an unexpected surgical delay during the Covid-19 pandemic. Level of Evidence 1

Telemedicine Interventions as an Attempt to Improve the Mental Health of Populations during the COVID-19 Pandemic—A Narrative Review

“…In the two included studies, the remote interventions were based on mobile applications [ 31 , 32 ]. The interventions used a system of sending text messages as well as more advanced features like displaying short videos or audio records.…”

“…For the HOOS JR and KOOS JR, 24% of the ACT group achieved minimal clinically important differences compared to 2.5% in the control group. The authors concluded that the psychological intervention delivered via text messaging improved physical functioning and prevented deterioration in outcome measures reported by patients who experienced an unexpected surgical delay during the COVID-19 pandemic [ 31 ]. Sun et al evaluated the effect of a mindfulness-based mobile health (mHealth) intervention among young adult students with elevated anxiety and/or depressive symptoms compared to a time- and attention-matched social support-based mHealth control.…”

“…Analysis of the quality of the included studies showed that three studies [ 29 , 32 , 34 ], presented excellent quality, four studies, [ 28 , 30 , 33 , 36 ], were of good quality, while two studies, [ 31 , 35 ], demonstrated fair quality. Table 2 shows the PEDro scores of the included studies.…”

Virtual Tools to Enable Management of Knee Osteoarthritis

“…A nested qualitative study showed that participants viewed the SMS intervention as a valuable exercise reminder that promoted accountability to the unsupervised exercise program [77]. Another RCT evaluated a psychological intervention delivered via automated SMS in people who had hip or knee joint replacement surgery postponed due to the COVID-19 pandemic [97]. It found that the intervention (two SMS per day for 14 days to encourage pain coping) led to meaningful clinical improvements at 2 weeks, compared to no contact.…”

A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design

“…SMS text message-based interventions, in particular, may be most effective in reaching the largest number of consumers, as texts do not require access to the internet, have low technology literacy requirements, and are low cost and familiar, as there is a high current use of text messaging worldwide [16][17][18]. Mobile phone text interventions have demonstrated effectiveness in facilitating health-related behavior change [18,19], helping people to quit smoking [20], improving outcomes in the management of musculoskeletal conditions [21], and even supporting people to manage perioperative pain [17,22].…”