Collection of Common Knee Patient-reported Outcome Instruments by Automated Mobile Phone Text Messaging in Pediatric Sports Medicine

Abstract

Background: Patient-reported outcome (PRO) instruments measure health status in a variety of domains. With the proliferation of mobile phones, delivering PROs across patient-friendly platforms (eg, apps, text messaging) may increase completion rates, particularly among children. The purpose of this study was to validate the collection of common knee PROs in sports medicine with text messaging by correlating text-messaging responses with paper delivery in adolescents. Methods: Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled prospectively. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) were completed during initial clinic visits. Over the next 72 hours, patients completed the text message delivery of the Pedi-IKDC and Pedi-Fab Scale. Correlations between paper and text message delivery of the 2 PROs were assessed. Results: Ninety-one patients (mean age: 16.0±2.0 y; 48% females) enrolled in the text-messaging study, with 55 (60.4%) completing the Pedi-Fab Scale, 48 (52.7%) completing the Pedi-IKDC, and 39 (42.9%) completing both PROs. The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-Fab Scale was 0.95 (P<0.001; 95% confidence interval, 0.91-0.97). The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (P<0.001; 95% confidence interval, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (P=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (P=0.41). Average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 and 159±155 minutes, respectively. High school enrollment (P=0.025), female sex (P=0.036), and race (P=0.002) were significantly associated with text completion of Pedi-IKDC. Conclusions: Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fab scores in adolescents. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance and reduce the labor cost of collecting PROs. Level of Evidence: Level III—prospective cohort study.

Pediatric Simple Knee Value: A simple patient-reported outcome measure for the knee

“…Also, the length of the questionnaire can lead to loss of concentration or even fragmented completion in children when they fill it out in a context without medical supervision. 28 The HSS Pedi-FABS is a simple, reliable and valid metric to assess activity in children and adolescents ten to 18 years old, but its responsiveness to how changes in activity over time correspond to clinical change has not been evaluated. 23 Also, parental assistance is needed for those under 13 years of age.…”

“…Questionnaire delivery by automated text messaging for example allows asynchronous response and may increase compliance and reduce the labour cost of collecting PROMs. 28 We believe the format of the pedi-SKV makes it perfectly suited to this type of collection.…”

Measures of Pediatric Function and Physical Activity in Arthritis

“…The electronic version does not require manual scoring and was preferred by patients over the paper form. Mellor et al examined agreement between the paper format and a text message delivery format of the Pedi‐IKDC; the ICC between the paper and mobile phone delivery of the Pedi‐IKDC was 0.96 ( P < 0.001; 95% CI 0.93‐0.98).…”

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

“…(11)(12)(13) Previous works have also utilized automated mobile phone messaging robots to communicate with patients to obtain information regarding blood pressure (14), opioid utilization (15)(16)(17), physical activity in patients with diabetes (18) and to obtain patient-reported outcome measures (PROMs). (19)(20)(21)(22) Interventions have also been performed utilizing this modern communication technique including medication adherence (23,24), office appointment reminders (25,26), blood pressure management (27) and as an adjunct to traditional communication techniques after hip and knee arthroplasty (28,29) and spine surgery. (30) The Covid-19 pandemic has led to significant changes in musculoskeletal healthcare delivery with elective surgery delay or cancellation becoming commonplace.…”