Monitoring Patient Recovery after THA or TKA using Mobile Technology

Abstract

Background Smartphones offer the possibility of assessing recovery of mobility after total hip or knee arthroplasty (THA or TKA) passively and reliably, as well as facilitating the collection of patient-reported outcome measures (PROMs) with greater frequency. Questions/Purposes We investigated the feasibility of using mobile technology to collect daily step data and biweekly PROMs to track recovery after total joint arthroplasty. Methods Pre- and post-operative daily steps were recorded in prospectively enrolled patients (128 THA and 139 TKA) via an app, which uses the phone's accelerometer. During 6-month follow-up, patients also completed PROMs (the pain numeric rating scale, the Hip Disability and Osteoarthritis Outcome Score Joint Replacement [HOOS JR] and the Knee Injury and Osteoarthritis Outcome Score Joint Replacement [KOOS JR]), and HOOS or KOOS JR quality of life domain via a mobile-enabled web link. Results At least 6 months of follow-up was completed by 65% for THA and 68% for TKA patients. Reasons for non-completion included time commitment, phone battery, app issues, and health complications. Responses from 78% of requested PROMs were returned with 96% of patients returning at least one post-operative PROM. Step data were available from 92% of days from male patients and 86% of days from female patients. The most robust recovery occurred early, within the first 2 months. The groups with higher pre-operative steps were more likely to recover their maximum daily steps at an earlier time point. Correlations between step counts and PROMs scores were modest. Conclusion Assessing large amounts of post-TKA and post-THA step data using mobile technology is feasible. Completion rates were good, making the technology very useful for collecting frequent PROMs. Being unable to ensure that patients always carried their phones limited our analysis of the step counts.

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

“…Previous studies have demonstrated the benefits of continuous measurement within the recovery process following cardiac [31] and neurological surgery [32]. This feature should be considered for orthopedic interventions, where quantifying the progress can motivate patients to take active roles in their recovery [33]. Mehta et al [34] aligned this idea with reports of positive reinforcement by setting and meeting individual recovery goals following hip arthroplasty.…”

Use of a Recovery Messaging Application in Outpatient Total Joint Replacement

“…Researchers have established that using a fast-track, streamlined educational protocol or a recovery instant messaging, educational application can reduce the rate of readmission in patients undergoing TJR (Bahadori et al, 2020; Berg et al, 2018; Campbell et al, 2019; Gabor et al, 2020; Hussain et al, 2017; Lyman et al, 2020; Stauber et al, 2020; Timmers et al, 2019; Zheng et al, 2019). A common theme among all articles was that same-day outpatient TJR patients who received adequate and streamlined perioperative education had fewer readmissions in the 30-day postoperative period.…”

The role of commercially available smartphone apps and wearable devices in monitoring patients after total knee arthroplasty: a systematic review

“…The observational study by Lyman et al . found that a smartphone app following TKA was able to collect step data on a median of 92% of days for men and 86% of days for women for 6 months following surgery ( 30 ). However, this study excluded a high proportion of patients who do not usually carry their phones, which may have biased the results toward greater compliance.…”

“…The PainCoach app improved pain control and decreased opioid use in the 2 weeks following TKA (29). The Moves app successfully collected complete 6-month follow-up data from 68% of patients, a rate that was considered satisfactory by the authors (30). When creating these appbased platforms, priority should be placed on creating personalized information based on the user's postoperative day, which was shown to increase physical functioning and decrease pain compared to standard informational apps (31).…”

“…The study is judged to be at some concern in the domain of missing outcomes data Castle et al (37) ROBINS-I This study is judged to be at low risk of bias across all domains Goel et al (38) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains Kelly et al (35) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains Lyman et al (30) ROBINS-I The study is judged to be at serious risk of bias in the domain of selection of participants but not at critical risk of bias in any domain Twiggs et al (32) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains Van Dijk-Huisman et al (26) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains Vaughn et al (39) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains Bini et al (34) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains Patterson et al (33) ROBINS-I The study is judged to be at low or moderate risk of bias for all domains…”