JMIR Publications

ABSTRACT

Background:

Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1 to 3 days after surgery. With this relatively short length of hospital stay, patients’ self-management is an important factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity and passive mode of communication.

Objective:

This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about the recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercise and daily self-care activities, satisfaction with information, perceived involvement by the hospital and health care consumption were assessed.

Methods:

A multicenter randomized controlled trial (RCT) was performed in five Dutch hospitals. In total, 213 patients who underwent elective, primary, unilateral TKR participated. All patients had access to an app for smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t-tests, chi-square tests and linear mixed models for repeated measures.

Results:

In total, 114 patients were enrolled in the intervention group and 99 in the control group. Four weeks after discharge patients in the intervention group performed significantly better than patients in the control group on all dimensions of pain: pain at rest (3.45 vs 4.59; p = .001), pain during activity (3.99 vs 5.08; p < .001) and pain at night (4.18 vs 5.21; p = .003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes, except health care consumption, for which a trend towards a lower consumption was found for the intervention group.

Conclusions:

In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information and perceived involvement by the hospital compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care. Clinical Trial: Netherlands Trial Register (NTR): 6992; https://www.trialregister.nl/trial/6992