Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 1, 2019
Date Accepted: Sep 23, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Postoperative eHealth: Day-to-day care offered through an app after total knee replacement surgery. A randomised controlled trial.
ABSTRACT
Background:
In modern medicine, patients who undergo 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 involves adequate pain management, 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 aims to determine whether compared to the standard of care, actively educating TKR patients with personalized day-to-day postoperative information through an app could improve their level of self-management. In addition, functional outcomes, quality of life, satisfaction and health care consumption were assessed.
Methods:
A multicenter randomized controlled trial (RCT) was performed in 5 hospitals. In total, 213 patients who underwent primary TKR participated. All patients had access to an app for smartphone and tablet to guide them after discharge. The intervention group could unlock personalized, day-to-day information by entering a personal code. Primary (self-management) and secondary outcomes (quality of life, functional outcomes, satisfaction and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for quality of life and functional outcomes, 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 primary outcomes: self-care (8.32 vs 7.64; p = .004), pain at rest (3.45 vs 4.59; p = .001), pain during activity (3.99 vs 5.08; p < .001), pain during the night (4.18 vs 5.21; p = .003) and physiotherapy exercises (7.50 vs 6.88; p = .025). 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, personalized and day-to-day education of patients via the app significantly improved their level of self-management, functional outcome, quality of life, and satisfaction 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 personalized and tailored information as a standard part of early postoperative care. Clinical Trial: Netherlands Trial Register (NTR): 6992; https://www.trialregister.nl/trial/6992
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