Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 1, 2022
Date Accepted: Aug 12, 2022
Warning: This is an author submission that is not peer-reviewed or edited.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 outcomes of digital program rehabilitation after total knee arthroplasty: a retrospective, observational feasibility study
ABSTRACT
Background:
Clinical guidelines typically recommend conservative interventions before invasive procedures in people with chronic musculoskeletal (MSK) pain. However, conservative treatment is not effective for everyone, and surgery can sometimes be the best solution. There is a lack of social support, care, and assistance in helping patients both prepare and recover from surgery. A digital MSK surgical care program was developed to address these care gaps and subsequent impacts on care quality and outcomes.
Objective:
To demonstrate safety, engagement, and acceptability and explore clinical outcomes, healthcare use, and satisfaction among participants of a digital MSK surgical care program
Methods:
The intervention group registered for a digital MSK surgical care program, which included health coaches, physical therapists (PTs), customized exercises, and tailored educational articles to provide pre and postoperative support to those who recently underwent total knee arthroplasty (TKA). Comparison group members received standard-of-care treatment. Engagement and acceptability were examined among those in the intervention group. Postoperative safety, clinical outcomes, healthcare use, and experience outcomes were compared against a comparison group.
Results:
53 participants (intervention: 22, comparison: 31) were included in this study, of which 35 (66.0%) were female and 25 (47.2%) were ages 45-60 years. On average, the intervention group completed 23 exercise therapy sessions (ETs), read 2.7 educational articles, sent 45.5 text messages to their health coach, and were actively engaged for 6 weeks after their operation. 14 out of 21 participants (66.7%) self-reported as Promoters on the Net Promoter Score (NPS). Intervention group members reported fewer postoperative complications (intervention: 6 out of 22 participants [27.3%], comparison: 15 out of 31 participants [48.4%]) and experienced better outcomes in function (mean KOOS-PS; intervention: 23.0, comparison: 32.5), depression (mean PHQ-2; intervention: 0.4, comparison: 1.6), anxiety (mean GAD-2; intervention: 0.6, comparison: 1.5), and impression of change (median PGIC; intervention: 7.0, comparison: 6.0), than comparison group members. The intervention group also reported less healthcare use, better adherence to their PT exercises, and higher surgery satisfaction.
Conclusions:
A digital surgical care MSK program shows promising levels of engagement and acceptability among those who recently underwent TKA. The surgical care program may also help with improving postsurgical complications and clinical outcomes, as well as lowering healthcare use.
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