Accepted for/Published in: JMIR Perioperative Medicine
Date Submitted: Jun 19, 2023
Date Accepted: Sep 21, 2023
Warning: This is an author submission that is not peer-reviewed or edited.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.
Acceptability of a Mobile Application for Postoperative Pain Management among Older Veterans Undergoing Total Knee Arthroplasty
ABSTRACT
Background:
Prescription opioid misuse risk is disproportionate among Veterans; military Veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse, use disorders, and overdoses are costly in terms of morbidity, mortality, and humanitarian and economic burden. Opioid misuse costs the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) more than $1.13 billion annually. Adjusted annual healthcare costs for diagnosed opioid abuse patients are higher than those for patients without diagnosed abuse, and prevalence of diagnosed opioid abuse is almost 7 times higher for those in the Veteran's Administration than in commercial health plans, translating to a significant economic burden for this population.
Objective:
The overarching purpose of this single-arm prospective pilot study was to explore whether deploying a mobile application (CPMRx) to track postoperative pain and medication use is feasible in a VA Medical Center. In support of this goal, we had four complementary specific aims: (1) to determine the technological and logistical feasibility of the mobile application, (2) to assess acceptability of the mobile application to participants, (3) to measure demand for and engagement with the mobile application, and (4) to explore potential utility of the mobile application to patients and providers.
Methods:
Participants (n = 10) were Veterans undergoing total knee arthroplasty within the Veterans Health Administration. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile application for patients, which includes a behavioral health intervention, and a clinical decision support tool for healthcare providers, which provides feedback about pain and medication use trends. Veterans self-managed their pain while using the CPMRx mobile app during their at-home recovery following surgery.
Results:
Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the application was 4.9 and the average rating for ease of use was 4.4. Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well, with a mean number of mobile application entries of 34.1 during the postoperative period. There were no reported technological or logistical issues with the mobile application. Participants took an average of 25.13 opioid tablets to manage their postoperative pain.
Conclusions:
Results of this study revealed that use of a mobile application for pain and medication management during postoperative recovery was both feasible and acceptable in older Veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential utility of the mobile application to provide actionable insights to clinicians if adopted more widely.
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