Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial

Abstract

Background Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery.

Telemedicine Technologies Selection for the Posthospital Patient Care Process after Total Hip Arthroplasty

“…To visual technologies belong, i.a. : Specialistic orthopedic telerehabilitation systems [ 20 , 57 , 58 , 59 , 60 , 61 , 62 , 72 ], Telerehabilitation systems using the Wii balance platform dedicated to games [ 73 , 74 , 75 , 76 ], Telerehabilitation application using smartphone camera [ 77 ], Technology-based home exercise program using iPad application [ 29 ], eHealth education program with web-based access to resources and communication log with hospital professionals [ 27 ], Tablet-based technology for daily biophysical measurements, photographs of operation wounds, and virtual interaction with a nurse [ 13 ], Mobile health applications for self-management rehabilitation intervention [ 30 , 31 ], Software for medical video consultations [ 15 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 56 , 78 , 79 ], some also with real-time language translation [ 51 , 52 ]. …”

A Smarter Health through the Internet of Surgical Things

“…Biosensor-based systems are able to wirelessly transmit data on physiological parameters of the patients in order to assist with postoperative monitoring. Authors have reported the incorporation of pulse rate, blood pressure and activity tracking sensors as being successful in monitoring the rehabilitation process of surgical patients [69][70][71][72][73][74][75][76][77]. Reported advantages, include successful vital signs readings, short training period of nurses and patients alike, less unplanned office visits, and predicting unplanned postoperative complications by indirect monitoring of vital signs [8].…”

“…Postoperative monitoring of physiological parameters with the use of biosensors can be further expanded to include automated action after the received sensor signal. In an example by Wang et al [75], patient-controlled analgesia was administered after indica- Within the surgical patient subgroup, there have been a few clinical studies looking into the applicability of telemonitoring, usually in the postoperative period [3,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] (Supplemental Table S3). Patients enrolled in an at-home monitoring program after chest wall surgery were also monitored effectively by utilizing the Internet to input certain parameters in an online platform [65,67] Cardiac surgery patients were also studied in an IoST rehabilitation program that included wearable biomedical and motion tracking sensors [68].…”

“…There are of course some hurdles still left in the way of universal internet-based patient monitoring. The biggest of which seems to be the reported difficulties elderly patients have with operating such systems [74][75][76][77][78]. Technological illiteracy is a persistent issue that seems harder to address than the technicalities of the systems.…”

ActiveHip+: A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic

“…[22][23][24][25] Despite the existence of evidence supporting the use of digital tools after hip surgery, [26][27][28][29] to the best of our knowledge, there are just a few mHealth interventions for this population. [30][31][32][33][34] It is important to develop new mHealth interventions to provide a comprehensive tele-rehabilitation program, focussing not only on rehabilitation but also on secondary fracture prevention. Thus, we developed the ActiveHip+ mHealth system as an alternative for those older adults who cannot access to in-person rehabilitation.…”