Postoperative care via smartphone following carpal tunnel release

Abstract

Introduction This study explores a novel smartphone application for postoperative care following carpal tunnel release (CTR). We hypothesized that a software-based ‘virtual visit’ for CTR could be safe, effective and convenient for the patient. Methods Our group developed the software application utilized in this study. Interactive steps with video instructions enabled patients to complete dressing and suture removal, capture a wound photo, answer a question about median nerve symptoms and capture a video of finger range of motion. Adult patients undergoing endoscopic or open CTR were enrolled. Prior to their scheduled postoperative visit, patients received and completed the module using their smartphone. Agreement between findings of the virtual visit and the corresponding in-person clinical visit was assessed using kappa values. Results Twenty-two patients were contacted regarding study enrolment and 17 patients were enrolled (ages 23–63, mean 48.2, 6M, 11F). Of 16 patients who participated, all completed dressing removal. Ten of 16 patients removed their sutures successfully. Fourteen patients captured a clinically adequate wound photo and 15 patients answered a question about median nerve symptoms. Fourteen patients captured a range of motion video. Software assessments of surgical wounds, nerve symptoms and physical exams agreed strongly with clinical assessments. Discussion Most patients were able to respond to a question about their symptoms, provide clinical assessment of their wound via a photo and record a video of their range of motion. Suture removal was the most difficult task. More investigation is needed to determine which patients can reliably remove their sutures.

Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial

“…Improved mood symptoms, less pain interference, and faster cessation of opioid pain medication are some of the recognized benefits of using ACT in clinic-based, interdisciplinary approaches to pain management after surgery [ 17 , 18 ]. Previous investigations have used automated mobile phone messaging robots to deliver PROs [ 20 , 23 ], improve communication with patients [ 27 , 31 ], deliver postoperative orthopedic care [ 32 ], and inquire about pain and opioid utilization [ 4 , 19 , 33 ]. In this study, we used ACT and a mobile phone messaging robot to assess whether these tools in combination could decrease opioid utilization and improve individuals’ perception of their early recovery from injury.…”

The Virtual Foot and Ankle Physical Examination

“…One study evaluating postoperative care also reported difficulty with virtually assisting patients in removing their own sutures, which over one third of patients were unable to do, again requiring an additional in-person follow-up. 19 In addition to suture removal, postoperative visits may require cast application or change, immediate issue of prescriptions, and urgent wound care, along with any necessary written consents, which would require in-person visits.…”

Telemedicine Evaluation and Techniques in Hand Surgery

“…Another specific patient encounter that was validated in the telemedicine setting is postoperative care for carpal tunnel release. As described by Tofte et al, 2 patients provided with instructions about removing surgical dressing and sutures, photographing the incision, and performing a basic neuromuscular examination were able to complete an effective 10-to 14-day postoperative visit remotely. However, suture removal proved to be the most difficult aspect.…”

“…However, suture removal proved to be the most difficult aspect. 2 With this in mind, we believe that postoperative visits for minor hand surgery such as carpal tunnel release or trigger finger release can be readily managed through a telemedicine visit, especially if absorbable sutures were used. Many other postoperative visits can likely be managed remotely but should be evaluated on a case by case basis to determine the level of care and individual patient demands.…”