Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology

Abstract

Background: Digital patient engagement has been suggested as a mean to increase patient activation and patient satisfaction after total joint arthroplasty. The purpose of this study was to assess patient engagement with application-based educational tools and to explore what content was most useful to patients in the perioperative period surrounding total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. Methods: Patients undergoing THA and TKA between October 2017 and January 2020 were enrolled to use an application-based digital technology. The App provides comprehensive patient education using a series of modules delivered at set intervals preoperatively and postoperatively. Patient engagement was defined as patients viewing at least one time the modules that were sent, or marking them as completed. Patient satisfaction was assessed using an in-application survey. Results: Complete data were available on 207 patients of which 95 (46%) underwent THA and 112 (54%) underwent TKA. The average age was 60 years. 54% with patients invited to the program completed registration. An average compliance rate of 48% (41 modules engaged out of 83) was observed. Of all modules completed, the top three most popular categories included physical therapy/exercise videos, health literacy, and anxiety/stress/pain management. The least viewed category was nutrition planning and education. Conclusion: When presented educational material related to THA and TKA, patients had a high rate of compliance. Digital technology platforms provide a scalable, meaningful approach to engaging patients throughout the continuum of joint replacement care and may serve as a cost-effective adjunct to traditional methods.

Barriers to Discharge After Hip Reconstruction Surgery in Non-ambulatory Children With Neurological Complex Chronic Conditions

“…7 Preoperative caregiver education interventions using audiovisual aids similar to the orthopaedic total joint population may help address many of these concerns and enable a more timely discharge from the hospital. 23,24 Delayed wheelchair ordering, delivery issues, or poor wheelchair fit proved to be a recurrent barrier to discharge in this study. Complications with obtaining the correct assistive devices for postoperative patients with neurological CCC are directly impacted by interdisciplinary staff member communication involving nursing, physical and occupational therapy, orthopaedic surgery, and case management.…”

“…Berry and colleagues found that multiple preoperative primary care visits were associated with lower hospital costs and shorter LOS 7. Preoperative caregiver education interventions using audiovisual aids similar to the orthopaedic total joint population may help address many of these concerns and enable a more timely discharge from the hospital 23,24…”

Patient Perceptions of Wearable and Smartphone Technologies for Remote Outcome Monitoring in Total Knee Arthroplasties

“…Overall, previous studies of orthopaedic patient perspectives with smartphone and smartwatch apps agree that the perception of personal benefit, ease of use, and satisfaction with the feedback provided by the technology are crucial to engagement, which was difficult to maintain beyond a relatively short study period, ranging from weeks up to a year. 13,17,18 These findings suggest that the enthusiasm for digital technology we recorded in our study for TKA, and thus the overarching compliance, may decline over time if it does not actively support or facilitate continued patient engagement. Depending on the technology and associated engagement approaches, therefore, challenges for collecting meaningful long-term real-world evidence about orthopaedic implant performance may exist.…”

“…Relatively few studies have focused on patient perspectives on using wearables and smartphones for orthopaedic patients, 13,17,18 complicating direct comparisons with our research. Knapp et al 17 studied the use of a smartphone or a web-based app to engage their total hip arthroplasty and TKA patients in their treatment with educational prehabilitation and postsurgery rehabilitation modules.…”

“…16 However, there are relatively few studies in the literature about patient perception and engagement with wearable and smartphone technologies in orthopaedics. 13,17,18 The purpose of this study was to explore how receptive OA knee patients are to wearable and smartphone technologies. We addressed the following research question: is there a difference in the perception of smart technologies between nonoperative OA and TKA patients?…”