The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial

Abstract

Background Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient’s self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it. Objective This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed. Methods A multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures. Results In total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes. Conclusions In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care. Trial Registration Netherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992

Usability of Mobile Health Apps for Postoperative Care: Systematic Review

“…Of the 33 included studies, 8 officially reported authors’ conflicts of interest, stating that they held shares in the app. Furthermore, several of the study groups were provided with the apps free of charge [ 28 ], which has clear implications on the usability domain of satisfaction; users who have paid for an app might be expected to have higher expectations than those who have been given an app for free. Perhaps more worryingly, a number of groups [ 38 ] declared no conflict of interest, despite seemingly being founders of their app.…”

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

“…As shown in Table 3 , function was significantly improved by perioperative interventions in 18 studies. Pain coping skills training [ 62 ], audiorecording guided imagery scripts [ 61 ], video promoting self-confidence and psychological support [ 64 ], music [ 35 , 36 ], occupational therapy in combination with self-monitoring using a diary [ 68 ], various types of education [ 41 , 43 , 45 , 47 , 51 – 53 ], weight-bearing biofeedback training [ 67 ], and psychological therapies (behavioural change intervention [ 60 ] and cognitive behavioural therapy [ 57 – 59 ]) positively affected any, but not all, of the functional outcome measures after TKA. In the most recent study by Riddle et al [ 63 ], patients receiving pain coping skills training did not have significantly better scores on WOMAC function and the short physical performance battery.…”

“…Only three studies with patients receiving TKA were included by Bay et al [ 25 ]. Compared to that review, we included fifteen additional RCTs [ 33 , 34 , 37 , 38 , 41 , 44 , 45 , 49 , 53 , 54 , 56 – 58 , 58 , 63 ]. Second, due to the current lack of RCTs on one specific type of intervention focused on psychological distress (for example only pain coping skills training) applied to patients undergoing TKA, we have decided to also include a wider range of study designs to create a complete overview of the perioperative interventions focused on psychological distress that have been used to decrease pain and improve function and/or QoL after surgery.…”

Development of a Personalized m/eHealth Algorithm for the Resumption of Activities of Daily Life Including Work and Sport after Total and Unicompartmental Knee Arthroplasty: A Multidisciplinary Delphi Study

“…Moreover, due to the importance of efficient use of hospital resources and the cuts of hospitalization costs, m/eHealth programs can support and guide patients during the recovery period at home. With m/eHealth programs, efficient use of hospital resources can be maintained and the needs of the patients can be fulfilled [ 19 , 20 , 21 , 22 , 23 ]. However, before such an m/eHealth program can be developed, consensus among different healthcare professionals about recommendations for return to daily life activities needs to be reached.…”