The Effects of Comparative Feedback via a Mobile Phone Application in improving Recovery post Total Knee Arthroplasty

Prospective, randomised trial comparing effects of comparative feedback vs. individualised feedback in enhancing recovery post total knee replacement . Patients will be recruited from Hollywood Private Hospital (HPH) in Perth Western Australia with the aim to have multiple surgeons encouraging their patients to participate in the study. We will also encourage hospital staff to take part so the patients can compare their mobility to the average mobility of groups of medical staff. Informed consent for patients will be attained through the app, which will contain a standardised consent form with details regarding the trial. The study will consist of 4 phases: 1) Using a custom developed Apple iPhone iOS based application (app) we aim to monitor an individual’s mobility level through their step count. This component will be exclusively available to all members of staff at HPH, who can download the app onto their iPhones. This phase will run for 30 days and in the analysis stage we will stratify participants into their sub-specialities and asses which specialities are more physically active than others 2) After the first month of trial, we will release the daily step count to the participants, who will be able to see how they performed against other staff groups. We will then monitor mobility levels for the next 30 days, observing any changes. This will enable us to assess the effect of motivation and competition on physical activity. We aim to complete phase 2 by time for submission to the British Medical Journal’s Christmas Edition. This edition is on a more humorous side of research 3) Our app will be provided to 50 patients undergoing TKR at HPH, without any feedback. This phase will serve as a pilot study, with the data collected serving as a baseline for providing feedback to patients that are randomised into the study arm of the trial in Phase 4 4) The same app will be given to at least 120 patients who will be undergoing elective TKR. For the purposes of our study, all enrolled participants will be randomised into the app group with instant feedback or into an app group without any instant feedback, which will be the control group. Participants randomised into the app group with feedback will have access to daily step counts, and comparisons of this against other patients, as well as their treating surgeons and health care professionals (all data will be anonymised and the patients will only see the subtotal scores of the specific population group, e.g. surgeons). They will also have access to average step counts of patients according to the number of days post-operatively. All patients will also be given weekly reminders (alerts) to complete a short app-based questionnaire (Forgotten Joint Score) and pain level (VAS) relating to their recovery and function, and basic psychological outcome measures regarding mood and post-operative satisfaction. Intervention group - participants in this arm of the trial will receive personalised feedback on their rehab, as well as how they compare against other patients at that stage in post operative recovery (i.e. at day 3 post op, 1 week post op, etc) 1. Participants will be recruited from many different Orthopaedic surgeons, each of whom will have their own little variations to post-operative rehabilitation for their respective patients. As such, the only influence we have if providing feedback on individual performance (for both groups) and overall group feedback (for study cohort). 2. a. Patients will be given physical/hard-copy versions of an information sheet outline our study. This will be provided during their pre-operative clinic appointment. b. The procedure being investigated is Total Knee Arthroplasty (replacement) c. Feedback provided to study group: i. Daily activity level – step count ii. Their performance at a particular point in post-operative time vs. other patients at that given time iii. Their activity level vs. hospital staff (e.g. surgeons, physiotherapists, administrative staff, etc). iv. Longitudinal (temporal) record of pain and joint range of motion Feedback given to control group v. Daily activity level – step count vi. Longitudinal (temporal) record of pain and joint range of motion d. Mode of delivery is the Apple iPhone e. All feedback will be given to patients via the app on their phone. The feedback will continue for up to 1 year post op. Our use of questionnaires will be up until 3 months post op. f. Location – all patients will be recruited from Hollywood Private Hospital 3. Patients will download our app onto their phone. They will be presented with the study information via the app, and if they consent to partake, they proceed through our app. Patient information sheets will also be given in hard-copy formats to patients when they attend their pre-op clinic appointment