Digital-powered healthcare: Optimising communication, engagement and treatment compliance in patients with implant-related infections

The current study aims to determine the effectiveness of digital communication, wearable device and support pathways in improving communication, patient activation/engagement, and treatment compliance in patients with implant-related infections. This is a pilot non-randomised controlled trial with consecutive sampling. The efficacy acceptability and feasibility of the app-based communication tool will be assessed quantitatively and qualitatively. In addition, effectiveness of wearable device along with app will also be assessed in this cohort. The intervention strategy will be based around delivery of a dynamic patient support pathway via an existing health communications platform, PEP Health, developed by Liquid State. The pathway will include a clinically aligned patient communications plan which will provide support and education content, feedback and progress surveys. The pathway will be responsive to patient journey changes and will facilitate the authorised sharing of information and patient progress between both professional and lay. Participants in this study will be assigned into one of the three following groups (two intervention groups and a control group) for 3 months. The intervention arm will be divided into two groups, 1. Group A will be provided Mobile App only (App only) 2. Group B will be provided Mobile app plus Xiaomi Mi Smart Band (App + Wearable device) A mobile app will be downloaded in Group A and B patients’ smartphones, and they will receive emails, pop-up notifications, surveys, visual analogue scale (VAS) to score pain (from 0, none to 10, worst) and additional educational content through the app. The patients will be able to track digital care journey, that will allow them to understand treatment plan and how best to optimize health outcomes through active participation and self-monitoring. Automated responses to patient entered data allow the patient to understand how to interpret self-monitoring results and the direct link to the clinicians will allow for early intervention in the event of disease exacerbation. Patients will also be able to view their data in graphical and tabular form in their mobile app. A unique reward system based on gamification will also be used to improve the commitment and activation of patients in their recovery journey. During routine multidisciplinary Device Related InFection Team (mDRIFT) clinic appointments at baseline, week-2, week-6, and 3-months, a research team members will ask Group A (App only) and B (App + Wearable device) participants to complete the following surveys using their mobile app: • Participants’ knowledge, skill and confidence to manage their health and health care (Patient Activation Measure, PAM 13) • Participants’ experiences of treatment and care (Australian Hospital Patient Experience Question Set, AHPEQS) • Participants’ health-related questionnaire (EQ-5D-3L) • Additionally, participants will receive pop-up notifications via the mobile App on their smartphone to record perceived pain on a scale from 0 (no pain) to 10 (worst pain) each week. On average it will take between 30 and 40 minutes to complete surveys at each clinic visit and less than 5 minutes to record pain score every week at home. The overall duration of app usage time will vary. Apart from complete surveys, the use of the app will be at the participants' discretion. Throughout the study, a pathology request form, clinical appointment or follow-up, educational content or video will be sent through the app to encourage participants to use the app. A Bluetooth enabled Xiaomi Smart Band 7 will be placed on the Group B (App + Wearable device) patients’ wrist. The Smart Band will record activity data generated by the sensors in real time, including heart rate, resting heart rate, sleep duration, steps, distance travelled and energy expenditure. The Smart Band app (Zepp Life) and Google Fit app will be downloaded in participants’ smartphones. Participants’ will be asked to charge the Band every three to four days. They will also be asked to open the Zepp Life and Google Fit Apps every day (preferably, or at least every two to three days) so that the app can automatically update the above-mentioned vitals. The Smart Band will be paired via Bluetooth to a third-party app (Zepp Life) which will be synced to Google Fit. Finally, the data from Google Fit will be transferred to the mDRIFT PEP Health Dashboard.