Novel Text-Messaging Bot in Patients Undergoing Joint Arthroplasty

Effectiveness of a Novel Text-Messaging Bot in Patients Undergoing Total Joint Arthroplasty: A Prospective Randomized Controlled Trial

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03388502

Enrollment

159

Registered

2018-01-03

Start date

2016-11-21

Completion date

2017-10-01

Last updated

2023-11-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Osteoarthritis, Hip, Osteoarthritis, Knee

Keywords

Total knee arthroplasty, Total hip arthroplasty

Brief summary

This study evaluates the addition of an automated physician-specific text-messaging (SMS) bot in patients undergoing total joint arthroplasty. Half of the patients received the traditional perioperative education and instructions (control group), while the other half were enrolled in their physician's SMS bot (intervention group).

Detailed description

In an era of value-based reimbursement and high-volume surgery, the patient experience is becoming increasingly important. Despite publicized efforts to place a greater emphasis on patient-centered care, patients often report poor access to their physician, lack of effective perioperative education, and frustration as their care is commoditized. A text-messaging (SMS) bot has the potential to help fill some of these voids. Bots are computer programs that are inherently automated to simulate human-like tasks. While a physician may wish he or she could contact each of their patients daily, it would be an impossible undertaking for most. An SMS bot could make daily contact possible by automating it, potentially improving patient education and engagement before and after surgery. Standard SMS has been previously reported to be an effective means for delivering timely information, increasing patient compliance and outcomes (medication adherence, decrease surgical infections with antiseptic showers), and reaching a socioeconomically diverse patient population. Further benefits may be seen with an SMS bot due to its automated capabilities.

Interventions

OTHERAutomated Text Messaging (SMS) Bot (intervention group)

Patients will be enrolled in an 'Automated Text Messaging (SMS) Bot (intervention group)' which is a computer program that sends patients timely reminders, instructions, and videos to help them prepare and recover from surgery.

OTHERRoutine perioperative education & teaching (control group)

Patients will receive the 'Routine perioperative education & teaching (control group)' and will not be enrolled in the physician-specific SMS bot.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* Inclusion criteria consisted of patients over 18 years of age, scheduled for primary total hip & knee arthroplasty, with smart phone capability, and proficiency in English.

Exclusion criteria

* Patients less than 18 years of age, no smart phone capability, poor English proficiency.

Design outcomes

Primary

Measure	Time frame	Description
Time Participating in Home-Based Exercises	over a six-week time period after arthroplasty surgery	Stretching, strengthening, and other rehab-specific exercises counted toward their home-based exercises, while walking was excluded.

Secondary

Measure	Time frame	Description
Use of Narcotics/Opiates	over a six-week time period after arthroplasty surgery	Medications designated as narcotics included any medications that contained: hydrocodone, oxycodone, codeine, morphine, or tramadol. Patients were instructed to record their responses during the same two-hour window each day in a daily diary.
Visual Analog Scale (VAS) Mood Score	6 weeks post-operative	VAS mood scores were collected from patients on the standard ten-point validated scale. If a patient circled two adjacent numbers on their daily diary, an average of the two numbers were assigned for that day. Minimum score 0. Maximum score 10. Higher score is worse outcome (more pain).
Knee Range of Motion	over a six-week time period after arthroplasty surgery	Degrees of flexion and extension of the operative knee will be measured at 6 weeks after surgery.
Number of Participants Reporting Satisfaction With Instruction Clarity	over a six-week time period after arthroplasty surgery	Patients were asked to fill out a satisfaction survey six weeks after surgery
Visits to the Emergency Department (ED)	over a six-week time period after arthroplasty surgery	The number of visits to the ED were tracked and recorded.
Calls to the Office	over a six-week time period after arthroplasty surgery	The number of patient calls to their physicians office were tracked and recorded.

Participant flow

Participants by arm

Arm	Count
Text Messaging (SMS) Bot Patients undergoing total joint (hip & knee) arthroplasty will be enrolled in their physician's automated 'Text Messaging (SMS) Bot' in addition to receiving the routine perioperative education and instructions. Automated Text Messaging (SMS) Bot (intervention group): Patients will be enrolled in an 'Automated Text Messaging (SMS) Bot (intervention group)' which is a computer program that sends patients timely reminders, instructions, and videos to help them prepare and recover from surgery.	76
Routine Perioperative Instructions Patients undergoing total joint (hip & knee) arthroplasty will receive only their 'Routine Perioperative Instructions'. Routine perioperative education & teaching (control group): Patients will receive the 'Routine perioperative education & teaching (control group)' and will not be enrolled in the physician-specific SMS bot.	83
Total	159

Baseline characteristics

Characteristic	Routine Perioperative Instructions	Text Messaging (SMS) Bot	Total
Age, Categorical <=18 years	0 Participants	0 Participants	0 Participants
Age, Categorical >=65 years	28 Participants	20 Participants	48 Participants
Age, Categorical Between 18 and 65 years	55 Participants	56 Participants	111 Participants
Age, Continuous	60.9 years STANDARD_DEVIATION 8.2	59.3 years STANDARD_DEVIATION 8	60.2 years STANDARD_DEVIATION 8.1
Ethnicity (NIH/OMB) Hispanic or Latino	—	—	0 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	—	—	0 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	—	—	0 Participants
Sex: Female, Male Female	36 Participants	35 Participants	71 Participants
Sex: Female, Male Male	47 Participants	41 Participants	88 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 76	0 / 83
other Total, other adverse events	0 / 76	0 / 83
serious Total, serious adverse events	0 / 76	4 / 83

Outcome results

Primary

Time Participating in Home-Based Exercises

Stretching, strengthening, and other rehab-specific exercises counted toward their home-based exercises, while walking was excluded.