Automated Text Messages Improve Results After Joint Replacement Surgery

Automated text messaging system increases patient participation in home exercise and promotes faster recovery after total knee or hip replacement surgery, reports study in January 16, 2019 issue The Journal of Bone and Joint Surgery.

Patients receiving timely messages showed an improvement in several key outcomes, including fewer days of opioid pain medication, more time spent at home, faster return of knee movements, and improved scores. higher satisfaction, according to research by Kevin J. Campbell, Rush University MD Medical Center, Chicago and colleagues. "A chatbot that sends timely, informative, and encouraging messages to patients can improve clinical outcomes and increase patient engagement early in the postoperative period after total joint replacement surgery," says Dr. Campbell.

Automated texts lead to improved results of surgery

The randomized trial included 159 patients undergoing total knee or hip arthroplasty. All received standard education, including instructions on home exercise after surgery.

In addition, a group of patients received a series of automated text messages specific to the physician. The preprogrammed texts provided recovery instructions, encouragement and empathy messages, personalized video messages from the surgeon, and brief instructional therapy videos. The texts were sent via a service called STREA®; Dr. Campbell is the CEO and co-founder of STREA®.

"The content of the text and video messages reinforced the perioperative instructions and was delivered to patients at the appropriate time depending on the status of their recovery," the researchers write. In the six weeks following surgery, patients in the SMS group received approximately 90 SMS. The system did not accept incoming text responses from patients, although patients could access additional information about the topics they selected.

Patients who received automated texts performed an average of 46 minutes of exercise per day at home, compared to 38 minutes in the standard care group, a significant difference of nine minutes per day. The SMS group had greater knee movement after three weeks of follow-up, suggesting faster recovery in the short term, but at six weeks, knee movement was similar between groups.

Patients in the SMS group discontinued opioid badgesics approximately 10 days earlier than those in the control group (22 days versus 32 days). They also had higher mood scores and were more likely to say that their postoperative instructions were clear. Patients badigned to automated texts also spent less phone calls to the surgeon's office. There was also a tendency to reduce the number of visits to emergency services, although this difference is not statistically significant.

There is a growing interest in the use of SMS to increase patient participation in recovery after surgery. However, previous digital patient engagement platforms have not been widely adopted by either patients or healthcare providers.

This study provides evidence of improved outcomes when an automated text messaging system establishes daily contact with patients and provides them with relevant information and encouragement. Benefits include more time to do recommended home exercises, faster recovery of knee movement, and increased patient satisfaction.

The 10 day reduction in opioid use is a potentially important benefit because it reduces the risk of persistent opioid use and other complications. "This result could be related to better patient education and the encouraging and empathic tone of text and video messages," said Dr. Campbell. "This could also reflect improved mood scores and patient confidence in their ability to manage their recovery, which have proven to be very effective painkillers."

The benefits of such an automated system could be particularly important at a time when more patients are undergoing joint replacement surgery with fewer contacts with the treatment team. "As we research practical methods to engage patients, automated messages providing education, support, and encouragement create a natural and convenient way for patients to receive information, potentially improving key outcomes without imposing additional time on patients. surgeon and staff "Campbell concludes.

Provided by
Wolters Kluwer Health