Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Department of Interventional Radiology, University of Washington, Seattle, Washington.
J Bone Joint Surg Am. 2019 Jan 16;101(2):145-151. doi: 10.2106/JBJS.17.01505.
Digital patient engagement platforms are designed to improve the efficacy of the perioperative surgical home, but the currently available solutions have shown low patient and provider adoption. The purpose of this study was to evaluate the effectiveness of a text-messaging (Short Message Service [SMS]) bot with respect to patient engagement following joint replacement procedures in a randomized clinical trial.
One hundred and fifty-nine patients (83 patients in the control group and 76 patients in the intervention group) were enrolled in a randomized controlled trial comparing the effectiveness of an SMS bot (intervention group) with the traditional perioperative education process (control group) in patients undergoing primary total knee or hip arthroplasty. There were no significant differences in the demographic characteristics between the 2 groups. The primary outcome of time participating in home-based exercises and the secondary outcomes of knee range of motion, the use of narcotics, visual analog scale (VAS) mood score, telephone calls to the office, patient satisfaction, and visits to the emergency department were measured and were compared between the 2 groups. Continuous outcomes were analyzed using linear regression, and categorical outcomes were analyzed using the Pearson chi-square test.
Patients in the intervention group exercised for 8.6 minutes more per day: a mean time (and standard deviation) of 46.4 ± 17.4 minutes compared with 37.7 ± 16.3 minutes for the control group (p < 0.001). The intervention group had an improved mood (mean VAS, 7.5 ± 1.8 points compared with 6.5 ± 1.7 points for the control group; p < 0.001), stopped their narcotic medications 10 days sooner (mean time, 22.5 ± 13.4 days compared with 32.4 ± 11.8 days for the control group; p < 0.001), placed fewer telephone calls to the surgeon's office (mean calls, 0.6 ± 0.8 compared with 2.6 ± 3.4 for the control group; p < 0.001), and had greater knee range of motion 3 weeks after the surgical procedure (mean flexion, 101.2° ± 11.2° compared with 93.8° ± 14.5° for the control group; p = 0.008), but had an equal range of motion at 6 weeks. There was a trend toward fewer visits to the emergency department in the intervention group, but this comparison lacked statistical power.
An SMS bot can improve clinical outcomes and increase patient engagement in the early postoperative period in patients undergoing hip or knee arthroplasty.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
数字患者参与平台旨在提高围手术期手术之家的疗效，但目前可用的解决方案显示患者和提供者的采用率较低。本研究的目的是在一项随机临床试验中评估短信 (SMS) 机器人在关节置换术后患者参与方面的有效性。
159 名患者（对照组 83 名，干预组 76 名）参与了一项比较 SMS 机器人（干预组）与传统围手术期教育流程（对照组）在接受初次全膝关节或髋关节置换术的患者中有效性的随机对照试验。两组患者在人口统计学特征方面无显著差异。主要结局是在家中进行锻炼的时间，次要结局是膝关节活动范围、使用麻醉药物、视觉模拟量表 (VAS) 情绪评分、给医生办公室打电话的次数、患者满意度和就诊急诊的次数。对两组间进行比较。连续结果采用线性回归分析，分类结果采用 Pearson 卡方检验。
干预组患者每天多锻炼 8.6 分钟：平均时间（标准差）为 46.4 ± 17.4 分钟，而对照组为 37.7 ± 16.3 分钟（p < 0.001）。干预组的情绪改善（平均 VAS 为 7.5 ± 1.8 分，对照组为 6.5 ± 1.7 分；p < 0.001），停止使用麻醉药物的时间早 10 天（平均时间为 22.5 ± 13.4 天，对照组为 32.4 ± 11.8 天；p < 0.001），给医生办公室打电话的次数更少（平均电话次数为 0.6 ± 0.8 次，对照组为 2.6 ± 3.4 次；p < 0.001），术后 3 周膝关节活动范围更大（平均屈曲度为 101.2° ± 11.2°，对照组为 93.8° ± 14.5°；p = 0.008），但 6 周时的活动范围相等。干预组到急诊就诊的次数有减少的趋势，但这种比较缺乏统计学效力。
短信机器人可改善髋关节或膝关节置换术后患者的临床结局并增加其术后早期的参与度。
治疗学 1 级。有关证据水平的完整描述，请参阅作者说明。
