University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Arthroscopy. 2020 Jul;36(7):1906-1916. doi: 10.1016/j.arthro.2020.02.045. Epub 2020 Apr 5.
To determine whether a mobile app can reduce the need for in-person visits and examine the resulting societal cost differences between mobile and conventional follow-up for postoperative anterior cruciate ligament (ACL) reconstruction patients.
Study design was a single-center, 2-arm parallel group randomized controlled trial. All patients undergoing ACL reconstruction aged 16 to 70 years were screened for inclusion in the study. Competent use of a mobile device and ability to communicate in English was required. Patients were randomly assigned to receive follow-up via a mobile app or conventional appointments. Analysis was intention-to-treat. The primary outcome was the number of in-person visits to any health care professional during the first 6 postoperative weeks. Secondary outcomes included analysis of costs incurred by the health care system and personal patient costs related to both methods of follow-up. Patient-reported satisfaction and convenience scores, rates of complications, and clinical outcomes were also analyzed.
Sixty patients were analyzed. Participants in the app group attended a mean of 0.36 in-person visits versus 2.44 in-person visits in the conventional group (95% confidence interval 0.08-0.28; P < .0001). On average, patients in the app group spent $211 (Canadian dollars) less than the conventional group over 6 weeks (P < .0001) on personal costs related to follow-up. Health care system costs were also significantly less in the app group ($157.5 vs CAD $202.2; P < .0001). There was no difference between groups in patient satisfaction, convenience, complication rates, or clinical outcome measures.
Mobile follow-up can eliminate a significant number of in-person visits during the first 6 postoperative weeks in patients undergoing ACL reconstruction with cost savings to both the patient and health care system. This method should be considered for dissemination among similar orthopaedic procedures during early postoperative care.
I: Prospective randomized controlled trial.
确定移动应用程序是否可以减少面对面就诊的需求，并研究移动随访与传统随访在接受前交叉韧带（ACL）重建术后患者之间的社会成本差异。
研究设计为单中心、2 臂平行组随机对照试验。所有年龄在 16 至 70 岁之间接受 ACL 重建的患者均接受入组筛选。需要具备使用移动设备的能力和用英语进行交流的能力。患者被随机分配接受移动应用程序或常规预约随访。分析采用意向治疗。主要结局是在术后 6 周内任何医疗保健专业人员的就诊次数。次要结局包括分析医疗保健系统产生的成本以及与两种随访方法相关的患者个人成本。还分析了患者报告的满意度和便利性评分、并发症发生率以及临床结局。
对 60 名患者进行了分析。与常规组相比，应用程序组的患者平均就诊 0.36 次，常规组就诊 2.44 次（95%置信区间 0.08-0.28；P <.0001）。平均而言，应用程序组患者在 6 周内与随访相关的个人费用比常规组少 211 加元（加拿大元）（P <.0001）。应用程序组的医疗保健系统成本也显著低于常规组（157.5 加元比 202.2 加元；P <.0001）。两组患者的满意度、便利性、并发症发生率和临床结局测量均无差异。
在接受 ACL 重建的患者中，移动随访可以在术后前 6 周内消除大量的面对面就诊次数，并为患者和医疗保健系统节省成本。这种方法应该在类似的骨科手术后早期护理中考虑推广。
I：前瞻性随机对照试验。
