Joint Implant Surgeons, New Albany, Ohio, USA.
Department of Orthopedics, Stanford University, Redwood City, California, USA.
Bone Joint J. 2021 Jul;103-B(7 Supple B):91-97. doi: 10.1302/0301-620X.103B7.BJJ-2020-2402.R1.
The purpose of this study is to evaluate early outcomes with the use of a smartphone-based exercise and educational care management system after total hip arthroplasty (THA) and demonstrate decreased use of in-person physiotherapy (PT).
A multicentre, prospective randomized controlled trial was conducted to evaluate a smartphone-based care platform for primary THA. Patients randomized to the control group (198) received the institution's standard of care. Those randomized to the treatment group (167) were provided with a smartwatch and smartphone application. PT use, THA complications, readmissions, emergency department/urgent care visits, and physician office visits were evaluated. Outcome scores include the Hip disability and Osteoarthritis Outcome Score (HOOS, JR), health-related quality-of-life EuroQol five-dimension five-level score (EQ-5D-5L), single leg stance (SLS) test, and the Timed Up and Go (TUG) test.
The control group was significantly younger by a mean 3.0 years (SD 9.8 for control, 10.4 for treatment group; p = 0.007), but there were no significant differences between groups in BMI, sex, or preoperative diagnosis. Postoperative PT use was significantly lower in the treatment group (34%) than in the control group (55.4%; p = 0.001). There were no statistically significant differences in complications, readmissions, or outpatient visits. The 90-day outcomes showed no significant differences in mean hip flexion between controls (101° (SD 10.8)) and treatment (100° (SD 11.3); p = 0.507) groups. The HOOS, JR scores were not significantly different between control group (73 points (SD 13.8)) and treatment group (73.6 points (SD 13); p = 0.660). Mean 30-day SLS time was 22.9 seconds (SD 19.8) in the control group and 20.7 seconds (SD 19.5) in the treatment group (p = 0.342). Mean TUG time was 11.8 seconds (SD 5.1) for the control group and 11.9 (SD 5) seconds for the treatment group (p = 0.859).
The use of the smartphone care management system demonstrated similar early outcomes to those achieved using traditional care models, along with a significant decrease in PT use. Noninferiority was demonstrated with regard to complications, readmissions, and ED and urgent care visits. This technology allows patients to rehabilitate on a more flexible schedule and avoid unnecessary healthcare visits, as well as potentially reducing overall healthcare costs. Cite this article: 2021;103-B(7 Supple B):91-97.
本研究旨在评估使用基于智能手机的锻炼和教育管理系统在全髋关节置换术后（THA）的早期效果，并证明减少了对面对面物理治疗（PT）的使用。
进行了一项多中心、前瞻性随机对照试验，以评估基于智能手机的原发性 THA 护理平台。随机分配到对照组（198 例）的患者接受机构标准护理。随机分配到治疗组（167 例）的患者提供智能手表和智能手机应用程序。评估了 PT 使用、THA 并发症、再入院、急诊/紧急护理就诊和医生就诊情况。结局评分包括髋关节残疾和骨关节炎结果评分（HOOS，JR）、健康相关生活质量欧洲五维健康量表 5 级评分（EQ-5D-5L）、单腿站立（SLS）测试和计时起立行走（TUG）测试。
对照组的平均年龄明显小 3 岁（对照组的 SD 为 9.8，治疗组为 10.4；p = 0.007），但两组在 BMI、性别或术前诊断方面无显著差异。治疗组术后 PT 使用明显低于对照组（34%比 55.4%；p = 0.001）。并发症、再入院或门诊就诊无统计学差异。90 天结局显示，对照组（101°（SD 10.8））和治疗组（100°（SD 11.3））之间的平均髋关节屈曲无显著差异（p = 0.507）。对照组（73 分（SD 13.8））和治疗组（73.6 分（SD 13 分））之间的 HOOS，JR 评分无显著差异（p = 0.660）。对照组 SLS 时间的平均 30 天时间为 22.9 秒（SD 19.8），治疗组为 20.7 秒（SD 19.5）（p = 0.342）。对照组 TUG 时间平均为 11.8 秒（SD 5.1），治疗组为 11.9 秒（SD 5 秒）（p = 0.859）。
使用智能手机护理管理系统在早期结果方面与传统护理模式相似，同时显著减少了 PT 的使用。并发症、再入院和 ED 及紧急护理就诊方面表现出非劣效性。这项技术使患者能够在更灵活的时间内康复，避免不必要的医疗就诊，同时可能降低整体医疗成本。
