Novel Text-Messaging Bot in Patients Undergoing Joint Arthroplasty

Not Applicable

Completed

Interventions: Other: Automated Text Messaging (SMS) Bot (intervention group)
Other: Routine perioperative education & teaching (control group)

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.

Recruitment & Eligibility

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.

Arm && Interventions

Group	Intervention	Description
Text Messaging (SMS) Bot	Automated Text Messaging (SMS) Bot (intervention group)	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.
Routine Perioperative Instructions	Routine perioperative education & teaching (control group)	Patients undergoing total joint (hip \& knee) arthroplasty will receive only their 'Routine Perioperative Instructions'.

Primary Outcome Measures

Name	Time	Method
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 Outcome Measures

Name	Time	Method
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.
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).
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.
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.
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.