A Novel, Automated Text-Messaging System Is Effective in Patients Undergoing Total Joint Arthroplasty
A Novel, Automated Text-Messaging System Is Effective in Patients Undergoing Total Joint Arthroplasty
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DOI：
10.2106/jbjs.17.01505
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发表时间：
2019-01-16
影响因子：
5.3
通讯作者：
Gerlinger, Tad L.
中科院分区：
文献类型：
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作者：
Campbell, Kevin J.;Louie, Philip K.;Gerlinger, Tad L.
背景：数字患者参与平台旨在提高围手术期外科家庭的疗效，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（短消息服务[SMS]）机器人在关节置换术后患者参与方面的有效性。方法：选取159例患者（对照组83例，干预组76例）进行随机对照试验，比较SMS bot（干预组）与传统围手术期教育过程（对照组）对原发性全膝关节或髋关节置换术患者的疗效。两组患者人口学特征无显著差异。测量并比较两组患者参加家庭锻炼时间的主要指标和膝关节活动度、麻醉品使用、视觉模拟量表（VAS）情绪评分、办公室电话、患者满意度和急诊就诊次数等次要指标。连续结局采用线性回归分析，分类结局采用Pearson卡方检验分析。结果：干预组患者每天多运动8.6分钟：平均时间（和标准差）为46.4 +/- 17.4分钟，对照组为37.7 +/- 16.3分钟（p < 0.001）。干预组患者情绪有所改善（VAS平均值为7.5 +/- 1.8分，对照组为6.5 +/- 1.7分，p < 0.001），提前10天停用麻醉药物（平均时间为22.5 +/- 13.4天，对照组为32.4 +/- 11.8天，p < 0.001），较少打电话到外科医生办公室(平均电话数为0.6 +/- 0.8次，对照组为2.6 +/- 3.4次；P < 0.001)，手术后3周的膝关节活动范围更大（平均屈曲101.2度+/- 11.2度，对照组为93.8度+/- 14.5度，P = 0.008），但6周时的活动范围相等。干预组的急诊科就诊人数有减少的趋势，但这种比较缺乏统计效力。结论：SMS机器人可以改善髋关节或膝关节置换术患者术后早期的临床结果并增加患者的参与度。
Background: 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.Methods: 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.Results: 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 degrees +/- 11.2 degrees compared with 93.8 degrees +/- 14.5 degrees 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.Conclusions: An SMS bot can improve clinical outcomes and increase patient engagement in the early postoperative period in patients undergoing hip or knee arthroplasty.