Authors: Jordan Werner MD, David Yeroushalmi BS, Alex Tang BS, Daniel Waren MSPH, James Slover MD, MS, Ran Schwarzkopf MD, MSc
Department of Orthopedic Surgery, NYU Langone Health, New York, NY
Abstract
Background
The traditional post-operative course only allows surgeons to see their patients immediately post-op, along with a few short office visits. A large percentage of patients often require additional help and detailed instruction throughout their recovery period. Rapid access to personalized care could improve patient monitoring and minimize the rate of ED visits and readmissions.
Objective
Evaluate the utility of application-based echnology and its benefit to patient following total knee replacement surgery. Determine the relationship between patients’ self-directed goals for recovery and functional outcomes.
Methods
1,726 patients undergoing primary TKA were prospectively enrolled from January 2017 to May 2019 to use an electronic patient rehabilitation application (Force Therapeutics, New York, NY) throughout the pre- and postoperative period. Patients utilized the application to communicate with the surgical team and access a daily, personalized care plan that drove recovery. Patient recovery goals were captured pre-op and categorized into three categories ("daily life", "sports" and "work) based on key text strings. Real-time data and outcomes were actively collected as patients progressed through their care.
Results
There was a moderate to high correlation between the total number of messages patients sent through the application and the total number of logins and sessions viewed (r=0.5). There was also a significant association and greater satisfaction in those patients who never sent messages to their surgeons (p<0.05). Patients who have more concrete goals for returning to sports or work achieved significantly higher KOOS Jr functional scores at 12 weeks post-op.
Conclusions
Patients enjoyed the greater access to their surgeons and the targeted rehabilitation provided by the application. “Unhappy” patients tend to utilize the messaging feature more frequently than their happier counterparts. Tracking patients message volume could allow physicians to provide early support to patients with postoperative issues. Patients with clear and directed goals for return to work or sports had measurably higher functional outcome scores when evaluated 3 months post-op. Further investigation into application-based technology is warranted; however, our experience shows that it may play a vital role in the rehab and recovery process of future patients.