Evaluating the Impact of an mHealth Platform for Managing Acute Post-Operative Dental Pain: A Randomized Controlled Trial (Preprint)
Authors: Tokede Bunmi , Yansane Alfa-Ibrahim , Ibarra-Noriega Ana , Mullins Joanna , Simmons Kristen , Skourtes Nicholas , Mehta Urvi , Tungare Sayali , Holmes David , White Joel , Walji Muhammad , Kalenderian Elsbeth 
Published: June 2023

BACKGROUND

Post-operative dental pain is pervasive and can significantly affect a patient's quality of life. Adopting a patient-centric approach to pain management involves having contemporaneous information about the patient's experience of pain and using it to personalize care.

OBJECTIVE

In this study, we evaluated the use of an mHealth platform to collect pain-related patient reported outcomes (PROs) over 7-days after pain-inducing dental procedures, relayed the information to the dentist, and determined its impact on the patient pain experience.

METHODS

The study employed a cluster-randomized experimental study design with: (1) an intervention arm where patients were prompted to complete a series of questions relating to their pain experience after automated text notifications on their smartphone on Days 1, 3, 5 and 7, with the resulting information fed back to dentists; and (2) a control arm where patients received usual care. Providers were randomized and patients subsequently assumed the enrollment status of their providers. Providers or their staff identified eligible patients and invited them to participate in the study. Provider interviews and surveys were conducted to evaluate acceptance of the mHealth platform.

RESULTS

A total of 42 providers and 1,525 patients participated. For the primary outcome (pain intensity on a 1 to 10 (most painful) scale), intervention group patients reported an average pain intensity of 4.8 (SD = 2.6), while those in the control group reported an average pain level of 4.7 (SD = 2.8). These differences were not significant. There were also no significant differences in secondary outcomes including pain interference with activity or sleep, patient satisfaction with pain management, or opioid prescribing. Patient surveys revealed reluctance to use the app was mostly due to technological challenges, data privacy concerns, and preference for phone calls over texting. Providers had high satisfaction with the app and suggested integrating additional features, such as an in-system camera for patients to upload pictures and videos of the procedural site as well as integration with the Electronic Health Record system.

CONCLUSIONS

While the mHealth platform did not have a significant impact on acute postoperative pain experience, patients and providers indicated improvement in patient-provider communication, patient-provider relationship, post-operative complication management, and ability to manage pain medication prescribing. Expanded collaboration between mHealth developers and frontline healthcare providers can facilitate the applicability of these platforms, further help improve its integration with normal clinic workflow, and assist in moving towards a more patient-centric approach to pain management.

CLINICALTRIAL

Clinical Trial registration: NCT03881891