Novel Text-Messaging Bot in Patients Undergoing Joint Arthroplasty

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effectiveness of a Novel Text-Messaging Bot in Patients Undergoing Total Joint Arthroplasty: A Prospective Randomized Controlled Trial

Conditions
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Osteoarthritis, Knee, Osteoarthritis, Hip

Intervention / Treatment
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* Other: Automated Text Messaging (SMS) Bot (intervention group)
* Other: Routine perioperative education & teaching (control group)


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Text Messaging (SMS) Bot<br>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. | Other: Automated Text Messaging (SMS) Bot (intervention group)<br>* Patients will be enrolled in an 'Automated Text Messaging (SMS) Bot (intervention group)' which is a computer program that sends patients timely reminders, instructions, and videos to help them prepare and recover from surgery.<br>|
| Active Comparator: Routine Perioperative Instructions<br>Patients undergoing total joint (hip & knee) arthroplasty will receive only their 'Routine Perioperative Instructions'. | Other: Routine perioperative education & teaching (control group)<br>* Patients will receive the 'Routine perioperative education & teaching (control group)' and will not be enrolled in the physician-specific SMS bot.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time Participating in Home-Based Exercises | Stretching, strengthening, and other rehab-specific exercises counted toward their home-based exercises, while walking was excluded. | over a six-week time period after arthroplasty surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knee Range of Motion | Degrees of flexion and extension of the operative knee will be measured at 6 weeks after surgery. | over a six-week time period after arthroplasty surgery | 
| Use of Narcotics/Opiates | 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. | over a six-week time period after arthroplasty surgery | 
| Visual Analog Scale (VAS) Mood Score | 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). | 6 weeks post-operative | 
| Calls to the Office | The number of patient calls to their physicians office were tracked and recorded. | over a six-week time period after arthroplasty surgery | 
| Number of Participants Reporting Satisfaction With Instruction Clarity | Patients were asked to fill out a satisfaction survey six weeks after surgery | over a six-week time period after arthroplasty surgery | 
| Visits to the Emergency Department (ED) | The number of visits to the ED were tracked and recorded. | over a six-week time period after arthroplasty surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Total knee arthroplasty, Total hip arthroplasty