A web-based communication tool for postoperative follow-up and pain assessment at home after primary knee arthroplasty: Feasibility and Usability Study (Preprint)

First-time use of electronic patient-reported outcome measures in a cluster randomized trial: a qualitative study

BACKGROUND

Although there is clear evidence supporting the beneficial effects of regularly assessing patient-reported outcomes (PROs), the comprehensive integration of patient-reported outcome measures (PROMs) into routine cancer care remains limited. This study aimed to explore the facilitators and barriers encountered by principal investigators (PIs) (oncologists) and study nurses during the implementation of the Eir ePROM within a cluster randomized trial (c-RCT) in cancer outpatient clinics. Additionally, we sought to examine the influence of Eir on the working routines of the participants.

METHODS

Individual semi-structured interviews and a focus group were conducted with nine oncologists and study nurses involved in the implementation of the ePROM tool Eir. Interviews elucidated their experiences of barriers and facilitators when implementing Eir through a cluster randomized trial. Data were analysed according to Framework Analysis, using both an inductive and deductive approach. The Consolidated Framework for Implementation Research (CFIR) was used in the deductive stages of analysis.

RESULTS

Three overarching themes were identified from the data: (1) Willingness to invest; accepting that new eras come with a cost, (2) Management anchoring; changes start at the top, and (3) Creation of a cohesive framework; fostering collective comprehension. We found a notable disparity between oncologists and nurses in their willingness to invest time and effort in implementing the tool. While participants recognized the need to transform patient consultation methods to benefit from digital symptom management, opinions varied on whether the potential benefits justified the associated cost. Furthermore, the degree of management anchoring at various levels significantly impacted the implementation process. At the local level, it was seen as either a facilitator or a barrier, influencing the outcome of the implementation. Additionally, establishing a cohesive framework was crucial, as this fostered a collective understanding among those involved in the implementation.

CONCLUSIONS

Our study underscores the importance of considering the diverse perspectives of health care professionals and fostering interprofessional collaboration for the successful implementation of ePROMs in healthcare settings. Future research should explore strategies to bridge professional disparities and promote a shared understanding of the value provided by ePROMs.

Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review

BACKGROUND

Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients.

OBJECTIVE

The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs.

METHODS

A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods.

RESULTS

We screened 8322 articles, of which 97 (1.17%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61%), a web-based platform (28/97, 29%), or a combination of both (10/97, 10%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23%) and stroke (11/97, 11%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13%) and time constraints to use the DHIs (10/97, 10%), and the top 2 enablers were the ability to use the DHIs (17/97, 18%) and their ease of use (11/97, 11%). The main conflicting theme was access (enabler; 28/97, 29%) or limited access (barrier; 15/97, 15%) to technology or the internet.

CONCLUSIONS

Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes.

A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study

BACKGROUND

Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement.

OBJECTIVE

The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge.

METHODS

Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app.

RESULTS

For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range -3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire.

CONCLUSIONS

The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw.

Patient-reported outcomes the first thirty days after fast-track primary total hip arthroplasty. A prospective cohort study using a web-based registration tool for postoperative follow-up

INTRODUCTION

The documentation on patient reported outcomes the first weeks at home following total hip arthroplasty (THA) is sparse. Length of hospital stay after THA is substantially reduced. Therefore, knowledge on whether patients are managing their own postoperative rehabilitation early after discharge is important, in order to give the patients realistic preoperative information, to modify expectations and enable patients to monitor their own rehabilitation process.

METHODS

Eighty-two THA patients were included in a prospective cohort study. Patient-reported outcomes were collected twice a week thirty days postoperatively using a web-based registration tool. Numeric rating scales (0-10) for pain, function, and quality of life, EQ-5D, and the use of opioids were registered. Four weeks postoperatively a telephone interview were conducted. Pain, EQ5D and hip specific physical function score (HOOS-PS) were recorded preoperatively, at three- and twelve-months follow-up.

RESULTS

Pain was maintained the first days after hospital discharge. From day 0 to day 30, pain decreased from 4.0 (SD 2.23) to 2.3 (SD 1.75), function improved from 4.4 (SD 2.06) to 7 (SD 1.57), quality of life improved from 6.3 (SD 2.69) to 7.8 (SD 1.47), and EQ-5D improved from 0.4 to (SD 0.27) to 0.7 (SD 0.14). After 30 days, 32% still used opioids. All patients completed the web-registration. Pain, EQ-5D and HOOS-PS improved substantially from preoperatively to twelve months follow-up.

CONCLUSION

Fast-track THA patients can expect continued postoperative pain and impaired quality of life the first week at home, before gradually improvement. After thirty days, 32 % of the patients still used opioids.

Physical activity in the first postoperative week in 132 knee arthroplasty patients randomized to 3 different analgesic regimens

BACKGROUND

The aim of this study was to investigate whether objectively recorded physical activity in the first week after surgery in total knee arthroplasty patients differed between patients allocated to 3 different analgesic regimens.

METHODS

A total of 132 total knee arthroplasty patients wore activity monitors 24 hours a day from day 1 after surgery for 6 consecutive days. The time mobilized (stepping/standing) and the number of steps were recorded. This study was a sub-study of a randomized controlled study comparing tapentadol extended-release (ER), oxycodone controlled-release (CR), or a non-opioid placebo analgesic regimen.

RESULTS

The placebo group spent significantly more time mobilized than the tapentadol ER and the oxycodone CR groups (P = .016 and .042, respectively), but no statistically significant differences were found between the groups in the number of steps taken. The activity levels of patients in all groups increased in the first week after surgery.

CONCLUSION

Patients in the non-opioid placebo group spent more time mobilized the first week after surgery than those in the tapentadol ER and the oxycodone CR groups, while the number of steps was not different between the groups.