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Cited by 162Total Knee Arthroplasty OutcomesMobile Health and mHealth ApplicationsMobile Learning in Education

The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial

Open access
Timmers, Thomas, Janssen, Loes, van der Weegen, Walter, Das, Dirk, Marijnissen, Willem-Jan, Hannink, Gerjon, van der Zwaard, Babette C, Plat, Adriaan +4 more·2019·JMIR mHealth and uHealth
DOI 10.2196/15323PMC PMC6914303

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Abstract

Background: Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient’s self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it. Objective: This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed. Methods: A multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures. Results: In total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes. Conclusions: In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care. Trial Registration: Netherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992

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Authors
Timmers, T., Janssen, L., van der Weegen, W., Das, D., Marijnissen, W.-J., Hannink, G., van der Zwaard, B. C., Plat, A., Thomassen, B., Swen, J.-W., Kool, R. B., & Lambers Heerspink, F. O.
Affiliations
  • Radboud University Medical Center (NL)
  • Máxima Medisch Centrum (NL)
  • St. Anna Ziekenhuis (NL)
  • Albert Schweitzer Ziekenhuis (NL)
  • Jeroen Bosch Ziekenhuis (NL)
  • Stichting Haaglanden Medisch Centrum (NL)
Corresponding author
Timmers, Thomas
ORCID
Venue
JMIR mHealth and uHealth
Publisher
JMIR Publications Inc.
Published
2019-10-21
Volume
7
Issue
10
Pages
e15323
ISSN
2291-5222 (ISSN-L)
DOI
10.2196/15323
PMC
PMC6914303
OpenAlex
W2976659513
Cited by
162
References
34
Citations by year
2026: 16 · 2025: 30 · 2024: 33 · 2023: 22 · 2022: 24 · 2021: 27 · 2020: 10
FWCI
14.55
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR mhealth and uhealth (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
Keywords
total knee arthroplasty, postoperative care, mobile health apps, patient education, pain management, self-management, discharge education, physical function, quality of life, physiotherapy adherence, self-care, patient satisfaction, health care utilization, smartphone-based intervention, length of hospital stay, patient-reported outcomes, postoperative rehabilitation
MeSH terms
Aged, Female, Humans, Male, Middle Aged, Netherlands, Patient Education as Topic, Postoperative Care, Surveys and Questionnaires, Treatment Outcome, Arthroplasty, Replacement, Knee, Mobile Applications

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