Novel Text-Messaging Bot in Patients Undergoing Joint Arthroplasty

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

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).

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.

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.

Patients undergoing total joint (hip & knee) arthroplasty will receive only their 'Routine Perioperative Instructions'.

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.

Patients will receive the 'Routine perioperative education & teaching (control group)' and will not be enrolled in the physician-specific SMS bot.

Stretching, strengthening, and other rehab-specific exercises counted toward their home-based exercises, while walking was excluded.

Degrees of flexion and extension of the operative knee will be measured at 3 and 6 weeks after surgery.

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.

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.

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.