Does Engagement in an Electronic Patient Rehabilitation Application Predict Outcomes After Total Joint Arthroplasty?

Abstract

Background: Electronic patient rehabilitation applications (EPRA) may both decrease cost and standardize postoperative rehabilitation after total joint arthroplasty (TJA). We hypothesize that increased engagement with EPRA leads to higher patient reported outcome measures (PROMs).

Methods: Prospective data from an orthopedic hospital were reviewed for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients between November 2016 and May 2019. Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.) were collected at 1 month prior to surgery, 6 weeks, 12 weeks, and 1 year postoperatively. Patients were compared based on how many days within the first 10 postoperative days they utilized EPRA.

Results: 1,865 patients undergoing THA and 875 patients undergoing TKA were registered for EPRA. THA patients who logged in to EPRA 6 or more of the first 10 postoperative days reported significantly better HOOS, JR. scores at 12 weeks compared to those who did not log in or logged in only 1-5 days (p = 0.033 and p = 0.030, respectively). TKA patients who logged in to EPRA 6 or more of the first 10 postoperative days trended towards better KOOS, JR. scores at all postoperative timepoints, but these findings did not reach significance.

Conclusion: Our data suggests that patients who engage early and frequently with EPRA may have increased PROMs after TJA. These findings support EPRA as a value-based tool for TJA rehabilitation and emphasize the importance of preoperative patient education for maximizing postoperative PROMs.