Completion of Patient Reported Outcome Measures Improved with Use of a Mobile Application in Arthroplasty Patients: Results from a Randomized Controlled Trial

INTRODUCTION:The collection of patient-reported outcome measures (PROMs) has historically been reported as costly and time-consuming, with low compliance rates that may impact reimbursement. Little research has reported the effects of mobile applications to support PROMs collection following arthroplasty. METHODS:Secondary analysis of data from a multicenter randomized controlled trial was performed. Patients undergoing knee and hip arthroplasty were randomized to utilize a smartphone-based care management platform (app) for self-directed rehabilitation and completed joint-specific PROMs (Hip Dysfunction and Osteoarthritis Outcome Score, Joint Replacement [HOOS JR] or Knee Injury and Osteoarthritis Score, Joint Replacement [KOOS JR]) via the application at prescribed intervals or on paper during clinic visits. Control patients received practice standard of care, and completed PROMs via emailed hyperlink or during clinic visits following lower limb arthroplasty. Overall, 455 patients underwent knee arthroplasty procedures (245 control, 210 app group) and 380 underwent total hip arthroplasty (213 control, 206 app group). Compliance with expected PROMs completion was calculated through one year post-operatively. RESULTS:Compliance was higher in the app group preoperatively in both knee (98.1 versus 86.9%, P<0.0001) and hip cohorts (96.0 versus 88.4%, P=0.008), and postoperatively, including at one year (knees, 72.2 versus 53.7%, P<0.0001; hips, 71.1 versus 49.2%, P<0.0001). On log-binomial regressions, intervention arm was the strongest predictor of completion of all PROMs, where app users undergoing knee (Relative Risk 2.039, 95% Confidence Interval 1.595 to 2.607, P<0.000) and hip arthroplasty (2.268 95%CI 1.742 to 2.953, P<0.0001) were more likely to be compliant at all timepoints. The majority of patients in the app group, including those over 65 years of age, completed PROMs using the application as opposed to paper methods. CONCLUSION:A smartphone mobile application that engages patients during recovery after knee and hip joint arthroplasty improved compliance with completion of pre- and post-operative PROMs compared to other electronic and paper methods.