Post-Op Text Bots Improve Patient Outcomes

Patients who received timely text messages after joint replacement surgery showed significant improvements more quickly than those who did not get alerts, according to a recent study published in The Journal of Bone & Joint Surgery.

Those who got text alerts had fewer days on opioid pain medications, spent more time on home exercises, had a faster return of knee motion and higher satisfaction scores.

“A chatbot that texts timely, informative and encouraging messages to patients can improve clinical outcomes and increase patient engagement in the early postoperative period after total joint replacement,” said study lead Kevin J. Campbell, M.D., department of orthopaedic surgery at Rush University Medical Center in Chicago.

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Campbell and his team of researchers conducted a randomized trial of 159 patients undergoing primary total knee or hip replacement.

All patients received standard education, including at-home exercise instructions.

Of the 159 patients, 76 were enrolled into their surgeon’s short message service bot called StreaMD and received scheduled texts and video messages that reinforced perioperative instructions. Messages were delivered to patients based on their recovery progress.

Those in the intervention group received a total of 93 messages each over the six-week study.

Along with the messages that included recovery instructions paired with encouraging and empathetic statements, participants in the group got personalized video messages from their surgeon and short instructional therapy videos.

Patients were able to respond to preconfigured keywords, like pain or shower, and would receive additional automated, informational responses. The patient responses were not monitored by the surgeon’s clinical staff.

Of the participants involved in the study, 147 (93 percent) completed diaries to record the amount of time they spent doing their exercises, their mood score and whether they were using narcotics.

The post-study survey was completed by 153 patients (96 percent).

The survey revealed that those who received the text messages did home-based exercises almost nine minutes longer than the those who did not, with the intervention group exercising approximately 46 minutes compared to 38.

Almost 93 percent of patients in the message group were likely to make it a priority to perform their rehabilitation exercises, while only 55.4 percent of patients who did not get messages made their rehab a priority.

And patients who got the messages stopped taking their medication 10 days earlier, only using the opioids for about 22 days, rather than 32. This result is especially important because it reduces the risk of persistent opioid use and other complications.

Close to 79 percent of patients who received messages responded that the healthcare team motivated them through their recovery, compared to 31.1 percent of the other group.

While four patients who did not get the messages showed up to the emergency department during their recovery process, nobody from the group that received messages presented.

“As we search for practical methods to engage patients, automated messages providing education, support and encouragement create a natural and convenient way for patients to receive information, potentially improving key outcomes without placing extra time demands on the surgeon and staff,” Campbell said.

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