Campbell KJ, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.17.0150.

February 18, 2019
2 min read

Novel text-messaging program may improve outcomes in patients after THA, TKA


Campbell KJ, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.17.0150.

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Philip K. Louie
Kevin J. Campbell

In patients who underwent total hip or knee arthroplasty, the use of a text-messaging short message service bot may improve clinical outcomes and increase patient engagement in the early postoperative period compared with the traditional perioperative education process, according to a recently published study.

“Texting patients digestible amounts of information relating to their care after hip and knee replacement can have a number of positive effects on their recovery,” Philip K. Louie, MD, and Kevin J. Campbell, MD, told “We observed that patients enrolled in their surgeon’s chatbot stopped their opiate medications sooner, spent more time on their home therapy, were more satisfied, visited the emergency room less and placed fewer calls to their surgeon's office.”

Researchers performed a randomized controlled trial of patients who underwent total hip or knee arthroplasty. There were 83 patients assigned to the control group that received a traditional perioperative education program and 76 patients received a text-messaging short message service chatbot. The time for participation of in-home exercises was the primary outcome. Other outcomes compared between the groups included knee range of motion (ROM), use of narcotics, VAS mood score, telephone calls to the office, patient satisfaction and emergency room visits. Linear regression was used to analyze continuous outcomes. The Pearson chi-square test was used to analyze categorical outcomes.

Results showed patients in the intervention group exercised for a mean of 46.4 minutes per day compared with 37.7 minutes for the control group. Investigators noted the intervention group had improved mood, topped their narcotic medications sooner, placed fewer telephone calls to surgeons’ offices and had greater knee ROM 3 weeks postoperatively. However, the ROM was equal between the groups at 6 weeks postoperatively. The intervention group saw a trend toward fewer emergency department visits; however, this finding lacked statistical power.

“Our chatbots are providing a better experience for both the physician and the patient, all while reducing the cost of care and workload,” Louie and Campbell said. “At a time when physicians wish they could contact their patients on a daily basis, we’re making that possible by automating the communication and offering patients access to an unprecedented breadth of information about their care and recovery. No longer are patients having to call the office for that information.”

They added, “As a result, patients are more informed, more satisfied and feel a great sense of appreciation that their physician went the extra mile to develop a chatbot that coaches them through their experience and creates measurable improvements in their outcomes. Perhaps most importantly, our chatbots are helping patients get off opioids sooner after surgery which may help prevent long-term use.” – by Monica Jaramillo


Disclosures: Campbell reports he is a co-founder of StreaMD. Please see the full study for a list of all other authors’ relevant financial disclosures.