Perspective

Accurate assessments may be possible with post-ACL reconstruction mobile app

Researchers noted mobile follow-up apps still need refining, so they can better facilitate interactions with patients who have questions.

Use of a mobile web-based application accurately assessed patient recovery following ACL reconstruction, according to results published in The Orthopaedic Journal of Sports Medicine.

“We can follow up patients electronically in lieu of in-person assessments and there is no difference in surgical outcome. The only difference is it is more cost-efficient with regard to time away from family and work and is convenient for the patient and the clinician,” John Theodoropoulos, MD, MSc, FRCSC, head of the division of orthopedics at Women’s College Hospital in Toronto, told Orthopedics Today.

Among 32 patients who used the mobile smartphone app after ACL reconstruction, one patient required in-person reassessment following surgeon review of an uploaded image to rule out an infection, preliminary results showed.

According to an estimate by Theodoropoulos and his colleagues, follow-up at 2 weeks and 6 weeks could have been avoided in many patients because the application was so effective.

Of the 97% of patients who completed a survey of their experience in this study, researchers found overall satisfaction with the mobile device was reported as excellent by 43% of patients, good by 40%, fair by 10% and poor by 7%. According to the results, 47% of patients stated they would be willing to pay for an app like the one they used in the study. Of the two surgeons involved in the study, researchers noted both reported having a positive experience with the most positive features of the app being portability, ease of use and user-friendliness.

Patients also saw significant cost savings when they used the mobile app, Theodoropoulos noted.

“In the time they spend putting in their information vs. the time they would spend driving to and from visits, taking time off work, paying for parking, gas, etc., ... there is a significant cost savings for the patient vs. the traditional follow-up, which is going to see your doctor, waiting in the waiting room, being assessed and then going home,” he said.

Traditional follow-up vs mobile apps

Theodoropoulos said one surprising result was patients who used the mobile app called the office as much as patients who went through traditional follow-up.

“We thought the traditional patients would call a little bit more, but both groups seemed to still telephone the office with questions that we thought the app would help with,” he said. “We have to have some way to interact with the patient via the app, so they can somehow ask questions as well, and we can get some signal that a question has been asked and to answer them back.”

Beyond finding better ways to interact with patients through this app, Theodoropoulos said investigators need to use of the app at different hospitals and with different surgeries, including knee, hip and shoulder replacements.

“In many cases, most of our patients go down a typical postoperative pathway where they recover quickly, they do very well, they have good communication with their physical therapist, they do not necessarily need to see their surgeon 2 weeks, 6 weeks, 12 weeks, 24 weeks and a year .... [Mostly], complications can be identified electronically and [we can] save the in-person visits for that 5% to 10% [of patients] who are not following the typical postoperative course or potentially have complications,” he said. – by Casey Tingle

Disclosure: Theodoropoulos reports no relevant financial disclosures.

Use of a mobile web-based application accurately assessed patient recovery following ACL reconstruction, according to results published in The Orthopaedic Journal of Sports Medicine.

“We can follow up patients electronically in lieu of in-person assessments and there is no difference in surgical outcome. The only difference is it is more cost-efficient with regard to time away from family and work and is convenient for the patient and the clinician,” John Theodoropoulos, MD, MSc, FRCSC, head of the division of orthopedics at Women’s College Hospital in Toronto, told Orthopedics Today.

Among 32 patients who used the mobile smartphone app after ACL reconstruction, one patient required in-person reassessment following surgeon review of an uploaded image to rule out an infection, preliminary results showed.

According to an estimate by Theodoropoulos and his colleagues, follow-up at 2 weeks and 6 weeks could have been avoided in many patients because the application was so effective.

Of the 97% of patients who completed a survey of their experience in this study, researchers found overall satisfaction with the mobile device was reported as excellent by 43% of patients, good by 40%, fair by 10% and poor by 7%. According to the results, 47% of patients stated they would be willing to pay for an app like the one they used in the study. Of the two surgeons involved in the study, researchers noted both reported having a positive experience with the most positive features of the app being portability, ease of use and user-friendliness.

Patients also saw significant cost savings when they used the mobile app, Theodoropoulos noted.

“In the time they spend putting in their information vs. the time they would spend driving to and from visits, taking time off work, paying for parking, gas, etc., ... there is a significant cost savings for the patient vs. the traditional follow-up, which is going to see your doctor, waiting in the waiting room, being assessed and then going home,” he said.

Traditional follow-up vs mobile apps

Theodoropoulos said one surprising result was patients who used the mobile app called the office as much as patients who went through traditional follow-up.

“We thought the traditional patients would call a little bit more, but both groups seemed to still telephone the office with questions that we thought the app would help with,” he said. “We have to have some way to interact with the patient via the app, so they can somehow ask questions as well, and we can get some signal that a question has been asked and to answer them back.”

PAGE BREAK

Beyond finding better ways to interact with patients through this app, Theodoropoulos said investigators need to use of the app at different hospitals and with different surgeries, including knee, hip and shoulder replacements.

“In many cases, most of our patients go down a typical postoperative pathway where they recover quickly, they do very well, they have good communication with their physical therapist, they do not necessarily need to see their surgeon 2 weeks, 6 weeks, 12 weeks, 24 weeks and a year .... [Mostly], complications can be identified electronically and [we can] save the in-person visits for that 5% to 10% [of patients] who are not following the typical postoperative course or potentially have complications,” he said. – by Casey Tingle

Disclosure: Theodoropoulos reports no relevant financial disclosures.

    Perspective
    David C. Flanigan

    David C. Flanigan

    I applaud Higgins and colleagues on their study of the use of mobile, web-based follow up after ACL reconstruction. Our society is continually changing with technology, and this mobile app allowed excellent physician-patient interaction during the early phases of recovery. Physicians were able to monitor incision healing, pain level, weight-bearing and key areas of postoperative complications. One important finding was a high level of anxiety our patients experience during recovery, which underscored the need for improved physician communication of expectations preoperatively. Furthermore, this app likely could reduce postoperative appointments during the early phase of recovery, efficiently using the patients and physicians time.

    • David C. Flanigan, MD
    • Associate professor, department of orthopedics The Ohio State University Wexner Medical Center Columbus, Ohio

    Disclosures: Flanigan reports no relevant financial disclosures.