Age, Sex, and Education Level Predict Telehealth Engagement in Total Joint Arthroplasty Patients
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ABSTRACT:
SUBMITTER: Lotito M
PROVIDER: S-EPMC10520290 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Project description:With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians' ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.
| S-EPMC8077983 | biostudies-literature
Project description:BackgroundThe validated Arthroplasty Risk Score (ARS) predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS), discharge disposition, and episode-of-care cost (EOCC).MethodsWe retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation.ResultsARS implementation was associated with fewer patients going to a skilled nursing or rehabilitation facility after discharge (63% vs 74%, P = .002). There was no difference in LOS, EOCC, readmission rates, or complications. While the adoption of the ARS did not change the mean EOCC, ARS >3 was predictive of high EOCC outlier (odds ratio 2.65, 95% confidence interval 1.40-5.01, P = .003). Increased ARS correlated with increased EOCC (P = .003).ConclusionsImplementation of the ARS was associated with increased disposition to home. It was predictive of high EOCC and should be considered in risk adjustment variables in alternative payment models.
| S-EPMC5859673 | biostudies-literature
Project description: Not available
| S-EPMC11827008 | biostudies-literature
Project description:BackgroundUtilizing conversational analytics in orthopaedic surgery may provide insights into patients' experiences and outcomes. This study retrospectively assessed how patients interacted with a perioperative chatbot and whether the topic of patients' queries could offer insight on their outcomes after total knee or hip arthroplasty.MethodsWe identified 1338 patients (746 knees and 592 hips) who enrolled in a short message service chatbot from 2020-2022 with greater than 3 months of follow-up. The total number and topics of patient-generated text responses to the chatbot were recorded. Independent t-tests, chi-squared tests, and linear regressions were performed to determine if specific patient-generated responses to the chatbot or overall chatbot engagement were associated with demographics or outcomes.ResultsReadmitted patients interacted less with the perioperative chatbot than those who were not readmitted (3.9 messages vs 12.7 messages, P < .0001). Return to emergency department (ED) and reoperation rates were not associated with engagement. Patients who visited the ED within 90 days of their surgery were most commonly seeking advice about walking after surgery (P = .0046) and weaning off their opiate pain medications (P = .0281). Patients who were readmitted to the hospital were similarly seeking advice about walking (P = .0188) and weaning off pain medications (P = .0218). Replying "exercise" was associated with no ED visits or readmissions (P = .0009). Patients with a mental health diagnosis were more likely to reply with high-acuity topics (P = .0052).ConclusionsThe topic of chatbot queries and chatbot engagement were associated with patient outcomes after total knee arthroplasty or total hip arthroplasty and may provide insight to patients' perioperative courses.
| S-EPMC11526051 | biostudies-literature
Project description:BackgroundAs length of stay decreases for total joint arthroplasty, much of the patient preparation and teaching previously done in the hospital must be performed before surgery. However, the most effective form of preparation is unknown. This randomized trial evaluated the effect of a one-time, one-on-one preoperative physical therapy education session coupled with a web-based microsite (preopPTEd) on patients' readiness to discharge from physical therapy (PT), length of hospital stay, and patient-reported functional outcomes after total joint arthroplasty.Questions/purposesWas this one-on-one preoperative PT education session coupled with a web- based microsite associated with (1) earlier achievement of readiness to discharge from PT; (2) a reduced hospital length of stay; and (3) improved WOMAC scores 4 to 6 weeks after surgery?MethodsBetween February and June 2015, 126 typical arthroplasty patients underwent unilateral TKA or THA. As per our institution's current guidelines, all patients attended a preoperative group education class taught by a multidisciplinary team comprising a nurse educator, social worker, and physical therapist. Patients were then randomized into two groups. One group (control; n = 63) received no further education after the group education class, whereas the intervention group (experimental; n = 63) received preopPTEd. The preopPTEd consisted of a one-time, one-on-one session with a physical therapist to learn and practice postoperative precautions, exercises, bed mobility, and ambulation with and negotiation of stairs. After this session, all patients in the preopPTEd group were given access to a lateralized, joint-specific microsite that provided detailed information regarding exercises, transfers, ambulation, and activities of daily living through videos, pictures, and text. Outcome measures assessed included readiness to discharge from PT, which was calculated by adding the number of postoperative inpatient PT visits patients had to meet PT milestones. Hospital length of stay (LOS) was assessed for hospital discharge criteria and 6-week WOMAC scores were gathered by study personnel. At our institution, to meet PT milestones for hospital discharge criteria, patients have to be able to (1) independently transfer in and out of bed, a chair, and a toilet seat; (2) independently ambulate approximately 150 feet; (3) independently negotiate stairs; and (4) be independent with a home exercise program and activities of daily living. Complete followup was available on 100% of control group patients and 100% patients in the intervention group for all three outcome measures (control and intervention of 63, respectively).ResultsThe preopPTEd group had fewer postoperative inpatient PT visits (mean, 3.3; 95% confidence interval [CI], 3.0-3.6 versus 4.4; 95% CI, 4.1-4.7; p < 0.001) and achieved readiness to discharge from PT faster (mean, 1.6 days; 95% CI, 1.2-1.9 days versus 2.7 days; 95% CI, 2.4-3.0; p < 0.001) than the control group. There was no difference in hospital LOS between the preopPTEd group and the control group (2.4 days; 95% CI, 2.1-2.6; p = 0.082 versus 2.6 days; 95% CI, 2.4-2.8; p = 0.082). There were no clinically relevant differences in 6-week WOMAC scores between the two groups.ConclusionsAlthough this protocol resulted in improved readiness to discharge from PT, there was no effect on LOS or WOMAC scores at 6 weeks. Preoperative PT was successful in improving one of the contributors to LOS and by itself is insufficient to make a difference in LOS. This study highlights the need for improvement in other aspects of care to improve LOS.Level of evidenceLevel II, therapeutic study.
| S-EPMC5919221 | biostudies-literature
Project description:ObjectiveTotal knee arthroplasty (TKA) outcomes are worse for patients from poor neighborhoods, but whether education mitigates the effect of poverty is not known. We assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function.MethodsPatient-level variables from an institutional registry were linked to US Census Bureau data (census tract [CT] level). Statistical models including patient and CT-level variables were constructed within multilevel frameworks. Linear mixed-effects models with separate random intercepts for each CT were used to assess the interaction between education and poverty at the individual and community level on WOMAC scores.ResultsOf 3,970 TKA patients, 2,438 (61%) had some college or more. Having no college was associated with worse pain and function at baseline and 2 years (P = 0.0001). Living in a poor neighborhood (>20% below poverty line) was associated with worse 2-year pain (P = 0.02) and function (P = 0.006). There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college (83.4% versus 75.7%; P < 0.0001); in wealthy communities, college was associated with a 1-point difference in pain. Function was similar.ConclusionIn poor communities, those without college attain 2-year WOMAC scores that are 10 points worse than those with some college; education has no impact on TKA outcomes in wealthy communities. How education protects those in impoverished communities warrants further study.
| S-EPMC6504983 | biostudies-literature
Project description:BackgroundArtificial intelligence (AI) in medicine has primarily focused on diagnosing and treating diseases and assisting in the development of academic scholarly work. This study aimed to evaluate a new use of AI in orthopaedics: content generation for professional medical education. Quality, accuracy, and time were compared between content created by ChatGPT and orthopaedic surgery clinical fellows.MethodsChatGPT and 3 orthopaedic adult reconstruction fellows were tasked with creating educational summaries of 5 total joint arthroplasty-related topics. Responses were evaluated across 5 domains by 4 blinded reviewers from different institutions who are all current or former total joint arthroplasty fellowship directors or national arthroplasty board review course directors.ResultsChatGPT created better orthopaedic content than fellows when mean aggregate scores for all 5 topics and domains were compared (P ≤ .001). The only domain in which fellows outperformed ChatGPT was the integration of key points and references (P = .006). ChatGPT outperformed the fellows in response time, averaging 16.6 seconds vs the fellows' 94 minutes per prompt (P = .002).ConclusionsWith its efficient and accurate content generation, the current findings underscore ChatGPT's potential as an adjunctive tool to enhance orthopaedic arthroplasty graduate medical education. Future studies are warranted to explore AI's role further and optimize its utility in augmenting the educational development of arthroplasty trainees.
| S-EPMC11190484 | biostudies-literature
Project description:In total ankle arthroplasty, the interaction at the joint between implant and bone is driven by a complex loading environment. Unfortunately, little is known about the loads at the ankle during daily activities since earlier attempts use two- or three-dimensional models to explore simplified joint mechanics. Our goal was to develop a framework to calculate multi-axial loads at the joint during simulated level walking following total ankle arthroplasty. To accomplish this, we combined robotic simulations of level walking at one-quarter bodyweight in three cadaveric foot and ankle specimens with musculoskeletal modeling to calculate the multi-axial forces and moments at the ankle during the stance phase. The peak compressive forces calculated were between 720 and 873 N occurring around 77%-80% of stance. The peak moment, which was the internal moment for all specimens, was between 6.1 and 11.6 N m and occurred between 72% and 88% of the stance phase. The peak moment did not necessarily occur with the peak force. The ankle joint loads calculated in this study correspond well to previous attempts in the literature; however, our robotic simulator and framework provide an opportunity to resolve the resultant three-dimensional forces and moments as others have not in previous studies. The framework may be useful to calculate ankle joint loads in cadaveric specimens as the first step in evaluating bone-implant interactions in total ankle replacement using specimen specific inputs. This approach also provides a unique opportunity to evaluate changes in joint loads and kinematics following surgical interventions of the foot and ankle.
| S-EPMC7749051 | biostudies-literature
Project description:BackgroundRestoring the joint line is an important principle in total knee arthroplasty. However, the effect of joint line level on patient outcomes after total ankle arthroplasty (TAA) remains unclear, as there is no established method for measuring ankle joint level in TAA. The objective of this study was to develop a reliable radiographic ankle joint line measurement method and to compare ankle joint line level measured pre-TAA, post-TAA, and in nonarthritic ankles.MethodsA total of 112 radiographic sets were analyzed. Each set included weightbearing anteroposterior radiographs of the operative ankle taken preoperatively, 1-year postoperatively, and of the contralateral ankle. Measurements of vertical intermalleolar distance (VIMD) and vertical joint line distance (VJLD) at pre-TAA, post-TAA, and of the contralateral ankle were recorded by 2 authors on 2 separate occasions. The ratio of VJLD to VIMD was defined as the joint line height ratio (JLHR). Reliability of measurements and correlation between VIMD and VJLD were assessed. Pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHR were compared and considered significantly different if P <.05.ResultsThe inter- and intrarater reliability of radiographic measurements was excellent (r > 0.9). There were strong positive correlations of VIMD and VJLD, r = 0.809 (pre-TAA)/0.756 (post-TAA), P < .001. Mean (SD) pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHRs were 1.54 (0.31), 1.39 (0.26), and 1.62 (0.49), respectively. Pre- and post-TAA JLHRs were significantly higher compared to the nonarthritic contralateral ankle (P < .05). JHLR was not significantly different between pre- and post-TAA (P = .15).ConclusionThe JLHR was reliable and could be a clinically applicable method for assessing ankle joint line level in patients undergoing TAA. End-stage ankle arthritis demonstrated elevated joint line level compared with nonarthritic ankles, and the joint line level post-TAA remained elevated compared with nonarthritic ankles. Further studies are needed to understand the effect of joint line elevation on clinical outcomes after TAA.Level of evidenceLevel III, retrospective comparative study.
| S-EPMC8697171 | biostudies-literature
Project description:BackgroundTotal joint arthroplasty (TJA) performed in the ambulatory surgical center (ASC) has been shown to be safe and cost-effective for an expanding cohort of patients. As criteria for TJA in the ASC become less restrictive, data guiding the efficient use of ASC resources are crucial.PurposeWe sought to identify factors associated with length of stay in the recovery room after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed in the ASC.MethodsWe conducted a retrospective review of 411 patients who underwent primary THA or TKA at our institution's ASC between November 2020 and March 2022. We collected patient demographics, perioperative factors, success of same-day discharge (SDD), and length of time in the recovery room.ResultsOf 411 patients, 100% had successful SDD. The average length of time spent in recovery was 207 minutes (SD: 73.9 minutes). Predictors of longer time in recovery were increased age, male sex, and operative start time before 9:59 am. Body mass index, preoperative opioid use, Charlson Comorbidity Index, type of surgery (THA vs TKA), urinary retention risk, and type of anesthesia (spinal vs general) were not significant predictors of length of time in the recovery room.ConclusionIn this retrospective study, factors associated with increased length of time in the recovery room included older age, male sex, and operative start time before 9:59 am. Such factors may guide surgeons in determining the optimal order of cases for each day at the ASC, but further prospective studies should seek to confirm these observations.
| S-EPMC10863596 | biostudies-literature