Mobile Health Supported Multi-Domain Recovery Trajectories After Major Arthroplasty or Spine Surgery: A Feasibility Study

Abstract

Abstract Background Recovery after surgery intersects the physical, psychological, and social domain. Predicting and early identification of deviations from these multi-domain recovery pathways can facilitate personalized postoperative management and reduce complications. In this study our aims were to assess the feasibility of a mobile health application called PositiveTrends to collect multi-domain data after hip, knee arthroplasty or spine surgery and track procedure-specific, multi-domain recovery trajectories. Methods Prospective, observational study in participants greater than eighteen years of age. Data was collected prior to and up to one hundred and eighty days after completion of surgery within the functional, psycho-social, pain and medication usage domains using PositiveTrends. Generalized linear mixed effects models were used to estimate the change in the outcomes over time. Heat maps and effect plots were used to visualize the recovery trajectories. Participants provided quantitative and qualitative evaluation of the PositiveTrends platform. Results Forty-two participants were enrolled over a four-month recruitment period. Function improved by 8 and 6.4 points per month after hip and knee arthroplasty, respectively. In spine participants, the Oswestry Disability Index decreased by 1.4 units per month. Mood improved in all three cohorts, however stress levels remained elevated in spine participants. Social support remained stable in all groups. Pain decreased by 0.16 (95% Confidence Interval: 0.20, 0.13), 0.25 (0.30, 0.20) and 0.14 (0.15, 0.12) units per month in hip, knee, and spine cohorts respectively. The odds of using no medication increased for each month postoperatively. There was a 10.9-to-40.3-fold increase in the probability of using no medication for each month postoperatively. Mixed-methods analysis demonstrated high app usability scores and acceptability of PositiveTrends by participants. Conclusions In this feasibility study we demonstrate the utility of a mobile health platform to map and track multi-domain recovery trajectories after major arthroplasty or spine surgery.