This study aims to 1) observe the course of pain, 2) mental status, and 3) possible effect of a behavioral intervention delivered via an automated mobile phone messaging robot in patients were indicated and/or scheduled to undergo joint replacement but have been cancelled or delayed due to the COVID-19 crisis.
Adult patients presenting to a University Hospital and found to have hip and knee
osteoarthritis that had failed conservative management were subsequently indicated for
primary hip or knee replacement (arthroplasty). Patients who subsequently had their surgery
delayed or cancelled due to the COVID-19 pandemic were eligible for this study. Eligible
patients consenting to the study will be assigned a unique study identification number (ID).
A master database linking patient ID to patient name and medical record number will be housed
on a password protected and encrypted departmental server location, which only research
personnel can access.
Participants will complete a basic demographics survey and preoperative/ baseline patient
reported outcome surveys at enrollment, including the Patient-reported outcomes measurement
information system (PROMIS) Pain Intensity 1A short form, PROMIS Pain Intensity 3A short
form, PROMIS Pain Interference 8A short form, and PROMIS 8A Emotional Distress-Anxiety 8A
short forms. Following completion of these surveys, subjects will be randomized in a 1:1
ratio using a random number generator into one of two study groups. The intervention group
will receive mobile messages communicating the behavior intervention. The control group will
not receive the intervention. Subjects will not be blinded to their study group. Participants
randomized to the intervention group were subsequently enrolled into the automated mobile
messaging protocol and received a confirmation message welcoming them to the study, which was
reviewed with them by the research assistant. Subjects were instructed that they were only
required to read all messages, no responses were required.
A single instance of follow-up will take place on Day 14 of the study. This will occur over
the phone with a research team member. Subjects will fill out a second set of the patient
reported outcome surveys completed at enrollment. Collection of these followup items marks
the end of the subject's participation in the study. No data collection is planned following
the two week study period. The study hypothesis is that subjects receiving the behavior
intervention delivered via an automated mobile messaging robot would demonstrate better
patient reported outcome survey scores than controls at follow-up.
Behavioral: Software Messaging
Acceptance and Commitment Therapy Delivered via an Automated Mobile Messaging Robot Mobile messages utilizing the principles of Acceptance and Commitment therapy. These messages were developed in collaboration with a pain psychologist who specializes in treating chronic pain with Acceptance and Commitment therapy. Subjects received twice-daily messages for two weeks following their orthopaedic procedure.
Inclusion Criteria:
- Any patient who had been indicated for primary joint replacement but subsequently
experienced a delay or cancellation in their surgical date due to the COVID-19
pandemic.
Exclusion Criteria:
- Patients undergoing revision joint replacement
- Patients who do not own a mobile phone or do not utilize text messaging as a form of
communication
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States
Nic Bedard, MD, Study Director
University of Iowa Department of Orthopaedics