Bruce Hellman*, ?, London, United Kingdom Track: Business Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2013-09-25

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Background: Joint preservation surgeries are used to prevent or delay the onset of osteoarthritis or other degenerative conditions affecting the joints, particularly in young patients. The aim is to improve the biomechanics of the hip and the patient’s symptoms, and to delay the need for joint replacement surgery (1).
Patients undergoing hip arthroscopy surgeries currently report their symptoms and recovery to their surgeons sporadically. Follow-ups are usually provided at 6 and 12 week intervals with patients completing one or more standard scores viz. Modified Harris Hip Scores. This process has inherent problems of unreliable recollection of symptoms by patient due to the gap between follow-ups. The inflexible nature of follow-up appointments means standard scores may not always capture information at critical time points in perioperative recovery. Therefore, surgeons and physiotherapists make management decisions with a relative lack of objective or longitudinal data.
Studies on physiotherapy following hip arthroplasty as a joint preservation technique are scarce. However, studies following Total Hip Replacement (THR) for osteoarthritis reports that physiotherapy after discharge benefits patients (2). Other studies report that prospective monitoring rather than adherence to clinical pathways alone reduces the chances of adverse outcomes in primary THR (3). We expect to have similar findings in young patients undergoing hip arthroscopic surgeries for joint preservation.
Objective: Explore the effectiveness of using a mobile app to:
- Support achieving Patient Reported Outcome Measures (PROMs) by promoting self-management
- Improve quality of the joint patient-clinician decision making.
Methods: This is a pilot study using an observational, cross section study design aimed at young adults undergoing joint preservation hip surgeries at the Barts and Royal London Hospitals. A bespoke app will be provided to 30-40 patients both before and up to 6 months after their surgery. The app is configured to track symptoms, access patient specific physiotherapy content, structured treatment and follow-up plans, and to report common complications. The app will be supported by a secure web-platform for clinicians who will have the option to view progress of all patients with specific tools to communicate with individual patients. All data collected will be owned by the patients with anonymous data available for the study analysis.
Results and Conclusions: Research in progress, to be reported at the Medicines 2.0 conference.
Partners involved: St Bartholomew’s and the Royal London Hospitals, led by Mr Manoj Ramachandran, Consultant Orthopaedic Surgeon and uMotif Digital Health Ltd led by Bruce Hellman.
References:
1. Jayakumar P, Ramachandran M, Youm T, Achan P. Arthroscopy of the hip for paediatric and adolescent disorders: current concepts. J Bone Joint Surg Br. 2012 Mar;94(3):290-6.
2. Lowe, C. J. M., Barker, K. L., Dewey, M. E., & Sackley, C. M. (2009). Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC musculoskeletal disorders, 10(1), 98.
3. Prospective monitoring improves outcomes of primary total hip replacement: a cohort study. Patient Safety in Surgery 2009, 3:7. doi:10.1186/1754-9493-3-7.