Effect of a Remote Lifestyle Coaching Program on Length of Hospitalization and Complications in Patients Undergoing Knee and Hip Arthroplasty

In the Optimizing Patients for Surgery blog, Dr Rebecca Barker describes SAPIEN, an ISRCTN-registered trial of a remote lifestyle coaching program for patients undergoing knee and hip replacement surgery.

I am Dr. Rebecca Barker and I am a consultant anesthetist at Sherwood Forest Hospitals. I enjoy optimizing patients for surgery. Outcomes are better for patients who are fitter, more active and engaged in their own health care.

This is even more important for the elective post-Covid recovery program, where patients are at higher risk of deconditioning due to waiting longer than usual for surgery.

Behavioral pilot project based on SAPIEN mobile application

A behavioral intervention based on the Sapien mobile application was developed as a solution for patients with a remote lifestyle. Patients undergoing elective surgery could use personalized digital guidance pre-operatively with individual remote health coaching and support their recovery during the post-operative phase.

The app aims to modify risk by supporting patients to:

Friends walking together in the park

Friends walking together in the park

  1. Increase your physical activity level
  2. Stop smoking
  3. Reduce alcohol intake
  4. Improve diet
  5. Improve the length and quality of your sleep
  6. Increase preparedness for their perioperative journey

We initially piloted this lifestyle coaching app from Sapien. He supported patients undergoing primary elective lower extremity arthroplasty to improve lifestyle and become active in their own care in the weeks before surgery. He also supported in the initial post-operative period when patients were going home.

Initial qualitative feedback from patients was positive. In the pilot project, the length of hospitalization was shown to be shorter with accompanying cost savings.

Patient activation measures were also calculated at the beginning and end of the pilot study and demonstrated that patients became more active in their own health and became active participants in their own recovery.

A randomized controlled trial

The pilot program has since evolved into a randomized controlled trial that is multicenter. Patients received either the Sapien lifestyle coaching app or usual care. The study again focuses on outcomes including patient activation measures and length of hospital stay.

The success of the intervention will be measured using the Patient Activation Measure (PAM) at program entry, preoperatively (preoperatively), and up to 30 days postoperatively. This is exciting because evidence shows that those who are more active have much better long-term health outcomes. Although you can’t easily measure this impact, more active patients have fewer inappropriate emergency room visits, manage self-limiting conditions better, attend fewer doctor appointments, and are more actively involved in their own health care.

Secondary outcome measures we monitor include:

  1. Postoperative complications within 30 days of surgery (pulmonary and cardiac)
  2. Readmission to the hospital within 30 days after surgery
  3. Length of stay
  4. The share of surgery cancellations
  5. Health behavior change

Patient feedback has been excellent regarding the support they feel from the app and face-to-face virtual lifestyle support. We hope this will translate into activated patients with fewer complications as data is collected and analyzed.

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