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Patient Evidence Summary
Doctor, I need knee replacement surgery. Can I use digital technology to reduce my pain after surgery?
Using digital technology such as step trackers and exercise programs delivered on an iPad may help people having knee surgery stick to an exercise plan which may reduce pain.
What is the evidence?
SUMMARY OF FINDINGS
Digital technology package plus usual care vs usual care
Outcome | Difference in score between groups | Effect |
|---|---|---|
| Pain score* | About 1 point | Both groups had less pain at 3 months; one group was not better than the other |
| Pain intensity* | About 4 points | People who used digital technology had lower pain intensity at 3 months than people who did not use digital technology |
| Pain Disability Index* | About 10 points | People who used digital technology had less disability due to pain at 3 months than people who did not use digital technology |
*higher score = greater pain
What kind of study was this?
This was a randomized controlled trial.
Who? This study included 102 adults (average age 68 years; 67% female; 90% White) admitted for rehabilitation following total knee replacement surgery for osteoarthritis. All participants owned a smartphone and were familiar with using the internet.
What? The study compared a digital technology package plus usual care with usual care alone.
Digital Technology Package + Usual Care | vs | Usual Care |
|---|---|---|
1. Exercise program delivered through verbal instructions and an Apple iPad® 2. Fitbit® tracker 3. Health coaching every 2 weeks for 3 months with goal setting based on individual progress Above provided for 6 months. | 1. Exercise program delivered by verbal or written instructions 2. Fitbit® tracker (with the following functions turned off: step count notifications, reminders to move, goals for step count) Above provided for 6 months. |
Why was this research done?
Strengthening and range of motion exercises are known to reduce pain and improve mobility in people with knee osteoarthritis. Digital technology such as computer or iPad® applications and Fitbit® step trackers may help people stick with the exercise plan recommended by their health care providers. The researchers wanted to know if using digital technology would reduce pain and increase physical activity for people after knee replacement surgery. People who used digital technology did not have lower pain scores compared to patients who didn't use the technology, but they reported lower pain intensity, and lower disability due to pain. Concerns about this study include the need for people to be comfortable with using the internet and and that participants knew which treatment group they were assigned to which could have affected how well they did at following their exercise plan.
This Evidence Summary is based on the following article:
Duong V, Robbins SR, Dennis S, et al. Combined Digital Interventions for Pain Reduction in Patients Undergoing Knee Replacement: A Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2333172. doi: 10.1001/jamanetworkopen.2023.33172. PubMed
Published: Tuesday, November 7, 2023
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
, McMaster University