Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty

Hanne Tønnesen; Rie Raffing; Susanne Vahr Lauridsen; Jes Bruun Lauritzen; Anne Marie Halmø Elholm; Helle Sæderup Jensen; Peter Espinosa; Karl Åke Jansson; Anne H Berman; Jenaro Fernández-Valencia; Ernesto Muñoz-Mahamud; Manuel Santiñà; Andrés Combalia

doi:10.1007/s00264-023-05890-y

Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty

Int Orthop. 2023 Nov;47(11):2645-2653. doi: 10.1007/s00264-023-05890-y. Epub 2023 Aug 8.

Affiliations

¹ WHO CC (DK-62), Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark. hanne.tonnesen@regionh.dk.
² WHO CC (DK-62), Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
³ Department of Orthopedic Surgery, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁴ Department of Molecular Medicine and Surgery, Karolinska Institute at Reconstructive Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Clinical Neuroscience, Karolinska Institute, Stockholm & Department of Psychology, Uppsala University, Uppsala, Sweden.
⁶ Department of Orthopedic Surgery, Hospital Clinic Barcelona and Faculty of Medicine & Health Sciences, University of Barcelona, Barcelona, Spain.

Abstract

Purpose: Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app).

Methods: Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed.

Results: In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff.

Conclusions: This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.

Keywords: Alcohol; Apps; Digital lifestyle intervention; Perioperative risk reduction; Tobacco.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Knee* / adverse effects
Humans
Mobile Applications*
Pilot Projects
Preoperative Exercise
Smoking
Smoking Cessation*