# Acceptability of a Digital Care App in Patients Undergoing Hip and Knee Arthroplasty: Prospective Cohort Study

## TL;DR

A study evaluated how acceptable a digital care app was for patients recovering from hip and knee surgeries, finding generally positive results despite some postoperative declines.

## Contribution

The study introduces a novel evaluation of mHealth app acceptability in orthopedic patients using a theoretical framework and satisfaction metrics.

## Key findings

- Acceptability of the app decreased postoperatively compared to preoperative expectations.
- Patients with higher education reported greater self-efficacy in using the app.
- The app was well-received overall, with only one patient expressing privacy concerns.

## Abstract

Mobile health (mHealth) apps have become more commonly used in orthopedics. However, for these apps to be efficient, patients should be willing to use them, making it essential to understand patients’ perspectives of mHealth interventions.

The aim of this single-center, intent-to-treat, preoperative single-cohort study of 100 patients was to evaluate the acceptability of mymobility (Zimmer-Biomet), an mHealth app designed for the postoperative care of total hip arthroplasty (THA) and total knee arthroplasty (TKA).

We measured acceptability using the theoretical framework for acceptability (TFA) preoperatively and at 3 months post operation. We also measured satisfaction with app use postoperatively using the Usefulness, Satisfaction, and Ease of Use questionnaire as well as patient-reported outcome measures preoperatively and postoperatively using the Oxford hip and knee scores and the visual analog scale for pain. Patients included were 18 years or older; underwent unilateral primary total hip, total knee, or partial knee arthroplasty; spoke and read French or English; and had a smartphone with internet access. Participants used mymobility in addition to standard government-funded physiotherapy.

The preoperative overall TFA result was 4.2 out of 5, but results decreased significantly postoperatively. There was higher self-efficacy in preoperative TFAs with higher education, and lower acceptability in postoperative TFAs with TKA. The Usefulness, Satisfaction, and Ease of Use questionnaire revealed a good level of satisfaction with the use of the app. Patient-reported outcome measures showed earlier improvement in THA (31.2 d) than in TKA (89.4 d), whereas the visual analog scale showed a rapid decrease in pain with both procedures. Only 1 patient expressed privacy concerns with the use of the app.

There was a good level of acceptability with the use of mymobility for the postoperative management of THA and TKA, although acceptability decreased postoperatively. This decrease could signify high expectations toward the app preoperatively or higher than expected difficulty and pain in the early postoperative period. Acceptability tended to increase with higher education and decrease with TKA. These trends are consistent with prior literature and constitute a potential gap to address for app developers. The influence of the natural recovery process on acceptability remains unclear. Future studies could explore this gap by comparing results in cohorts using the app to cohorts with standard care.