TJR Guru--a Mobile App for Shared Informed Decisionmaking in Total Joint Replacement Surgery

Osteoarthritis (OA) is the number one cause of disability in the United States, affecting more than 60 percent of adults over 65 years. There is no cure for OA, so when medication and rehabilitation are no longer effective, joint replacement becomes one solution. Total joint replacement (TJR) surgeries, including knee and hip replacement, account for more than one million hospitalizations annually. However, there are identified patient risk factors that predict a patient’s sub-optimal functional gain after TKR. Patients must carefully consider treatment options and, if TKR is preferred, patients should be aware that pre-existing clinical risk factors may influence post-operative functional gains.

This project developed a smartphone application (app), TJR App, to help OA patients track their pain and activity. The app provided access to patient-centered outcome prediction models designed for advanced knee arthritis patients, and to their clinicians to support shared treatment decisions. This project was conducted at the University of Massachusetts Arthritis and Joint Center (AJC).

The specific aims of the project were as follows:

• Develop the TJR App using user-centered design principles that rely on potential user engagement. 
• Assess TJR App usability with arthritis patients and clinicians in the laboratory and clinic settings. 
• Conduct a small feasibility study to pilot-test the TJR App with 30 patients with knee arthritis. 

Researchers conducted focus groups with 10 patients and interviews with three clinicians to iteratively develop and then assess app usability. They then pilot tested the app, randomizing 30 patients into two groups: 1) patients using TJR App before their visit to monitor pain and function and who received standard care during their visit, and 2) patients receiving an office-based patient reported symptoms survey and who received standard care during their AJC visit.

Findings indicated that all intervention participants used the daily pain reporting feature consistently, while none of the control group participants tracked their pain in a systematic way. Many intervention participants mentioned that the app would have been useful in the earlier stages of OA, when they were less knowledgeable about their condition, indicating an opportunity for early OA diagnosis and promotion of self-care. Participants also indicated that the app would allow for more data-driven conversations with their doctor and lead to more informed questions and active participation in the decision-making process during visits. Researchers recommend further studies to understand if the perceived benefits are actualized when the app is in use.