An Interactive Voice Response System for Postoperative Care in Primary Total Joint Arthroplasty Patients: A Pilot Study

Abstract

Objective

Effective postoperative care is crucial for the success of total joint arthroplasty (TJA) and prevention of unnecessary emergency department (ED) visits. We explore the feasibility and acceptability of utilizing an Interactive Voice Response System (IVRS) to enhance postoperative monitoring in primary TJA patients.

Methods

This pilot study was conducted with 24 participants undergoing primary TJA randomly assigned to an intervention group receiving IVRS calls (n = 12) or a control group (n = 12) receiving standard postoperative follow-up. Feasibility and acceptability were assessed through patient satisfaction and willingness to participate. Outcome measures included the Short Form 36 Health Survey Questionnaire, the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and pain assessments using the Visual Analog Scale.

Results

The IVRS group exhibited a 92.3% retention rate, with 100% completion of the 12-week study. IVRS calls triggered 10 notifications, addressing pain control and respiratory concerns, leading to timely interventions and preventing ED visits. The IVRS demonstrated an 81% (95% confidence interval, 77.1–86.0%) overall response rate, with high patient satisfaction (92% finding calls “very useful”).

Conclusion

This pilot study demonstrates the feasibility and acceptability of an IVRS-based postoperative follow-up system for TJA patients. Patients reported high satisfaction and expressed willingness to use the IVRS service again.

Keywords

telemedicine and telehealth - interactive response voice system - postoperative - arthroplasty - follow-up - patient satisfaction

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by our institution's internal review board (UAB, IRB-300005894). Informed consent was received from all participants prior to participation. This study was registered at ClinicalTrials.gov (identifier: NCT04586296).

Publication History

Received: 21 July 2024

Accepted: 13 February 2025

Accepted Manuscript online:
14 February 2025

Article published online:
11 June 2025

• References

• 1 Hällfors E, Saku SA, Mäkinen TJ, Madanat R. A consultation phone service for patients with total joint arthroplasty may reduce unnecessary emergency department visits. J Arthroplasty 2018; 33 (03) 650-654
• 2 Harkey K, Kaiser N, Inman M, Reinke CE. “Are we there yet?”- factors affecting postoperative follow-up after general surgery procedures. Am J Surg 2018; 216 (06) 1046-1051
• 3 Bender M, Jain N, Giron A, Harder J, Rounds A, Mackay B. Factors influencing compliance to follow-up visits in orthopaedic surgery. J Am Acad Orthop Surg Glob Res Rev 2024; 8 (01) e23
• 4 Edelstein AI, Terzaghi C, Nudelman B, Qin C, Kwasny M, Manning DW. Early response to warfarin initiation and the risk of venous thromboembolism after total joint arthroplasty. J Am Acad Orthop Surg 2018; 26 (04) e90-e97
• 5 Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur?. J Bone Joint Surg Am 2007; 89 (01) 27-32
• 6 Choi JK, Geller JA, Patrick Jr DA, Wang W, Macaulay W. How are those “lost to follow-up” patients really doing? A compliance comparison in arthroplasty patients. World J Orthop 2015; 6 (01) 150-155
• 7 Aggarwal VK, Elbuluk A, Dundon J. et al. Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J 2019; 101-B [phone]
• 8 Belmont Jr PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 2014; 96 (01) 20-26
• 9 Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352 (16) 1685-1695
• 10 Kelly MP, Prentice HA, Wang W, Fasig BH, Sheth DS, Paxton EW. Reasons for ninety-day emergency visits and readmissions after elective total joint arthroplasty: results from a US integrated healthcare system. J Arthroplasty 2018; 33 (07) 2075-2081
• 11 Ramkumar PN, Chu CT, Harris JD. et al. Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop 2015; 44 (09) 397-405
• 12 Kee JR, Edwards PK, Barnes CL, Foster SE, Mears SC. After-hours calls in a joint replacement practice. J Arthroplasty 2019; 34 (07) 1303-1306
• 13 Sibia US, Mandelblatt AE, Callanan MA, MacDonald JH, King PJ. Incidence, risk factors, and costs for hospital returns after total joint arthroplasties. J Arthroplasty 2017; 32 (02) 381-385
• 14 Maldonado-Rodriguez N, Gandhi R, Sundararajan K, Rampersaud YR, Mahomed N, Leroux TS. What goes bump in the night: an evaluation of emergency department visits following total joint arthroplasty. J Arthroplasty 2021; 36 (04) 1232-1238
• 15 Saleh A, Faour M, Sultan AA, Brigati DP, Molloy RM, Mont MA. Emergency department visits within thirty days of discharge after primary total hip arthroplasty: a hidden quality measure. J Arthroplasty 2019; 34 (01) 20-26
• 16 Forster AJ, LaBranche R, McKim R. et al. Automated patient assessments after outpatient surgery using an interactive voice response system. Am J Manag Care 2008; 14 (07) 429-436
• 17 Forster AJ, Boyle L, Shojania KG, Feasby TE, van Walraven C. Identifying patients with post-discharge care problems using an interactive voice response system. J Gen Intern Med 2009; 24 (04) 520-525
• 18 Piette JD, Striplin D, Marinec N. et al. Improving post-hospitalization transition outcomes through accessible health information technology and caregiver support: protocol for a randomized controlled trial. J Clin Trials 2015; 5 (05) 240
• 19 Ben Ismail E, Jaana M, Sherrard H, MacPhee E. IVR system use by patients with heart failure: compliance and services utilization patterns. J Med Syst 2022; 46 (10) 69
• 20 Calder LA, Cwinn AA, Gatien M. et al. The feasibility of an interactive voice response system (IVRS) for monitoring patient safety after discharge from the ED. Emerg Med J 2018; 35 (03) 180-185
• 21 Gwam CU, Urquico KB, Etcheson JI, George NE, Higuera Rueda CA, Delanois RE. Use of new interactive patient-provider software improves patient satisfaction and outcomes-a retrospective single-center study. Arthroplast Today 2018; 5 (01) 73-77
• 22 Campbell KJ, Louie PK, Bohl DD. et al. A novel, automated text-messaging system is effective in patients undergoing total joint arthroplasty. J Bone Joint Surg Am 2019; 101 (02) 145-151
• 23 Byonanebye DM, Nabaggala MS, Naggirinya AB. et al. An interactive voice response software to improve the quality of life of people living with HIV in Uganda: randomized controlled trial. JMIR Mhealth Uhealth 2021; 9 (02) e22229
• 24 Thirumalai M, Brown N, Niranjan S. et al. An interactive voice response system to increase physical activity and prevent cancer in the rural Alabama black belt: design and usability study. JMIR Hum Factors 2022; 9 (01) e29494
• 25 Kumah-Crystal YA, Pirtle CJ, Whyte HM, Goode ES, Anders SH, Lehmann CU. Electronic health record interactions through voice: a review. Appl Clin Inform 2018; 9 (03) 541-552
• 26 Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 2005; 4: 287-291
• 27 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 28 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
• 29 Follow up: hip and knee care. AAHKS Hip and Knee Care. Accessed September 20, 2024 at: https://hipknee.aahks.org/dont-take-your-new-joint-for-granted-follow-up-care/
• 30 Lu K, Marino NE, Russell D. et al. Use of short message service and smartphone applications in the management of surgical patients: a systematic review. Telemed J E Health 2018; 24 (06) 406-414
• 31 Jildeh TR, Castle JP, Abbas MJ, Dash ME, Akioyamen NO, Okoroha KR. Age significantly affects response rate to outcomes questionnaires using mobile messaging software. Arthrosc Sports Med Rehabil 2021; 3 (05) e1349-e1358
• 32 Ngowi K, Msoka P, Mtesha B. et al. “The phone number tells us good things we didn't know before.” Use of interactive voice response calling for improving knowledge and uptake of family planning methods among Maasai in Tanzania. PLOS Digit Health 2023; 2 (05) e0000254
• 33 Bhuyian MSI, Perin J, Endres K. et al. Reduced diarrhea prevalence and improvements in handwashing with soap and stored drinking water quality associated with diarrheal disease awareness measured by interactive voice response messages in the CHoBI7 mobile health program. Am J Trop Med Hyg 2023; 108 (03) 530-535
• 34 Steiner JF, Zeng C, Comer AC. et al. Factors associated with opting out of automated text and telephone messages among adult members of an integrated health care system. JAMA Netw Open 2021; 4 (03) e213479