An investigation of mobile health (mHealth) applications available to support knee arthroplasty rehabilitation and recommendations for implementation: A scoping review

Keywords: mHealth; Applications; Arthroplasty Purpose: Length of hospital-stay following total knee arthroplasty (TKA) is approximately 1-3 days, with associated costs of revisions around £75,000 per patient. Patient control of recovery, self-management and compliance to home-based rehabilitation is therefore of utmost importance. The use of mHealth applications (apps), to promote independence and self-management, provides potential for a cost-effective, patient-centred strategy to achieve this. The objective of this study was to scope and review the quality of publicly available, patient-focused apps for TKA, with the aim of identifying and recommending one for trial and clinical implementation within a Hampshire hospital. Methods: A scoping review was chosen to systematically map, synthesise and review the latitude of apps available via the Apple Store and Google Play. Apps were identified if they were free of charge to the user, suitable for use within the UK and in English; due to the ubiquitous nature of app usage, apps were selected if they targeted both total knee or hip arthroplasty. Quality analysis of each app was conducted using the Mobile App Rating Scale (MARS); a simple 4-dimension, objective, and reliable tool for classifying and assessing quality of mhealth apps. Results: Nine apps, from 692 screened, met the inclusion criteria and were reviewed using MARS. The mean overall MARS score (where 1 = inadequate and 5 = excellent) was 3.57 (SD = ±0.87). Four apps had a score above 4, three of which were identified as utilising an app platform already in use by NHS Trusts. Five apps had a score of less than 3. The highest rated app was the Northumbria Orthopaedic NHS Trust App (4.57) which utilised the app platform ‘My Patient Journey’. This app was noted to consider features that ensured the app was engaging and also likely to promote positive rehabilitative behaviours. Conclusion(s): This study provides an overview of mHealth apps available to health-care professionals and patients post-TKA. Further investigation into the use of this platform is required, to personalise and adjust it for specific Trust use. Randomised trials are now required in order to characterise the use and efficacy of this app on health knowledge, behaviours and use. Moreover, to understand their effectiveness in rehabilitation and improve quality of life following TKA, hereby reducing its burden on public health and clinical systems. Impact: The NHS finds itself in the midst of an mHealth revolution and mobile technology offers the opportunity to access clinical apps, evidence-based resources and advanced mobile communication in one device. The mobility of such apps enables patients to use them in their home setting, reducing the need for face-to-face contact and, in light of the COVID-19 pandemic, has shown itself to be a technology that presents a future healthcare option. This study provides an overview of the mHealth apps available to a range of health-care professionals across all disciplines and patients post-TKA surgery; summarising their strengths and limitations to make recommendations for future implementation. The introduction of such management will take time, funding, a shift in clinician approach and patient expectation-management, in addition to further research to optimise delivery. Funding acknowledgements: This study is a final year physiotherapy dissertation, courtesy of University of Winchester. No funding was received from internal/external sources.