When patients’ hip or knee replacements were delayed in response to COVID-19 surges, chatbots delivering encouraging messages not only benefited their mental health but also boosted their physical health.

Twice as many of the patients who received the messages informed by psychotherapy experienced meaningful clinical improvements compared to those who didn’t, a study published in The Journal of Arthroplasty suggests.

“We think it is very significant that we saw benefits in both mental and physical health. This demonstrates the importance of the relatively unexplored area between a patient’s psychological well-being and their joint function.”

— lead author Christopher Anthony, MD, associate director of Hip Preservation at Penn Medicine and an assistant professor of Orthopaedic Surgery in the Perelman School of Medicine at the University of Pennsylvania

Amid the COVID-19 pandemic, especially in its early stages, elective surgeries at hospitals across the United States were postponed as surges in the virus strained hospitals. Among the elective surgeries pushed back were those for replacing painful joints. As such, Anthony and others wanted to help these patients manage their pain and boost their hopes while their surgeries were on hold.

Twice-Per-Day Text Messages

The study team employed an automated system that delivered text messages twice a day to the delayed joint replacement patients. Every text was informed by a psychotherapeutic concept called Acceptance and Commitment Therapy (ACT), which emphasizes a focus on a patient’s own goals for themselves and their health while directly addressing feelings of pain or disappointment.

For example, one message said, in part, “If you are experiencing some pain today, we encourage you to acknowledge it and then turn your focus to the things in your life that matter most to you.”

A total of 90 patients were recruited and randomly divided in half, with one group receiving the text messages. Each patient was enrolled for 2 weeks, and their conditions were clinically assessed at the beginning and end of the time period.

Overall, patients enrolled in the text messaging system scored better on all measured outcomes except for anxiety – in which neither group showed improvement. Among the mental health measures, 31% of patients receiving texts experienced a clinically significant improvement, compared to 25% not receiving texts. And while 15% of those in the texting program experienced a decline in mental health, more than twice as many outside of the program experienced one, too.

Physical Benefits, Too

But the benefits of the texting program appeared to extend beyond mental health into the physical. Of those who received texts, 38% reported improved physical health over the study period, compared to just 17% of those not receiving the texts. In measures specifically related to their joint health, roughly 24% of patients getting the texts had significant improvement. Just 2.5% of those who didn’t receive the messages had the same improvement.

The texting program is the same one that Anthony previously used to carefully decrease the number of prescription opioid pills used by joint replacement patients following surgery. That effort was shown to result in a third fewer opioids being taken that also coincided with a reduction in experiences of pain. With the evidence he’s gathered across these studies, Anthony believes that a program like this could have significant benefits in future crises.

“We would like to see our methods utilized by others and implemented in practice given the ongoing pandemic needs,” Anthony says. “We really think this could help some people.”

[Source(s): Perelman School of Medicine at the University of Pennsylvania, Newswise]