Automated Mobile Phone Messaging Utilizing a Cognitive Behavioral Intervention: A Pilot Investigation

Area of Science:

• Orthopaedic Surgery
• Digital Health
• Pain Management

Background:

• Outpatient orthopaedic surgery presents challenges in managing postoperative opioid utilization.
• Automated mobile messaging offers a novel approach to deliver interventions and monitor patients remotely.
• Assessing patient-reported outcomes and adherence is crucial for optimizing postoperative care.

Purpose of the Study:

• To evaluate the feasibility and interaction rates of a software-delivered cognitive behavior therapy (CBT) intervention for postoperative opioid use.
• To determine the reliability of patient-reported opioid utilization via a mobile messaging platform.
• To assess the effect of a CBT intervention on patient-reported pain and opioid utilization in the early postoperative period.

Main Methods:

• A pilot study randomized musculoskeletal tumor patients undergoing outpatient surgery into control and intervention groups.
• The intervention group received daily automated text messages with pain/opioid monitoring and CBT.
• Opioid utilization was compared between groups using median values and interquartile ranges; reliability was assessed using Spearman correlation.

Main Results:

• The intervention group showed significantly lower opioid utilization (20%) compared to the control group (50%).
• Patient interaction with the mobile messaging system was high, with 90% completion of pain and opioid questions.
• Patient-reported opioid use via the platform strongly correlated with in-office pill counts (r=0.90, p=0.037).

Conclusions:

• Automated mobile messaging is a feasible and highly interactive method for delivering CBT interventions in outpatient surgery.
• This platform reliably captures patient-reported opioid utilization, correlating well with objective measures.
• Software-delivered CBT via mobile messaging shows promise in decreasing postoperative opioid utilization.