Effectiveness of a theory-driven mHealth intervention in promoting post-surgery rehabilitation adherence in patients who had anterior cruciate ligament reconstruction: A randomized clinical trial

Sing Yeung Alfred LEE, Patrick Shu-Hang YUNG, Michael Tim-Yun ONG, Chris LONSDALE, Thomson W.L. WONG, Parco M. SIU, Martin S. HAGGER, King Chung Derwin CHAN

Research output: Contribution to journalArticlespeer-review

Abstract

Rationale: Patients with anterior cruciate ligament (ACL) reconstruction often have poor adherence to post-surgery rehabilitation. 

Objective: This study applied the integrated model of self-determination theory and the theory of planned behavior to examine the effects of a smartphone-delivered intervention on the recovery outcomes of patients with an ACL rupture during post-surgery rehabilitation period. Additionally, we explored the effects of the intervention on participants with different beliefs toward rehabilitation at baseline. 

Methods: The randomized control trial recruited 96 eligible participants (M age = 27.82 years, SD = 8.73; female = 39%) who underwent ACL reconstruction surgery. Participants were randomly assigned to an intervention group (n = 41), which received standard post-surgical treatment (usual-care) and smartphone application (“ACL-Well”), or a usual-care control group (n = 55). The primary outcomes were recovery outcomes from ACL surgery measured by knee muscle strength and laxity, and subjective knee evaluation completed 4-month post-intervention. Secondary outcomes were the psychological and behavioral outcomes measured at baseline, at 2- and 4-month post-intervention. 

Results: ANCOVA indicated no significant between-group differences in primary outcomes: knee muscle strength, knee laxity and subjective knee evaluation, Fs(1, 27 to 55) = 0.01 to 1.36, p =.25 to.99, η2 = 0.01 to 0.03. For the secondary outcomes, growth mixture modelling revealed self-determined treatment motivation declined significantly over the intervention period in the control group (M slope = -0.39 to -0.12, p =.01 to .04), but not in the intervention group (M slope = -0.19 to -0.08, p =.06 to.38). 

Conclusions: The smartphone application fell short in promoting orthopedic outpatients' recovery outcomes. Yet, it shows some promises as a mean to maintain patients’ motivation and adherence to treatment. Copyright © 2023 Elsevier Ltd. All rights reserved.

Original languageEnglish
Article number116219
JournalSocial Science and Medicine
Volume335
Early online dateSept 2023
DOIs
Publication statusPublished - Oct 2023

Citation

Lee, A. S. Y., Yung, P. S.-H., Ong, M. T.-Y., Lonsdale, C., Wong, T. W. L., Siu, P. M., Hagger, M. S., & Chan, D. K. C. (2023). Effectiveness of a theory-driven mHealth intervention in promoting post-surgery rehabilitation adherence in patients who had anterior cruciate ligament reconstruction: A randomized clinical trial. Social Science & Medicine, 335, Article 116219. https://doi.org/10.1016/j.socscimed.2023.116219

Keywords

  • mHealth
  • Integrated model
  • Motivation
  • Social cognition beliefs
  • Treatment adherence
  • ACL
  • Self-determination theory
  • Theory of planned behavior

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