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Performance of Automated Mobile Phone Text Messaging in the Delivery of Patient Reported Outcome Instruments
Chris A. Anthony, MD; Natalie Glass, MD; Katelyn McDonald, MD; Ericka A. Lawler, MD; Apurva S. Shah, MD
University of Iowa, Iowa City, IA

Introduction: Patient-reported outcome (PRO) instruments are integral in evaluating orthopaedic treatments and outcomes. Mobile phone use is high in the United states at 85% of the adult population and we recognize that mobile phones and software algorithms enable health care systems to communicate with and evaluate patients outside of the traditional hospital setting. This investigation is the first attempt to validate text message or software driven delivery of orthopaedic PRO instruments (12-Item Short Form Health Survey (SF-12) and short form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH)) on mobile phones. We hypothesized there would be a high correlation between PROs collected by automated delivery of text messages on mobile phones compared to paper delivery.

Materials & Methods: Written versions of the SF-12 and the QuickDASH were completed by patients in our orthopaedic hand and upper extremity clinic. Over the next 48 hours, the same patients also completed the mobile phone portion of the study outside of the clinic which included software driven, automated text message delivery of the SF-12 and QuickDASH, assigned in a random order. Correlations between written and text message delivery of the two PROs were assessed. Based on a power analysis (80% power, alpha 0.05), 39 patients were required to detect an intraclass correlation coefficient (ICC) value of 0.8 (excellent reproducibility) distinguishable from 0.6 (fair reproducibility).

Results: Seventy-two patients were enrolled in the investigation. Completion rates for mobile phone delivery of QuickDASH and SF-12 were 75% and 77% respectively. There were no significant differences in patient demographics between completers and non-completers of SF-12 or QuickDASH delivered by mobile phone. The ICC between the written and mobile phone delivery of QuickDASH was 0.91 (95% CI: 0.85-0.95). The ICC between the written and mobile phone delivery of the SF-12 physical health component summary was 0.88 (95% CI: 0.79-0.93) and 0.86 (95% CI: 0.75-0.92) for the SF-12 mental health component summary.

Conclusions: We find that text message delivery using mobile phones permits valid assessment of SF-12 and QuickDASH scores. The findings suggest software driven automated delivery of text communication to patients via mobile phones may be a valid method to obtain other PRO scores in orthopaedic patients. The results also suggest that appropriately designed software and mobile phone technology platforms may be utilized to communicate with patients outside of the hospital setting, and we emphasize the need for further inquiry in this area.

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