Development and Measurement of the Effects of a Digital Education Solution for Patients Undergoing Total Hip or Knee Arthroplasty

Generic health-related quality-of-life measure including five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and a visual analogue scale (VAS).

Range:

Index score: typically ranges from <0 (health states worse than death) to 1 (perfect health).

VAS: 0 to 100, where 100 indicates the best imaginable health.

Direction: Higher scores reflect better health status.

Patient satisfaction with hospital care will be evaluated using the Association Nationale pour la Qualité (ANQ) patient satisfaction questionnaire.

The ANQ questionnaire includes multiple items each rated on a Likert scale from 1 to 5, where higher scores indicate greater satisfaction. Depending on the domain structure used locally, total scores typically range from 1 (lowest satisfaction) to 5 (highest satisfaction) per item; domain or global scores are expressed as mean values, with higher values reflecting better satisfaction with care.

Patient engagement in disease management and surgical preparation will be assessed using the Patient Activation Measure-13 (PAM-13).

The PAM-13 contains 13 items, each scored from 1 (strongly disagree) to 4 (strongly agree).

Raw scores are converted to a standardized activation score ranging from 0 to 100.

Higher scores indicate greater patient activation, confidence, and involvement in their own health management.

Scores classify patients into four activation levels, with Level 1 = lowest activation and Level 4 = highest activation.

Physical activity levels will be assessed using the International Physical Activity Questionnaire (IPAQ - Short Form).

The IPAQ evaluates physical activity performed in the last 7 days across four domains: walking, moderate-intensity activity, vigorous-intensity activity, and sedentary time.

Scores are expressed as Metabolic Equivalent of Task (MET)-minutes per week. Total physical activity score typically ranges from 0 MET-min/week (no reported activity) to > 3,000 MET-min/week (very high activity levels).

Higher MET-min/week scores indicate higher levels of physical activity.

Participants will also be classified into the IPAQ categories:

Low physical activity, Moderate physical activity, High physical activity, based on standard IPAQ scoring guidelines.

Fear and anxiety associated with the upcoming surgery will be measured using the Survey of Surgical Fear (SSF).

The SSF includes 8 items, each rated from 0 (not at all fearful) to 10 (extremely fearful).

Total score range: 0 to 80.

The questionnaire provides two subscale scores:

• Short-term surgical fear (items 1-4), range 0-40
• Long-term surgical fear (items 5-8), range 0-40

Higher scores indicate higher levels of fear and anxiety related to surgery.

Patients will report pain intensity using the Numeric Rating Scale (EVA), during routine follow-up visits.

Patient expectations concerning pain relief, mobility, essential daily activities, psychological benefits, and non-essential activities (e.g., sport/leisure) will be measured using the Hospital for Special Surgery (HSS) Knee or Hip Expectations Survey, depending on the type of surgery.

A qualitative review of the messages sent by patients to the remote care support team (CTS) will be performed to identify difficulties encountered during the intervention and the solutions provided.

Joint-specific questionnaire assessing knee or hip pain and functional ability after knee or hip surgery.

Range: 0 to 48, based on 12 items (0-4 per item).

Direction: Higher scores indicate better knee or hip function and less pain.

Satisfaction with the mobile application will be assessed using the User Version of the Mobile Application Rating Scale (uMARS).

The uMARS consists of 20 items rated from 1 to 5, grouped into four objective quality subscales (engagement, functionality, aesthetics, information) and one subjective quality subscale. Subscale and total scores range from 1 (poor quality) to 5 (excellent quality). Higher uMARS scores reflect greater perceived app quality and satisfaction.

Health literacy will be evaluated using the French version of the eHealth Literacy Scale (F-eHEALS).

The F-eHEALS contains 8 items, each rated from 1 (strongly disagree) to 5 (strongly agree).

Total score range: 8 to 40. Higher scores indicate better perceived eHealth literacy, including ability to find, appraise, and use online health information.

Postoperative complications will be recorded by clinical staff according to routine medical documentation.

Outcomes include the presence or absence of complications and the type of complication (e.g., infection, thromboembolic event, wound complication, cardiovascular or respiratory event).

This is a categorical clinical outcome (no scoring scale).

Length of hospital stay, expressed in days, with higher values indicating longer hospitalization.

Hospital readmissions within the follow-up period will be recorded by clinical staff.

Reported as yes/no, with reason for readmission documented when applicable. This is a binary clinical outcome (no scoring scale).

A stratified analysis will be conducted to evaluate whether the impact of the digital education intervention varies across patient subgroups (e.g., age, education level, comorbidity profile). This will help identify clusters of patients who benefit most from digital education.