title: Are patients satisfied with a web-based followup after total joint arthroplasty?
abstract: BACKGROUND
  A web-based followup assessment may be a feasible, cost-saving alternative of tracking patient outcomes after total joint arthroplasty. However, before implementing a web-based program, it is important to determine patient satisfaction levels with the new followup method. Satisfaction with the care received is becoming an increasingly important metric, and we do not know to what degree patients are satisfied with an approach to followup that does not involve an in-person visit with their surgeons.
  
  
  OBJECTIVE
  We determined (1) patient satisfaction and (2) patients' preferences for followup method (web-based or in-person) after total joint arthroplasty.
  
  
  METHODS
  We randomized patients who were at least 12 months after primary THA or TKA to complete a web-based followup or to have their appointment at the clinic. There were 410 eligible patients contacted for the study during the recruitment period. Of these, 256 agreed to participate, and a total of 229 patients completed the study (89% of those enrolled, 56% of those potentially eligible; 111 in the usual-care group, 118 in the web-based group). Their mean age was 69 years (range, 38-86 years). There was no crossover between groups. All 229 patients completed a satisfaction questionnaire at the time of their followup appointments. Patients in the web-based group also completed a satisfaction and preference questionnaire 1 year later. Only patients from the web-based group were asked to indicate preference as they had experienced the web-based and in-person followup methods. We used descriptive statistics to summarize the satisfaction questionnaires and compared results using Pearson's chi-square test.
  
  
  RESULTS
  Ninety-one patients (82.0%) in the usual-care group indicated that they were either extremely or very satisfied with the followup process compared with 90 patients (75.6%) who were in the web-based group (p < 0.01; odds ratio [OR] = 3.95; 95% CI, 1.79-8.76). Similarly, patients in the usual care group were more satisfied with the care they received from their surgeon, compared with patients in the web-based group (92.8% versus 73.9%; p < 0.01, OR = 1.37; 95% CI, 0.73-2.57). Forty-four percent of patients preferred the web-based method, 36% preferred the usual method, and 16% had no preference (p = 0.01).
  
  
  CONCLUSIONS
  Our results show moderate to high satisfaction levels with a web-based followup assessment. Patients who completed the usual method of in-person followup assessment reported greater satisfaction; however, the difference was small and may not outweigh the additional cost and time-saving benefits of the web-based followup method.
  
  
  METHODS
  Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Faculty of Health Sciences, The University of Western Ontario, 1201 Western Road, London, ON, N6G 1H1, Canada, marsh.jacquelyn@gmail.com.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Marsh
authors.forename: Dianne
authors.initials: D
authors.lastname: Bryant
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.forename: Douglas
authors.initials: D
authors.lastname: Naudie
authors.forename: Alliya
authors.initials: A
authors.lastname: Remtulla
authors.forename: Richard
authors.initials: R
authors.lastname: McCalden
authors.forename: James
authors.initials: J
authors.lastname: Howard
authors.forename: Robert
authors.initials: R
authors.lastname: Bourne
authors.forename: James
authors.initials: J
authors.lastname: McAuley
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits; D009864:Ontario; D057240:Patient Preference; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D019112:Teleradiology; D013997:Time Factors; D016896:Treatment Outcome