Impact of a remote lifestyle coaching program on the length of hospital stay and complications in patients undergoing knee and hip arthroplasty surgery

In a blog about the optimization of patients for surgery, Dr Rebecca Barker discusses SAPIEN, a study of a remote lifestyle coaching program for patients undergoing knee and hip arthroplasty surgery, registered at the ISRCTN registry.

I am Dr Rebecca Barker a Consultant Anesthetist at Sherwood Forest Hospitals. I am passionate about the optimization of patients for surgery. Outcomes are better for patients who are fitter, more activated and engaged in their own healthcare.

This is even more relevant for the elective recovery program post-COVID, with patients having higher risks of deconditioning due to having waited for surgery for longer than usual.

The SAPIEN mobile app-based behavioral pilot

As a solution to patients having a remote lifestyle, a mobile app-based behavioral intervention, Sapien, was developed. Patients undergoing elective surgery were able to use personalized digital guidance with one-to-one remote health coaching preoperatively and support their recovery during the postoperative phase.

The app aims to modify risk by supporting patients to:

Friends walking together in a park
Friends walking together in a park
  1. Increase physical activity levels
  2. Stop smoking
  3. Reduce alcohol intake
  4. Improve diet
  5. Improve sleep duration and quality
  6. Enhance preparedness for their perioperative journey


Initially we piloted this lifestyle coaching app from Sapien. It supported patients undergoing lower limb primary elective arthroplasty to make lifestyle improvements and become activated in their own care in the weeks running up to surgery. It also supported in the initial post-operative period as patients went home.

The initial qualitative feedback from patients was positive. The length of hospital stay was shown in the pilot to be shorter with accompanying cost savings.

Patient activation measures were also calculated at the start and end of the study of the pilot and demonstrated that patients became more activated in their own health and an active participant in their own recovery.

Randomized controlled trial

The pilot program has since developed into a randomized controlled trial which is multicentered. Patients received either the Sapien lifestyle coaching app or routine care. Again, the study focuses on outcomes including patient activation measures and the length of hospital stay.

Intervention success will be measured using Patient Activation Measure (PAM) scoring at program entry, pre-operatively (before surgery) and up to 30 days post-surgery. This is exciting as the evidence shows that those who are more activated have much better long-term health outcomes. Whilst you cannot measure this impact easily, more activated patients make fewer inappropriate emergency department attendances, manage self-limiting conditions better, attend fewer doctor’s appointments and engage more actively in taking care of their own health.

The secondary outcome measures we are looking at include:

  1. Postoperative complications within 30 days of surgery (pulmonary and cardiac)
  2. Readmission to the hospital within 30 days after surgery
  3. Length of stay
  4. The proportion of cancellations of surgeries
  5. Health behavior change

Patient feedback has been excellent about the support felt by having the app and the virtual face-to-face lifestyle support. The hope is that this will translate into activated patients with fewer complications as the data is gathered and analyzed.

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