Acute postoperative pain trajectories may differ between surgical procedures [1] and individuals who undergo the same procedure [2]. To date, clinical measurement of acute pain has been generally limited to pain intensity, which provides an inadequate assessment of recovery [3]. Despite recommendations to incorporate patient-reported outcomes into peri-operative pain assessment and management [3], technological and other barriers have prevented incorporation into routine clinical care.

Using an automated short message service text messaging system described previously for peripheral nerve block follow-up [4], we attempted implementation of patient-reported pain intensity and interference measurement for one week following total knee arthroplasty (TKA) and total shoulder arthroplasty (TSA) as a clinical care improvement project and tested the feasibility of this as a data collection tool.

Over 8 months, a convenience sample of patients who underwent primary TKA and TSA at a single Veterans Affairs hospital were invited to participate. All patients owned a mobile telephone and expressed willingness to respond to pain-related questions once daily for postoperative days 1–7 as part of clinical care. Retrospective review of the data was performed with IRB approval and waiver of informed consent.

All patients received multimodal analgesia with oral paracetamol and celecoxib before surgery, if not contraindicated, and a perineural catheter appropriate for site which infused 0.2% ropivacaine 6 ml.h^-1 postoperatively with 5 ml patient-controlled boluses available every 30 min. Patients undergoing TKA received spinal or general anaesthesia and all patients undergoing TSA received general anaesthesia.

To assess pain interference with activity, sleep, mood and stress in addition to pain intensity over the previous 24 h, we utilised the Defence and Veterans Pain Rating Scale and supplemental questions [3, 5]. These Likert-type questions (0 = no pain/interference, 10 = maximum pain/interference) were programmed securely within REDCap (Nashville, TN, USA) for data collection and integrated with Twilio (San Francisco, CA, USA) for automated text messaging at the same time each day [4]. The daily text messages and code are available in online Supporting Information Appendix S1. Any response triggered the instrument, whereas no response triggered a reminder at 15.00.

Given the small sample, data are presented as descriptive statistics and no comparisons were made. From December 2021 to July 2022, 16 patients participated. Median (IQR [range]) age of patients having TKA (n = 10) was 70 (68–74 [63–79]) y, and patients having TSA (n = 6) was 50 (41–62 [27–73]) y. One TSA patient was female, and all other patients were male. Duration of stay was 3.5 (3–4 [2–8]) days for patients having TKA and 1 (1–1 [1–3]) days for patients having TSA, with 1 day being same-day discharge.

The proportion of text messaging respondents per postoperative day, in aggregate and divided by inpatient vs. outpatient status, is shown in Figure 1. The highest response rate from all participants was 69% (11/16) on postoperative day 3. On postoperative days 1 and 4, 62% (10/16) responded. By postoperative days 6 and 7, only 44% (7/16) and 50% (8/16) of participants responded, respectively.

This project provides some important observations related to the challenges of collecting patient-reported outcomes in routine clinical practice. Despite using the common communication modality of text messaging [4], the rate of non-responders was high during the 7-day follow-up period, and some of the responses were incomplete or invalid (e.g. text response in lieu of numerical score) despite pre-operative teaching.

Response rates may have been higher in outpatients in the early postoperative period. We speculate that inpatients may have had limited access to their mobile phones or viewed the text messaging questions as redundant. However, the outpatients in this pilot were predominantly younger people who underwent TSA. Our small convenience sample, low overall recruitment rate and high frequency of attempted patient contact (i.e. daily) prevent us from drawing any definitive conclusions.

We also recognise that alternative technological innovations now exist for gathering patient-reported data such as smartphone applications [6, 7] and that there may be preferences for or against the use of technology that may vary by age group or patient population [8]. The results of this pilot project suggest that automated daily text messaging may not be a reliable means for collecting patient-reported outcomes in routine clinical care. As the demand for these data increases with the trend towards patient-centred care, further research is needed to identify the most acceptable frequency and mode of contact for patients while balancing the potential burden of clinician time and effort involved in measurement.

手术过程 [1] 和接受相同手术的个体之间的急性术后疼痛轨迹可能不同 [2]。迄今为止，急性疼痛的临床测量通常仅限于疼痛强度，这对恢复情况的评估不充分[3]。尽管建议将患者报告的结果纳入围手术期疼痛评估和管理中[3]，但技术和其他障碍阻碍了纳入常规临床护理。

使用先前描述的用于周围神经阻滞随访的自动短信服务文本消息系统[4]，我们尝试在全膝关节置换术（TKA）和全肩关节置换术（TSA）后一周内实施患者报告的疼痛强度和干扰测量）作为临床护理改进项目，并测试了其作为数据收集工具的可行性。

在 8 个多月的时间里，在一家退伍军人事务部医院接受过初次 TKA 和 TSA 的患者的方便样本被邀请参加。所有患者都拥有移动电话，并表示愿意在术后第 1-7 天每天回答一次与疼痛相关的问题，作为临床护理的一部分。数据的回顾性审查是在 IRB 批准并放弃知情同意的情况下进行的。

所有患者术前均接受多模式镇痛，如无禁忌症，口服扑热息痛和塞来昔布，并在术后使用适合部位的神经周围导管输注 0.2% 罗哌卡因 6 ml.h ^-1 ，每次可使用 5 ml 患者自控推注。 30分钟。接受 TKA 的患者接受脊髓或全身麻醉，所有接受 TSA 的患者均接受全身麻醉。

为了评估疼痛对活动、睡眠、情绪和压力以及过去 24 小时内疼痛强度的干扰，我们使用了国防和退伍军人疼痛评定量表和补充问题 [3, 5]。这些 Likert 型问题（0 = 无疼痛/干扰，10 = 最大疼痛/干扰）在 REDCap（美国田纳西州纳什维尔）内安全编程以进行数据收集，并与 Twilio（美国加利福尼亚州旧金山）集成以实现自动文本每天同一时间发送消息[4]。每日短信和代码可在在线支持信息附录 S1 中找到。任何响应都会触发仪器，而没有响应则会在 15 点触发提醒。

鉴于样本较小，数据以描述性统计的形式呈现，未进行比较。 2021年12月至2022年7月，共有16名患者参与。接受 TKA 患者 (n = 10) 的中位年龄 (IQR [范围]) 为 70 (68–74 [63–79]) 岁，接受 TSA 患者 (n = 6) 为 50 (41–62 [27–73]) 岁]) y。一名 TSA 患者为女性，所有其他患者均为男性。 TKA 患者的住院时间为 3.5 (3–4 [2–8]) 天，TSA 患者的住院时间为 1 (1–1 [1–3]) 天，其中 1 天为当天出院。

术后每天发短信的受访者比例（按住院患者与门诊状态划分）如图 1 所示。术后第 3 天，所有参与者的最高回复率为 69% (11/16)。 1 和 4，62% (10/16) 做出了回应。到术后第 6 天和第 7 天，只有 44% (7/16) 和 50% (8/16) 的参与者分别做出了反应。

该项目提供了一些与在常规临床实践中收集患者报告结果的挑战相关的重要观察结果。尽管使用了短信这种常见的沟通方式[4]，但在7天的随访期间，不回复者的比例很高，并且一些回复不完整或无效（例如，以文字回复代替数字分数）尽管进行了术前教学。

术后早期门诊患者的反应率可能更高。我们推测，住院患者使用手机的机会可能有限，或者认为短信问题是多余的。然而，该试点项目的门诊患者主要是接受 TSA 的年轻人。我们的样本量较小，总体招募率较低，并且尝试接触患者的频率较高（即每天），因此我们无法得出任何明确的结论。

我们还认识到，现在存在用于收集患者报告数据的替代技术创新，例如智能手机应用程序 [6, 7]，并且可能会根据年龄组或患者群体的不同而偏好或反对使用技术 [8]。该试点项目的结果表明，每日自动短信可能不是收集常规临床护理中患者报告结果的可靠手段。随着以患者为中心的护理趋势对这些数据的需求不断增加，需要进一步的研究来确定患者最可接受的接触频率和模式，同时平衡临床医生在测量中所花费的时间和精力的潜在负担。