RXWell to Decrease Post-Operative Opioid Use in Total Knee or Hip Arthroplasty

NCT ID: NCT05658796

Last Updated: 2025-11-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-27

Study Completion Date

2026-12-30

Brief Summary

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It is envisioned that multipronged benefits from this pilot work for the UPMC ISD and its members. It is expected the RxWell platform to provide the following benefits: expansion of the use of RxWell to all UPMC ISD members providing peri-operative mood management with advantage of improved peri-operative outcomes, improving saving for the UPMC ISD by hastening the recovery and decreased resource utilization, and addition to the high-value care of UPMC with this holistic approach to patient perioperative care

Detailed Description

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The content of the digital behavioral tool was developed based on standard Cognitive Behavioral Therapy (CBT) techniques. An additional layer of support includes a behavioral health coach who provides guidance and motivation throughout the use of the app via in-app text messaging.

This approach has already been tested at UPMC on multiple adult clinical populations. This project represents the first pilot of the digital behavioral tool with perioperative patients

The digital behavioral tool can provide a resource gap by providing preventive mental health services to promote mental health wellness for patients to help reduce the deleterious impact of established mood disorders on recovery following primary total knee replacements including:

* pain and opioid requirement,
* functional recovery,
* decrease complications, and
* reduce resources utilization such as hospital length of stay, postoperative need for visits and the use of rehabilitation.

1. Determine the feasibility of using RxWell for patients undergoing elective surgery who have mood disorder symptoms using MyUPMC platform and established either at the time of visiting the Center for Perioperative Care (CPC) either in-person or via anesthesia telemedicine services (ATS) in a tertiary care system.
2. Determine the impact of RxWell-associated improvements in anxiety, depression, and catastrophizing on postoperative outcomes with a special focus on resources utilization.

Subjects who choose to sign electronically will be provided a link via email for REDCap. This link will include an electronic consent document and the ability to sign with a computer cursor, stylus, or their finger depending on the device the subject uses to access this link.

Conditions

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Mood Disorders Anxiety Depressive Symptoms Depression Anxiety Disorders Anxiety Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Investigators

Study Groups

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Control

No intervention (No RxWell). Subjects will receive standard of care and education regarding potential resources for anxiety and depression. Subjects will complete questionnaires via REDCap assessing primary and secondary outcomes

Group Type ACTIVE_COMPARATOR

-RxWell

Intervention Type BEHAVIORAL

Treatment as usual

Intervention: RxWell

RxWell Intervention. Subjects will receive standard of care and digital cognitive behavioral intervention by using the application RxWell. Subjects will complete questionnaires via REDCap assessing primary and secondary outcomes and will complete GAD-7 (Generalized Anxiety Disorder Scale) and PHQ-8 (Patient Health Questionnaire for Depression) every 2 weeks within the RxWell application.

Group Type EXPERIMENTAL

+RxWell

Intervention Type BEHAVIORAL

During the SuRxgWell trial, if a participant is randomized to receive RxWell, they will be provided with an access code that is required to download the app. Once the participant has downloaded the app, they will be paired with a UPMC coach who will guide the person through the sessions using in-app texting to help give them the tools needed to actively cope with anxiety and/or depression. The UPMC coaches are supervised by a licensed UPMC mental health clinician. The participant will have access to the app and coach for six months after they have consented. The digital behavioral tool includes over 30 brief Cognitive Behavioral Therapy (CBT) and mindfulness-based techniques.

Control (screen failures)

We will collect data on patient outcomes for patients that did not meet criteria for the RxWell intervention.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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+RxWell

During the SuRxgWell trial, if a participant is randomized to receive RxWell, they will be provided with an access code that is required to download the app. Once the participant has downloaded the app, they will be paired with a UPMC coach who will guide the person through the sessions using in-app texting to help give them the tools needed to actively cope with anxiety and/or depression. The UPMC coaches are supervised by a licensed UPMC mental health clinician. The participant will have access to the app and coach for six months after they have consented. The digital behavioral tool includes over 30 brief Cognitive Behavioral Therapy (CBT) and mindfulness-based techniques.

Intervention Type BEHAVIORAL

-RxWell

Treatment as usual

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Adults \>18 years
* Scheduled for elective primary total knee arthroplasty (TKA) or hip replacement (THA) at the approved UPMC hospitals
* Moderately high levels of mood disorder symptoms on validated PROMIS measures, defined as a T-score \> or = to 60 on PROMIS Anxiety 4a short form and/or PROMIS Depression4a short form

Exclusion Criteria

* Patients undergoing non-elective surgery or secondary arthroplasty
* Active delirium, neurocognitive impairment, or severe intellectual disability
* No access to a smart device (phone or tablet)
* Active alcoholism (defined as daily use of more than 1 liter of wine and /or 3 or more shots of hard liquor) or drug abuse (defined as daily use of illicit drugs)
* Profound mood disorders requiring immediate intervention such as suicidal ideation, defined as a PROMIS Depression score of more than 70
* A PROMIS Anxiety and/or Depression T-score \>70, which corresponds to severe anxiety and depression.

* Patients needing immediate care will be referred to psychiatrists and primary team.
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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Ata Murat Kaynar

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ata Murat Kaynar, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

UPMC Department of Anesthesiology and Perioperative Medicine

Locations

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UPMC East

Monroeville, Pennsylvania, United States

Site Status RECRUITING

UPMC Shadyside

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

UPMC Passavant

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Ata Murat Kaynar, MD, MPH

Role: CONTACT

412-383-3463

Carly Riedmann, MPH

Role: CONTACT

412-623-4147

Facility Contacts

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Ata Murat Kaynar, MD, MPH

Role: primary

412-383-3463

Amy Monroe, MPH, MBA

Role: backup

4126236382

Ata Murat Kaynar, MD, MPH

Role: primary

412-383-3463

Amy Monroe, MPH, MBA

Role: backup

4126236382

Ata Murat Kaynar, MD, MPH

Role: primary

412-383-3463

Amy Monroe, MPH, MBA

Role: backup

4126236382

References

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Kaynar AM, Lin C, Sanchez AG, Lavage DR, Monroe A, Zharichenko N, Strassburger M, Saucier K, Groff YJ, Klatt BA, O'Malley MJ, Szigethy E, Wasan AD, Chelly JE. SuRxgWell: study protocol for a randomized controlled trial of telemedicine-based digital cognitive behavioral intervention for high anxiety and depression among patients undergoing elective hip and knee arthroplasty surgery. Trials. 2023 Nov 9;24(1):715. doi: 10.1186/s13063-023-07634-0.

Reference Type DERIVED
PMID: 37946291 (View on PubMed)

Other Identifiers

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R21DA061414-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY21120053

Identifier Type: -

Identifier Source: org_study_id

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