Expanding role of the internet in the orthopaedic outpatient setting

The number of patients requiring review after joint arthroplasty is increasing. With an ageing population, increasing expectations from patients, and improved diagnostic methods and treatments, the demand for these procedures will also increase.1\ud\udThe Department of Orthopaedic Surgery at Royal Devon and Exeter Hospital (Exeter, UK) started to experience a backlog of long-term arthroplasty patients requiring follow-up owing to limited outpatient resources and clinical staff. This scenario led us to think about other ways of reviewing these patients and to explore the feasibility of ‘virtual’ follow-ups.\ud\udIn 2002, Gupte and colleagues reviewed Internet use in the setting of orthopaedic outpatient clinics. They investigated the: (i) prevalence of Internet use; (ii) perception of the quality of medical information provided by the Internet; (iii) future intentions and attitudes towards Internet-based consultations.2 Their study showed promising data about the potential use of Internet-based follow-up, concluding that more than half of the patients evaluated were willing to access the Internet for medical information, with younger patients more likely to do so. Moreover, a significant proportion of respondents were willing to undergo an Internet-based consultation.\ud\udThe decade between the study by Gupte and colleagues and the present study has seen huge expansion in the use and availability of the Internet in the domestic setting. In 2002, a poll by the UK Office of National Statistics (ONS) concluded that 46% of UK households had an Internet connection. In 2011, ONS data showed that 77% of UK homes had an active internet connection.3 This rise has continued and, in 2014, 84% of individuals used the internet and 76% of adults accessed the internet each day.4\ud\udIn addition, the way in which individuals access the internet is evolving, with 45% of internet users now accessing it via mobile devices. An estimated 6 million people accessed the internet via a mobile device for the first time in 2011.3\ud\udWith the huge growth in internet availability in the past decade, we aimed to: (i) ascertain how use, attitudes and perceptions of the internet have changed over this time; (ii) explore potential uses and problems of internet follow-up in a patient cohort; (iii) ascertain if patients had access to an email account and, if so, would consider using an email-based questionnaire on follow-up; (iv) discover if individuals who did not have direct access to the internet had friends or relatives who did, and whether they would be willing to engage in follow-up by ‘proxy’