Web Application-Based Health Education Effect in Reducing Preoperative Anxiety Among Orthopaedic Surgery Patients: A Systematic Review

Agus Gunawan; Arif Setyo Upoyo

doi:10.26714/mki.9.2.2026.182-195

Web Application-Based Health Education Effect in Reducing Preoperative Anxiety Among Orthopaedic Surgery Patients: A Systematic Review

Agus Gunawan^(1*), Arif Setyo Upoyo⁽²⁾

(1) Universitas Jenderal Soedirman
(2) Universitas Jenderal Soedirman
(*) Corresponding Author

Abstract

Preoperative anxiety is highly prevalent among patients undergoing Orthopaedic surgery and is associated with adverse postoperative outcomes, including increased pain, delayed functional recovery, and prolonged hospital stay. Digital and web-based preoperative health education has emerged as a potential strategy to address these challenges; however, evidence regarding its effectiveness remains heterogeneous. This systematic review aimed to synthesize current evidence on the effectiveness of digital and web-based preoperative education interventions in reducing preoperative anxiety and related outcomes among Orthopaedic surgery patients. This review followed PRISMA 2020 guidelines. A thorough search was performed on ScienceDirect, PubMed, Scopus, EBSCOhost, and Wiley Online Library for studies released from January 2020 to September 2025. Eligible studies included randomized controlled trials, feasibility or pilot randomized studies, and trial protocols. The outcomes of interest encompassed preoperative anxiety, pain levels, opioid consumption, functional recovery, and patient satisfaction. Methodological quality was assessed using the Joanna Briggs Institute's critical appraisal tools. Six studies met the inclusion criteria, involving diverse Orthopaedic populations, including elective and trauma surgeries. Interventions varied and included web-based education, digital behavioral programs, and AI-based chatbot support. Several studies reported reductions in preoperative anxiety, although results were heterogeneous. Digital behavioral interventions demonstrated more consistent benefits for postoperative pain and pain catastrophizing, while education-only platforms showed mixed findings. Patient satisfaction was consistently higher in digital intervention groups. Digital preoperative education shows promising potential to reduce anxiety and enhance patient experience in Orthopaedic surgery. However, heterogeneity in interventions and study designs limits generalizability, indicating the need for larger, methodologically robust trials.

Keywords

Orthopaedic Surgical Procedures; Preoperative Anxiety; Digital Health Education; Mobile Applications; Web-Based Intervention

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References

Pokharel K, Bhattarai B, Tripathi M, Khatiwada S, Subedi A. Nepalese patients’ anxiety and concerns before surgery. J Clin Anesth 2011;23:372–8. https://doi.org/10.1016/J.JCLINANE.2010.12.011.

Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients - experience of a single unit. Acta Anaesthesiol Taiwanica 2012;50:3–6. https://doi.org/10.1016/J.AAT.2012.02.004.

Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Predictors of Acute Postsurgical Pain and Anxiety Following Primary Total Hip and Knee Arthroplasty. J Pain 2013;14:502–15. https://doi.org/10.1016/J.JPAIN.2012.12.020.

Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand 2001;45:298–307. https://doi.org/10.1034/j.1399-6576.2001.045003298.x.

Pekcan YO, Tuncalı B, Erol V. Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study. Brazilian J Anesthesiol (English Ed 2023;73:85–90. https://doi.org/10.1016/J.BJANE.2021.11.003.

Lee A, Chui PT, Gin T. Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions. Anesth Analg 2003;96:1424–31. https://doi.org/10.1213/01.ANE.0000055806.93400.93.

Van Oirschot G, Pomphrey A, Dunne C, Murphy K, Blood K, Doherty C. An Evaluation of the Design of Multimedia Patient Education Materials in Musculoskeletal Health Care: Systematic Review. JMIR Rehabil Assist Technol 2024;11:e48154. https://doi.org/10.2196/48154.

Saunders R, Seaman K, Emery L, Bulsara M, Ashford C, McDowall J, et al. Comparing an ehealth program (my hip journey) with standard care for total hip arthroplasty: Randomized controlled trial. JMIR Rehabil Assist Technol 2021;8. https://doi.org/10.2196/22944.

Chen C, Lam KT, Yip KM, So HK, Lum TYS, Wong ICK, et al. Comparison of an AI Chatbot With a Nurse Hotline in Reducing Anxiety and Depression Levels in the General Population: Pilot Randomized Controlled Trial. JMIR Hum Factors 2025;12. https://doi.org/https://doi.org/10.2196/65785.

Kim J, Chiesa N, Raazi M, Wright KD. A systematic review of technology-based preoperative preparation interventions for child and parent anxiety. Can J Anesth 2019;66:966–86. https://doi.org/10.1007/s12630-019-01387-8.

Ng SX, Wang W, Shen Q, Toh ZA, He H-G. The effectiveness of preoperative education interventions on improving perioperative outcomes of adult patients undergoing cardiac surgery: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2022;21:521–36. https://doi.org/10.1093/eurjcn/zvab123.

Yahagi M, Hiruta R, Miyauchi C, Tanaka S, Taguchi A, Yaguchi Y. Comparison of Conventional Anesthesia Nurse Education and an Artificial Intelligence Chatbot (ChatGPT) Intervention on Preoperative Anxiety: A Randomized Controlled Trial. J PeriAnesthesia Nurs 2024;39:767–71. https://doi.org/https://doi.org/10.1016/j.jopan.2023.12.005.

Ziadni MS, You DS, Keane R, Salazar B, Jaros S, Ram J, et al. “My Surgical Success”: Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery - A Randomized Trial. Anesth Analg 2022;135:394–405. https://doi.org/10.1213/ANE.0000000000006088.

Krishnamurthy P, Heathcote L, Wheeler A, Mackey I, Darnall B, Taub C, et al. “My Surgical Success”: Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial. Pain Med 2019;0:1–10. https://doi.org/10.1093/pm/pnz094.

Turkdogan S, Roy CF, Chartier G, Payne R, Mlynarek A, Forest V-I, et al. Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022;148:173–9. https://doi.org/10.1001/jamaoto.2021.3765.

Baas DC, van AALDEREN-WICHERS JC, VAN DER GOOT TH, Verhagen RJ. The effect of pain neuroscience education on chronic postsurgical pain after total knee arthroplasty: a randomized controlled trial. Acta Orthop 2024;95:485–91. https://doi.org/10.2340/17453674.2024.41346.

Kaynar AM, Lin C, Sanchez AG, Lavage DR, Monroe A, Zharichenko N, et al. 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;24. https://doi.org/10.1186/s13063-023-07634-0.

Mohammadi S, Westby MD, Schneeberg A, Watson W, Dhariwal A, Simpson E, et al. The hip instructional prehabilitation program for enhanced recovery (HIPPER) as an eHealth approach to presurgical hip replacement Education: Feasibility randomized controlled trial. Int J Orthop Trauma Nurs 2025;58:101210. https://doi.org/10.1016/j.ijotn.2025.101210.

Lazarus RS, Folkman S. Stress, appraisal, and coping. New York, NY: Springer; 1984.

Ghoneim MM, O’Hara MW. Depression and postoperative complications: An overview Visceral and general surgery. BMC Surg 2016;16:1–10. https://doi.org/10.1186/s12893-016-0120-y.

Zainal NH, Soh CP, Van Doren N, Benjet C. Do the effects of internet-delivered cognitive-behavioral therapy (i-CBT) last after a year and beyond? A meta-analysis of 154 randomized controlled trials (RCTs). Clin Psychol Rev 2024;114:102518. https://doi.org/10.1016/j.cpr.2024.102518.

Johnson E, Corrick S, Isley S, Vandermeer B, Dolgoy N, Bates J, et al. Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs. PLOS Digit Heal 2024;3:e0000435.

Wright JH, Owen J, Eells TD, Antle B, Bishop LB, Girdler R, et al. Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression among Adults in Primary Care: A Randomized Clinical Trial. JAMA Netw Open 2022;5:1–13. https://doi.org/10.1001/jamanetworkopen.2021.46716.

Hollis C, Falconer CJ, Martin JL, Whittington C, Stockton S, Glazebrook C, et al. Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review. J Child Psychol Psychiatry 2017;58:474–503. https://doi.org/10.1111/jcpp.12663.

Buvanendran A, Sremac AC, Merriman PA, Della Valle CJ, Burns JW, McCarthy RJ. Preoperative cognitive–behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial. Reg Anesth &Amp; Pain Med 2021;46:313 LP – 321. https://doi.org/10.1136/rapm-2020-102258.

Chunduri A, Aggarwal AK. Multimodal Pain Management in Orthopedic Surgery. J Clin Med 2022;11. https://doi.org/10.3390/jcm11216386.

Goode VM, Morgan B, Muckler VC, Cary MPJ, Zdeb CE, Zychowicz M. Multimodal Pain Management for Major Joint Replacement Surgery. Orthop Nurs 2019;38:150–6. https://doi.org/10.1097/NOR.0000000000000525.

Giravi HY, Biskupiak Z, Tyler LS, Bulaj G. Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care. Front Digit Heal 2022;4:884047. https://doi.org/10.3389/fdgth.2022.884047.

Wang J, Bi H, Wang Y, Song Y, Xu H, Zhong S, et al. Application of artificial intelligence in postoperative orthopedic rehabilitation: a scoping review. Front Digit Heal 2026;Volume 7-. https://doi.org/10.3389/fdgth.2025.1746552.

Singh G, Dhaniwala N, Jadawala VH, Suneja A, Batra N. Recovery of Muscular Strength Following Total Hip Replacement: A Narrative Review. Cureus 2024;16:e68033. https://doi.org/10.7759/cureus.68033.

AlHossan AM, Jahhaf RH, Alharbi AS, Alqahtani LM, Alshahrani RM, Alowaidah LT, et al. Digital and virtual reality-based rehabilitation versus conventional therapy for rotator cuff tears and post-repair recovery: a systematic review and meta-analysis. JSES Rev Reports, Tech 2026;6:100584. https://doi.org/10.1016/j.xrrt.2025.09.003.

Abraham JJ, Kumar S, Vedavyasa Acharya KK. Determinants of patient compliance with post-operative rehabilitation after lower limb orthopaedic surgery: a prospective study. BMC Musculoskelet Disord 2025;26:1065. https://doi.org/10.1186/s12891-025-09320-5.

Lau CKY, Saad A, Camara B, Rahman D, Bolea-Alamanac B. Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review. J Med Internet Res 2024;26:e52609. https://doi.org/10.2196/52609.

Torous J, Bucci S, Bell IH, Kessing L V, Faurholt-Jepsen M, Whelan P, et al. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021;20:318–35. https://doi.org/10.1002/wps.20883.

Torous J, Linardon J, Goldberg SB, Sun S, Bell I, Nicholas J, et al. The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality. World Psychiatry 2025;24:156–74. https://doi.org/10.1002/wps.21299.

Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: A Health Technology Assessment. Ont Health Technol Assess Ser 2019;19:1–199.

Crocamo C, Palpella D, Cavaleri D, Nasti C, Piacenti S, Morello P, et al. Digital health interventions for mental health disorders: an umbrella review of meta-analyses of randomised controlled trials. Lancet Digit Heal 2025;7:100878. https://doi.org/https://doi.org/10.1016/j.landig.2025.100878.

Donner S, Knauer P, Kienzle A, Dinneen J, Burger J, Perka C, et al. Exploring Patient Perspectives, Engagement, and Output Quality in Doctor-Supervised Use of Artificial Intelligence During Informed Consent Consultation With ChatGPT and Retrieval Augmented Generation (RAG): Quantitative Exploratory Study. J Med Internet Res 2025;27:e73717. https://doi.org/10.2196/73717.

Chen T, Li Q, Zhao D, Zhang W, Chen Y, Yang J, et al. Utilisation of AI-driven chatbots for perioperative health information seeking: a descriptive qualitative study of orthopaedic patients and family members. BMJ Open 2025;15. https://doi.org/10.1136/bmjopen-2025-099824.

Schmidt D, Fritsch J, Feil K, Weyland S, Rittmann L-M, Jekauc D. Impact of digital and conventional rehabilitation aftercare on physical and mental health in orthopedic patients in Germany. Front Public Heal 2024;12:1344063. https://doi.org/10.3389/fpubh.2024.1344063.