Digital Literacy and Patient Satisfaction in Telemedicine Follow-Up With In-Person App Instruction Versus Outpatient Department Follow-Up After Upper-Extremity Surgery: A Randomized Controlled Trial.

Background: Telemedicine is increasingly used for postoperative follow-up in orthopedic surgery, but concerns remain regarding whether patients' digital literacy influences satisfaction with virtual care. Objective: This study aimed to compare patient satisfaction between telemedicine and in-person outpatient department (OPD) follow-up after upper-extremity surgery and to examine the association between digital literacy and patient satisfaction. Methods: This single-center, open-label randomized controlled trial enrolled adults undergoing nontraumatic hand or upper-extremity surgery. After trial registration, 70 participants were randomized in a 1:1 ratio to telemedicine (n=35, 50%) or in-person OPD follow-up (n=35, 50%) using block randomization with a fixed block size of 4. All participants received standardized postoperative education at the 2-week visit. Participants in the telemedicine group additionally received brief in-person instruction on the hospital-based Vajira@Home telemedicine app before completing a scheduled video-based follow-up at 6 weeks. Patient satisfaction was assessed at 2 and 6 weeks using a validated 6-item Likert scale questionnaire covering communication, convenience, understanding of care, and overall satisfaction. Digital literacy was measured at baseline using a standardized questionnaire. Between-group comparisons were performed using appropriate parametric or nonparametric tests. Results: Participants in the telemedicine group were younger than those in the outpatient department (OPD) group (mean 53.3, SD 11.5 years vs mean 59.7, SD 14.2 years) and had higher digital literacy scores (mean 12.0, SD 3.5 vs mean 10.2, SD 2.5). Overall satisfaction scores were high in both groups at 2 and 6 weeks postoperatively (median 5, IQR 5-5 at both time points). No statistically significant differences were observed between groups across any satisfaction domains, including communication (P=.27), convenience (P=.41), and overall satisfaction (P=.35). Satisfaction scores remained stable over time within each group. Digital literacy was not associated with patient satisfaction. Conclusions: Telemedicine follow-up supported by brief in-person app instruction resulted in patient satisfaction that was not significantly different from traditional in-person outpatient follow-up after upper-extremity surgery. Although age and digital literacy differed modestly between groups, these factors did not influence satisfaction. These findings support telemedicine as an acceptable option for postoperative follow-up in appropriately selected patients.