M. van der Velde1,2,3, K. Valkenet2,1, E. Geleijn3, M. Kruisselbrink4, M. Marsman5, L. Janssen6, J. Ruurda7, D. van der Peet8, J. Aarden9, C. Veenhof2,1, M. van der Leeden3,10
1University of Applied Science Utrecht, Innovation of Human Movement Care Research Group, Utrecht, Netherlands, 2University Medical Center Utrecht, Utrecht University, Physical Therapy Science and Sports, Utrecht, Netherlands, 3Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, Netherlands, 4Utrecht University, Clinical Health Sciences, Program Physiotherapy Sciences, Utrecht, Netherlands, 5University Medical Center Utrecht, Utrecht University, Department of Anesthesiology, Utrecht, Netherlands, 6Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Anesthesiology, Amsterdam, Netherlands, 7University Medical Center Utrecht, Utrecht University, Department of Surgery, Utrecht, Netherlands, 8Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, Netherlands, 9Amsterdam University of Applied Sciences, European School of Physiotherapy, Faculty of Health, Amsterdam, Netherlands, 10Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
Background: Prehabilitation aims to improve the functional capacity of patients in the period between diagnosis and surgery, so that the patient can withstand the forthcoming stressor of major surgery. Prehabilitation often consists of physical training and nutritional interventions, with additional attention to other (lifestyle) risk factors such as smoking and alcohol cessation. Complying with prehabilitation can be difficult for patients due to the limited time frame before surgery, stress and barriers like problems with transportation. Mobile health (mHealth) has the potential to remove these barriers and improve the effectiveness of prehabilitation. In this study we investigate the Be Prepared mHealth application (app) prototype; a multimodal prehabilitation app for patients undergoing major surgery.
Purpose: This study aims to
1) evaluate the usability of the Be Prepared app,
2) explore whether the app was capable of bringing about a change in risk behaviors prior to surgery, and
3) explore a first effect of the app on functional recovery after major surgery.
1) evaluate the usability of the Be Prepared app,
2) explore whether the app was capable of bringing about a change in risk behaviors prior to surgery, and
3) explore a first effect of the app on functional recovery after major surgery.
Methods: A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. Eighty-six people undergoing major surgery participated. The intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual.
Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires.
Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about usability were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data.
Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires.
Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about usability were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data.
Results: Seventy-nine people, of which 40 in the intervention group, were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that the Be Prepared app had acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app.
Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=–2.4 [95% CI –5.9 to 1.1]).
Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=–2.4 [95% CI –5.9 to 1.1]).
Conclusions: The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified. Further research on the effectiveness of mHealth for prehabilitation is needed.
Implications: When proven effective, mHealth can be a promising new approach within prehabilitation. The improved Be Prepared app is currently being evaluated for effectiveness in a large multicenter randomized controlled trial.
Funding acknowledgements: This work was supported by the Foundation Innovative Alliance—Regional Attention and Action for Knowledge circulation.
Keywords:
mHealth
Prehabilitation
Lifestyle
mHealth
Prehabilitation
Lifestyle
Topics:
Innovative technology: information management, big data and artificial intelligence
Disability & rehabilitation
Innovative technology: information management, big data and artificial intelligence
Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Amsterdam University Medical Center
Committee: Bureau METc VUmc
Ethics number: NL61503.029.18
All authors, affiliations and abstracts have been published as submitted.
