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The Effectiveness of the Be Prepared mHealth App on Recovery of Physical Functioning After Major Elective Surgery:
Miriam van der Velde1,2, Marike van der Leeden3,4, Edwin Geleijn3
1Research Group Innovation of Human Movement Care, Center for Healthy and Sustainable Living, HU University of Applied Sciences, Heidelberglaan 7, Utrecht, 3264 LJ, The Netherlands, 31 0642214251.
Background:
Patients undergoing major surgery are at risk of complications and delayed recovery. Prehabilitation has shown promise in improving postoperative outcomes. Offering prehabilitation by means of mHealth can help overcome barriers to participating in prehabilitation and empower patients prior to major surgery. We developed the Be Prepared mHealth app, which has shown potential in an earlier pilot study.
Objective:
This study aims to evaluate the effectiveness of the Be Prepared app on postoperative recovery of physical functioning (PF) in patients undergoing major elective surgery.
Methods:
This study was a multicenter randomized controlled trial with 2 arms. Adults scheduled for major elective surgery were randomly assigned to the control (usual care) or intervention group (Be Prepared app in addition to usual care). The Be Prepared app is a smartphone app with pre- and postoperative information and instructions on changing risk behavior for patients undergoing major elective surgery. The primary outcome was recovery of postoperative PF up to 12 weeks after hospital discharge measured with the Computer Adaptive Test Patient-Reported Outcomes Measurement Information System-PF. Secondary outcomes included social participation, self-reported recovery, health-related quality of life, postoperative outcomes, and patient satisfaction. Measurements were performed at 5 time points: before random assignment and 1, 3, 6, and 12 weeks after hospital discharge.
Results:
A total of 369 patients were analyzed, 181 in the control group and 188 in the intervention group. The result of the linear mixed effects model showed a mean slope difference in recovery of PF over 12 weeks of 2.97 (95% CI 0.90-5.02) in favor of the intervention group. However, this effect was not clinically relevant and was negated by the significantly lower PF score 1 week after hospital discharge in the intervention group (mean difference -1.72, 95% CI -3.38 to -0.07). Most secondary outcome measures did not show significantly greater improvements in the intervention group compared to the control group. Patient satisfaction with overall perioperative care was significantly higher in the intervention group compared to the control group and satisfaction with the Be Prepared app was high.
Conclusions:
The use of the Be Prepared app as a stand-alone intervention does not seem beneficial for improving postoperative recovery in patients undergoing major surgery. However, satisfaction with perioperative care was higher in patients using the app. Given the advantages of digital technology in health care, it can be considered a basis for prehabilitation care pathways, complemented by guidance from health care professionals as needed.
