Factors Influencing the Use of Mobile Apps and Wearables: Pre- and Post-Surgery Quality of Life Assessment Study

Quality of life (QoL) is an important surgical outcome, commonly assessed through self-reports, and has the potential to be enhanced by objective information from personal technologies such as smartphone apps and wearables. Understanding patients' perspectives on this application of personal technologies is scarce.

This study aimed to identify operational aspects of smartphone- and wearable-based assessments, as well as human and operational factors that may influence the acceptability of already owned (mostly smartphone) or new (mostly wearable) technologies by patients for pre- and post-surgery QoL assessments.

Through purposive sampling, 41 patients from 3 health care centers in Switzerland, the United States, and the United Kingdom, who were undergoing or scheduled for surgery for degenerative cervical myelopathy (DCM), liver transplantation, or total hip replacement, were interviewed about their perceptions of QoL, current use of smartphones, health apps, and wearables for self-management and their views on using these technologies to assess QoL before and after surgery.

Across the 3 studies (n=41), most (n=36) patients reported improved QoL after surgery, mainly due to reduced pain and fatigue and regained autonomy, while a few patients with DCM reported no change (n=2) or worsening (n=1). Patients were generally comfortable using smartphones and tablets, but few (n=4) used them for health management. Wearables were perceived differently across groups: they were well accepted in transplant@US, moderately in hip@UK, and least in myelopathy@CH. Many patients with DCM found wearables "useless," believing they added little to their self-awareness or recovery and could not replace human clinical judgment. Others expressed concerns about privacy, complexity, notifications, and battery life, while some acknowledged their motivational value when the data were clearly interpreted. Despite varying acceptance levels, most participants said they would consider using such devices if they contributed to research or improved care.

Given a mostly negative attitude of patients toward wearables, we discuss the use of smartphone-based automated logging of physical functioning (sleep and physical activity) instead. Such logging may be less accurate than a dedicated wearable, but it may be accurate enough to measure their pre- and post-surgery physical functioning changes. Additionally, a smartphone has the advantage of being already well integrated into the daily life of patients from the perspective of its functionality and the patients' routines, contrary to wearable devices, which would have been provided to the patients in the context of pre- and post-surgery clinical care and require additional attention for their continuous wear, charging, and data synchronization, among others.