JMIR Publications

ABSTRACT

Background:

Sedentary behavior (SB) is common after cancer surgery and may negatively affect recovery and quality of life, but postoperative symptoms (e.g., pain) can be a significant barrier to patients achieving recommended physical activity levels. We conducted a single-arm pilot trial evaluating the usability and acceptability of a real-time mobile intervention that detects prolonged sedentary behavior in the perioperative period and delivers prompts to walk that are tailored to daily self-reported symptom burden.

Objective:

To develop and test a mobile technology-supported intervention to reduce SB before and after cancer surgery and to evaluate the usability and feasibility of the intervention.

Methods:

Fifteen patients scheduled for abdominal cancer surgery consented to the study, which involved using a Fitbit smartwatch with a companion smartphone app across the perioperative period (from a minimum of 2 weeks before surgery through 30 days post-discharge). Participants received prompts to walk after any SB that exceeded a prespecified threshold, which varied from day to day based on patient-reported symptom severity. Participants also completed weekly semi-structured interviews to collect information on usability, acceptability, and experience using the app, and smartphone and smartwatch logs were examined to assess participant study compliance.

Results:

Of eligible patients approached, 79% agreed to participate. Attrition was low (7%) and due to poor health and prolonged hospitalization. Participants rated (0-100) the smartphone and smartwatch apps as very easy (M = 92.3 and 93.2, respectively) and pleasant to use (M = 93.0 and 93.2, respectively). Overall satisfaction with the whole system was 89.9, and the mean System Usability Scale score was 83.8 out of 100. Overall compliance with symptom reporting was 53%, decreasing significantly from before surgery (73% of all days) to inpatient recovery (32%) and post-discharge (41%). Overall Fitbit compliance was 76% but also declined from before surgery (90%) to inpatient (38%) and post-discharge (65%).

Conclusions:

Perioperative cancer patients were willing to use a smartwatch- and smartphone-based real-time intervention to reduce SB, and they rated the apps as very easy and pleasant to use. Compliance with the intervention declined significantly after surgery. The effects of the intervention on postoperative activity patterns, recovery, and quality of life will be evaluated in an ongoing randomized trial.