JMIR Publications

ABSTRACT

Background:

Major surgery is associated with negative postoperative outcomes, such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mHealth could be an effective new approach.

Objective:

The objectives of this pilot study were 1) to evaluate the usability of the ‘Be Prepared’ mHealth application prototype for people undergoing major surgery, 2) to explore if the application was capable of bringing about a change in risk behaviours and 3) to estimate a preliminary effect of the application on functional recovery after major surgery.

Methods:

A (mixed methods) pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total 86 people undergoing major surgery participated. Participants in the intervention group received access to the ‘Be Prepared’ mHealth application, a smartphone application using behaviour change techniques to address risk behaviour prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviours 3-days prior to surgery and functional recovery 30-days after discharge from hospital (PROMIS 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 analysis. Semi-structured interviews about the usability of the application were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data.

Results:

Eighty-six people, of whom 40 in the intervention group and 39 in the control group, were available for further analysis. The participants had a median age of 61 years (51.0; 68.0). The System Usability Scale showed that patients considered the ‘Be Prepared’ application to have acceptable usability (mean 68.2, SD 18.4). Interviews supported the usability of the application. The major point of improvement identified was further personalization of the app. Compared to the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2/2 frequent alcohol users in the intervention group vs 1/9 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 (Beta = -2.4 [95CI −5.9, 1.1]).

Conclusions:

The ‘Be Prepared’ mHealth application prototype shows potential in terms of usability and changing risk behaviour prior to major surgery. No preliminary effect of the application on functional recovery was found yet. Points of improvement have been identified with which the application and future research can be optimized. Clinical Trial: This pilot study was not registered at the Netherlands Trial Registry. The following main study is registered with the reference number NL8623.