JMIR Publications

ABSTRACT

Background:

Health behaviour changes made by patients during the perioperative period can impact on the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopaedic surgery patients is central to motivating healthier behaviour change, improving recovery and optimizing overall surgical success in the short- and long-term.

Objective:

This qualitative investigation explores patient perspectives on the key technology features that would help support them to change their lifestyle behaviours during the pre- and post-operative periods, and that could potentially maintain long-term healthy lifestyles following recovery.

Methods:

Semi-structured interviews with pre- and post-operative elective orthopaedic patients were conducted between May and June 2020, via telephone and video call-based software. Patient perspectives of using digital technologies to complement current surgical care and support with lifestyle behaviour change were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with NVivo (version 12) software facilitating data management. Ethical approval was obtained from the NHS Health Research Authority.

Results:

Eighteen participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the elective perioperative journey. These center around an intervention’s ability to: 1) deliver both general and specific surgical advice in a timely manner, 2) direct a descriptive and structured recovery, 3) enable customizable, patient-controlled settings, and 4) incorporate interactive, user-centered features. Pre-operative initiation of interventions, and post-operative continuation, were sought after by this cohort. Interventions designed with personalized milestones for patients were found to better guide through a structured recovery. Individualised tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity prior to surgery. Use of apps with personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behaviour change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery.

Conclusions:

Specific intervention design and functionality features can provide better, structured support for elective orthopaedic patients across the whole perioperative journey, and beyond. This work provides much needed evidence relating to the optimal design and timing of digital interventions for elective orthopaedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behaviour changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored and targeted digital health technologies within modern healthcare settings.