JMIR Publications

ABSTRACT

Background:

Prostate cancer is a common cancer form, often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support have the potential to increase patient’s outcomes, but have rarely been evaluated longitudinally in randomized controlled trials. We therefore developed and evaluated the effects of a digital self-care support, electronic Patient Activation in Treatment at Home (ePATH) on prostate-specific symptoms.

Objective:

The aim was to investigate the effects of a web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy.

Methods:

A multicenter randomized controlled trial (ClinicalTrials.gov NCT18055968; http://clinicaltrials.gov/ct2/show/NCT18055968) with two study arms was conducted, with the longitudinal effects of the additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patient’s activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at three county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for one year after surgery with self-assessed questionnaires. Analyzes were performed using linear mixed models and ordinal regression analysis.

Results:

The study included 170 men (85 in each group) from January 2018 to December 2019. Participants in the intervention and control groups did not differ in demographic characteristics. Of the intervention group 64% (53/83) used ePATH, but usage declined over time. The linear mixed model showed no significant differences between groups in urinary continence [β -4.65, P .19; confidence interval -11.54–2.25] or sexual function [β -.64, P .86; confidence interval -7.80–6.51]. Participants in the intervention group performed statistically significantly more pelvic floor muscle exercises [odds ratio 1.71, P .03; confidence interval 1.06–2.76] than the control group, but did not differ in physical activity [odds ratio 1.16, P .53; confidence interval 0.74–1.81].

Conclusions:

ePATH did not affect postoperative side effects. However, it seemed to increase adherence in performing pelvic floor muscle exercises. To complement standard rehabilitation, digital self-care support needs to be adapted to the context and individual preferences for usage and effect. Clinical Trial: ClinicalTrials.gov NCT18055968; https://clinicaltrials.gov/ct2/show/NCT18055968