Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 22, 2024
Date Accepted: Mar 27, 2025
The effectiveness of the Be Prepared mHealth application on recovery of physical functioning after major elective surgery: a multicenter randomized controlled trial
ABSTRACT
Background:
Patients undergoing major surgery are at risk of complications and delayed recovery. Prehabilitation has shown promise in improving postoperative outcomes. Offering prehabilitation by means of mHealth can help overcome barriers for participating in prehabilitation and empower patients prior to major surgery. We developed the Be Prepared mHealth application, which has shown potential in an earlier pilot study.
Objective:
The aim of this study was to evaluate the effectiveness of the Be Prepared application on postoperative recovery of physical functioning in patients undergoing major elective surgery.
Methods:
This study was a multicenter RCT with two arms. Adults scheduled for major elective surgery were randomly assigned to the control (usual care) or intervention group (Be Prepared application in addition to usual care). The Be Prepared application is a stand-alone smartphone application with pre- and postoperative information and instructions on changing risk behavior for patients undergoing major elective surgery. All outcome measures were collected using online questionnaires and electronic health records. The primary outcome was recovery of postoperative physical functioning up to 12 weeks after hospital discharge measured with the CAT PROMIS Physical Functioning. Secondary outcomes included social participation, self-reported recovery, health-related quality of life, postoperative outcomes and patient satisfaction. Measurements were performed at five time points: before random assignment, and one, three, six and twelve weeks after hospital discharge.
Results:
A total of 369 patients were analyzed, 181 in the control group and 188 in the intervention group. Of the 188 patients in the intervention group, 146 patients (78%) used the app at least once after first login. The between-group difference in recovery of physical functioning was 2.97 (95% CI 0.90 to 5.02) in favor of the intervention group. However, this effect was negated by the significantly lower physical functioning score one week after hospital discharge in the intervention group (MD -1.72, 95% CI -3.38 to -0.07). Most secondary outcome measures did not show significant greater improvements in the intervention group compared to the control group. Patient satisfaction with overall perioperative care was significantly higher in the intervention group compared to the control group and satisfaction with the Be Prepared app was high.
Conclusions:
The use of the Be Prepared application as a stand-alone intervention does not seem beneficial for improving postoperative recovery in patients undergoing major surgery. However, satisfaction with perioperative care was higher in patients using the application. Given the advantages of digital technology in healthcare, it can be considered a basis for prehabilitation care pathways, complemented by guidance from health care professionals as needed. Clinical Trial: Netherlands Trial Register NL8623
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.