Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Urol Oncol. 2021 Jul;39(7):434.e31-434.e38. doi: 10.1016/j.urolonc.2020.11.035. Epub 2020 Dec 8.
Financial incentive programs are effective in increasing physical activity for overweight, ambulatory adults. We sought to determine the potential effect size and direction of financial incentives on ambulation after radical cystectomy.
We performed a pilot randomized controlled trial of daily financial incentives to meet postoperative step goals among adults with Eastern Cooperative Oncology Group performance status ≤2 who underwent radical cystectomy for bladder cancer at a single center. Step counts were measured over a 3- to 14-day preoperative period and 30-day postoperative period using a wearable activity monitor. Postoperative daily step goals of 10%, 25%, 40%, and 55% of mean preoperative daily step counts were set for postoperative weeks 1 through 4, respectively. The primary outcome was the number of postoperative days on which the step goals were met. Secondary outcomes included the number of daily postoperative steps taken and the length of stay. Participants randomized to the intervention arm received $1.50 for every day the goal was met with a 20% chance of a $100 reward if the step goal was met on >75% of the first 30 postoperative days. Questionnaires assessing self-reported physical activity, disability, and social support were administered preoperatively at 30 days postoperatively.
Thirty-three patients were analyzed, 11 in the control and 22 in the intervention arms. There were no statistically significant differences between incentive and control arms for the primary outcome (4.5/30 days vs. 9/30 days, P = 0.53). Results after adjusting for differences in baseline characteristics were similar (RR 1.00, 95% CI 0.24-4.19, P = 1.00). There were also no differences in average daily postoperative steps (median 979 vs. 1191, 95% CI -810 to 1,400, P = 0.59), length of stay (7.5 vs. 7, 95% CI -2.7 to 5.1, P = 0.56), or self-reported measures of disability, activity, and social support.
While this trial was a pilot study and not powered to detect a difference between groups, there was no suggestion of any clinically important impact of this financial incentive on postoperative ambulation. While a fully-powered trial is feasible, given the small range of plausible benefit, such a trial would be unlikely to influence clinical practice.
经济激励计划对超重、可走动的成年人增加身体活动是有效的。我们旨在确定经济激励对根治性膀胱切除术患者术后走动的潜在效应大小和方向。
我们在一家单中心进行了一项随机对照试验，该试验对接受根治性膀胱切除术治疗膀胱癌的东方合作肿瘤学组表现状态≤2 的成年人，在术后 3 至 14 天的术前期间和 30 天的术后期间，使用可穿戴活动监测器，每天提供经济激励，以达到术后步骤目标。术后每周 1 至 4 天分别设定术后 10%、25%、40%和 55%的平均术前日常步骤数的术后每日步骤目标。主要结果是达到术后目标的天数。次要结果包括每天术后的步骤数和住院时间。随机分配到干预组的参与者，如果每天达到目标，则可获得 1.50 美元，前 30 天的术后，如果每天达到目标超过 75%，则有 20%的机会获得 100 美元的奖励。在术前和术后 30 天进行问卷调查，评估自我报告的体力活动、残疾和社会支持。
对 33 名患者进行了分析，对照组 11 名，干预组 22 名。在主要结局方面，激励组与对照组之间无统计学差异（4.5/30 天 vs. 9/30 天，P=0.53）。在调整了基线特征差异后，结果也相似（RR 1.00，95%CI 0.24-4.19，P=1.00）。术后平均每日步骤数（中位数 979 与 1191，95%CI-810 至 1400，P=0.59）、住院时间（7.5 与 7，95%CI-2.7 至 5.1，P=0.56）或残疾、活动和社会支持的自我报告测量均无差异。
虽然这项试验是一项试点研究，没有检测到组间差异的能力，但没有任何迹象表明这种经济激励对术后走动有任何临床重要影响。虽然进行完全有效的试验是可行的，但考虑到可能的获益范围较小，这样的试验不太可能影响临床实践。
