School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
J Med Internet Res. 2021 Mar 8;23(3):e25885. doi: 10.2196/25885.
Health behavior changes made by patients during the perioperative period can impact 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 orthopedic surgery patients is central to motivating healthier behavior change, improving recovery, and optimizing overall surgical success in the short and long term.
The aim of this study is to explore patient perspectives on technology features that would help support them to change their lifestyle behaviors during the pre- and postoperative periods, and that could potentially maintain long-term healthy lifestyles following recovery.
Semistructured interviews with pre- and postoperative elective orthopedic patients were conducted between May and June 2020 using telephone and video call-based software. Patient perspectives on the use of digital technologies to complement current surgical care and support with lifestyle behavior changes were discussed. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with QSR NVivo software (version 12) facilitating data management. Ethical approval was obtained from the National Health Service Health Research Authority.
A total of 18 participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the perioperative journey. These center around an intervention's ability to incorporate interactive, user-centered features; direct a descriptive and structured recovery; enable customizable, patient-controlled settings; and deliver both general and specific surgical advice in a timely manner. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial. Interventions designed with personalized milestones were found to better guide patients through a structured recovery. Individualized tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity before surgery. The use of personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behavior change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery.
Specific intervention design and functionality features can provide better, structured support for elective orthopedic patients across the entire surgical journey and beyond. This study provides much-needed evidence relating to the optimal design and timing of digital interventions for elective orthopedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behavior 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 health care settings.
患者在围手术期做出的健康行为改变可能会影响择期手术的结果和成功率。然而，目前对于如何在这段时间内最好地支持患者，尤其是通过使用数字健康干预措施，仍然缺乏了解。认识和理解择期骨科手术患者的潜在未满足需求对于激励更健康的行为改变、改善康复以及优化短期和长期的整体手术成功率至关重要。
本研究旨在探讨患者对有助于支持他们在术前和术后期间改变生活方式行为的技术特征的看法，以及这些特征可能在术后恢复后维持长期健康生活方式的潜力。
2020 年 5 月至 6 月期间，通过电话和视频通话软件对择期骨科手术的术前和术后患者进行半结构式访谈。讨论了患者对使用数字技术补充当前手术护理和支持生活方式行为改变的看法。对访谈进行了音频录制，并逐字转录。反思性主题分析使数据中发展出主题，使用 QSR NVivo 软件（第 12 版）促进数据管理。本研究获得了英国国家卫生服务局健康研究管理局的伦理批准。
共有 18 名参与者接受了采访。从数据中得出了关于设计和功能的四个主题，以最好地支持围手术期的旅程。这些主题围绕着干预措施能够整合互动、以用户为中心的功能；直接描述和结构化的恢复；能够实现定制、患者控制的设置；以及及时提供一般和具体的手术建议。参与者认为术前开始并持续到术后的干预措施是有益的。设计具有个性化里程碑的干预措施被发现可以更好地指导患者进行结构化的恢复。术前活动水平较高的患者希望对术前和恢复信息进行个性化定制。使用基于个性化进度的练习进一步鼓励身体恢复；游戏式的奖励和激励措施被认为是促进和维持健康行为改变的动力。内置的视频通话和消息传递功能为患者提供了与同伴和临床医生的连接，以提供支持性护理。
特定的干预设计和功能特征可以为整个手术过程以及之后的择期骨科患者提供更好、更结构化的支持。本研究提供了与择期骨科手术患者的数字干预措施的最佳设计和时间相关的急需证据。研究结果表明，患者希望得到个性化的围手术期护理，从而支持他们做出健康行为改变，以优化手术效果。这些发现应该被用来影响未来的共同设计项目，以在现代医疗保健环境中设计和实施以患者为中心、量身定制和有针对性的数字健康技术。
