Knight Stephen R, Ng Nathan, Tsanas Athanasios, Mclean Kenneth, Pagliari Claudia, Harrison Ewen M
Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
School of Medicine, University of Edinburgh, Edinburgh, United Kingdom.
NPJ Digit Med. 2021 Nov 12;4(1):157. doi: 10.1038/s41746-021-00525-1.
Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.
手术后的并发症很常见，且常常在出院后出现。移动和可穿戴数字健康干预措施（DHI）为术后恢复期间监测和支持患者提供了机会。缺乏高质量证据常被视为实施DHI的障碍。本综述收集并评估了手术后移动和可穿戴DHI的当前使用情况、证据基础及报告质量。在Embase、Cochrane图书馆、科学网和世界卫生组织全球医学索引数据库以及临床试验注册库和谷歌学术中进行了关键词搜索。纳入的研究涉及接受任何需要皮肤切口手术的患者，且在出院后使用DHI测量术后结果，其中DHI被定义为用于改善卫生系统效率和健康结果的移动和无线健康技术。使用经过验证的移动健康证据报告与评估（mERA）指南确定方法学报告质量。根据研究类型，使用Cochrane协作网随机研究工具或MINORS评估偏倚。总体而言，共筛选了6969篇文章，纳入了44篇文章。大多数（n = 34）描述的是小型前瞻性研究设计，显示出较高的偏倚风险。所有领域的报告标准都不尽人意，尤其是在数据安全、患者前期参与和成本分析方面。尽管DHI有改善术后患者护理的潜力，但目前的进展因方法学报告的局限性而受到严重限制。迫切需要改进手术后DHI的报告，以确定患者受益情况、促进可重复性并鼓励可持续性。
