Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Hernia. 2023 Apr;27(2):449-458. doi: 10.1007/s10029-022-02646-2. Epub 2022 Jul 16.
Patient-reported outcomes (PROs) are essential to evaluate inguinal hernia surgery. There is a need for digital and disease-specific PRO measurement. Current measuring instruments (PROMs) have several disadvantages, for example, fixed measuring moments with a chance of recall bias. The Q1.6 Inguinal Hernia application has been developed to overcome these challenges. This pilot study reports the first clinical feasibility results.
All surgically treated inguinal hernia patients were eligible for inclusion. The application uses "twitch crowdsourcing"; after unlocking a smartphone or tablet, a single short question is asked. This can easily be repeated multiple times a day/week/month. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualised set of questions. Alerts are generated when a complication is suspected.
A total of 229 patients were given over 50.000 questions of which 92% were answered. Pre- and postoperative patient characteristics and their reported clinical outcomes confirmed a standard inguinal hernia population. Compliance with the application was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. After months 3, 6 and 11, respectively, 3.0%, 4.4% and 4.5% of patients reported inguinal pain or discomfort (NRS ≥ 4). Patients were highly satisfied (92.8% preferred the app over standard care).
This smartphone application shows promising results for clinical practice. It might allow for continuous digital patient-reported outcome measurement using non-intrusive, concise questions. Remote monitoring may become standard postoperative care after (inguinal hernia) surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.
患者报告的结局（PROs）对于评估腹股沟疝手术至关重要。需要数字化和特定于疾病的 PRO 测量方法。当前的测量工具（PROMs）存在一些缺点，例如具有回忆偏倚可能性的固定测量时刻。Q1.6 腹股沟疝应用程序的开发就是为了克服这些挑战。本初步研究报告了首次临床可行性结果。
所有接受手术治疗的腹股沟疝患者均符合纳入标准。该应用程序使用“抽搐众包”；解锁智能手机或平板电脑后，会询问一个简短的问题。这可以很容易地每天/每周/每月重复多次。实施了经过验证的问卷中的问题。自适应问题引擎生成个性化的问题集。当怀疑出现并发症时会生成警报。
共有 229 名患者收到了超过 50000 个问题，其中 92%得到了回答。术前和术后患者特征及其报告的临床结局证实了标准的腹股沟疝人群。应用程序的依从性在 14 天后为 91.7%，3 个月后为 69.0%，1 年后为 28.8%。在 3、6 和 11 个月后，分别有 3.0%、4.4%和 4.5%的患者报告腹股沟疼痛或不适（NRS≥4）。患者非常满意（92.8%更喜欢该应用程序而非标准护理）。
这款智能手机应用程序在临床实践中显示出有前景的结果。它可能允许使用非侵入性、简洁的问题进行连续的数字患者报告结局测量。远程监测可能成为（腹股沟疝）手术后标准的术后护理。目前的应用程序将进一步改进和评估成本效益、安全性和有效性。
