WHO CC (DK-62), Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Orthopedic Surgery, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Int Orthop. 2023 Nov;47(11):2645-2653. doi: 10.1007/s00264-023-05890-y. Epub 2023 Aug 8.
Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app).
Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed.
In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff.
This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.
每日吸烟或危险饮酒会使手术并发症风险增加约 50%。旨在完全戒断的强化康复治疗可降低并发症发生率，但耗时。本研究旨在对两种新型康复应用程序 habeat®（Ha-app）或 rehaviour®（Re-app）进行术前试点研究（随机设计），以检验其可行性（1A）和有效性（1B）。
每日吸烟、危险饮酒或两者兼有的髋或膝关节置换术患者被随机分配到两种应用程序中的一种。在 1A 部分中，8 名患者及其工作人员使用视觉模拟量表（VAS）评估可行性，并就效果良好的内容和需要改进的挑战进行访谈。在 1B 部分中，7 名患者及其工作人员在最多两周内测试了改进后的应用程序，然后使用 VAS 验证对应用程序的理解、可用性、覆盖范围和赋能程度，并进行访谈。
在 1A 部分中，所有患者及其工作人员对理解应用程序的评分均≥5，且大多提出了技术改进建议。在 1B 部分中，两个应用程序的评分差异很大，没有达成共识。两种应用程序各有两名患者（Ha-app）和三分之一的患者（Re-app）认为该应用程序有助于减少吸烟，但并未成功戒烟。患者的应用程序能力低，工作人员的时间消耗高。具体而言，患者最常需要 Ha-app 的帮助，而工作人员最常需要 Re-app 的帮助；但是，工作人员报告说 Re-app 仪表板更便于使用。建议为应用程序配备成瘾专家工作人员，以提供支持和随访，从而增加工作人员的时间消耗。
本试点研究测试了原型应用程序，为应用程序开发者提供了有益的反馈。根据患者和工作人员的意见，在扩大评估范围以研究康复治疗对术前和术后并发症的影响之前，似乎需要对功能进行多次改进。
