van der Velde Miriam, van der Leeden Marike, Geleijn Edwin, Veenhof Cindy, Valkenet Karin
Research Group Innovation of Human Movement Care, Center for Healthy and Sustainable Living, HU University of Applied Sciences, Heidelberglaan 7, Utrecht, 3264 LJ, The Netherlands, 31 0642214251.
Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
JMIR Mhealth Uhealth. 2025 May 30;13:e58703. doi: 10.2196/58703.
Patients undergoing major surgery are at risk of complications and delayed recovery. Prehabilitation has shown promise in improving postoperative outcomes. Offering prehabilitation by means of mHealth can help overcome barriers to participating in prehabilitation and empower patients prior to major surgery. We developed the Be Prepared mHealth app, which has shown potential in an earlier pilot study.
This study aims to evaluate the effectiveness of the Be Prepared app on postoperative recovery of physical functioning (PF) in patients undergoing major elective surgery.
This study was a multicenter randomized controlled trial with 2 arms. Adults scheduled for major elective surgery were randomly assigned to the control (usual care) or intervention group (Be Prepared app in addition to usual care). The Be Prepared app is a smartphone app with pre- and postoperative information and instructions on changing risk behavior for patients undergoing major elective surgery. The primary outcome was recovery of postoperative PF up to 12 weeks after hospital discharge measured with the Computer Adaptive Test Patient-Reported Outcomes Measurement Information System-PF. Secondary outcomes included social participation, self-reported recovery, health-related quality of life, postoperative outcomes, and patient satisfaction. Measurements were performed at 5 time points: before random assignment and 1, 3, 6, and 12 weeks after hospital discharge.
A total of 369 patients were analyzed, 181 in the control group and 188 in the intervention group. The result of the linear mixed effects model showed a mean slope difference in recovery of PF over 12 weeks of 2.97 (95% CI 0.90-5.02) in favor of the intervention group. However, this effect was not clinically relevant and was negated by the significantly lower PF score 1 week after hospital discharge in the intervention group (mean difference -1.72, 95% CI -3.38 to -0.07). Most secondary outcome measures did not show significantly greater improvements in the intervention group compared to the control group. Patient satisfaction with overall perioperative care was significantly higher in the intervention group compared to the control group and satisfaction with the Be Prepared app was high.
The use of the Be Prepared app as a stand-alone intervention does not seem beneficial for improving postoperative recovery in patients undergoing major surgery. However, satisfaction with perioperative care was higher in patients using the app. Given the advantages of digital technology in health care, it can be considered a basis for prehabilitation care pathways, complemented by guidance from health care professionals as needed.
接受大手术的患者有发生并发症和恢复延迟的风险。术前康复已显示出改善术后结局的前景。通过移动健康技术提供术前康复可以帮助克服参与术前康复的障碍，并在大手术前增强患者的能力。我们开发了“做好准备”移动健康应用程序，该程序在早期的试点研究中已显示出潜力。
本研究旨在评估“做好准备”应用程序对接受大择期手术患者术后身体功能（PF）恢复的有效性。
本研究是一项双臂多中心随机对照试验。计划接受大择期手术的成年人被随机分配到对照组（常规护理）或干预组（除常规护理外还使用“做好准备”应用程序）。“做好准备”应用程序是一款智能手机应用程序，为接受大择期手术的患者提供术前和术后信息以及关于改变风险行为的指导。主要结局是出院后长达12周的术后PF恢复情况，使用计算机自适应测试患者报告结局测量信息系统-PF进行测量。次要结局包括社会参与、自我报告的恢复情况、健康相关生活质量、术后结局和患者满意度。在5个时间点进行测量：随机分组前以及出院后1、3、6和12周。
共分析了369例患者，其中对照组181例，干预组188例。线性混合效应模型的结果显示，干预组在12周内PF恢复的平均斜率差异为2.97（95%CI 0.90-5.02），有利于干预组。然而，这种效果在临床上并不显著相关，并且由于干预组出院后1周的PF评分显著较低（平均差异-1.72，95%CI -3.3八至-0.07）而被抵消。与对照组相比，大多数次要结局指标在干预组中并未显示出显著更大的改善。干预组患者对围手术期整体护理的满意度显著高于对照组，并且对“做好准备”应用程序的满意度很高。
将“做好准备”应用程序作为单一干预措施使用似乎对改善大手术患者的术后恢复没有益处。然而，使用该应用程序的患者对围手术期护理的满意度更高。鉴于数字技术在医疗保健中的优势，可以将其视为术前康复护理路径 的基础，并根据需要辅以医疗保健专业人员的指导。
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