A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility

Abstract

Background Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child’s pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting. Objective The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents’ satisfaction. Methods Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child’s pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user’s adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app’s ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round. Results Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30% (interquartile range [IQR] 22%-33%) of alerts within 1 hour in round 1, and subsequently to median 60% (IQR 44%-64%) in round 2 and median 64% (IQR 56%-72%) in round 3 ( P =.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 ( P =.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts. Conclusions It is feasible for parents or guardians to use Panda at home to manage their child’s medication schedule and track their pain. Simple modifications to the app’s alert sounds and user interface improved response times.

The use of the Panda-Nerve Block pain app in single-shot peripheral nerve block patients: a feasibility study

“…A one-hour response time was selected as it was felt to be the maximum allowable delay to still be considered compliant with the medication regime; this cut-off has been used by our group in the past. 11,12 These data were collated for each individual round; the median [interquartile range (IQR)] of each parameter was calculated and the Kruskal-Wallis test was used to compare data between rounds. A P value of less than 0.05 was considered significant.…”

“…We attribute this to the rounds of testing and iterative improvements conducted across multiple studies. 11,12 Most patients found the app useful and responded appropriately to alerts. Additionally, response rates were high in the first 48 hr post-discharge, capturing the critical transition from blockade to oral analgesia, including documentation of opioid usage and real-time nerve injury assessment.…”

“…This sample size was selected as it has been used in similar studies. 11,12,16 Selection and description of participants Patients were recruited in the surgical daycare unit and surgical procedure room, an ambulatory surgery unit at St. Paul's Hospital, a tertiary academic site in Vancouver, Canada. The inclusion criteria were American Society of Anesthesiologists physical status I-III, age 19-75 years, undergoing ambulatory surgery under PNB, and anticipated post-surgical pain.…”

“…10 Panda (pain assessment via a novel digital app), an app developed by the Digital Health Innovation Lab at British Columbia Children's Hospital, is usable and feasible for parents managing their child's postoperative pain. 11,12 This app has undergone extensive testing with patients' parents, patients, and nurses. A version of the app, Panda-Nerve Block (hereafter ''Panda''), was created for adult PNB patients and includes features for monitoring a PNB.…”

An Interactive Pain Application (MServ) Improves Postoperative Pain Management

“…An app-based pain management programme for children with juvenile arthritis reduced pain intensity, but no control arm was used [ 29 ]. A postoperative version of this app and another app for the management of paediatric postoperative pain were well accepted but have yet to be assessed for effect on outcomes [ 30 – 32 ]. A proof-of-concept study in adults by Thiel et al showed that patients' recording of postoperative pain was easy via an app, reporting similar pain severity to that recorded by nursing staff [ 33 ].…”