Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial

Meij, Eva van der; Anema, Johannes R.; Leclercq, Wouter K G; Bongers, Marlies Y.; Consten, Esther C. J.; Koops, Steven E. Schraffordt; Ven, Peter M. van de; Terwee, Caroline B.; Dongen, Johanna M. van; Schaafsma, Frederieke; Meijerink, W.J.H.J.; Bonjer, H. Jaap; Huirne, Judith A.F.

doi:10.1016/s0140-6736(18)31113-9

Cited by 81 publications

(95 citation statements)

References 31 publications

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“…This renders the clinical relevance of the effect sizes from our quantitative analysis questionable. In contrast, clinically relevant improvements in QoL are described after integrated care interventions, compared with usual care, among non-surgical back pain patients41 42 and patients undergoing abdominal or gynaecological surgeries 43–45. Studies reporting on interventions of e/mHealth34 35 and, in particular in combination with active referral or goal setting,24 showed additional effectiveness in reducing pain and pain interference.…”

Section: Discussionmentioning

confidence: 99%

Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis

Coenen

Hulsegge

Daams

et al. 2020

BMJ Open Sport Exerc Med

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ObjectivesOrthopaedic surgery is primarily aimed at improving function and pain reduction. Additional integrated care may enhance patient’s participation in sports and work, possibly improving performance of physical activities and quality of life (QoL). We aimed to assess the effectiveness of integrated care among orthopaedic surgery patients.DesignSystematic review with meta-analysis.Data sourceMedline, EMBASE and CINAHL (until 17 June 2019).Eligibility for selecting studiesWe searched for controlled studies on integrated care interventions consisting of active referral to case managers, rehabilitation with participation-based goals and/or e/mHealth, with outcomes of sports and work participation, performance of physical activities and/or QoL. Outcomes were normalised to 0–100 scales and statistically pooled.ResultsSeventeen articles (n=2494) of moderate quality were included reporting on patients receiving back, upper limb, knee or hip surgery. Only one study reported on return to sports and found no significant benefit. For return to work, one study did (90% vs 82%) and one did not (relative risk=1.18 (0.80 to 1.70)) observe significant benefits. Integrated care showed small effects for improving performance of physical activities (2.69 (–0.20 to 5.58); eight studies, n=1267) and QoL (2.62 (1.16 to 5.05); nine studies, n=1158) compared with usual care.Summary/ConclusionWe found insufficient and inconsistent evidence for the effectiveness of integrated care for orthopaedic surgery patients regarding sport and work participation. Small effects were found for performance of physical activities and QoL. High quality research on integrated care focusing on sports and work participation is needed before integrated care can be implemented for orthopaedic surgery patients.

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Section: Discussionmentioning

confidence: 99%

Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis

Coenen

Hulsegge

Daams

et al. 2020

BMJ Open Sport Exerc Med

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“…Studies of other ePRO systems have typically focused on evaluating the feasibility of PRO data collection alone, rather than their real-time integration of ePRO data into routine post-discharge clinical management [41][42][43][44]. A recent RCT of 344 patients in the Netherlands concluded that use of a "personalised" e-Health programme improved rates of return to normal activities compared to usual care following general or gynaecological surgery for benign conditions [45]. This programme was not integrated into hospital EHR and alerts to contact a health professional were sent only to patients reporting a delayed recovery, and not to clinicians.…”

Section: Discussionmentioning

confidence: 99%

A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery

et al. 2020

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Background: Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patientreported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery. Methods: A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly postdischarge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptomreports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery. Results: Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63-100%). Of 197 ePRO completions analysed, 76 (39%) triggered selfmanagement advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients' experiences during recovery.

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“…a short form consisting of the five most problematic items for the patient at issue, as rehabilitation treatment is focused on patient's request for help and, therefore, tailor-made. The use of tailor-made short forms appeared to be feasible [24].…”

Section: Discussionmentioning

confidence: 99%

Changes in the ability to participate in and satisfaction with social roles and activities in patients in outpatient rehabilitation

Tamminga

Vree²,

Volker³

et al. 2020

J Patient Rep Outcomes

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Background: One of the main aims of rehabilitation is to improve participation. Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks 'Ability to Participate in Social roles and Activities, (PROMIS-APS) and 'Satisfaction with Social Roles and Activities' (PROMIS-SPS) are promising options to measure participation, but the literature on PROMIS measures of (satisfaction with) participation across diagnoses in rehabilitation is limited. Therefore, the objective of this study was to describe levels of and changes in participation, as assessed with the PROMIS-APS and the PROMIS-SPS short forms, of patients in outpatient rehabilitation. Methods: This study had quantitative, observational design with assessments at admission and discharge. Consecutive patients treated between April and August 2018 receiving outpatient multidisciplinary rehabilitation were the population of this study. The following diagnosis categories were included: brain injury (e.g. stroke), spinal cord and nerve injury, neuromuscular disorder (e.g. lateral sclerosis), amputation, musculoskeletal condition (e.g. osteoarthritis) or heart or lung disease (e.g. myocardial infarction, chronic obstructive pulmonary disease). The main patient-reported outcomes (PRO) of this study were the short form of the PROMIS-APS (8 items, Dutch general population reference score 50.6 [SD 9.5]), and PROMIS-SPS (8 items, Dutch general population reference score 47.5 [SD 8.3]. Results: Of the 1279 patients invited, 777 (61%) completed the online forms at admission. Of those, 329 patients were invited at discharge, with 209 (64%) completing the forms. The mean (SD) T-scores of the PROMIS-APS and PROMIS-SPS were lower at admission (42.7 [SD 7.4]; (41.4 [SD 7.7]) and discharge (43.6 [SD 7.2]; (43.7 [SD 7.8]) than the Dutch general population. The change scores of the PROMIS-APS and PROMIS-SPS were 1.2 (95% CI 0.4-1.9; p = 0.004; effect size 0.16), and 2.4 (95% CI 1.6-3.2; p < 0.0001; effect size 0.31), respectively. In all diagnostic subgroups with > 30 paired measurements statistically significant improvements of PROMIS-APS, PROMIS-SPS or both were seen. Conclusions: Patients undergoing outpatient rehabilitation had, both at admission and discharge, considerably lower PROMIS-APS and PROMIS-SPS T-scores short forms than the general Dutch population, and showed small T-score improvements at discharge.

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Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial

Cited by 81 publications

References 31 publications

Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis

Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis

A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery

Changes in the ability to participate in and satisfaction with social roles and activities in patients in outpatient rehabilitation

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