Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial

Meij, Eva van der; Huirne, Judith A F; Bouwsma, Esther V.A.; Dongen, Johanna M. van; Terwee, Caroline B.; Ven, Peter M. van de; Bakker, Chantal M. den; Meij, Suzan van der; Baal, W.M. van; Leclercq, Wouter K G; Geomini, Peggy M.A.J.; Consten, Esther C. J.; Koops, Steven E. Schraffordt; Kesteren, P. J. M. van; Stockmann, H. B. A. C.; Cate, A.D. Ten; Davids, P. H. P.; Scholten, Piet C.; Heuvel, Baukje van den; Schaafsma, Frederieke; Meijerink, W. J. H. J.; Bonjer, H. Jaap; Anema, Johannes R.

doi:10.2196/resprot.6580

Cited by 23 publications

(24 citation statements)

References 48 publications

(45 reference statements)

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“…This process evaluation was carried out alongside a multicenter randomized clinical trial in seven teaching hospitals in the Netherlands (Netherlands Trial Registry NTR4699). A detailed description of the study design has been published earlier in this journal [ 10 ]. The study was reported in accordance with Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) [ 13 ] and was approved by the local medical ethics committee under the registration number 2014.301.…”

Section: Methodsmentioning

confidence: 99%

“…A sample size calculation was performed; a total of 308 participants would be required. More details about the study population and sample size calculation have been described in the study protocol [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, the intervention was further developed; new features, such as a mobile phone app, an activity tracker, and an electronic consultation (eConsult) function, were added. In addition, the intervention was extended, whereby it could also be used in the perioperative period of commonly applied general surgical procedures [ 10 ]. Due to these promising results regarding the effectivity of the intervention, implementation of the intervention in clinical practice seems logical.…”

Section: Introductionmentioning

confidence: 99%

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A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial

Meij¹,

Huirne²,

Cate³

et al. 2018

J Med Internet Res

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BackgroundElectronic health (eHealth) interventions have proven effective, but implementation in clinical practice is difficult. More research focusing on the implementation process of eHealth interventions is necessary.ObjectiveThe objective of this study was to describe the process evaluation of a perioperative eHealth intervention, aiming to enhance recovery after laparoscopic abdominal surgery.MethodsA process evaluation was carried out alongside a multicenter randomized controlled trial. Patients aged between 18 and 75 years who were scheduled for a laparoscopic cholecystectomy, hernia inguinal surgery, or laparoscopic adnexal surgery were included. The eHealth intervention comprised a website and mobile phone app with the possibility to develop a personalized convalescence plan, a section with information about the surgical procedure and the recovery period, the possibility to ask questions via an electronic consultation (eConsult), and an activity tracker. The process evaluation was carried out using the model of Linnan and Steckler, measuring components such as reach, dose delivered, dose received, fidelity, and participants’ attitudes. Implementation scores were calculated based on the average of the four components. Quantitative data were collected by means of an electronic questionnaire, a logistic database, a weblog, and medical files. Qualitative data were collected by conducting interviews with a subsample of the study participants.ResultsA total of 344 of the 863 eligible patients were included in the study, which accounted for a reach of 39.9%, and 173 participants were randomized to the intervention group. The implementation scores of the different functions of the intervention ranged between 60% and 65%. The website, mobile phone app, and activity tracker were rated 7.3 to 7.6 on a scale of 1 to 10. Almost all participants who were interviewed about the eConsult function rated it as being of additional value if combined with the usual care but not as a replacement for usual care.ConclusionsAlthough participants were overall satisfied with the intervention, the implementation scores of the different functions of the intervention were fair. More research is needed to evaluate the barriers and facilitators for implementation of this perioperative eHealth intervention in normal practice outside study setting.Trial RegistrationNetherlands Trial Registry NTR4699; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4699 (Archived by WebCite at http://www.webcitation.org/6vr02V4KK)

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial

Meij¹,

Huirne²,

Cate³

et al. 2018

J Med Internet Res

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“…The use of e-health is very promising, allows for personalized 24-hour monitoring, and does not force postoperative problems onto the general practitioner or external emergency services. 6,14,27,31 The model we propose remains at an acceptable cost to our institution, which saves money by reducing the LOS. 8…”

Section: Implementation Of Erasmentioning

confidence: 99%

Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Debono

Corniola

Pietton

et al. 2019

Neurosurgical Focus

103

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OBJECTIVEEnhanced Recovery After Surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. Thanks to the improvement in care protocols and the fluidity of the patient pathway, the first goal of ERAS is the improvement of surgical outcomes and patient experience, with a final impact on a reduction in the hospital length of stay (LOS). The implementation of ERAS in spinal surgery is in the early stages. The authors report on their initial experience in applying an ERAS program to several degenerative spinal fusion procedures.METHODSThe authors selected two 2-year periods: the first from before any implementation of ERAS principles (pre-ERAS years 2012–2013) and the second corresponding to a period when the paradigm was applied widely (post-ERAS years 2016–2017). Patient groups in these periods were retrospectively compared according to three degenerative conditions requiring fusion: anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), and posterior lumbar fusion. Data were collected on patient demographics, operative and perioperative data, LOSs, 90-day readmissions, and morbidity. ERAS-trained nurses were involved to support patients at each pre-, intra-, and postoperative step with the help of a mobile application (app). A satisfaction survey was included in the app.RESULTSThe pre-ERAS group included 1563 patients (159 ALIF, 749 ACDF, and 655 posterior fusion), and the post-ERAS group included 1920 patients (202 ALIF, 612 ACDF, and 1106 posterior fusion). The mean LOS was significantly shorter in the post-ERAS group than in the pre-ERAS group for all three conditions. It was reduced from 6.06 ± 1.1 to 3.33 ± 0.8 days for the ALIF group (p < 0.001), from 3.08 ± 0.9 to 1.3 ± 0.7 days for the ACDF group (p < 0.001), and from 6.7 ± 4.8 to 4.8 ± 2.3 days for posterior fusion cases (p < 0.001). There was no significant difference in overall complications between the two periods for the ALIF (11.9% pre-ERAS vs 11.4% post-ERAS, p = 0.86) and ACDF (6.0% vs 8.2%, p = 0.12) cases, but they decreased significantly for lumbar fusions (14.8% vs 10.9%, p = 0.02). Regarding satisfaction with overall care among 808 available responses, 699 patients (86.5%) were satisfied or very satisfied, and regarding appreciation of the mobile e-health app in the perceived optimization of care management, 665 patients (82.3%) were satisfied or very satisfied.CONCLUSIONSThe introduction of the ERAS approach at the authors’ institution for spinal fusion for three studied conditions resulted in a significant decrease in LOS without causing increased postoperative complications. Patient satisfaction with overall management, upstream organization of hospitalization, and the use of e-health was high. According to the study results, which are consistent with those in other studies, the whole concept of ERAS (primarily reducing complications and pain, and then reducing LOS) seems applicable to spinal surgery.

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“…Patients undergoing these surgical procedures are chosen as part of the target population, next to those patients undergoing gynecological procedures including hysterectomy and adnexal surgery as the other part of the target population. This way, a broad patient population of general surgical and gynecological patients can be achieved [18][19][23][24]. The study population is divided in 1) the minor abdominal general surgical and gynecological procedures group which consists of laparoscopic cholecystectomy and adnexal surgery;…”

mentioning

confidence: 99%

Electronic Health Program to Empower Patients in Returning to Normal Activities After General Surgical and Gynecological Procedures: Intervention Mapping as a Useful Method for Further Development (Preprint)

Bakker¹,

Schaafsma²,

Meij³

et al. 2018

Preprint

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Funding: This study is carried out with funding of ZonMw (projectnumber 837002409), an organization for health research and development in the Netherlands. A B S T R A C TBackground: Guiding and monitoring postoperative recovery and resumption of activities are usually not provided to patients after discharge from the hospital. Therefore a perioperative eHealth intervention ('ikherstel'-intervention or 'I recover'-intervention) was developed to empower gynecological patients during the perioperative period. This eHealth intervention requires a need for further development for patients who will undergo various types of general surgical and gynecological procedures.Objective: To further develop the 'ikherstel' eHealth intervention to fit a broader patient population.Methods: The Intervention Mapping protocol was used to guide further development of the 'ikherstel'-intervention. Firstly, patients' needs were identified using i) the information of a process evaluation of the earlier performed 'ikherstel'-study; ii) a review of the literature; iii) a survey study; and iv) focus group discussions among stakeholders. Next, program and change-objectives were defined. Thirdly, behavior change theories and practical tools were selected for the intervention program. Finally, an implementation and evaluation plan was developed.Results: The outcome for an effective eHealth intervention tool for patients recovering from abdominal general surgical and gynecological procedures was redefined as 'achieving earlier recovery including return to normal activities and work'. The Attitude-Social influence-self-Efficacy model was used as a theoretical framework to transform personal and external determinants into change-objectives of personal behavior. The knowledge gathered in the needs assessment and using the theoretical framework in the preparatory steps of the Intervention Mapping protocol resulted in additional tools. A mobile application, an activity tracker and an eConsult will be incorporated in the further developed eHealth intervention. This intervention will be evaluated in a multicenter single blinded randomized controlled trial with 18 departments in 11 participating hospitals in the Netherlands. I N T R O D U C T I O NThe length of in-hospital stay after general surgical and gynecological procedures decreased significantly due to a growing trend in day care surgery, introduction of minimal invasive techniques and Enhanced Recovery after Surgery programs (ERAS) [1][2][3]. Due to this shortening of in-hospital stay, perioperative in-hospital care has been reduced and the greater part of the recovery period takes place at home [4][5]. As a result, guiding and monitoring resumption of normal activities (RNA) including return to work (RTW), and long term recovery is now transferred to primary care [6].However, frequently no or conflicting advice is given resulting in patients being unsure whom to contact for support in case of complaints. Patients often lack the knowledge themselves to determine how and when to resume ac...

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Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial

Cited by 23 publications

References 48 publications

A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial

A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial

Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Electronic Health Program to Empower Patients in Returning to Normal Activities After General Surgical and Gynecological Procedures: Intervention Mapping as a Useful Method for Further Development (Preprint)

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