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A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial

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Abstract

Background

Increased adherence with enhanced recovery pathways (ERP) is associated with improved outcomes. However, adherence to postoperative elements that rely on patient participation remains suboptimal. Mobile device apps may improve delivery of health education material and have the potential to foster behavior change and improve patient compliance. The objective of this study was to estimate the extent to which a novel mobile device app affects adherence to an ERP for colorectal surgery in comparison to standard written education.

Methods

This was a superiority, parallel-group, assessor-blind, sham-controlled randomized trial involving 97 patients undergoing colorectal resection. Participants were randomly assigned with a 1:1 ratio into one of two groups: (1) iPad including a novel mobile device app for postoperative education and self-assessment of recovery, or (2) iPad without the app. The primary outcome measure was mean adherence (%) to a bundle of five postoperative ERP elements requiring patient participation: mobilization, gastrointestinal motility stimulation, breathing exercises, and consumption of oral liquids and nutritional drinks.

Results

In the intervention group, app usage was high (94% completed surveys on POD0, 82% on POD1, 72% on POD2). Mean overall adherence to the bundle on the two first postoperative days was similar between groups: 59% (95% CI 52–66%) in the intervention group and 62% (95% CI 56–68%) in the control group [Adjusted mean difference 2.4% (95% CI − 5 to 10%) p = 0.53].

Conclusions

In this randomized trial, access to a mobile health application did not improve adherence to a well-established enhanced recovery pathway in colorectal surgery patients, when compared to standard written patient education. Future research should evaluate the impact of applications integrating novel behavioral change techniques, particularly in contexts where adherence is low.

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Funding

SAGES SMART™ Enhanced Recovery Grant. Seamless MD provided the mobile app without charge.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9.309, Montreal, QC, H3G 1A4, Canada

    Juan Mata, Nicolò Pecorelli, Pepa Kaneva, Mohsen Alhashemi, Stephan Robitaille, Saba Balvardi, Lawrence Lee, Julio F. Fiore Jr. & Liane S. Feldman

  2. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Dan Moldoveanu, Alexandre Gosselin-Tardiff, Lawrence Lee, Barry L. Stein, Sender Liberman, Patrick Charlebois, Julio F. Fiore Jr. & Liane S. Feldman

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  1. Juan Mata
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  2. Nicolò Pecorelli
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  3. Pepa Kaneva
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  9. Lawrence Lee
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  14. Liane S. Feldman
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Corresponding author

Correspondence to Liane S. Feldman.

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Disclosures

Lawrence Lee received an investigator-initiated research grant from Johnson & Johnson for an unrelated project. Liane S. Feldman received investigator initiated research grant from Merck (unrelated project) and educational grant from Medtronic (unrelated project). Juan Mata, Nicolò Pecorelli, Pepa Kaneva, Dan Moldoveanu, Alexandre Gosselin-Tardiff, Mohsen Alhashemi, Stephan Robitaille, Saba Balvardi, Barry L. Stein, Sender Liberman, Patrick Charlebois, and Julio F. Fiore Jr., have no conflicts of interest or financial ties to disclose.

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Mata, J., Pecorelli, N., Kaneva, P. et al. A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial. Surg Endosc 34, 742–751 (2020). https://doi.org/10.1007/s00464-019-06823-w

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  • DOI: https://doi.org/10.1007/s00464-019-06823-w

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