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Engagement and Adherence with a Web-Based Prehabilitation Program for Patients Awaiting Abdominal Colorectal Surgery

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Understanding the drivers of patient engagement and adherence is critical to developing and implementing preoperative optimization programs. The aim of this project is to determine whether existing health beliefs are associated with engagement and adherence in a home-based online prehabilitation program.

Methods

Patients undergoing abdominal colorectal operations were enrolled in an online nutrition and exercise program. We collected baseline health beliefs and mindsets, daily exercises, and weekly diet recalls. Multivariable binary logistic regression predicted engagement, multivariable ordinary least squares regression predicted diet adherence, and generalized linear models with a binomial distribution predicted engagement and exercise adherence.

Results

Of the 227 patients who agreed to participate, 75% activated their accounts; of those, 75% used the program. Engagement with the program was unrelated to health beliefs or mindsets. Positive diet-related health beliefs and a growth mindset were associated with positive diet behaviors and inversely associated with negative diet behaviors. Exercise-related health beliefs and mindsets were not associated with exercise adherence. Patients enrolled within 4 weeks of surgery used the program more than those enrolled more than 4 weeks from surgery.

Conclusions

This app-based prehabilitation program demonstrated moderate acceptability, engagement, and adherence. Addressing health beliefs and mindsets may be an effective way of increasing adherence to diet recommendations. To increase adherence to exercise recommendations, further assessment of potential barriers is critical. While an online platform is a highly promising scalable strategy, more customization and user engagement are necessary to make it an effective way of delivering a preoperative health behavior change intervention.

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References

  1. Durrand J, Singh SJ, Danjoux G. Prehabilitation. Clin Med (Lond). Nov 2019;19(6):458-464. https://doi.org/10.7861/clinmed.2019-0257

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gillis C, Buhler K, Bresee L, et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology. 08 2018;155(2):391-410.e4. https://doi.org/10.1053/j.gastro.2018.05.012

    Article  PubMed  Google Scholar 

  3. Hughes MJ, Hackney RJ, Lamb PJ, Wigmore SJ, Christopher Deans DA, Skipworth RJE. Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-analysis. World J Surg. 07 2019;43(7):1661-1668. https://doi.org/10.1007/s00268-019-04950-y

    Article  PubMed  Google Scholar 

  4. Steffens D, Beckenkamp PR, Young J, Solomon M, da Silva TM, Hancock MJ. Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis. Eur J Surg Oncol. 04 2019;45(4):510-518. https://doi.org/10.1016/j.ejso.2018.10.063

    Article  PubMed  Google Scholar 

  5. Kamarajah SK, Bundred J, Weblin J, Tan BHL. Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis. Surgery. Mar 2020;167(3):540-549. https://doi.org/10.1016/j.surg.2019.07.032

    Article  PubMed  Google Scholar 

  6. Kehler DS, Stammers AN, Tangri N, et al. Systematic review of preoperative physical activity and its impact on postcardiac surgical outcomes. BMJ Open. Aug 2017;7(8):e015712. https://doi.org/10.1136/bmjopen-2016-015712

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gillis C, Fenton TR, Sajobi TT, et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr. Jul 2018;https://doi.org/10.1016/j.clnu.2018.06.982

    Article  PubMed  Google Scholar 

  8. Boden I, Robertson IK, Neil A, et al. Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial. J Physiother. Jul 2020;66(3):180-187. https://doi.org/10.1016/j.jphys.2020.06.005

    Article  PubMed  Google Scholar 

  9. Barberan-Garcia A, Ubre M, Pascual-Argente N, et al. Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. Br J Anaesth. 10 2019;123(4):450-456. https://doi.org/10.1016/j.bja.2019.05.032

    Article  CAS  PubMed  Google Scholar 

  10. Barberan-Garcia A, Ubré M, Roca J, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. Jan 2018;267(1):50-56. https://doi.org/10.1097/SLA.0000000000002293

    Article  PubMed  Google Scholar 

  11. Waite I, Deshpande R, Baghai M, Massey T, Wendler O, Greenwood S. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg. Oct 2017;12(1):91. https://doi.org/10.1186/s13019-017-0655-8

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ngo-Huang A, Parker NH, Bruera E, et al. Home-Based Exercise Prehabilitation During Preoperative Treatment for Pancreatic Cancer Is Associated With Improvement in Physical Function and Quality of Life. Integr Cancer Ther. 2019 Jan-Dec 2019;18:1534735419894061. https://doi.org/10.1177/1534735419894061

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Rispoli M, Salvi R, Cennamo A, et al. Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection. Tumori. 2020:300891619900808. https://doi.org/10.1177/0300891619900808

  14. Robinson A, Slight R, Husband A, Slight S. The value of teachable moments in surgical patient care and the supportive role of digital technologies. Perioper Med (Lond). 2020;9:2. https://doi.org/10.1186/s13741-019-0133-z

    Article  PubMed  PubMed Central  Google Scholar 

  15. Flocke SA, Clark E, Antognoli E, et al. Teachable moments for health behavior change and intermediate patient outcomes. Patient Educ Couns. Jul 2014;96(1):43-9. https://doi.org/10.1016/j.pec.2014.03.014

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cummings KM, Jette AM, Rosenstock IM. Construct validation of the health belief model. Health Educ Monogr. 1978;6(4):394-405. https://doi.org/10.1177/109019817800600406

    Article  CAS  PubMed  Google Scholar 

  17. Schlund D, Poirier J, Bhama AR, et al. Value of an interactive phone application in an established enhanced recovery program. Int J Colorectal Dis. Jun 2020;35(6):1045-1048. https://doi.org/10.1007/s00384-020-03563-5

    Article  PubMed  Google Scholar 

  18. Gollish JD, Pereira L, MacLeod AM, et al. myHip&Knee: Improving Patient Engagement and Self-Management Through Mobile Technology. Healthc Q. Jul 2019;22(2):63-67. https://doi.org/10.12927/hcq.2019.25902

    Article  PubMed  Google Scholar 

  19. Pickens R, Cochran A, Tezber K, et al. Using a Mobile Application for Real-Time Collection of Patient-Reported Outcomes in Hepatopancreatobiliary Surgery within an ERAS® Pathway. Am Surg. Aug 2019;85(8):909-917.

    Article  Google Scholar 

  20. Pecorelli N, Fiore JF, Kaneva P, et al. An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability. Surg Endosc. 05 2018;32(5):2263-2273. https://doi.org/10.1007/s00464-017-5920-3

    Article  PubMed  Google Scholar 

  21. 21.Renner B, Knoll N, Schwarzer R. Age and body make a difference in optimistic health beliefs and nutrition behaviors. . International Journal of Behavioral Medicine. 2000;7(2):143-159. https://doi.org/10.1207/S15327558IJBM0702_4

    Article  Google Scholar 

  22. 22.Schwarzer R, Renner B. Social-cognitive predictors of health behavior: action self-efficacy and coping self-efficacy. Health Psychol. Sep 2000;19(5):487-95.

    Article  CAS  Google Scholar 

  23. Schwarzer R, Renner B. Health-Specific Self-Efficacy Scales. Accessed April 4, 2019. https://userpage.fu-berlin.de/health/healself.pdf

  24. Dweck CS. Mindset: the new psychology of success. Ballantine Books; 2008.

  25. Sujka J, St Peter S, Mueller CM. Do health beliefs affect pain perception after pectus excavatum repair? Pediatr Surg Int. Dec 2018;34(12):1363-1367. https://doi.org/10.1007/s00383-018-4354-x

    Article  PubMed  Google Scholar 

  26. Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes. Aug 2013;11:138. https://doi.org/10.1186/1477-7525-11-138

    Article  PubMed  PubMed Central  Google Scholar 

  27. H W, M A, J B, et al. Welcome to the Tidyverse. Journal of Open Source Software. 2019;4(43):1-6

  28. Team RC. A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/. Accessed 30 May 2021

  29. Thomas G, Tahir MR, Bongers BC, Kallen VL, Slooter GD, van Meeteren NL. Prehabilitation before major intra-abdominal cancer surgery: A systematic review of randomised controlled trials. Eur J Anaesthesiol. 12 2019;36(12):933-945. https://doi.org/10.1097/EJA.0000000000001030

    Article  PubMed  PubMed Central  Google Scholar 

  30. Halliday LJ, Doganay E, Wynter-Blyth V, Osborn H, Buckley J, Moorthy K. Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients. J Gastrointest Surg. 04 2021;25(4):890-899. https://doi.org/10.1007/s11605-020-04561-2

    Article  PubMed  Google Scholar 

  31. Anderson K, Burford O, Emmerton L. Mobile Health Apps to Facilitate Self-Care: A Qualitative Study of User Experiences. PLoS One. 2016;11(5):e0156164. https://doi.org/10.1371/journal.pone.0156164

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Floryan M, Chow PI, Schueller SM, Ritterband LM. The Model of Gamification Principles for Digital Health Interventions: Evaluation of Validity and Potential Utility. J Med Internet Res. 06 2020;22(6):e16506. https://doi.org/10.2196/16506

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bollyky JB, Bravata D, Yang J, Williamson M, Schneider J. Remote Lifestyle Coaching Plus a Connected Glucose Meter with Certified Diabetes Educator Support Improves Glucose and Weight Loss for People with Type 2 Diabetes. J Diabetes Res. 2018;2018:3961730. https://doi.org/10.1155/2018/3961730

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to acknowledge the generous gift by the Bauer Family Research Fund which supported this work.

Funding

Bauer Family Research Gift Fund.

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Authors and Affiliations

  1. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Elizabeth Shelton, Andrew Shelton & Cindy J. Kin

  2. Department of Surgery, Stanford-Surgery Policy Improvement Research and Education (SSPIRE), Palo Alto, CA, USA

    Nicolas B. Barreto, Serena Bidwell & Amber W. Trickey

  3. Stanford Health Care, Palo Alto, CA, USA

    Margaret Folk-Tolbert

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  1. Elizabeth Shelton
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Contributions

Elizabeth Shelton: Data acquisition/analysis/interpretation, drafting and critical revisions, final approval, and agrees to be accountable for all aspects of the work.

Nicolas Barreto and Amber Trickey: Data analysis/interpretation, drafting and critical revisions, final approval, and agrees to be accountable for all aspects of the work.

Serena Bidwell, Margaret Folk-Tolbert, and Andrew Shelton: Acquisition of data, critical revisions, final approval, and agrees to be accountable for all aspects of the work.

Cindy Kin: Conception/design of the work, acquisition, analysis and interpretation of data, drafting and critical revisions, final approval, and agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Cindy J. Kin.

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Shelton, E., Barreto, N.B., Bidwell, S. et al. Engagement and Adherence with a Web-Based Prehabilitation Program for Patients Awaiting Abdominal Colorectal Surgery. J Gastrointest Surg 25, 3198–3207 (2021). https://doi.org/10.1007/s11605-021-05171-2

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  • DOI: https://doi.org/10.1007/s11605-021-05171-2

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