An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability



While patient engagement and clinical audit are key components of successful enhanced recovery programs (ERPs), they require substantial resource allocation. The objective of this study was to assess the validity and usability of a novel mobile device application for education and self-reporting of adherence for patients undergoing bowel surgery within an established ERP.


Prospectively recruited patients undergoing bowel surgery within an ERP used a novel app specifically designed to provide daily recovery milestones and record adherence to 15 different ERP processes and six patient-reported outcomes (PROs). Validity was measured by the agreement index (Cohen’s kappa coefficient for categorical, and interclass correlation coefficient (ICC) for continuous variables) between patient-reported data through the app and data recorded by a clinical auditor. Acceptability and usability of the app were measured by the System Usability Scale (SUS).


Forty-five patients participated in the study (mean age 61, 64% male). Overall, patients completed 159 of 179 (89%) of the available questionnaires through the app. Median time to complete a questionnaire was 2 min 49 s (i.q.r. 2′32″–4′36″). Substantial (kappa > 0.6) or almost perfect agreement (kappa > 0.8) and strong correlation (ICC > 0.7) between data collected through the app and by the clinical auditor was found for 14 ERP processes and four PROs. Patient-reported usability was high; mean SUS score was 87 (95% CI 83–91). Only 6 (13%) patients needed technical support to use the app. Forty (89%) patients found the app was helpful to achieve their daily goals, and 34 (76%) thought it increased their motivation to recover after surgery.


This novel application provides a tool to record patient adherence to care processes and PROs, with high agreement with traditional clinical audit, high usability, and patient satisfaction. Future studies should investigate the use of mobile device apps as strategies to increase adherence to perioperative interventions.

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This study was funded by SAGES SMART research grant 2015. The Steinberg-Bernstein Center for Minimally Invasive Surgery and Innovation is supported in part by an unrestricted educational grant from Medtronic®.

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Correspondence to Liane S. Feldman.

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Nicolò Pecorelli, Julio F. Fiore Jr., Pepa Kaneva, Abarna Somasundram, Patrick Charlebois, Barry L. Stein, A. Sender Liberman, and Francesco Carli have no conflicts of interests or financial ties to disclose. Liane S. Feldman is the recipient of an unrestricted educational grant from Medtronic.

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Pecorelli, N., Fiore, J.F., 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 32, 2263–2273 (2018).

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  • Mobile applications
  • Health education
  • Outcome and process assessment (health care)
  • Colorectal surgery
  • Enhanced recovery