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e-Assessed follow-up of postoperative recovery: developement, evaluation and patient experiences
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-4170-6451
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 182
Keywords [en]
Ambulatory surgery, cost-effectiveness, eHealth, mobile applications, postoperative recovery, qualitative research, randomised controlled trial
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-65776ISBN: 978-91-7529-249-6 (print)OAI: oai:DiVA.org:oru-65776DiVA, id: diva2:1190502
Public defence
2018-06-15, Örebro universitet, Forumhuset, Hörsal F, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-14 Created: 2018-03-14 Last updated: 2019-03-26Bibliographically approved
List of papers
1. Evaluation of the Swedish Web-Version of Quality of Recovery (SwQoR): Secondary Step in the Development of a Mobile Phone App to Measure Postoperative Recovery
Open this publication in new window or tab >>Evaluation of the Swedish Web-Version of Quality of Recovery (SwQoR): Secondary Step in the Development of a Mobile Phone App to Measure Postoperative Recovery
2016 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 5, no 3, article id e192Article in journal (Refereed) Published
Abstract [en]

Background: The majority of all surgeries are performed on an outpatient basis (day surgery). The Recovery Assessment by Phone Points (RAPP) app is an app for the Swedish Web-version of Quality of Recovery (SwQoR), developed to assess and follow-up on postoperative recovery after day surgery.

Objectives: The objectives of this study are (1) to estimate the extent to which the paper and app versions of the SwQoR provide equivalent values; (2) to contribute evidence as to the feasibility and acceptability of a mobile phone Web-based app for measuring postoperative recovery after day surgery and enabling contact with a nurse; and (3) to contribute evidence as to the content validity of the SwQoR.

Methods: Equivalence between the paper and app versions of the SwQoR was measured using a randomized crossover design, in which participants used both the paper and app version. Feasibility and acceptability was evaluated by a questionnaire containing 16 questions regarding the value of the app for follow-up care after day surgery. Content validity evaluation was based on responses by day surgery patients and the staff of the day surgery department.

Results: A total of 69 participants completed the evaluation of equivalence between the paper and app versions of the SwQoR. The intraclass correlation coefficient (ICC) for the SwQoR was .89 (95% CI 0.83-0.93) and .13 to .90 for the items. Of the participants, 63 continued testing the app after discharge and completed the follow-up questionnaire. The median score was 69 (inter-quartile range, IQR 66-73), indicating a positive attitude toward using an app for follow-up after day surgery. A total of 18 patients and 12 staff members participated in the content validity evaluation. The item-level content validity index (I-CVI) for the staff group was in the 0.64 to 1.0 range, with a scale-level content validity index (S-CVI) of 0.88. For the patient group, I-CVI was in the range 0.30 to 0.92 and S-CVI was 0.67. The content validity evaluation of the SwQoR, together with three new items, led to a reduction from 34 to 24 items.

Conclusions: Day surgery patients had positive attitudes toward using the app for follow-up after surgery, and stated a preference for using the app again if they were admitted for a future day surgery procedure. Equivalence between the app and paper version of the SwQoR was found, but at the item level, the ICC was less than .7 for 9 items. In the content validity evaluation of the SwQoR, staff found more items relevant than the patients, and no items found relevant by either staff or patients were excluded when revising the SwQoR.

Place, publisher, year, edition, pages
Toronto, Canada: JMIR Publications, Inc, 2016
Keywords
mHealth, ambulatory surgical procedures, postoperative period, mobile phones
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-52584 (URN)10.2196/resprot.5881 (DOI)27679867 (PubMedID)
Available from: 2016-09-27 Created: 2016-09-27 Last updated: 2018-05-22Bibliographically approved
2. Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial
Open this publication in new window or tab >>Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial
2017 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1030-1038Article in journal (Refereed) Published
Abstract [en]

Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.

Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.

Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.

Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
Mobile application, patient outcome assessment, postoperative complications, postoperative period
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-61084 (URN)10.1093/bja/aex331 (DOI)000413642900026 ()29077818 (PubMedID)2-s2.0-85034763250 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2017-09-19 Created: 2017-09-19 Last updated: 2019-03-26Bibliographically approved
3. Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial
Open this publication in new window or tab >>Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial
Show others...
2017 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed) Published
Abstract [en]

Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

Clinical trial registration:NCT02492191

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
Ambulatory surgery, cost effectiveness, mobile applications, postoperative period
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-61954 (URN)10.1093/bja/aex332 (DOI)000413642900027 ()29077819 (PubMedID)2-s2.0-85034731856 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2019-03-26Bibliographically approved
4. Holding it together: patients’ perspectives on postoperative recovery when using an e-assessed follow-up
Open this publication in new window or tab >>Holding it together: patients’ perspectives on postoperative recovery when using an e-assessed follow-up
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-67060 (URN)
Available from: 2018-05-21 Created: 2018-05-21 Last updated: 2019-03-26Bibliographically approved

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