Design of an mHealth application for optimizing preoperative physical function

Abstract: Limited physical reserve capacity in older people might be a risk factor for further functional decline and complications after surgery (Griffiths et al., 2014). A shift in cancer care in Sweden toward standardized and enhanced care processes, has led to that time between diagnosis and surgery has been shortened. Therefore, it has become important to focus on the effects of a short exercise program with high intensity and frequency. Recent qualitative studies have shown that patients with cancer need personalized support to perform preoperative exercises and that they prefer to do it at home or close to home (Beck et al., 2020). It is also important with a design that is tailored to the patient's needs, and goal setting, performance feedback, self-monitoring and reminders are all known facilitators for motivation and adherence to physical activity interventions (Michie et al., 2011).Development of the application: In a previous study, physiotherapists visited patients in their homes and supported them in conduction physical exercises during their preoperative phase. In the next step we developed a digital application consisting of, among other things, exercises, support and motivational features.The detailed features of the application were defined together with users during a co-creation process in workshops. Two workshops were conducted together with five patients. During the first workshop the participants discussed experiences from the previous intervention, factors they deemed relevant for adhering to the protocol and motivational aspects. During the second workshop the participants gave input on features and functionalities. One workshop was held together with five physiotherapists. In these workshops, experiences with the previous intervention, support needed for the patients and functionalities and interface for remote support were discussed. Further meetings and workshops were also conducted iteratively during the development phase.Content and interaction with the application: The specific aim of the application is to support the creation and tailoring of exercise programs with high intensity and frequency. The application consists of two parts, one used by the physiotherapists and one used by the patients. Physiotherapists are able to create individual exercise programs by selecting exercises from an exercise library, and then choosing settings for the exercises (e.g., numbers of sets and repetitions) based on a patient's needs and abilities. New types of exercises can be created by the physiotherapist and added to the library. The application allows the physiotherapist to monitor the patient's progress (based on data reported by the patient) and the exercise program can be adjusted if needed. The application also provides support for conveying a sense of presence and encouragement to the patient by allowing physiotherapist to write comments and to give the patient ”likes” on reported exercises, which will then be visible in the patient's part.The patient part of the application allows patients to see which exercises they are supposed to do each day, and to report to which extent the exercises have been completed. During reporting, the application will ask the patient to input data about how and when the exercise was performed (e.g., number of sets and reps, time of day, etc), and how the patient experienced the effort. All reported data are automatically gathered in a training diary section of the application, giving the patient access to the whole training history for later inspection. Any comments or likes sent by the physiotherapist also appears in the diary. The application includes different features for supporting and increasing the motivation to conduct the exercises. For example, rewards in the form of medals are given based on how well the patient follows the exercise program. Also, information about why this kind of training is important for improving the recovery after the surgery is provided in a theory section, to further strengthen the motivation to follow the exercise program. In the workshops patients had expressed the importance of this kind of information since it will be a reminder of how they can contribute to the best outcome as possible.ReferencesGriffiths R et al. Peri-operative care of the elderly 2014 Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2014;69:81-98. Beck A et al. Investigating the experiences, thoughts, and feelings underlying and influencing prehabilitation among cancer patients: a qualitative perspective on the what, when, where, who, and why. Disabil Rehabil. 2020 May 13:1-8.Michie S et al. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 2011;26:1479-98.

Keywords: mHealth, digital health, preoperative physical activity

DOI: 10.54941/ahfe1004083

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