Preliminary Evaluation of a Web-Based Psychological Screening Tool in Adolescents Undergoing Minimally Invasive Pectus Surgery: Single-Center Observational Cohort Study

Davina Wildemeersch, Lisa Bernaerts, Michiel D'Hondt, Guy Hans, Davina Wildemeersch, Lisa Bernaerts, Michiel D'Hondt, Guy Hans

Abstract

Background: Preoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health support and enhanced recovery after surgery.

Objective: This study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform.

Methods: Patients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of the International Council for Harmonisation-Good Clinical Practice guidelines and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). An online preoperative psychological inventory was performed using the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and State-Trait Anxiety Inventory. Postoperatively, pain intensity and interference were assessed using the Multidisciplinary Pain Inventory, Coping With Pain Questionnaire, and numeric pain rating scale assessment. Patient satisfaction of the Web-based platform was evaluated.

Results: A total of 21 adolescent patients used our Web-based psychological perioperative screening platform. Patients rated the mobile phone app, usability, and accessibility of the digital platform as good or excellent in 85% (17/20), 89% (17/19), and 95% (20/21) of the cases, respectively. A total of 89% (17/19) of the patients rated the effort of generating answers to the online questionnaires as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R=-0.72, P<.001) and overall anxiety characteristics (R=-0.49, P=.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R=0.52, P=.03 and R=0.6, P=.02, respectively) measured by the online self-report questionnaires. Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R=0.58, P=.02). Finally, there was a negative correlation between self-esteem and pain interference (R=-0.62, P=.01). Conclusions: Perioperative screening of psychological symptoms and trait characteristics with specific treatment, if necessary, could further improve postoperative pain and overall health status. Research on eHealth technology, even for psychological patient care, is rapidly increasing.

Trial registration: ClinicalTrials.gov NCT03100669; https://ichgcp.net/clinical-trials-registry/NCT03100669 (Archived by WebCite at http://www.webcitation.org/6zPvHDhU5).

Keywords: funnel chest; mental health; pectus carinatum; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Davina Wildemeersch, Lisa Bernaerts, Michiel D’Hondt, Guy Hans. Originally published in JMIR Mental Health (http://mental.jmir.org), 31.05.2018.

Figures

Figure 1
Figure 1
Flow diagram of patient screening and study inclusion during the summer holidays of 2017.
Figure 2
Figure 2
Study design.
Figure 3
Figure 3
Appi@home online platform—patient view.
Figure 4
Figure 4
Appi@home online platform—provider view listing completed questionnaires (Vragenlijsten).
Figure 5
Figure 5
Fear avoidance model of pain by Vlaeyen and Linton [39].

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