RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies

U Nilsson, M Jaensson, K Dahlberg, S Odencrants, Å Grönlund, L Hagberg, M Eriksson, U Nilsson, M Jaensson, K Dahlberg, S Odencrants, Å Grönlund, L Hagberg, M Eriksson

Abstract

Introduction: Day surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life.

Methods and analysis: This study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either e-assessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery.The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A-C) at 1 and 2 weeks and (D) at 1 and 4 months.

Trial registration number: NCT02492191; Pre-results.

Keywords: QUALITATIVE RESEARCH.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Trial flowchart showing the steps in participant recruitment, intervention, outcome assessments and analysis.

References

    1. Stomberg MW, Brattwall M, Jakobsson JG. Day surgery, variations in routines and practices a questionnaire survey. Int J Surg 2013;11:178–82. 10.1016/j.ijsu.2012.12.017
    1. Young J, O'Connell B, McGregor S. Day surgery patients’ convalescence at home: does enhanced discharge education make a difference? Nurs Health Sci 2000;2:29–39. 10.1046/j.1442-2018.2000.00036.x
    1. Berg K, Arestedt K, Kjellgren K. Postoperative recovery from the perspective of day surgery patients: a phenomenographic study. Int J Nurs Stud 2013;50:1630–8. 10.1016/j.ijnurstu.2013.05.002
    1. Ross J. Preoperative assessment and teaching of postoperative discharge instructions: the importance of understanding health literacy. J Perianesth Nurs 2013;28:318–20. 10.1016/j.jopan.2013.07.002
    1. Kobayashi LC, Wardle J, von Wagner C. Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med 2014;61:100–5. 10.1016/j.ypmed.2013.11.012
    1. Segerdahl M, Warren-Stomberg M, Rawal N et al. . Clinical practice and routines for day surgery in Sweden: results from a nation-wide survey. Acta Anaesthesiol Scand 2008;52:117–24. 10.1111/j.1399-6576.2007.01472.x
    1. Semple JL, Sharpe S, Murnaghan ML et al. . Using a mobile app for monitoring post-operative quality of recovery of patients at home: a feasibility study. JMIR Mhealth Uhealth 2015;3:e18 10.2196/mhealth.3929
    1. Gray RT, Sut MK, Badger SA et al. . Post-operative telephone review is cost-effective and acceptable to patients. Ulster Med J 2010;79:76–9.
    1. Myles PS, Weitkamp B, Jones K et al. . Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 2000;84:11–5. 10.1093/oxfordjournals.bja.a013366
    1. Myles PS, Hunt JO, Nightingale CE et al. . Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 1999;88:83–90.
    1. Idvall E, Berg K, Unosson M et al. . Assessment of recovery after day surgery using a modified version of quality of recovery-40. Acta Anaesthesiol Scand 2009;53:673–7. 10.1111/j.1399-6576.2009.01914.x
    1. Gornall BF, Myles PS, Smith CL et al. . Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth 2013;111:161–9. 10.1093/bja/aet014
    1. Valderas JM, Kotzeva A, Espallargues M et al. . The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res 2008;17:179–93. 10.1007/s11136-007-9295-0
    1. Rose M, Bezjak A. Logistics of collecting patient-reported outcomes (PROs) in clinical practice: an overview and practical examples. Qual Life Res 2009;18:125–36. 10.1007/s11136-008-9436-0
    1. Klasnja P, Pratt W. Healthcare in the pocket: mapping the space of mobile-phone health interventions. J Biomed Inform 2012;45:184–98. 10.1016/j.jbi.2011.08.017
    1. Ainsworth J, Palmier-Claus JE, Machin M et al. . A comparison of two delivery modalities of a mobile phone-based assessment for serious mental illness: native smartphone application vs text-messaging only implementations. J Med Internet Res 2013;15:e60 10.2196/jmir.2328
    1. Weaver A, Young AM, Rowntree J et al. . Application of mobile phone technology for managing chemotherapy-associated side-effects. Ann Oncol 2007;18:1887–92. 10.1093/annonc/mdm354
    1. Bass EB, Steinberg EP, Pitt HA et al. . Comparison of the rating scale and the standard gamble in measuring patient preferences for outcomes of gallstone disease. Med Decis Making 1994;14:307–14.
    1. Jaensson M, Dahlberg K, Eriksson M et al. . The Development of the recovery Assessments by Phone Points (RAPP): a mobile phone application for post-operative recovery monitoring and assessment. JMIR MHealth UHealth 2015;3:e86 10.2196/mhealth.4649
    1. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002;21:271–92. 10.1016/S0167-6296(01)00130-8
    1. Taft C, Karlsson J, Sullivan M. Do SF-36 summary component scores accurately summarize subscale scores? Qual Life Res 2001;10:395–404. 10.1023/A:1012552211996
    1. Sullivan M, Karlsson J. The Swedish SF-36 Health Survey III. Evaluation of criterion-based validity: results from normative population. J Clin Epidemiol 1998;51:1105–13. 10.1016/S0895-4356(98)00102-4
    1. EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208. 10.1016/0168-8510(90)90421-9
    1. Ishikawa H, Nomura K, Sato M et al. . Developing a measure of communicative and critical health literacy: a pilot study of Japanese office workers. Health Promot Int 2008;23:269–74. 10.1093/heapro/dan017
    1. Wangdahl JM, Martensson LI. The communicative and critical health literacy scale—Swedish version. Scand J Public Health 2014;42:25–31. 10.1177/1403494813500592
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 10.1191/1478088706qp063oa
    1. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, CA: Sage Publications, 1985.
    1. World Medical Association. Declaration of Helsinki. Ethical principles for medical research involving human subjects (cited 12 February 2013).

Source: PubMed

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