The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment

Maria Jaensson, Karuna Dahlberg, Mats Eriksson, Åke Grönlund, Ulrica Nilsson, Maria Jaensson, Karuna Dahlberg, Mats Eriksson, Åke Grönlund, Ulrica Nilsson

Abstract

Background: In Sweden, day surgery is performed in almost 2 million patients per year. Patient satisfaction is closely related to potential adverse events during the recovery process. A way to empower patients and give them the opportunity to affect care delivery is to let them evaluate their recovery process. The most common evaluation method is a follow-up telephone call by a nurse one or two days after surgery. In recent years, mHealth apps have been used to evaluate the nurse-patient relationship for self-management in chronic diseases or to evaluate pain after surgery. To the best of our knowledge, no previous research has explored the recovery process after day surgery via mobile phone in a Swedish cohort.

Objective: The objective of the study is to describe the process of developing a mobile phone app using a Swedish Web-based Quality of Recovery (SwQoR) questionnaire to evaluate postoperative recovery after day surgery.

Methods: The development process included five steps: (1) setting up an interdisciplinary task force, (2) evaluating the potential needs of app users, (3) developing the Swedish Web version of a QoR questionnaire, (4) constructing a mobile phone app, and (5) evaluating the interface and design by staff working in a day-surgery department and patients undergoing day surgery. A task force including specialists in information and communication technology, eHealth, and nursing care worked closely together to develop a Web-based app. Modifications to the QoR questionnaire were inspired by instruments used in the field of recovery for both children and adults. The Web-based app, Recovery Assessment by Phone Points (RAPP) consists of two parts: (1) a mobile app installed on the patient's private mobile phone, and (2) an administrator interface for the researchers.

Results: The final version of the SwQoR questionnaire, which includes 31 items, was successfully installed in RAPP. The interface and the design were evaluated by asking for user opinions about the design and usefulness of the app with 10 day surgery patients. Some minor adjustments were made concerning text size and screen color.

Conclusions: Taking advantage of joint expertise, a useable Web-based app adaptable to different technical platforms was constructed. In addition, the SwQoR was successfully transferred into digital format for use on mobile phones.

Keywords: cellular phone; day care; postoperative recovery.

Conflict of interest statement

Conflicts of Interest: Author UN and Örebro University Enterprise AB hold shares in RAPP-AB.

Figures

Figure 1
Figure 1
An example of the Recovery Assessed by Phone Points (RAPP) after the patients’ feedback, the background has a darker background and the text has been increased. (During the last 24 hours I have: Slept well, None of the time-All the time).
Figure 2
Figure 2
The patient can move the dot simply by touching the line. (During the last 24 hours Have you had any of the following: pain, None of the time-All the time) © Ulla-Carin Ekblom.

References

    1. Stomberg MW, Brattwall M, Jakobsson JG. Day surgery, variations in routines and practices a questionnaire survey. Int J Surg. 2013;11(2):178–182. doi: 10.1016/j.ijsu.2012.12.017.
    1. Gornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, Bost JE, Kluivers KB, Nilsson UG, Tanaka Y, Forbes A. Measurement of quality of recovery using the QoR-40: A quantitative systematic review. Br J Anaesth. 2013 Aug;111(2):161–169. doi: 10.1093/bja/aet014.
    1. Darwin L, Chung F. Patient selection for day surgery. Anaesthesia & Intensive Care Medicine. 2013 Mar;14(3):114–118. doi: 10.1016/j.mpaic.2013.01.003.
    1. Segerdahl M, Warrén-Stomberg M, Rawal N, Brattwall M, Jakobsson J. Clinical practice and routines for day surgery in Sweden: Results from a nation-wide survey. Acta Anaesthesiol Scand. 2008 Jan;52(1):117–124. doi: 10.1111/j.1399-6576.2007.01472.x.
    1. Jaensson M, Gupta A, Nilsson U. Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: A prospective study. BMC Anesthesiol. 2014;14(56):1–8. doi: 10.1186/1471-2253-14-56.
    1. Shirakami G, Teratani Y, Namba T, Hirakata H, Tazuke-Nishimura M, Fukuda K. Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia. J Anesth. 2005;19(2):93–101. doi: 10.1007/s00540-004-0297-6.
    1. Lehmann M, Monte K, Barach P, Kindler CH. Postoperative patient complaints: A prospective interview study of 12,276 patients. J Clin Anesth. 2010 Feb;22(1):13–21. doi: 10.1016/j.jclinane.2009.02.015.
    1. Myles PS, Hunt JO, Moloney JT. Postoperative 'minor' complications. Comparison between men and women. Anaesthesia. 1997 Apr;52(4):300–306.
    1. Palfreyman S. Patient-reported outcome measures and how they are used. Nurs Older People. 2011 Feb;23(1):31–36. doi: 10.7748/nop2011.02.23.1.31.c8295.
    1. Barham L, Devlin N. Patient-reported outcome measures: Implications for nursing. Nurs Stand. 2011;25(18):42–45. doi: 10.7748/ns2011.01.25.18.42.c8233.
    1. Semple JL, Sharpe S, Murnaghan ML, Theodoropoulos J, Metcalfe KA. Using a mobile app for monitoring post-operative quality of recovery of patients at home: A feasibility study. JMIR Mhealth Uhealth. 2015;3(1):e18. doi: 10.2196/mhealth.3929.
    1. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: Results of a prospective survey of 10,811 patients. Br J Anaesth. 2000 Jan;84(1):6–10.
    1. Dicianno BE, Parmanto B, Fairman AD, Crytzer TM, Yu DX, Pramana G, Coughenour D, Petrazzi AA. Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation. Phys Ther. 2015 Mar;95(3):397–405. doi: 10.2522/ptj.20130534.
    1. Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: A decade of evolution. J Med Internet Res. 2013;15(5):e95. doi: 10.2196/jmir.2430.
    1. Blake H. Mobile phone technology in chronic disease management. Nurs Stand. 2008;23(12):43–46. doi: 10.7748/ns2008.11.23.12.43.c6728.
    1. Kratzke C, Wilson S, Vilchis H. Reaching rural women: Breast cancer prevention information seeking behaviors and interest in Internet, cell phone, and text use. J Community Health. 2013 Feb;38(1):54–61. doi: 10.1007/s10900-012-9579-3.
    1. Stomberg MW, Platon B, Widén Annette, Wallner I, Karlsson O. Health information: What can mobile phone assessments add? Perspect Health Inf Manag. 2012;9:1–10.
    1. Keyser DJ, Abedin Z, Schultz DJ, Pincus HA. Mentorship in the context of interdisciplinary geriatric research: Lessons learned from the RAND/Hartford Program for Building Interdisciplinary Geriatric Research Centers. J Am Geriatr Soc. 2012 Aug;60(8):1546–1555. doi: 10.1111/j.1532-5415.2012.04063.x.
    1. Herschman J, Kasenberg T, Levy D, Ruth N, Taberner C, Kaufman M, Regina A. Development of a smartphone app for adolescents with lupus: A collaborative meeting-based methodology inclusive of a wide range of stakeholders. Rev Panam Salud Publica. 2014;35(5-6):471–476.
    1. Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting prevention in their pockets: Developing mobile phone-based HIV interventions for black men who have sex with men. AIDS Patient Care STDS. 2013 Apr;27(4):211–222. doi: 10.1089/apc.2012.0404.
    1. Idvall E, Berg K, Unosson M, Brudin L, Nilsson U. Assessment of recovery after day surgery using a modified version of quality of recovery-40. Acta Anaesthesiol Scand. 2009 May;53(5):673–677. doi: 10.1111/j.1399-6576.2009.01914.x.
    1. Allvin R, Ehnfors M, Rawal N, Svensson E, Idvall E. Development of a questionnaire to measure patient-reported postoperative recovery: Content validity and intra-patient reliability. J Eval Clin Pract. 2009 Jun;15(3):411–419. doi: 10.1111/j.1365-2753.2008.01027.x.
    1. Berg K, Idvall E, Nilsson U, Arestedt KF, Unosson M. Psychometric evaluation of the post-discharge surgical recovery scale. J Eval Clin Pract. 2010 Aug;16(4):794–801. doi: 10.1111/j.1365-2753.2009.01197.x.
    1. Nilsson U, Idvall E. Pain assessments in day surgery patients. J Clin Nurs. 2010 Oct;19(19-20):2942–2943. doi: 10.1111/j.1365-2702.2010.03417.x.
    1. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15. Anesthesiology. 2013 Jun;118(6):1332–1340. doi: 10.1097/ALN.0b013e318289b84b.
    1. Marcano Belisario JS, Huckvale K, Saje A, Porcnik A, Morrison CP, Car J. Comparison of self administred survey questionnaire responses collected using mobile apps versus other methods (Protocol) Cochrane Database of Systematic Reviews. 2014;(4):1–11. doi: 10.1002/14651858.MR000042.
    1. SFS 2003:460 . Lag om etikprövning av forskning som avser människor. Stockholm: Utbildningsdepartementet; 2003. [2015-08-30].
    1. Knight-Agarwal C, Davis DL, Williams L, Davey R, Cox R, Clarke A. Development and pilot testing of the Eating4two mobile phone app to monitor gestational weight gain. JMIR Mhealth Uhealth. 2015;3(2):e44. doi: 10.2196/mhealth.4071.
    1. Dunsmuir DT, Payne BA, Cloete G, Petersen CL, Görges Matthias, Lim J, von DP, Dumont GA, Ansermino JM. Development of mHealth applications for pre-eclampsia triage. IEEE J Biomed Health Inform. 2014 Nov;18(6):1857–1864. doi: 10.1109/JBHI.2014.2301156.
    1. Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs. 2013 Jan;69(1):4–15. doi: 10.1111/j.1365-2648.2012.06064.x.
    1. Klasnja P, Pratt W. Healthcare in the pocket: Mapping the space of mobile-phone health interventions. J Biomed Inform. 2012 Feb;45(1):184–198. doi: 10.1016/j.jbi.2011.08.017.
    1. Coons SJ, Gwaltney CJ, Hays RD, Lundy JJ, Sloan JA, Revicki DA, Lenderking WR, Cella D, Basch E, ISPOR ePRO Task Force Recommendations on evidence needed to support measurement equivalence between electronic and paper-based patient-reported outcome (PRO) measures: ISPOR ePRO Good Research Practices Task Force report. Value Health. 2009 Jun;12(4):419–429. doi: 10.1111/j.1524-4733.2008.00470.x.
    1. Hunter J, Corcoran K, Leeder S, Phelps K. Is it time to abandon paper? The use of emails and the Internet for health services research--a cost-effectiveness and qualitative study. J Eval Clin Pract. 2013 Oct;19(5):855–861. doi: 10.1111/j.1365-2753.2012.01864.x.
    1. Huryk LA. Factors influencing nurses' attitudes towards healthcare information technology. J Nurs Manag. 2010 Jul;18(5):606–612. doi: 10.1111/j.1365-2834.2010.01084.x.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere