A Mobile Phone-Based Self-Monitoring Tool for Perioperative Gastric Cancer Patients With Incentive Spirometer: Randomized Controlled Trial

Abstract

Background: An incentive spirometer (IS) is a medical device used to help patients improve the functioning of their lungs. It is provided to patients who have had any surgery that might jeopardize respiratory function. An incentive spirometer plays a key role in the prevention of postoperative complications, and the appropriate use of an IS is especially well known for the prevention of respiratory complications. However, IS utilization depends on the patient's engagement, and information and communication technology (ICT) can help in this area.

Objective: This study aimed to determine the effect of mobile ICT on the usage of an IS (Go-breath) app by postoperative patients after general anesthesia.

Methods: For this study, we recruited patients from April to May 2018, who used the Go-breath app at a single tertiary hospital in South Korea. The patients were randomly classified into either a test or control group. The main function of the Go-breath app was to allow for self-reporting and frequency monitoring of IS use, deep breathing, and active coughing in real time. The Go-breath app was identical for both the test and control groups, except for the presence of the alarm function. The test group heard an alarm every 60 min from 9 am to 9 pm for 2 days. For the test group alone, a dashboard was established in the nurse's station through which a nurse could rapidly assess the performance of multiple patients. To evaluate the number of performances per group, we constructed an incentive spirometer index (ISI).

Results: A total of 44 patients were recruited, and 42 of them completed the study protocol. ISI in the test group was 20.2 points higher than that in the control group (113.5 points in the test group and 93.2 points in the control group, P=.22). The system usability scale generally showed almost the same score in the 2 groups (79.3 points in the test group and 79.4 points in the control group, P=.94). We observed that the performance rates of IS count, active coughing, and deep breathing were also higher in the test group but with no statistically significant difference between the groups. For the usefulness "yes or no" question, over 90% (38/42) of patients answered "yes" and wanted more functional options and information.

Conclusions: The use of the Go-breath app resulted in considerable differences between the test group and control group but with no statistically significant differences.

Trial registration: ClinicalTrials.gov NCT03569332; https://ichgcp.net/clinical-trials-registry/NCT03569332 (Archived by WebCite at http://www.webcitation.org/74ihKmQIX).

Keywords: gastric cancer; incentive spirometer; mobile health; motivation; postoperative care.

Conflict of interest statement

Conflicts of Interest: IP, GS, NH, and CH are employees of the company that developed the Go-breath app.

©Ji Yeong Soh, Se Uk Lee, Inpyo Lee, Ki Sang Yoon, Changho Song, Nam Hun Kim, Tae Sung Sohn, Jae Moon Bae, Dong Kyung Chang, Won Chul Cha. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 19.02.2019.

Figures

Figure 1

Study protocol. Superscripted "a" indicates alarm every 50 min for insufficient during 9am-9pm (alarm off during 9pm-9am); "b" indicates calculation of performance score applies only to incentive spirometer (full score 240, 10 out of 10 points). V/S: blood pressure, fever, body temperature, respiration rate; CRP: C-reactive protein; IS: incentive spirometer; PA: posterior to anterior; WBC: white blood cell.

Figure 2

Screenshot of the Go-breath app (left) and dashboard (right). The original version was in Korean, but it was modified to display English.

Figure 3

System architecture. API: application programming interface; AWS: Amazon Web Service.