Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study

Background Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications. Objective The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting. Methods We enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device. Results All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency. Conclusions The use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required.


Anxiety
The level of anxiety and nervousness remained fairly low among both groups throughout the recovery period.

General Well being
The level of discomfort experienced by breast reconstruction patients gradually decreased over 30 days following surgery. A slight spike in discomfort was witnessed between day of discharge (day 1) and the second day of being home. This is perhaps due to patients adjusting to the home environment (i.e. the addition of stairs, walking, etc.). In the orthopedic ACL patient group, the decline in discomfort occurred more gradually and patients had a higher level of pain throughout recovery. Had a feeling of general well being Orthopedic ACL Surgery (n = 32)

Support from Others
All patients had higher levels of support during the first few days post--surgery. This is to be expected immediately post--surgery with the need for support dropping as recovery progresses. Had support from others Orthopedic ACL Surgery (n = 32) Note: Day 1 marks the day of discharge

Free from Pain
Looking at trends over time, severe pain or constant moderate pain in the breast reconstruction group was primarily high up to four days following surgery. A more sporadic trend of pain was experienced among the orthopedic patients and could reflect increased pain as physical therapy begins.

Breathing
Among both groups, patients indicated being able to breathe easily almost all the time to most of the time. It appears that orthopedic ACL patients had a slightly higher difficulty in breathing throughout the recovery period.

Unaided Personal Hygiene
From the application data we see that breast reconstruction patients experienced initial difficulty in their ability to look after personal toilet and hygiene unaided. Difficulty dropped substantially between day 1 and day 2 post--discharge. Orthopedic patients required assistance with personal hygiene for a longer period of time in comparison to the breast reconstruction group (Figure  42). This is likely due to the nature of orthopedic ACL surgery which can cause mobility difficulties. Level of Difficulty

Days Post Surgery
Been able to look aLer personal toilet and hygiene unaided.

Orthopedic ACL Surgery (n =32)
Note: Day 1 marks the day of discharge

Able to Pass Urine
Looking at trends in recovery, patients reported being able to pass urine without difficulty fairly quickly following surgery. However, it appears that it took a longer amount of time for the orthopedic patients to return to normal urine function in comparison with breast reconstruction patients. Level of Difficulty

Days Post Surgery
Been able to pass urine. Orthopedic ACL Surgery (n = 32)

Normal Bowel Function
For both groups, bowel function returned to normal within 10 days of surgery and remained fairly steady thereafter. The orthopedic ACL group exhibited a slower return to normal bowel function than the breast reconstruction group.

Free from Nausea, Dry--retching and Vomiting
Looking at Figures, breast reconstruction patients experienced an initial higher level of discomfort from nausea, dry--retching or vomiting compared to orthopedic ACL patients. However, the discomfort in both groups fades away roughly two weeks following surgery. The discomfort in breast reconstruction patients has a sharper and more rapid decline post--surgery in comparison to the orthopedic ACL patients.

Comprehend Instructions
Little difference in the level of difficulty in comprehending instructions was illustrated between days immediately following surgery and 30 days later in the breast reconstruction group. The orthopedic ACL group showed slightly more difficulty in understanding instructions and advice especially in the first two weeks post--discharge.

Been able to understand instruc8ons and advice. Not being confused. Orthopedic ACL Surgery (n = 32)
Free from headache, backache or muscle pains Both groups of patients reported low levels of aches during the 30 day recovery period with a slow decrease in discomfort over time.

Difficulty with Mobility among Orthopedic ACL Patients
The following figures illustrate indicators that describe the level of difficulty in mobility that orthopedic ACL patients experience. These indicators include difficulty in performing activities of daily living, climbing up and down the stairs, walking, and standing. As expected with normal recovery from orthopedic ACL surgery, a gradual decrease in the level of difficulty in mobility is demonstrated in these graphs.