Abstract
BackgroundSedentary behavior (SB) is common after cancer surgery and may negatively affect recovery and quality of life, but postoperative symptoms such as pain can be a significant barrier to patients achieving recommended physical activity levels. We conducted a single-arm pilot trial evaluating the usability and acceptability of a real-time mobile intervention that detects prolonged SB in the perioperative period and delivers prompts to walk that are tailored to daily self-reported symptom burden.ObjectiveThe aim of this study is to develop and test a mobile technology-supported intervention to reduce SB before and after cancer surgery, and to evaluate the usability and feasibility of the intervention.MethodsA total of 15 patients scheduled for abdominal cancer surgery consented to the study, which involved using a Fitbit smartwatch with a companion smartphone app across the perioperative period (from a minimum of 2 weeks before surgery to 30 days postdischarge). Participants received prompts to walk after any SB that exceeded a prespecified threshold, which varied from day to day based on patient-reported symptom severity. Participants also completed weekly semistructured interviews to collect information on usability, acceptability, and experience using the app and smartphone; in addition, smartwatch logs were examined to assess participant study compliance.ResultsOf eligible patients approached, 79% (15/19) agreed to participate. Attrition was low (1/15, 7%) and due to poor health and prolonged hospitalization. Participants rated (0-100) the smartphone and smartwatch apps as very easy (mean 92.3 and 93.2, respectively) and pleasant to use (mean 93.0 and 93.2, respectively). Overall satisfaction with the whole system was 89.9, and the mean System Usability Scale score was 83.8 out of 100. Overall compliance with symptom reporting was 51% (469/927 days), decreasing significantly from before surgery (264/364, 73%) to inpatient recovery (32/143, 22%) and postdischarge (173/420, 41%). Overall Fitbit compliance was 70% (653/927 days) but also declined from before surgery (330/364, 91%) to inpatient (51/143, 36%) and postdischarge (272/420, 65%).ConclusionsPerioperative patients with cancer were willing to use a smartwatch- and smartphone-based real-time intervention to reduce SB, and they rated the apps as very easy and pleasant to use. Compliance with the intervention declined significantly after surgery. The effects of the intervention on postoperative activity patterns, recovery, and quality of life will be evaluated in an ongoing randomized trial.
Highlights
MethodsSurgery is the first step of curative treatment for most cancers, but despite advances in surgical techniques and perioperative care, postoperative morbidity and complication rates remain high
Perioperative physical activity is a promising target for behavioral intervention given evidence that higher step counts after cancer resection are associated with lower readmission risk [4]
In the context of major abdominal cancer surgery, breaking up prolonged sedentary behavior (SB) bouts with brief walking breaks may be more attainable than increasing moderate physical activity (PA) or aiming for a specific step count goal
Summary
MethodsSurgery is the first step of curative treatment for most cancers, but despite advances in surgical techniques and perioperative care, postoperative morbidity and complication rates remain high. Risks are high after advanced abdominal cancer resection and include 30%-40% major complication rates, 15%-40% readmission rates, 40% reduction in functional capacity, and significant persistent symptoms [1,2,3]. Perioperative physical activity is a promising target for behavioral intervention given evidence that higher step counts after cancer resection are associated with lower readmission risk [4]. In the context of major abdominal cancer surgery, breaking up prolonged sedentary behavior (SB) bouts with brief walking breaks may be more attainable than increasing moderate physical activity (PA) or aiming for a specific step count goal. Sedentary behavior (SB) is common after cancer surgery and may negatively affect recovery and quality of life, but postoperative symptoms such as pain can be a significant barrier to patients achieving recommended physical activity levels. We conducted a single-arm pilot trial evaluating the usability and acceptability of a real-time mobile intervention that detects prolonged SB in the perioperative period and delivers prompts to walk that are tailored to daily self-reported symptom burden
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