Fit 4 surgery, a bespoke app with biofeedback delivers rehabilitation at home before and after elective lung resection

Salma Bibi Kadiri,Alina-Maria Budacan,Christopher Golby,Amy Pamela Kerr,Sarah Flanagan,Stuart Lightfoot,Nicola Katy Oswald,Babu Naidu

doi:10.1186/s13019-019-0951-6

Abstract

BackgroundPulmonary rehabilitation programme for lung surgery patients can reduce the risk of post-operative complications but compliance to programmes can be limited by access to health care. We developed a home-based rehabilitation app and tested its feasibility in patients undergoing lung resection surgery.MethodsA cohort study was conducted over 18 months at a regional thoracic unit. The Fit 4 Surgery app included ten exercises. Patients were instructed to exercise for at least three minutes for each exercise. Data was transmitted back to the researchers remotely. Data was also collected from a contemporaneous group of surgery patients who attended local outpatient-based Chronic Obstructive Pulmonary Disease rehabilitation classes. Quality of Life and outcomes data in the app group were collected. Patients were also interviewed about their experience of the app.ResultsApp patients had a shorter wait before surgery compared to patients attending rehabilitation classes (24 vs 45 days) but managed four times as many sessions (2 vs 9), improving incremental shuttle walk test distance by 99 ± 83 (p < 0.05) metres before surgery. Five themes were gathered from the interviews.ConclusionAn app based programme of rehabilitation can be delivered in a timely fashion to lung surgery patients with demonstrable physiological benefits; this will need to be confirmed in further clinical trials.Clinical trial registration numberISRCTN00061628. Registered 27 May 2011.

Highlights

Pulmonary rehabilitation programme for lung surgery patients can reduce the risk of post-operative complications but compliance to programmes can be limited by access to health care
Inclusion criteria were broad; any patient deemed eligible for curative lung cancer surgery based on British Thoracic Society guidelines by the multidisciplinary teams referring to a regional thoracic surgery unit
Further work is required in adapting the app to deal with the changing needs and motivation to exercise after surgery

Summary

Introduction

Pulmonary rehabilitation programme for lung surgery patients can reduce the risk of post-operative complications but compliance to programmes can be limited by access to health care. We developed a homebased rehabilitation app and tested its feasibility in patients undergoing lung resection surgery. Up to 15% of patients develop post- operative complications after lung surgery which can result in death, admission into an intensive care unit, prolonged hospital stay and readmission to hospital after discharge [1, 2]. The evidence on pre- and post-operative rehabilitation in lung resection surgery is poor, mainly due to the heterogeneity of patient population, interventions and outcomes [3]. Meta-analysis of studies of pulmonary rehabilitation and/or exercise classes for lung surgery patients demonstrate improvement in exercise capacity, quality of life and a reduction in post-operative complications [5, 6]. Rehabilitation services can find it difficult to deal with the fluctuation in demand from flow of lung cancer surgery patients so can struggle to provide a consistent service [7]

Methods

Results

Discussion

Conclusion