Table 3 Objectives, study design, methods and results in studies included in the scoping review

Abelson et al. 2017 [27]

USA

To determine NY State residents’ willingness to engage in mHealth after surgery and compare socioeconomic factors that may affect willingness to engage

Survey

Primary outcome:

The majority reported a willingness to engage with mHealth, including wearing a tracker on their wrist, filling out daily surveys, sending pictures, and sharing updates

Secondary outcome:

Higher education, trust on the internet, and pre-existing smartphone use were associated with higher willingness to engage with mHealth. Black race and Hispanic ethnicity, but not age, were associated with lower willingness

Bouwsma et al. 2018 [28]

Netherlands

To study the implementation of the care programme in the daily practice of nine hospitals in the Netherlands

Multicentre stepped-wedge cluster randomized controlled study

Primary outcome:

The median duration until return to work was shorter in the intervention group than in the usual care group, 48/62 days

Secondary outcomes:

At the two-week follow-up, the intervention group differed significantly from the usual care group in quality of life (p = .0046), pain (p = .014), and disability (p = .000). These differences disappeared over time. There were no differences in functional health status, self-efficacy, or coping between the groups

Cnossen et al. 2016 [29]

Netherlands

To investigate the feasibility of the selfcare education programme in clinical practice by assessing uptake and usage rate and user satisfaction of a programme supplementary to regular care

The secondary aim was to investigate which sociodemographic and clinical factors are associated with user satisfaction

Multicentre single group cross-sectional study design

Usage:

Sixty-nine percent of the patients logged in, 55% spent < 60 min. using the programme, 29% 60–90 min. and 16% > 90 min. in the study period of 2 weeks. The majority (84%) found the programme beneficial in managing self-care and reported no problems performing self-care. Three patients had technical problems watching videos, and three were not interested

Davidovitch et al. 2018 [30]

USA

The aim was to investigate the clinical utility and economic burden associated with digital rehabilitation apps in primary total hip arthroplasty (THA) recipients

Single-centre retrospective review

Both the platform-only and the platform-HHS cohorts demonstrated similar improvements in all PROs at 12 weeks. The platform-only cohort was significantly (p =  < 05) more likely to download the mobile platform and demonstrated a significantly (p = .0001) greater engagement with the platform

Felbaum et al. 2018 [31]

USA

To demonstrate that app-based instructions with built-in reminders may improve patient understanding and compliance and contribute to reducing the number of surgery cancellations and postoperative complications and readmissions

Prospective evaluation

Fifty-four (96%) of the 56 included patients successfully downloaded, registered and used the studied app

There were no cancelled surgeries, and one postoperative complication was registered. Eight patients called the office on a single occasion regarding perioperative care

Glauser et al. 2019 [32]

The objective of this innovative app is to integrate enhanced recovery after surgery (ERAS) principles, patient education, and real-time pain and activity monitoring in a home setting with unencumbered two-way communication

A quality improvement effort

Eight (27%) of 30 patients logged in nearly every day from a week pre-op to > 45 days post-op. They found the daily reminders and graphical presentations of their trends most helpful. Helpful was also the daily to-do list, wound pictures, walking measures, pain level tracking, and communication with care. The non-users (n = 22, 73%) chose not to use the app due to no interest, difficulties with registration, difficulties using it, and not remembering to use it

Gustavell et al. 2019 [33]

Sweden

The aim was to evaluate the impact on health-related quality-of-life and self-care activity when using the Interaktor app following pancreaticoduodenectomy due to cancer

Historically controlled single-centre design

Health-related quality-of-life ratings at 6 weeks and 6 months were significantly higher in the intervention group. At 6 months, the intervention group rated higher (p = .033) engagement in self-care activities. The intervention group reported non-significant changes in 21 of health- related quality of life as compared to 8 for the control group

In the first 4 weeks, the intervention group reported symptoms as intended, (Mdn) 95%. Alerts were triggered (Mdn) three times. Self-care advice was viewed (Mdn) 13.5 times, mostly regarding pancreatic enzyme supplements, dietary advice, and pain

From 4 weeks to 6 months, the adherence was (Mdn) 83%. Alerts were triggered (Mdn) 7 times. Self-care advice was viewed (Mdn) 11 times

Hou et al. 2019 [34]

China

The aim of this study was to examine the efficacy of mobile-phone-based rehabilitation systems in patients who underwent lumbar spinal surgery

Multicentre prospective RCT

A total of 50 (78%), 37/58%), and 38 (59%) patients had high compliance at 6, 12, and 24 months, respectively. Twenty-four (37%) completed the whole trial. Reasons for low compliance included lack of communication with doctors, concerns about the accuracy of the action, limited symptom improvement, and lack of motivation

Primary outcomes:

The Owestry Disability Index (ODI) and pain were high in both groups, and no significant differences were seen at baseline up to 12 months. At 24 months, ODI and pain were significantly (p =  < .05) improved in the e-health group

Secondary outcomes:

No significant differences between groups were found for movement at 3, 6, and 12 months; at 24 months, there was a significant (p =  < .05) improvement in the e-health group. The EuroQol-5 improved significantly (p =  < .05) in the e-health group at 6, 12, and 24 months. The SF-36 improvement was significant (p =  < .05) at 3, 6, and 24 months in the e-health group. In the group with the highest adherence (subgroup with e-Health), there were significant (p =  < .05) changes in ODI and pain at 6, 12, and 24 months

van der Meij et al. 2018 [35]

Netherlands

The effect of a personalized e-healthcare programme on return to normal activities after surgery was evaluated

A multicentre, single-blind, randomized controlled trial

100% completed the baseline questionnaire, and questionnaires at 1, 3, and 6 weeks, and 3 and 6 months after surgery were completed by, respectively, (95%), (94%), (90%), (88%), and (87%)

Primary outcome:

Median time until return to normal activities was significantly (p = .007) shorter in the intervention group

Secondary outcomes:

Median time until 75% of normal activities and time until full resumption of work were in favour of the intervention group. Up to 6 months social participation (p = .038) and physical function (p = .024) scores were significantly higher in the intervention group; other measures did not differ between groups

Mundi et al. 2015 [36]

The primary objective was to assess the feasibility of using a smartphone app with EMA/EMI functionality to prepare patients for bariatric surgery

Ecological Momentary Assessment (EMA)/intervention study

Twenty (67%) out of 30 patients pursued the study. On average in this group, seven out of nine app modules were completed. There was a correlation between EMA response and confidence in maintaining an exercise regimen. The app was reported as being helpful in preparing for surgery. A small increase in nutrition knowledge and feeling more engaged in healthy lifestyle was seen. Two (10%) of twenty patients did not pursue surgery due to weight loss

Pecorelli et al. 2018 [37]

The objective was to assess the validity and usability of a novel mobile device app for education and self-reporting of adherence for patients undergoing bowel surgery within an established ERP

A prospective, single-group pilot study

follow-up

Patients used the app a median of 10 min/day. Patients completed 89% of available questionnaires. Reasons for non-completion were ongoing postoperative complications (n = 8), patient forgot (n = 7), patient did not understand the task (n = 2), and technical issues (n = 2). The majority (89%) of patients found the app to be very helpful in understanding and achieving recovery goals and reported increased motivation to recover after surgery

Pickens et al. 2019 [38]

USA

The aim was to demonstrate the novel implementation of an established mobile health app for PRO collection in an ERAS programme for hepatopancreatobiliary (HPB) surgery

A prospective, single-group pilot study

Patient engagement was 93% (114/122) before surgery. Immediate postoperative engagement was 88%, after discharge 52%, and 30% at week 3. Patients submitted 57% of prompted PROs. The 30-day end-of-study PROMIS survey was completed by 41%

The app helped the majority (29/30, 97%) feel more prepared before surgery and allowed (69/88, 78% to “feel more confident” and “worry less” during their recovery. Twenty-five to 36 patients reported compliance with self-care day 1–7. Twelve patients reported that the app prevented phone calls to the office and a visit to the ED. Most alerts (393/521) needed no further help due to given guided responses to further self-care or to call the nurse. Seven patients were directed to an ED

Russ et al. 2020 [39]

The research objectives were twofold:

1. To assess the views relating to the app with a cohort of diverse surgical patients recruited from the community and to understand perceptions of the app, perceived impacts on care and safety, and areas of improvement

2. To describe and evaluate the approach and impact of incorporating diverse PPI into the project design, planning, and delivery

Participatory action research

There were no significant differences in perceptions of the app according to sex, age, ethnicity, or length of hospital stay. Those with a disability were significantly less likely to agree that the app was easy to use. Those who had experienced previous surgery were significantly more positive. The majority experienced help in conversations around their care and changed the way they behaved. One third encountered technical difficulties when downloading the app

Reflective notes:

Patients could care better for themselves; the app promoted confidence and a sense of security, reduced worry, and made them feel less alone

Timmers et al [40]

2019

The aim was to investigate the effect of an interactive app on patients’ level of pain, physical functioning, quality of life, satisfaction, and healthcare consumption in the first four weeks of recovery after total knee replacement (TKR)

Randomized controlled trial

Primary outcome:

In the intervention group, pain was significantly lower during rest, activity, and night at postoperative weeks 2, 3, and 4

Secondary outcomes:

Physical functioning (p = . < 001) and quality of life (p = . < 001) were significantly better in the intervention group at 4 weeks postoperatively. In both groups, the ability to perform physiotherapy exercises and daily self-care activities during the first 4 weeks after discharge increased, and the intervention group performed better from the second week onwards. In both groups, perceptions of hospital involvement in their recovery process decreased during the 4 weeks; the intervention group had a smaller decrease. There was a significant (p = .014) difference in health consumption, in favour of the intervention group. The app was primarily used the first 2 weeks. Information and videos on pain, wound care, physiotherapy exercises, and self-care activities were most frequently used

Tofte et al. 2020 [41]

The purpose was to (1) implement a software platform to remotely and asynchronously accomplish the typical requisite elements of a postoperative CTR visit, (2) determine whether patients can reliably accomplish these tasks without direct supervision in clinic, and (3) describe characteristics of the software interface and patient population that were associated with patient success

Intervention prospective cohort study

Twelve of 16 (75%) of patients underwent surgery on their dominant extremity. The average time to complete the software modules was 13 min. Eleven (69%) patients used help from an intimate to complete the study objectives. All patients successfully completed dressing removal. Ten (62%) removed their sutures. Fourteen (88%) captured wound photos and classified the wound status. Fifteen (94%) patients successfully answered a question about median nerve symptoms, and 14 (88%) captured a physical exam video. Eight (50%) completed all aspects of the software module. No significant wound complications were identified. Hand dominance, age, self-perception of tech savviness, volume of text messaging, surgical technique, and phone usage activities were not predictive of successful study completion