Background: During the Covid-19 pandemic the PREPWELL team at South Tees Hospitals developed a three-tiered digital prehabilitation strategy to support patients preoperatively, with escalating intervention intensity tailored to individual patient need (Universal – Targeted – Complex). We assessed the impact of the ‘Complex’ tier (1:1 digital health coaching through a mobile phone app) on self-efficacy (using the Patient Activation Measure [PAM]) and lifestyle change in patients undergoing primary hip and knee arthroplasty.
Methods: Patients were risk assessed and consented before enrolment. Those suitable completed an 8-week multi-behavioural preoperative digital health coaching programme. Evaluations included change in PAM (score range 0–100) and lifestyle change, with assessments performed on programme enrolment (Entry) and completion (Exit).
Results: A total of 189 patients were approached, 57 (30%) enrolled and 39 (68%) completed the process: 67% female, median (range) age 63 (45–83) yr. The median (inter-quartile [IQR]) change in group PAM score was +9.7 (17) (see Fig. 12). On enrolment, 37% were in a ‘non-activated’ group (PAM level 1–2, low self-efficacy), with 69% transitioning into ‘activated’ levels (3 or 4). Self-rated scores for lifestyle improved by: exercise 20%, nutrition 5%, mental well-being 20%, sleep 20%.
Conclusions: We observed improvements in all measures of self-efficacy and lifestyle in patients completing the programme demonstrating the potential utility of digital health coaching in preparing patients for surgery. Encouragingly, the higher-risk group for adverse health outcomes (PAM levels 1 or 2 at entry) experienced a disproportionate benefit, with more than two-thirds of patients exiting at a lower risk level. This suggests those with greatest need may benefit most. The majority of participants were female and from a younger age group; we are therefore mindful of the need to improve future equality of access.
Fig 12.
Patient Activation Measure (PAM) for all patients at entry and exit.
Funding
PREPWELL is funded by a grant from Sport England and South Tees Hospitals Research and Development.