A mobile app significantly improves adherence to multimodal prehabilitation in elective colon cancer surgery: A Prospective Quasi-Randomized Controlled Pilot Study
This prospective quasi-randomized pilot study demonstrates that a mobile application significantly improves adherence to multimodal prehabilitation for elective colon cancer surgery compared to paper-based methods, while maintaining high usability and patient satisfaction, although the increased adherence did not translate into statistically significant differences in short-term functional or postoperative outcomes.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Before a major operation, doctors often worry about a patient's ability to recover. Surgery is a physical shock, and if a body is weak, tired, or poorly nourished before the knife even touches the skin, the road to healing becomes longer and more difficult. To counter this, medical teams have developed a strategy called prehabilitation. Think of it as a training camp for the body, designed to happen in the weeks leading up to a scheduled surgery. Instead of waiting to see how a patient fares after the operation, prehabilitation asks them to build strength, improve their nutrition, and calm their minds beforehand. The goal is to enter the operating room in the best possible shape, which theoretically leads to fewer complications and a faster return to normal life. For patients facing colon cancer surgery, this preparation is crucial, as the procedure carries significant risks. However, a major hurdle has always been getting patients to actually do the work. Doing exercises, tracking meals, and practicing relaxation techniques at home without a trainer watching over the shoulder is difficult. Many people start with good intentions but stop before the surgery date arrives.
Researchers at the Elche University Hospital in Spain decided to test a new way to solve this problem of sticking to the plan. They wondered if a smartphone application could act as a digital coach, keeping patients on track better than a simple paper booklet. They recruited patients scheduled for elective colon cancer surgery and divided them into two groups. One group received the standard care: a paper folder with written instructions, illustrated exercise guides, and a sheet to fill out by hand every day. The other group received the exact same instructions and exercises, but delivered through a custom mobile app called PREHapp. This app did more than just show pictures; it allowed patients to log their activities, tracked their walking distance automatically using their phone's sensors, and provided video tutorials for their workouts. The researchers wanted to see if the app could make patients more likely to complete the daily tasks compared to the paper version.
The results showed a dramatic difference in how well the two groups followed the program. In the group using the paper booklet, only about one in five patients successfully completed the required daily logs and activities. In stark contrast, nearly all patients in the app group, roughly nine out of ten, managed to stick to the plan. The app group achieved an adherence rate of 92.3 percent, while the paper group managed only 21.9 percent. This suggests that the digital tool was far more effective at helping patients remember and complete their daily regimen. The app seemed to provide a level of structure and accountability that a piece of paper could not match, turning a home-based program into something that felt as organized as a supervised gym session.
However, the story does not end with better attendance. The researchers also measured whether this higher adherence actually changed the patients' physical condition before the surgery or their recovery afterward. They looked at how far patients could walk in six minutes, their muscle strength, and their anxiety levels. While the patients who stuck to the program—regardless of whether they used the app or paper—did show some improvement in their walking distance, the difference between the app group and the paper group was not statistically significant. Both groups improved similarly, and neither group saw a clear advantage in their short-term recovery after surgery, such as fewer complications or shorter hospital stays. The hospital stay was five days for both groups, and the rate of complications was nearly identical.
This outcome highlights a specific nuance in the study. The app was a powerful tool for getting patients to do the work, but the study did not prove that doing the work led to better surgical results in this specific, small group of people. The researchers noted that the patients in the app group were slightly younger on average, which might have influenced the results, and the study was too small to definitively say whether the extra effort translated into a safer surgery. They found that patients who actually completed the exercises, no matter how they tracked them, walked further than those who did not. This suggests that the benefit comes from the exercise itself, not the app. The app's true value, according to this study, is its ability to act as a facilitator. It bridges the gap between a doctor's recommendation and a patient's daily action, ensuring that the patient actually gets the training they need. While the app did not magically improve the surgical outcome in this pilot study, it successfully solved the problem of getting patients to show up for their own preparation, demonstrating that digital tools can make home-based medical training feasible and highly engaging.
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