A Real-Time Mobile Intervention to Reduce Sedentary Behavior Before and After Cancer Surgery: Pilot Randomized Controlled Trial.
A Real-Time Mobile Intervention to Reduce Sedentary Behavior Before and After Cancer Surgery: Pilot Randomized Controlled Trial.
复制标题
一种实时的移动干预措施，可在癌症手术前后减少久坐行为：飞行员随机对照试验。
DOI：
10.2196/41425
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发表时间：
2023-01-12
影响因子：
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通讯作者：
Jakicic, John M
中科院分区：
文献类型：
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作者：
Low, Carissa A;Danko, Michaela;Durica, Krina C;Vega, Julio;Li, Meng;Kunta, Abhineeth Reddy;Mulukutla, Raghu;Ren, Yiyi;Sereika, Susan M;Bartlett, David L;Bovbjerg, Dana H;Dey, Anind K;Jakicic, John M
腹部癌症手术后久坐行为（SB）很普遍，针对围手术期久坐行为的干预措施可以改善术后恢复和结果。我们进行了一项试点研究，以评估实时移动干预的可行性和初步效果，该干预相对于仅监测的控制条件来检测和破坏癌症手术前后的长期 SB。我们的目的是评估围手术期 SB 干预对客观活动行为、患者报告的生活质量和症状以及 30 天再入院的可行性和初步效果。计划接受转移性胃肠癌手术的患者 (n=26) 被纳入并随机接受 SB 干预或仅接受活动监测。两组患者均使用 Fitbit 智能手表和配套智能手机应用程序来评估日常症状，并收集从手术前至少 10 天到出院后 30 天的连续客观活动行为数据。干预组的参与者在任何超过预设阈值的 SB 发作后也会收到步行提示，而在患者报告更严重症状的日子里，提示的频率会降低。参与者完成了研究结束时的可接受性评级，我们还检查了对评估和步行提示的遵守情况。此外，我们还研究了干预措施对客观 SB 和步数、患者报告的生活质量、抑郁和身体症状以及再入院的影响。应计率 (74%)、保留率 (88%) 和可接受性评级（平均总体满意度 88.5/100，SD 9.1）相对较高。然而，手术后对评估的依从性和对 SB 干预的参与度显着下降，并且术后出院后并未恢复到术前水平。所有参与者在手术后均表现出 SB 和症状显着增加，步数和生活质量下降，并且随机接受 SB 干预的参与者与对照组相比，意外地出现了更长的最大 SB 发作。在活动、生活质量、症状或再入院方面没有观察到干预的显着益处。转移性胃肠癌围手术期患者对实时 SB 干预感兴趣，并认为该干预高度可接受，但手术后对干预以及日常症状和活动监测的参与度显着下降。干预对步数、患者报告的生活质量或症状以及术后再入院没有显着影响，并且对最大 SB 有明显的不利影响。结果强调需要进行额外的工作来修改干预措施，以减少腹部癌症手术后的 SB 并使用移动医疗技术更加可行和有益。 ClinicalTrials.gov NCT03211806； https://tinyurl.com/3napwkkt
Sedentary behavior (SB) is prevalent after abdominal cancer surgery, and interventions targeting perioperative SB could improve postoperative recovery and outcomes. We conducted a pilot study to evaluate the feasibility and preliminary effects of a real-time mobile intervention that detects and disrupts prolonged SB before and after cancer surgery, relative to a monitoring-only control condition. Our aim was to evaluate the feasibility and preliminary effects of a perioperative SB intervention on objective activity behavior, patient-reported quality of life and symptoms, and 30-day readmissions. Patients scheduled for surgery for metastatic gastrointestinal cancer (n=26) were enrolled and randomized to receive either the SB intervention or activity monitoring only. Both groups used a Fitbit smartwatch and companion smartphone app to rate daily symptoms and collect continuous objective activity behavior data starting from at least 10 days before surgery through 30 days post discharge. Participants in the intervention group also received prompts to walk after any SB bout that exceeded a prespecified threshold, with less frequent prompts on days that patients reported more severe symptoms. Participants completed end-of-study ratings of acceptability, and we also examined adherence to assessments and to walking prompts. In addition, we examined effects of the intervention on objective SB and step counts, patient-reported quality of life and depressive and physical symptoms, as well as readmissions. Accrual (74%), retention (88%), and acceptability ratings (mean overall satisfaction 88.5/100, SD 9.1) were relatively high. However, adherence to assessments and engagement with the SB intervention decreased significantly after surgery and did not recover to preoperative levels after postoperative discharge. All participants exhibited significant increases in SB and symptoms and decreases in steps and quality of life after surgery, and participants randomized to the SB intervention unexpectedly had longer maximum SB bouts relative to the control group. No significant benefits of the intervention with regard to activity, quality of life, symptoms, or readmission were observed. Perioperative patients with metastatic gastrointestinal cancer were interested in a real-time SB intervention and rated the intervention as highly acceptable, but engagement with the intervention and with daily symptom and activity monitoring decreased significantly after surgery. There were no significant effects of the intervention on step counts, patient-reported quality of life or symptoms, and postoperative readmissions, and there was an apparent adverse effect on maximum SB. Results highlight the need for additional work to modify the intervention to make reducing SB and engaging with mobile health technology after abdominal cancer surgery more feasible and beneficial. ClinicalTrials.gov NCT03211806; https://tinyurl.com/3napwkkt