Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Jan 30;8(1):e017781.
doi: 10.1136/bmjopen-2017-017781.

Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation

Esther V A Bouwsma  1   2   3 , Judith A F Huirne  1   3 , Peter M van de Ven  4 , Antonie Vonk Noordegraaf  5 , Frederieke G Schaafsma  2   3 , Steven E Schraffordt Koops  6 , Paul J M van Kesteren  7 , Hans A M Brölmann  1 , Johannes R Anema  2   3
Affiliations
Randomized Controlled Trial

Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation

Esther V A Bouwsma et al. BMJ Open. .

Abstract

Objective: To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.

Design: Stepped-wedge cluster randomised controlled trial.

Setting: Secondary care, nine hospitals in the Netherlands, 2011-2014.

Participants: 433 employed women aged 18-65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery.

Interventions: An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice.

Main outcome measures: The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers.

Results: Median time until RTW was 49 days (IQR 27-76) in the intervention group and 62 days (42-85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%).

Conclusions: Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries.

Trial registration number: NTR2933; Results.

Keywords: minimally invasive surgery; organisation of health services; quality in healthcare; telemedicine.

PubMed Disclaimer

Conflict of interest statement

Competing interests: JRA reports a chair in insurance medicine paid by the Dutch Social Security Agency, and he is a stockholder of Evalua. JAFH reports grants from Samsung, Gideon Richter and Celonova, outside the submitted work. HAMB reports grants from Olympus and personal fees from Nordic Farma, during the conduct of the study. JRA and JAFH intend to set up a spin-off company concerning the implementation of a mobile application concerning the ikherstel intervention in the Netherlands. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Stepped-wedge design with nine clusters. At baseline, all clusters provide usual care. At 2-month intervals, the clusters cross over to the intervention. How long the care programme is implemented in a cluster at 20 months varies from 2 months (cluster 9) to 18 months (cluster 1).
Figure 2
Figure 2
Trial profile.
Figure 3
Figure 3
Survival curves for duration until full sustainable return to work (RTW). Median time to full sustainable RTW in the control group was 62 days (95% CI 54.9 to 69.1) and in the intervention group 49 days (95% CI 44.2 to 53.8); log-rank test P=0.153.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Majeed AW, Brown S, Williams N, et al. . Variations in medical attitudes to postoperative recovery period. BMJ 1995;311:296 10.1136/bmj.311.7000.296 - DOI - PMC - PubMed
    1. Cox H. Recovery from gynaecological day surgery: are we underestimating the process. Ambul Surg 2003;10:114–21. 10.1016/S0966-6532(03)00007-6 - DOI
    1. Evenson M, Payne D, Nygaard I. Recovery at home after major gynecologic surgery: how do our patients fare? Obstet Gynecol 2012;119:780–4. 10.1097/AOG.0b013e31824bb15e - DOI - PubMed
    1. Møller C, Ottesen M, Kehlet H, et al. . (Convalescence recommendations after hysterectomy. a study of opinions among Danish physicians). Ugeskr Laeger 2001;163:7043–7. - PubMed
    1. Ottesen M, Møller C, Kehlet H, et al. . Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. a nationwide questionnaire study. Acta Obstet Gynecol Scand 2001;80:1062–8. - PubMed

Publication types

Associated data

LinkOut - more resources