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. 2025 Jan 1:14:e60420.
doi: 10.2196/60420.

Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial

Jianwei Su  1 , Cuiling Ye  1 , Qian Zhang  1 , Yi Liang  1 , Jianwei Wu  1 , Guixi Liang  1 , Yalan Cheng  1 , Xiaojuan Yang  1
Affiliations

Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial

Jianwei Su et al. JMIR Res Protoc. .

Abstract

Background: Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management through electronic patient-reported outcomes (ePROs) offers a potential solution to improve adherence by enabling more effective monitoring and intervention.

Objective: This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery for lung cancer.

Methods: In this single-center, prospective, randomized controlled trial, 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomly assigned 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and postdischarge days 3, 7, 14, 21, and 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, and fatigue) scored ≥4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is the rehabilitation exercise adherence rate. Secondary outcomes include postdischarge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction.

Results: The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data have been collected and thoroughly reviewed.

Conclusions: This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence after video-assisted thoracic surgery for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings.

Trial registration: ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946.

International registered report identifier (irrid): DERR1-10.2196/60420.

Keywords: eHealth; mobile phone; patient participation; patient-reported outcome measures; rehabilitation medicine; telemedicine; thoracic surgery.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flowchart of this parallel-group randomized controlled trial. ePRO: electronic patient-reported outcome; PPC: postdischarge pulmonary complication.
Figure 2
Figure 2
Workflow of patient self-reporting via the shuyu app and healthcare provider alert interface.
See this image and copyright information in PMC

References

    1. Zheng RS, Zhang SW, Sun KX, Chen R, Wang SM, Li L, Zeng HM, Wei WW, He J. Cancer statistics in China, 2016 [Article in Chinese] Zhonghua Zhong Liu Za Zhi. 2023;45(3):212–220. doi: 10.3760/cma.j.cn112152-20220922-00647. - DOI - PubMed
    1. Zhang W, Zhang Y, Qin Y, Shi J. Outcomes of enhanced recovery after surgery in lung cancer: a systematic review and meta-analysis. Asia Pac J Oncol Nurs. 2022 Nov;9(11):100110. doi: 10.1016/j.apjon.2022.100110. https://linkinghub.elsevier.com/retrieve/pii/S2347-5625(22)00168-8 S2347-5625(22)00168-8 - DOI - PMC - PubMed
    1. Stone AB, Yuan CT, Rosen MA, Grant MC, Benishek LE, Hanahan E, Lubomski LH, Ko C, Wick EC. Barriers to and facilitators of implementing enhanced recovery pathways using an implementation framework: a systematic review. JAMA Surg. 2018;153(3):270–279. doi: 10.1001/jamasurg.2017.5565.2669915 - DOI - PubMed
    1. Kampshoff CS, van Mechelen W, Schep G, Nijziel MR, Witlox L, Bosman L, Chinapaw MJM, Brug J, Buffart LM. Participation in and adherence to physical exercise after completion of primary cancer treatment. Int J Behav Nutr Phys Act. 2016;13(1):100. doi: 10.1186/s12966-016-0425-3. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0425-3 10.1186/s12966-016-0425-3 - DOI - PMC - PubMed
    1. Bassett S. Measuring patient adherence to physiotherapy. J Nov Physiother. 2012;02(07):e124. doi: 10.4172/2165-7025.1000e124. - DOI

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