Using a digital prehabilitation tool to support patients preparing for surgery

University Hospital of Southampton (UHS) recognised that patients would benefit from help to prepare for surgery.

This included:

• advice
• tools
• behaviour change techniques

However due to resource constraints, many patients receive little or no support during the preoperative period.

Patients are often seen very close to the time of their operation and given insufficient information about prehabilitation.

Situation

Elective surgery wait times increased because of pressures caused by COVID-19. Patients were waiting longer and becoming less prepared for surgery in the process.

With other relevant organisations, the Centre for Perioperative Care released joint guidance for preoperative assessment and optimisation of adult patients awaiting surgery. The guidance suggests a holistic approach to transform waitlists into 'preparation lists' for surgery.

It combines optimising comorbidities with improving nutritional, mental and physical wellbeing. The combined effect improves perioperative fitness, recovery and encourages behaviour change for better long-term health.

Aspiration

Face-to-face preoperative services help patients to prepare for surgery and also improve recovery after surgery. However, most NHS sites do not have the capacity to deliver these services to all patients.

The team wanted to take an already-successful prehabilitation model and transform it into a digital intervention. This digital tool prepares patients mentally and physically for surgery. It also identifies patients who would benefit from more targeted interventions.

The team also saw an opportunity to use behaviour change science to support patients with their long-term health. This would be delivered through both prehabilitation and additional support for comorbidities.

The aim is to:

• improve outcomes, reduce complication rates and improve efficiency and costs in elective care
• help patients waiting for major elective surgery to improve their fitness, reduce stress and anxiety and optimise nutrition before their operation

Solution and impact

UHS and my mhealth worked together to develop myOp.

myOp is an intervention designed to support patients before elective surgery. It combines evidence-based prehabilitation interventions with behavioural change techniques to improve physical and mental fitness and optimise nutrition.  

For patients, there are a series of platforms which can be accessed from a range of devices.

Patients of all ages can use the app to assess their level of:

• physical fitness
• psychological wellbeing
• nutritional status

They then use the tools within the app to improve these areas.

Through regular in-app support based on behaviour change science, they can take part in fitness and mental wellbeing programmes in the run up to surgery.

Educational videos and literature within the app provide information on what to expect when going for an operation and how to make the most of their recovery period.

The app helps patients manage long-term conditions.

For clinicians, my mhealth enables patients to be risk assessed and helps identify those who might benefit from specialist services like:

• mental health support
• help to stop smoking

It also contains two-way chat and video consultations, making face-to-face appointments less frequent but more efficient.

Functionality

myOp is available as a web and mobile app and can be accessed using almost any device with a web connection.

It engages the patient with a series of interventions that aim to physically and mentally prepare them for surgery. Interventions include:

• an aerobic fitness programme
• active breathing cycles
• mindfulness-based cognitive therapy
• education
• nutritional advice

These interventions are wrapped in behavioural change methodology to encourage engagement and healthy lifestyle changes. 

For clinicians, the app uses standardised assessments including the: 

• Duke Activity Status Index
• Hospital Anxiety and Depression Scale
• alcohol audit
• smoking audit
• nutrition screen

By encouraging patients to complete the assessments regularly, clinicians can monitor progress and improvement over time in each area.

Capabilities

• myOp is suitable for almost every patient undergoing major elective surgery.
• The app delivers holistic prehabilitation with specific tools for physical fitness, mental health support and nutritional optimisation.
• It incorporates several behaviour change techniques, including setting SMART goals.
• One-way messaging, two-way text chat and video consultations are included.

The app enables optimisation of comorbidities using other my mhealth apps like:

• myCOPD
• myAsthma
• myDiabetes
• myHeart

Scope

Patients undergoing elective surgery can be registered to myOp early in their surgical journey. This could happen when deciding to operate or even when the patient is contemplating surgery.

Ideally patients should have at least 2 weeks to use the app’s tools to help them prepare their body and mind.

Patients can use the app at home to prepare ahead of surgery.

During this period clinicians can use the dashboard to remotely manage their patients. For example clinicians can refer patients to other services for mental health support or stopping smoking. They can also use the chat and video call functions to speak to their patients remotely.

Key learning points

By working in partnership, it has been possible to combine the clinical expertise of the UHS team with the technical ability of my mhealth.

This has led to the development of a comprehensive app with the potential to benefit thousands of patients across the NHS and beyond.

Key quotes

"The perioperative medicine team at UHS are proud to have worked in partnership with my mhealth to develop and launch myOp. The UHS team is actively planning how to embed this app within care pathways, supporting surgical patients and the elective recovery."

Professor Denny Levett, Professor in Perioperative Medicine and Critical Care, Consultant in Perioperative Medicine, UHS

“Effective prehabilitation has been shown to reduce complications and improve quality of life.

As the health service recovers from COVID-19, it’s now more important than ever to support and optimise patients preoperatively. This leads to better outcomes, reduced complications, shorter hospital stays and improved efficiency in surgical pathways.

Prehabilitation and enhanced recovery after surgery should form a key part of current elective recovery plans.”

Professor Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, Consultant in Critical Care Medicine, UHS

Key contact

Professor Denny Levett, Professor in Perioperative Medicine and Critical Care, Consultant in Perioperative Medicine, UHS

d.levett@soton.ac.uk

Sarah Behmardi, UK Commercial Officer, my mhealth Limited

sarah.behmardi@mymhealth.com or info@mymhealth.com