Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation
ObjectiveTo evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.DesignStepped-wedge cluster randomised controlled trial.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Par...
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| creator | Bouwsma, Esther V A Huirne, Judith A F van de Ven, Peter M Vonk Noordegraaf, Antonie Schaafsma, Frederieke G Schraffordt Koops, Steven E van Kesteren, Paul J M Brölmann, Hans A M Anema, Johannes R |
| description | ObjectiveTo evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.DesignStepped-wedge cluster randomised controlled trial.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Participants433 employed women aged 18–65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery.InterventionsAn 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 measuresThe 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.ResultsMedian 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%).ConclusionsImplementation 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. |
| doi_str_mv | 10.1136/bmjopen-2017-017781 |
| format | Article |
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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 measuresThe 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.ResultsMedian 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%).ConclusionsImplementation 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.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2017-017781</identifier><identifier>PMID: 29382673</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Cancer surgery ; Convalescence ; Cross-Over Studies ; Evidence-based medicine ; Female ; Gynecologic Surgical Procedures - rehabilitation ; Gynecological surgery ; Gynecology ; Hospitals ; Humans ; Hysterectomy ; Internet ; Intervention ; Laparoscopy ; Middle Aged ; Netherlands ; Obstetrics and Gynaecology ; Patients ; Perioperative Care - methods ; Postoperative Period ; Proportional Hazards Models ; Recovery (Medical) ; Return to Work - statistics & numerical data ; Sick leave ; Systematic review ; Telemedicine ; Web portals</subject><ispartof>BMJ open, 2018-01, Vol.8 (1), p.e017781-e017781</ispartof><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b3871-c03fd9b55843813f08b662286ad91f5d53fdc9c60c82f9e0f501ee133a931e373</citedby><cites>FETCH-LOGICAL-b3871-c03fd9b55843813f08b662286ad91f5d53fdc9c60c82f9e0f501ee133a931e373</cites><orcidid>0000-0002-9010-6743</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopen.bmj.com/content/8/1/e017781.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopen.bmj.com/content/8/1/e017781.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,27530,27531,27905,27906,53772,53774,77350,77381</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29382673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bouwsma, Esther V A</creatorcontrib><creatorcontrib>Huirne, Judith A F</creatorcontrib><creatorcontrib>van de Ven, Peter M</creatorcontrib><creatorcontrib>Vonk Noordegraaf, Antonie</creatorcontrib><creatorcontrib>Schaafsma, Frederieke G</creatorcontrib><creatorcontrib>Schraffordt Koops, Steven E</creatorcontrib><creatorcontrib>van Kesteren, Paul J M</creatorcontrib><creatorcontrib>Brölmann, Hans A M</creatorcontrib><creatorcontrib>Anema, Johannes R</creatorcontrib><title>Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectiveTo evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.DesignStepped-wedge cluster randomised controlled trial.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Participants433 employed women aged 18–65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery.InterventionsAn 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 measuresThe 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.ResultsMedian 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%).ConclusionsImplementation 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.</description><subject>Adult</subject><subject>Cancer surgery</subject><subject>Convalescence</subject><subject>Cross-Over Studies</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Gynecologic Surgical Procedures - rehabilitation</subject><subject>Gynecological surgery</subject><subject>Gynecology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Internet</subject><subject>Intervention</subject><subject>Laparoscopy</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Obstetrics and Gynaecology</subject><subject>Patients</subject><subject>Perioperative Care - methods</subject><subject>Postoperative Period</subject><subject>Proportional Hazards Models</subject><subject>Recovery (Medical)</subject><subject>Return to Work - statistics & numerical data</subject><subject>Sick leave</subject><subject>Systematic review</subject><subject>Telemedicine</subject><subject>Web portals</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkk1r3DAQhk1paUKaX1Aogl56caoPy5Z6KJSQNoFAL-1ZyPLYq8WWXMnesL-vf6yz7DZNe6pA6GOeeWcG3qJ4zegVY6J-307bOEMoOWVNibtR7FlxzmlVlTWV8vmT-1lxmfOW4qqklpK_LM64ForXjTgvft70PbjF7yBAziT2xAbiwwIpwFK2NkNHZkgeiyV7wIizCcic4pDsNAFZIoGwscHhZ8zLHy6BiztIe1Qjwz5YfI5x8M6OZEYCwpI_EDeuGWsRF8OS4jhitSV5RB78siHJhi5O_tADUvMMXfkA3QDET_MIE0qgUAyvihe9HTNcns6L4vvnm2_Xt-X91y9315_uy1aohpWOir7TrZSqEoqJnqq2rjlXte0062UnMey0q6lTvNdAe0kZABPCasFANOKi-HjUndd2gs5h_WRHMyc_2bQ30XrzdyT4jRnizkjFdS0rFHh3Ekjxxwp5MTicg3G0AeKaDdNaUFpXXCH69h90G9cUcDzDqdZVoxmTSIkj5VLMOUH_2Ayj5uATc_KJOfjEHH2CWW-ezvGY89sVCFwdAcz-L8VfDOrQtA</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Bouwsma, Esther V A</creator><creator>Huirne, Judith A F</creator><creator>van de Ven, Peter M</creator><creator>Vonk Noordegraaf, Antonie</creator><creator>Schaafsma, Frederieke G</creator><creator>Schraffordt Koops, Steven E</creator><creator>van Kesteren, Paul J M</creator><creator>Brölmann, Hans A M</creator><creator>Anema, Johannes R</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9010-6743</orcidid></search><sort><creationdate>20180101</creationdate><title>Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation</title><author>Bouwsma, Esther V A ; Huirne, Judith A F ; van de Ven, Peter M ; Vonk Noordegraaf, Antonie ; Schaafsma, Frederieke G ; Schraffordt Koops, Steven E ; van Kesteren, Paul J M ; Brölmann, Hans A M ; Anema, Johannes R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b3871-c03fd9b55843813f08b662286ad91f5d53fdc9c60c82f9e0f501ee133a931e373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Cancer surgery</topic><topic>Convalescence</topic><topic>Cross-Over Studies</topic><topic>Evidence-based medicine</topic><topic>Female</topic><topic>Gynecologic Surgical Procedures - rehabilitation</topic><topic>Gynecological surgery</topic><topic>Gynecology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Internet</topic><topic>Intervention</topic><topic>Laparoscopy</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Obstetrics and Gynaecology</topic><topic>Patients</topic><topic>Perioperative Care - methods</topic><topic>Postoperative Period</topic><topic>Proportional Hazards Models</topic><topic>Recovery (Medical)</topic><topic>Return to Work - statistics & numerical data</topic><topic>Sick leave</topic><topic>Systematic review</topic><topic>Telemedicine</topic><topic>Web portals</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bouwsma, Esther V A</creatorcontrib><creatorcontrib>Huirne, Judith A F</creatorcontrib><creatorcontrib>van de Ven, Peter M</creatorcontrib><creatorcontrib>Vonk Noordegraaf, Antonie</creatorcontrib><creatorcontrib>Schaafsma, Frederieke G</creatorcontrib><creatorcontrib>Schraffordt Koops, Steven E</creatorcontrib><creatorcontrib>van Kesteren, Paul J M</creatorcontrib><creatorcontrib>Brölmann, Hans A M</creatorcontrib><creatorcontrib>Anema, Johannes R</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bouwsma, Esther V A</au><au>Huirne, Judith A F</au><au>van de Ven, Peter M</au><au>Vonk Noordegraaf, Antonie</au><au>Schaafsma, Frederieke G</au><au>Schraffordt Koops, Steven E</au><au>van Kesteren, Paul J M</au><au>Brölmann, Hans A M</au><au>Anema, Johannes R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>8</volume><issue>1</issue><spage>e017781</spage><epage>e017781</epage><pages>e017781-e017781</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectiveTo evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease.DesignStepped-wedge cluster randomised controlled trial.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Participants433 employed women aged 18–65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery.InterventionsAn 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 measuresThe 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.ResultsMedian 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%).ConclusionsImplementation 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.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>29382673</pmid><doi>10.1136/bmjopen-2017-017781</doi><orcidid>https://orcid.org/0000-0002-9010-6743</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Cancer surgery Convalescence Cross-Over Studies Evidence-based medicine Female Gynecologic Surgical Procedures - rehabilitation Gynecological surgery Gynecology Hospitals Humans Hysterectomy Internet Intervention Laparoscopy Middle Aged Netherlands Obstetrics and Gynaecology Patients Perioperative Care - methods Postoperative Period Proportional Hazards Models Recovery (Medical) Return to Work - statistics & numerical data Sick leave Systematic review Telemedicine Web portals |
| title | Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation |
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