Design of an mHealth application for optimizing preoperative physical
function
Authors: Sjölinder Marie , Ståhl Olov , Rydwik Elisabeth , Torikka Simon 
Published: July 2023

Limited physical reserve capacity in older people might be a risk factor
for further functional decline and complications after surgery (Griffiths et
al., 2014). A shift in cancer care in Sweden toward standardized and
enhanced care processes, has led to that time between diagnosis and surgery
has been shortened. Therefore, it has become important to focus on the
effects of a short exercise program with high intensity and frequency.
Recent qualitative studies have shown that patients with cancer need
personalized support to perform preoperative exercises and that they prefer
to do it at home or close to home (Beck et al., 2020). It is also important
with a design that is tailored to the patient's needs, and goal setting,
performance feedback, self-monitoring and reminders are all known
facilitators for motivation and adherence to physical activity interventions
(Michie et al., 2011).Development of the application: In a previous study,
physiotherapists visited patients in their homes and supported them in
conduction physical exercises during their preoperative phase. In the next
step we developed a digital application consisting of, among other things,
exercises, support and motivational features.The detailed features of the
application were defined together with users during a co-creation process in
workshops. Two workshops were conducted together with five patients. During
the first workshop the participants discussed experiences from the previous
intervention, factors they deemed relevant for adhering to the protocol and
motivational aspects. During the second workshop the participants gave input
on features and functionalities. One workshop was held together with five
physiotherapists. In these workshops, experiences with the previous
intervention, support needed for the patients and functionalities and
interface for remote support were discussed. Further meetings and workshops
were also conducted iteratively during the development phase.Content and
interaction with the application: The specific aim of the application is to
support the creation and tailoring of exercise programs with high intensity
and frequency. The application consists of two parts, one used by the
physiotherapists and one used by the patients. Physiotherapists are able to
create individual exercise programs by selecting exercises from an exercise
library, and then choosing settings for the exercises (e.g., numbers of sets
and repetitions) based on a patient's needs and abilities. New types of
exercises can be created by the physiotherapist and added to the library.
The application allows the physiotherapist to monitor the patient's progress
(based on data reported by the patient) and the exercise program can be
adjusted if needed. The application also provides support for conveying a
sense of presence and encouragement to the patient by allowing
physiotherapist to write comments and to give the patient ”likes” on
reported exercises, which will then be visible in the patient's part.The
patient part of the application allows patients to see which exercises they
are supposed to do each day, and to report to which extent the exercises
have been completed. During reporting, the application will ask the patient
to input data about how and when the exercise was performed (e.g., number of
sets and reps, time of day, etc), and how the patient experienced the
effort. All reported data are automatically gathered in a training diary
section of the application, giving the patient access to the whole training
history for later inspection. Any comments or likes sent by the
physiotherapist also appears in the diary. The application includes
different features for supporting and increasing the motivation to conduct
the exercises. For example, rewards in the form of medals are given based on
how well the patient follows the exercise program. Also, information about
why this kind of training is important for improving the recovery after the
surgery is provided in a theory section, to further strengthen the
motivation to follow the exercise program. In the workshops patients had
expressed the importance of this kind of information since it will be a
reminder of how they can contribute to the best outcome as
possible.ReferencesGriffiths R et al. Peri-operative care of the elderly
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feelings underlying and influencing prehabilitation among cancer patients: a
qualitative perspective on the what, when, where, who, and why. Disabil
Rehabil. 2020 May 13:1-8.Michie S et al. A refined taxonomy of behaviour
change techniques to help people change their physical activity and healthy
eating behaviours: the CALO-RE taxonomy. Psychol Health 2011;26:1479-98.