Wouter Leclercq

Personalised perioperative care by e-health after intermediate-grade abdominal surgery: A multicentre, single-blind, randomised, placebo-controlled trial 173 10 DISCUSSION The findings of our study show that delivering personalised care via an e-health intervention programme is effective with respect to the time taken to return to normal activities after intermediate-grade abdominal surgery (as assessed with a personalised patient-reported outcome measure). Furthermore, the intervention care programme had a positive effect on social participation and physical function. No negative effects of the e-health intervention were noted, and complications before and after surgery were low. As far as we know, our study is the first to assess the effect of an e-health intervention on the time to return to normal activities after intermediate-grade abdominal surgery. In a systematic review about the effects of e-health in perioperative care, 11 studies were identified in which educational e-health interventions were evaluated. 27 However, only one study was done in patients undergoing abdominal surgery. 25 This paucity of studies is remarkable considering the increasing popularity of minimally invasive techniques done in day-care settings in this area and the associated lack of postoperative guidance in the postoperative course, which creates an urgent need for e-health solutions. In that study, 25 an educational perioperative e-health intervention was evaluated in patients undergoing gynaecological surgery. Participants in the intervention group returned to work (full resumption) 9 days earlier than participants in the control group. Our intervention was based on that study, 25 thus, we expected comparable results. In our study, we noted a significant difference in time to full resumption of work, in favour of the intervention group; however, the difference between groups was only 1 day. The reason for this discrepancy between studies could be because the intervention in our study focused mainly on resumption of normal activities, and return to work was only assessed in employed participants (74%). A second explanation could be that return to work was assessed in a less extensive way in our study (first day of work resumption and day of complete work resumption) by comparison with the earlier study, 25 in which sickness absence calendars were assessed prospectively. Finally, the type of surgical procedures included in our study were, overall, less invasive in character compared with the earlier study, which might have caused the smaller difference between groups in return to work time because of the overall shorter duration of sickness absence after these types of surgical procedures. A major strength of our study was the use of a personalised patient-reported outcome measure for assessment of the primary outcome. In several studies assessing the effects of an intervention on recovery after surgery, instruments or outcome measures were used that were not sensitive to measure effects or were not relevant in the context of the research question. 22,28,29 A patient-reported outcome measure has the potential to