149 7 Improving Enhanced Recovery After Surgery (ERAS): The Effect of a Patient-Centred Mobile Application (< 50 years and > 50 years). Participants, their involved healthcare professionals, and outcome assessors of study were not blinded to the treatment allocation as one group received the ERAS App and the other group did not. Participants were instructed not to tell other patients in their ward if they are assigned to the intervention or control group to avoid societal bias. Procedures Participants received care in adherence to the local ERAS protocol in their hospital, which were locally different among study centres. Additionally, the ERAS APPtimize intervention group was supported by the ERAS App spanning from 1-3 weeks preoperatively until 42 days postoperatively. The app was based on the generic ERAS protocol and was designed to educate and actively involve patients in their local perioperative care pathway promoting daily activity. The active ERAS elements reported in Table 1 were translated into practical patient-centred features. Push notifications were used to alert patients to new information at specific times to prompt them to complete the necessary actions for each element. All information on the ERAS protocol and required steps could be retrieved and accessed in the app at any time. Daily activity was measured using an activity tracker, starting 7 days prior to surgery or as soon as possible after surgery was scheduled. The average daily step count during the preoperative period of seven days is used to set an individual baseline. During the postoperative phase, daily step goals (Table S1) were offered via push notifications and taken steps were monitored in the app, until 21 days postoperatively. Questionnaires are also completed through the app. In study setting, participants had access to the app, as an access code were provided by the research team or healthcare providers. Participants received instructions at the treatment allocation, had the option the contact the research team for technical support if needed, and used the app according to their own preferences, without any intervention of the research team. Figure 1 displays the app layout. The ERAS App is CE-marked (NL-CA002-2019-47000), complies with the General Data Protection Regulation, and follows ISO 27001 data and security guidelines.30 Participants assigned to the control group received the usual care following the local ERAS protocol and were given a blinded activity tracker to monitor activity. Participants received a paper booklet containing the ERAS elements completion checklist and questionnaires. They were instructed to complete the checklists once a day and the questionnaires according to the time points shown in Table S2. Figure 2 illustrates the study pathways for both groups.
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