52 Chapter 2 yet adequate. 31 One app monitored bariatric patients and provided advice on whether the patients were on track or to seek symptom management by reviewing the educational materials or contacting a HCP.32 The app was evaluated in a cohort in which clinical outcomes such as hospital stay or readmission did not differ between app users and the control group. Although adherence was relatively low, most patients were satisfied with the app. Weight loss Two apps mainly focused on a healthy diet, provided nutritional information and allowed bariatric patients to monitor their intake and weight.33,34 The already available app “MyfitnessPal” also allowed patients to make a diet program. The app was clinically evaluated in a RCT in which the control group was not allowed to use the app and only received self-monitoring journals.33 The percentage of weight loss after two years was significantly higher for patients using the app (71,5%) than for those who did not use the app (59,1%). The other app, developed by Dolan et al., had high adherence, but a relatively low patient.34 The other three apps were aimed at engagement and stimulation of physical activity and a healthy diet of bariatric patients.35-37 The extensive app of Sysko et al. was provided in combination with eight weekly virtual check-ins to review weight loss and the overall process before bariatric surgery.35 The app was evaluated in a pilot RCT. On average, patients opened the app five times per week and entered their weight twice per week. Patients using the app showed a significant moderate decrease instress and anxiety, whereas the effect on the caloric intake, weight loss and quality of life did not improve. The app of Mundi et al. provided automatic text messages stimulating a healthy lifestyle, and patients using this app had an average postoperative weight loss of 7.3 kg.36 The app “PromMera” monitors and stimulates physical activity and self-registered vitamin intake, but its clinical evaluation in a RCT has not yet been completed.37 Postoperative recovery Four apps intended to improve postoperative recovery, providing perioperative information and feedback on the postoperative recovery process.38-44 The app “IkHerstel” (I recover) was initially developed for gynaecological patients and adapted to fit a general gastrointestinal surgical population.38 The app was evaluated in a RCT, in which the control group received access to a placebo website containing standard general information.39 The time until postoperative return to normal daily activities significantly was shortened of four days in the intervention group (21 vs 25 days), whereas other postoperative complications did not differ. Patients were satisfied with the app and had relatively high involvement with the app and the activity tracker.40 The app is available in the app stores, but not freely accessible.
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