Assessment of postsurgical recovery after discharge using a pen computer diary*

Abstract

We assessed patients after their return home following gynaecological surgery, using a daily electronic diary. Thirty-two females aged 27-77 years took part. After a hospital stay of 1-6 days (mean 2.3), they were given a pen-based electronic diary and asked to record symptoms and other data over one month. They also completed a questionnaire at the end of the study. Substantial effects on quality and duration of sleep, pain during both the night and day, interference with daily activities, energy, and ability to concentrate were recorded, mostly during the first week of treatment. Symptoms reported in the final questionnaire correlated significantly with diary data. Most patients found the electronic diary easy to use, and none found it difficult. Daily electronic diaries are an acceptable method of obtaining better information on the extent and duration of symptoms and other difficulties after discharge following surgery. The costs of healthcare provision increase the pressure for efficient use of resources. Reducing the length of hospital stay after surgery is one approach to cost reduction. To properly assess cost effectiveness, information is needed on the degree to which patients are affected by postsurgical problems on their return home, and their speed of recovery.Most of the work in this area has investigated day case surgery, which now accounts for a large proportion of surgical procedures. In Scotland, for example, about 60% of elective surgery is carried out on a day basis [1]. Some studies have investigated the immediate postoperative recovery period using functional measures (ability to drink, void urine, or walk), symptom measures (pain, nausea) or cognitive testing [2][3][4][5]. Others have used questionnaires to assess symptoms and their impact, as well as overall satisfaction, after return home. Studies considering several time-points after discharge show that a substantial proportion of patients have at least moderate pain sufficient to interfere with daily activities, after their return home [4,6,7]. As well as pain, the after effects of surgery may include cognitive impairments. Thus Tzabar et al.[8] used the Cognitive Failures Scale over a 3-day period after day case surgery, and found more failures in patients who had received a general anaesthetic compared to those given only a local anaesthetic. 1101Work on patients undergoing surgery as in-patients has mostly focused on the recovery period before discharge [9][10][11]. Myles et al.[4] administered a Quality of Recovery Scale to patients daily for 6 days then weekly for up to 6 weeks after minor or major surgery. The scale assessed wellbeing, specific functions, symptoms, and need for support. Questionnaires were administered by telephone after discharge, but it is not clear from the report how long these patients stayed in hospital. Substantially greater effects were recorded after major surgery, as expected, with scores returning to baseline after about one week. Other studies have used questionnaires to assess patient satisfa...

Ambulatory and diary methods can facilitate the measurement of patient-reported outcomes

“…Diary measurement, and in particular momentary assessment, typically provides high resolution data from multiple assessments of the same construct, presenting the opportunity to study dynamic processes and how they unfold over time. Diaries have been used to closely monitor the course of symptoms following surgery [68,69], and to examine the exact course of physical and emotional side effects during chemotherapy [37,70,71]. They have also been employed in the investigation of situational contingencies of behaviors and experiences, such as the effect of momentary mood on smoking and substance use [72], emotional and physical symptom reactivity to daily stressors [73], and the effects of sleep disturbance on next-day symptoms [74].…”

Electronic data capture using the Womac® NRS 3.1 Index (m-Womac®): a pilot study of repeated independent remote data capture in OA

“…More recently, in various fields of medicine, there has been growing interest in electronic data capture (EDC) using a number of different platforms and applications (Dale and Hagen 2007;Abasomi et al 2006;Bolger et al 2003;Stubbs et al 2000;Blake 2008;Tufano and Karras 2005;Palmblad and Tiplady 2004;Cameron et al 2001;Kvien et al 2005;Tseng et al 1998;Begg et al 2003). In OA, there are already several published validation studies of EDC for the WOMAC Ò Index data using desktop and laptop computers (Bellamy et al 1997;Theiler et al 2002;Theiler et al 2004;Bischoff-Ferrari et al 2005), and growing interest in delivering the WOMAC Ò Index on personal digital assistants (PDAs).…”

The Importance of Electronic Diary Studies for Occupational Therapy Research

“…Although diary research methods were used initially for psychological and sociological research (Bolger et al, 2003), interdisciplinary scholars now use this methodology to assess many health-related conditions in both adult and pediatric populations. They include chronic pain (LiszkaHackzell & Martin, 2004;Palermo, Valenzuela, & Stork, 2004;Peters, Sorbi, Kruise, Kerssens, Verhaak, & Bensing, 2000), asthma (Hyland, Kenyon, Allen, & Howarth, 1993), cardiovascular disease (Kamarck et al, 2002), urinary incontinence (Haab, Stewart, & Dwyer, 2004), migraine (Giffin et al, 2003), diabetes (Tsang et al, 2001), and postoperative recovery (Begg, Drummond, & Tiplady, 2003). This methodology is also used to assess psychological and psychiatric disorders and conditions (Henker, Whalen, Jamner, & Delfino, 2002;Schärer et al, 2002).…”