A Behavioral Study of Digital Technology for Improving Post-Operative Incentive Spirometer Adherence

Abstract

TITLE: A Behavioral Study of Digital Technology for Improving Post-Operative Incentive Spirometer Adherence Laura Banashek, BA, John Pearson, MD, Charles Safran, MD Purpose: This study seeks to determine whether incentive spirometer (IS) data gathered via a smartphone platform can be utilized to determine baseline adherence to prescribed IS exercises, as well as improve patient adherence in the post-operative period. A customized smartphone-based device will be the primary intervention and will record as well as encourage use of prescribed spirometer exercises through a connected spirometer device (Smart Peak FlowTM) and smartphone-based app. By establishing a dose-response relationship between IS and post-operative pulmonary complications (PPCs), we can make a more informed decision regarding the use of IS in the post-operative period. Methods: This study is a prospective, randomized, participant blinded, single center, clinical trial. Based on our planned analysis, we expect to enroll 50 patients (25 in each arm). The control group will be given the BIDMC standard VoldyneTM IS with an attached Smart Peak FlowTM device to passively record usage. The study group will be given the Smart Peak FlowTM device connected to an android smartphone to record usage. Patients in the study group will also utilize a smartphone application to view their usage and receive encouragement to continue using their device. Results: Due to delays in device development, outcomes data are not currently available for analysis. However, we plan to begin recruiting participants over the next two to three months. The primary endpoint is patient adherence to prescribed IS exercises in the perioperative period. Secondary outcomes are largely clinical and included PPCs as measured by atelectasis, respiratory failure, tracheobronchial infection, or pneumonia. Other secondary measures include total mortality from respiratory causes, all other post-op complications, length of in hospital stay, all-cause mortality, and cost analysis. Conclusions: Incentive spirometry has been a mainstay of affordable PPC prevention for decades, but a lack of adherence data (whether due to imperfect use or imperfect data capture) has led many to question the true clinical effectiveness of this intervention. Our study utilizes a custom IS and Smart Peak FlowTM meter to measure and record baseline adherence data on a smartphone platform. Once we have a more reliable measure of baseline adherence, we can analyze the dose-response relationship between IS exercises and the incidence of PPCs. This will provide more conclusive evidence to support either the continued use of post-operative IS or its discontinuation.