University of Pennsylvania, Perelman School of Medicine
Introduction: Patient mobility after major abdominal surgery is a key factor in postoperative outcomes and readmissions. Gamification with social incentives may improve mobility for hospitalized medical patients. We evaluated this approach to improve post-operative mobility in patients undergoing major abdominal surgery such as radical cystectomy. Methods: This was a randomized clinical trial with enrollment from 1/2020 to 9/2021 at a single institution. All participants received a FitBit device. The control group received feedback from the device, whereas the intervention group entered a game that continued for 12 weeks after discharge. The game assigned points and levels for achieving step goals that were reinforced by a support partner who received live updates on the progress of the patient. Each participant in the intervention group was given a new goal each week to increase 10%. Results: 61 patients were enrolled, with 30 in the intervention arm and 31 in the control arm. Overall, the average preoperative step count per day was 5385 (SD 3536), decreasing to an average of 777 (SD 1265) steps per day postoperatively, increasing to 6082 steps per day (SD 3742) by 12 weeks. The intervention group had an average +793 more steps (95% CI -446, 2031) compared to control at the end of the 12-week post-discharge period, but the difference was not statistically significant (p=0.21). For patients who had a significant drop in mobility from their preoperative baseline, defined as more > 60% decrease in steps during their first week after discharge, we found that intervention participants had +1735 more steps than the control arm (p=0.015) at the end of the 12-week post-discharge period. Those who reported lower levels of social support had significantly higher step counts with the intervention compared to the control. Those in the intervention also reported significantly lower 30-day complication rates (16.7%) than those in the control arm (32.3%, p=0.02). Conclusions: Gamification with social incentives did not improve mobility for all participants, but did significantly improve mobility for at-risk populations such as those who had significant post-operative mobility declines, and those with low social support. Complication rates were lower for those in the gamification and incentives intervention. Although promising, larger randomized mobility trials may need to target at-risk populations to impact mobility outcomes after major abdominal surgery. SOURCE OF Funding: none
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