Technology-assisted behavioral intervention to encourage prehabilitation in frail older adults undergoing surgery: Development and design of the BeFitMe™ Apple Watch app

Savanna Kerstiens; Edward M Bender; Michael G Rizzo Jr; Andrea Landi; Lauren J Gleason; Megan Huisingh-Scheetz; Daniel Rubin; Mark Ferguson; Maria Lucia L Madariaga

doi:10.1177/20552076231203957

Technology-assisted behavioral intervention to encourage prehabilitation in frail older adults undergoing surgery: Development and design of the BeFitMe™ Apple Watch app

Digit Health. 2023 Sep 26:9:20552076231203957. doi: 10.1177/20552076231203957. eCollection 2023 Jan-Dec.

Authors

Savanna Kerstiens¹, Edward M Bender², Michael G Rizzo Jr³, Andrea Landi⁴, Lauren J Gleason⁴, Megan Huisingh-Scheetz⁴, Daniel Rubin⁵, Mark Ferguson¹, Maria Lucia L Madariaga¹

Affiliations

¹ Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
² Department of Cardiothoracic Surgery, Stanford University Medicine, Stanford, CA, USA.
³ Department of Orthopedic Surgery, University of Miami, Coral Gables, FL, USA.
⁴ Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA.
⁵ Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, IL, USA.

Abstract

Objective: Increasing the physical activity of frail, older patients before surgery through prehabilitation (prehab) can hasten return to autonomy and reduce complications postoperatively. However, prehab participation is low in the clinical setting. In this study, we re-design an existing prehab smartphone application (BeFitMe™) using a novel standalone Apple Watch platform to increase accessibility and usability for vulnerable patients.

Methods: Design Science Research Methodology was used to (1) develop an approach to clinical research using standalone Apple Watches, (2) re-design BeFitMe™ for the Apple Watch platform, and (3) incorporate user feedback into app design. In phase 3, beta and user testers gave feedback via a follow-up phone call. Exercise data was extracted from the watch after testing. Descriptive statistics were used to summarize accessibility and usability.

Results: BeFitMe™ was redesigned for the Apple Watch with full functionality without requiring patients to have an iPhone or internet connectivity and the ability to passively collect exercise data without patient interaction. Three study staff participated in beta testing over 3 weeks. Six randomly chosen thoracic surgery patients participated in user testing over 12 weeks. Feedback from beta and user testers was addressed with updated software (versions 1.0-1.10), improved interface and notification schemes, and the development of educational materials used during enrollment. The majority of users (5/6, 83%) participated by responding to at least one notification and data was able to be collected for 54/82 (68%) of the days users had the watches. The amount of data collected in BeFitMe™ Watch app increased from 2/11 (16%) days with the first patient tester to 13/13 (100%) days with the final patient tester.

Conclusions: The BeFitMe™ Watch app is accessible and usable. The BeFitMe™ Watch app may help older patients, particularly those from vulnerable backgrounds with fewer resources, participate in prehab prior to surgery.

Keywords: Apple Watch; design science research; frailty; mHealth; prehabilitation; surgery; wearable technology.