Präoperative Physiotherapie vor viszeralen abdominalen Operationen digital umsetzen? – Eine qualitative Machbarkeitsstudie

Zusammenfassung

Hintergrund Große Operationen am Bauchraum stellen die größte Gruppe der Operationen in Deutschland dar. Besonders Patient*innen mit Komorbiditäten zeigen ein hohes Risiko für die Entwicklung postoperativer respiratorischer Komplikationen und damit einhergehend postoperativer Einbußen der körperlichen Funktionsfähigkeit. Obwohl präoperative Physiotherapie positiven Einfluss auf die Komplikationsrate nehmen kann, wird sie in Deutschland nicht regelhaft umgesetzt.

Ziel Untersuchung der Machbarkeit einer digitalen Umsetzung präoperativer Physiotherapie aus der Perspektive von Ärzt*innen, Physiotherapierenden und Patient*innen. Dazu werden Bedarfe an eine digitale Intervention sowie inhaltliche und technische Anforderungen erfragt.

Methode In einer qualitativen Studie wurden 2 Ärzt*innen, 5 Physiotherapierende und 2 Patienten interviewt. Die Daten wurden transkribiert und mittels qualitativer Inhaltsanalyse nach Schreier [35] ausgewertet.

Ergebnisse Die Ergebnisse bestätigten die hohe Relevanz der präoperativen Versorgung. Digitale Interventionen können die in diesem Zusammenhang existierende Versorgungslücke schließen. Die formulierten Anforderungen an eine Individualisierung und einen motivierenden Charakter können insbesondere durch Apps realisiert werden.

Diskussion Die zu entwickelnde App soll darauf abzielen 1.) eine Verhaltensänderung anzubahnen, 2.) Wissen zu vermitteln und 3.) Übungen anzuleiten. Vor dem Hintergrund der Zielsetzungen und dem Kontext, in dem die App Anwendung finden soll, ist von einer hohen Komplexität bei der Entwicklung und besonders der Implementierung auszugehen. Gleichzeitig ermöglicht die vorgelegte Analyse eine direkte Bearbeitung der identifizierten Herausforderungen.

Schlussfolgerung Die Entwicklung einer App als Teil der präoperativen Vorbereitung hat das Potenzial, eine aktuelle Versorgungslücke zu schließen und die möglichen negativen Folgen einer Operation zu adressieren. Die vorgelegte Studie gibt Hinweise für die nächsten Entwicklungsschritte.

Abstract

Background Major abdominal surgery builds the largest group of surgery in Germany. Especially patients with comorbidities are of high risk to develop postoperative respiratory complications associated with a decrease in functional capacity. Although preoperative physiotherapy can have a positive impact on complication rate, patients in Germany do not receive preoperative physiotherapy management in general.

Aim The feasibility of digitized preoperative physiotherapy will be studied from different stakeholder perspectives (physicians, physiotherapists, patients). Needs as well as content-related and technical requirements will be discussed.

Methods 2 physicians, 5 physiotherapists and 2 patients were interviewed for this qualitative study. Data were transcribed verbatim and analyzed using qualitative content analysis by Schreier [35].

Results Underlining the relevance of preoperative treatment. Digitized interventions have the potential to close the existing gap in current health services. Individualization and motivating design can be best achieved in developing an app. 

Discussion The preoperative physiotherapy app should 1) initiate behavioral changes, 2) impart knowledge and 3) instruct exercises. The development and implementation of the app is expected to be of high complexity, due to the context and unknown user and health-professional use in practice. Nevertheless, the identified challenges can be processed on the basis of this analysis.

Conclusion The development of an app as part of the preoperative management has the potential to close a gap in current health service and therefore address the possible negative consequences of a surgery. This study can inform the next steps in the development of this app. 

Schlüsselwörter

präoperative Physiotherapie - Prähabilitation - Gesundheitsapps - Viszeralchirurgie - Komplikationen - Funktionsfähigkeit

Key words

preoperative physiotherapy - prehabilitation - mHealth - visceral surgery - complications - functional capacity

Publication History

Received: 14 September 2021

Accepted: 30 April 2022

Article published online:
22 July 2022

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