Patient reported postoperative pain with a smartphone application: A proof of concept

• Published in: PLoS ONE 2020, Vol.15 (5), p.e0232082
• Main Authors: Thiel, Bram, Godfried, Marc B, van Huizen, Elise C, Mooijer, Bart C, de Boer, Bouke A, van Mierlo, Rover A.A.M, van Os, Johan, Geerts, Bart F, Kalkman, Cor J, Loeffen, Erik, ten Klooster, Peter M
• Format: Report
• Language: English
• Subjects: Analgesia; Diagnosis; Health aspects; Medical diagnostic software; Medical research; Methods; Nurses; Pain management; Pain measurement; Postoperative pain; Self examination (Medical); Smart phones; Surgery
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232082

Postoperative pain management and pain assessment are still lacking the perspective of the patient. We have developed and studied a prototype smartphone application for patients to self-record postoperative pain. The main objective was to collect patient and stakeholder critique of improvements on the usability in order to develop a definitive version. The secondary objective was to investigate if patient self-recording compared to nurse-led assessment is a suitable method for postoperative pain management. Fifty patients and a stakeholder group consisting of ten healthcare- and ICT professionals and two members of the patient council participated in this study. Main outcome Thirty patients (60%) found it satisfying or very satisfying to communicate their pain with the app. Pain experienced after surgery was scored by patients as 'no': 3 (6%), 'little': 5 (10%), 'bearable': 25 (50%), 'considerable': 13 (26%) and 'severe': 1 (2%). Forty-five patients (90%) were positive about the ease of recording. Forty-five patients (90%) could correctly record their pain with the app. Thirty-eight patients (76%) agreed that in-app notifications to record pain were useful. Two patients (4%) were too ill to use the application. Based on usability feedback, we will redesign the pain intensity wheel and the in-app pain chart to improve clarity for patients to understand the course of their pain. Secondary outcomes The median patient recorded pain app score 4.0 (range 0 to 10) and nurse recorded numerical rating scale (NRS) for pain NRS 4.0 (range 0 to 9) were not statistically different (p = 0.06). Forty-two percent from a total of 307 patient pain app scores were [greater than or equal to] 5 (on a scale from 0 no pain at all to 10 worst imaginable pain). Of these, 83% were recorded as 'bearable' while only in 18% of the recordings patients asked for additional analgesia. The results suggest that self-recording the severity of postoperative pain by patients with a smartphone application could be useful for postoperative pain management. The application was perceived as user-friendly and had high satisfaction rates from both patients and stakeholders. Further research is needed to validate the 11-point numeric and faces pain scale with the current gold standards visual analogue scale (VAS) and NRS for pain.