Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial. (8th January 2020) - Guo, Bingmei
Abstract: Aims: To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet‐based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy. Design: A prospective, single‐blinded, randomized controlled trial. Methods: We performed a prospective, endoscopist‐blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017–March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection. Results: A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ 2 test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p < .001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p = .029) based on the χ 2 test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group ( p < .001) based on the χ 2 test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively ( p = .008), based on the χ 2 test. Conclusion: Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy. Impact: This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation. Trial registration: Chinese clinical trial registration number: ChiCTR1900024666. Abstract : 目的: 与传统手册+口头指示方式相比, 以医用智能手机应用程序+口头和书面指示方式提供宣传教育信息, 是否能改善接受结肠镜检查的住院患者的肠道准备质量。 设计: 一项前瞻性、单盲、随机对照试验。 方法: 2017年10月至2018年3月期间, 我们在中国山东大学齐鲁医院进行了一项前瞻性、内镜盲、随机、对照试验。根据入选标准, 符合条件的住院患者被随机分为两组。两组均接受肠道准备的口头和书面指示。另外, 智能手机应用程序组通过医用智能手机应用程序接收肠道准备指示。主要预后指标是根据Boston肠道准备量表评分进行充分肠道准备的比率。次要预后指标包括患者遵守关于如何服用泻药、副作用和腺瘤检出率的指示。 结果: 共计293例患者入选该研究。两组的人口统计学特征具有可比性。χ2检验结果显示, 与对照组相比, 医用智能手机应用程序组肠道准备充足率明显提高(77.2%vs.56.8%, p<.001)。基于χ2检验结果, 智能手机应用程序组的腺瘤检出率(ADR)明显高于对照组(21.4%vs.12.8%, p=.029)。基于χ2检验结果, 智能手机应用程序组和对照组的不完整依从率分别为15.17%和33.11%(p<.001)。基于χ2检验结果, 智能手机应用程序组和对照组的总体不良事件发生率分别为23.45%和37.84%(p=.008)。 结论: 通过移动社交媒体应用程序+传统的口头和书面指示方式提供指导, 可以改善肠道准备的质量, 增加腺瘤检出率, 减少不良反应。应用程序指示可被视为是对接受结肠镜检查的住院患者提供口头和书面指示的有效补充。 影响: 该研究表明, 临床人员可通过智能手机传递信息, 作为传统教育方法的有力补充, 这可以提高工作效率, 帮助患者提高肠道准备的成功率。 试验注册: 中国临床试验注册号:ChiCTR1900024666。