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eHealth program shortens sick leave after gynecological surgery

Clinical Question:
Does an interactive eHealth intervention shorten sick leave after elective gynecological surgery for benign indications?

Bottom Line:
Women enrolled in the eHealth intervention before elective gynecological surgery for benign indications returned to work more rapidly and reported less pain and better quality of life than women in a control group. Further research is needed to determine whether this approach is generalizable to other kinds of elective surgeries. (LOE = 1b)

Reference:
Vonk Noordegraaf A, Anema J, van Mechelen W, et al. A personalized eHealth programme reduces the duration until return to work after gyneacological surgery: results of a multicenter randomized trial. BJOG 2014;121(9):1127-36.  [PMID:24511914]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Government

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
This randomized controlled trial was undertaken to determine whether an eHealth intervention for women undergoing elective gynecological surgery would result in less time off before her return to work. The authors enrolled 215 women, aged 18 years to 65 years, who were scheduled for elective surgery for benign causes, including hysterectomy or adnexal laparoscopic surgery. Enrollment was stratified by hospital site (N = 6) and type of surgical procedure. Women were excluded if they were pregnant, had deeply infiltrating endometriosis or concomitant major medical or psychiatric comorbidities, were off work more than 2 months preoperatively because of their condition, were involved in litigation against their employer, could not complete surveys in Dutch, or did not have Internet access. Women were masked to treatment group assignment, but clinicians and researchers were not. The eHealth intervention included detailed and personalized instructions on postoperative resumption of work and daily activities. It also included an extensive list of frequently asked questions, online feedback regarding the evaluation of complications and advice on which provider(s) to approach in case of problems, a forum enabling patient contact with other patients, an educational video, and links to other relevant websites. The control intervention consisted of telephone numbers of participating hospitals and access to patient education leaflets by the Dutch Society of Obstetrics and Gynaecology. The period of access to the eHealth site was from 4 weeks prior to surgery until 7 weeks after surgery. The median time spent online with the eHealth intervention was 118 minutes in the intervention group and 11 minutes in the control group. The median length of time until full return to work was 39 days for the eHealth group and 48 days for the control group. Quality of life was significantly better in the intervention group for both physical and mental health domains as assessed at a 26-week follow-up visit using the Rand-36 Health Survey. Pain intensity at 26 weeks, assessed by a 10-point visual analog scale, was also less in the intervention group (mean = 1.92 vs 3.52; P = .035).

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