A Mixed Method Study Exploring The Efficacy of Personalised Digital Prehabilitation Programme, Fit4surgery (F4S), For Patients Undergoing Major Surgery in Decreasing The Anaesthesia and Surgical Complications

Abstract

Background: Patients undergoing major thoracic surgeries such as lung cancer resection and lung volume reduction surgery are at high risk of postoperative complications, reduced functional capacity, and prolonged recovery. Prehabilitation has emerged as a promising strategy to enhance patients’ physical and psychological readiness for surgery. However, traditional prehabilitation services face limitations in accessibility and scalability. This thesis aimed to evaluate the feasibility, acceptability, and clinical impact of a novel digital prehabilitation intervention, the Fit4Surgery (F4S) app.

Methods: A mixed-methods design was adopted across five integrated studies. A matched case-control analysis using propensity score matching compared patients who underwent pulmonary rehabilitation (PR) to those who did not, assessing outcomes including postoperative pulmonary complications (PPC), hospital length of stay (LOS), and quality of life (QoL). Concurrently, the F4S app was developed using the Double Diamond design framework, underpinned by Self-Determination Theory. Its feasibility, usability, and impact were evaluated through physical performance measures, validated QoL instruments, and patient engagement metrics. Qualitative interviews explored patient experiences and barriers to engagement.

Results: Participation in PR was associated with a 60% reduction in PPC and a LOS reduction of up to 1.8 days. The F4S app demonstrated high levels of feasibility and acceptability, with strong patient satisfaction and engagement. Statistically and clinically significant improvements were observed in exercise capacity and QoL domains, with sustained gains up to 6 months post-surgery. Positive correlations were found between app engagement and functional outcomes. Qualitative findings highlighted the app’s usability, its role in enhancing patient autonomy, and its psychological benefits.

Conclusion: This thesis provides robust evidence supporting the role of digital prehabilitation in optimising surgical outcomes. The F4S app, developed through a user-centred, theory-driven process, represents a scalable and accessible solution to conventional rehabilitation barriers. Its implementation could enhance perioperative care, improve clinical outcomes, and support patient-centred recovery. Future research should focus on large-scale randomised controlled trials and explore long-term cost-effectiveness, digital equity, and broader applicability across surgical populations.