This prospective cohort study was conducted at the Kaohsiung Chang-Gung Memorial Hospital, Taiwan. The study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board (IRB)/Ethics committee of Chang-Gung Memorial Hospital. The informed consent was obtained from all subjects.
The prototype application named as the Postoperative Care application (PC app) was developed for the Android and iOS operating systems. The patients could avail the application free of charge on their smartphones. During the study, the application was securely connected to the data server of the cloud computer server according to the standards of privacy protection mandated by the Taiwan Personal Data Protection Law.
Participants and recruitment
Patients undergoing outpatient cataract surgery and possessing a smartphone with an Android or iOS operating system were considered as eligible participants. Individuals who were unable to read or understand Mandarin were excluded from this study. Patients were asked to participate in this study during their visit to the outpatient pre-surgery clinic and a written informed consent was obtained from all participants. In addition, the researcher helped the participants download the application on their smartphone and provided instructions on its usage and the course of the study. A sample size of approximately 50 participants was estimated to be sufficient for collecting end-user feedback. Patients were recruited in consecutive order of cataract surgeries.
During postoperative assessment, patients willing to participate received verbal and “hands on” instructions on how to use the application. After downloading the application from Google Play or App store, the patients were asked to allow the application to permit storage, message, and contact upon opening the application. Thereafter, the patients had to register an account by filling in their name and the last four digits of their mobile number. Once logged in, they were required to fill in the date of cataract surgery and download an alarm application that worked with PC app. The account created was connected to the research database following authorization by a researcher. Furthermore, the patients completed a questionnaire on the application after 7 days to obtain feedback on whether any future improvements to the application need to be made.
After surgery, once the patients left the postoperative care unit, they could start using the application to self-report on any postoperative symptoms and signs (Figure 1). In addition, all patients were notified four times daily at 8:00, 12:00, 16:00, and 20:00 by the application to report their condition. They could answer the questions by themselves or with the help of their co-resident family members. Six of the following questions were required to be answered: 1. How is your eye pain? 2. How is the blurriness of your vision? 3. Do you have headache? 4. Are you experiencing nausea or vomiting? 5. Degree of comfort level 6. Are you seeing black shadows, floating dots, or flashlights? For each question, there were four options: 1. Better 2. Same or none 3. Not good. 4. Worse. If the patient had chosen the “Worse” option, the application would send notification to the medical facility, so that a doctor could contact the patient and decide whether any further treatment was needed. Afterward, a survey was conducted that collected the patients’ feedback. There were seven questions in the survey, with three options for patients to choose: 1. Satisfied 2. No comment 3. Unsatisfied.