In just two years, COVID-19 has broadly impacted and disrupted usual health care, often leading to the postponement of non-urgent health care practices [1]. Despite these and other negative consequences, the pandemic is also responsible for an increase in the use of tele- and eHealth applications. Such applications use the potential of smartphones, computers, and the internet to allow for remote patient treatment and monitoring [2, 3]. Specifically, patient education via e-learning seems to be a cost-effective and easy-to-implement use of such eHealth applications. In fact, studies introducing eHealth applications as a way to further inform and educate patients have already been completed successfully [4-6]. Though eHealth interventions for perioperative education in patients undergoing lumbar surgery are still evolving, early evidence is supportive of such applications [7].

Recently, the B²EARS-trial was designed with the aim to improve surgical outcome in at-risk patients undergoing surgery for lumbar radiculopathy by introducing a blended care program combining a pre- and postoperative personal education session with an educational web application. This trial builds upon the results of a study by Louw et al. (2014), as well as the B²aSic-trial, which both successfully introduced perioperative pain neuroscience education via patient-therapist education sessions and educational brochures to patients undergoing surgery for lumbar radiculopathy [8, 9]. Though the content of the intervention will remain similar, an update of the educational brochure has led to the development of an educational B²EARS-application which will presents patients with a detailed summary of the education sessions, as well as complementary images. Moreover, the content is divided in different modules which are offered in order of complexity. Following each module, a short questionnaires allows patients to test their understanding of the presented content. When patients go through the application for the first time, they are required to follow the proposed order of modules. Any subsequent use of the application is more free, and patients can choose which module to repeat. The application is accessible via both a mobile and a desktop version, and will be available to patients until one year after their surgery.

Such applications are durable alternatives to existing informative channels. Also, they are easy to implement and allow for a fast adjustment whenever an update is warranted. Our B²EARS-application offers patients continuous access to information regarding their surgery and the following recovery, allowing them to quickly and easily repeat the information presented during their personal education sessions. Therefore, our blended care program follows current trends in eHealth research by introducing a promising – and mostly timely - tool to aid current perioperative educational strategies.

Wouter Van Bogaert

Wouter received a predoctoral research fellowship strategic basic research from the Research Foundation Flanders (FWO) to work on the B²EARS-project, which investigates the effectiveness of pain neuroscience education to prevent unfavorable outcome in at-risk patients undergoing surgery for lumbar radiculopathy. He specifically focuses on the effect of the education on postoperative health-related quality of life, analgesic use, and return to work. His primary research interests also include health-related quality of life, as well as its associations with pain and pain cognitions.

2022Pain in Motion

References and further reading:

[1] Arnold, P. M., Owens, L., Heary, R. F., Webb, A. G., Whiting, M. D., Vaccaro, A. R., Iyer, R. K., & Harrop, J. S. (2021). Lumbar Spine Surgery and What We Lost in the Era of the Coronavirus Pandemic: A Survey of the Lumbar Spine Research Society. Clinical spine surgery, 34(10), E575–E579. https://doi.org/10.1097/BSD.0000000000001235

[2] Dwivedi, R., Mehrotra, D., & Chandra, S. (2021). Potential of Internet of Medical Things (IoMT) applications in building a smart healthcare system: A systematic review. Journal of oral biology and craniofacial research, 10.1016/j.jobcr.2021.11.010. Advance online publication. https://doi.org/10.1016/j.jobcr.2021.11.010

[3] Morimoto, T., Kobayashi, T., Hirata, H., Otani, K., Sugimoto, M., Tsukamoto, M., Yoshihara, T., Ueno, M., & Mawatari, M. (2022). XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis. Journal of clinical medicine, 11(2), 470. https://doi.org/10.3390/jcm11020470

[4] Timmers, T., Janssen, L., van der Weegen, W., Das, D., Marijnissen, W. J., Hannink, G., van der Zwaard, B. C., Plat, A., Thomassen, B., Swen, J. W., Kool, R. B., & Lambers Heerspink, F. O. (2019). The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial. JMIR mHealth and uHealth, 7(10), e15323. https://doi.org/10.2196/15323

[5] Guldager, T. B., Hyldgaard, C., Hilberg, O., & Bendstrup, E. (2021). An E-Learning Program Improves Patients' Knowledge After Lung Transplantation. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 27(7), 800–806. https://doi.org/10.1089/tmj.2020.0101

[6] Bäcker, H. C., Wu, C. H., Schulz, M., Weber-Spickschen, T. S., Perka, C., & Hardt, S. (2021). App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial. Archives of orthopaedic and trauma surgery, 141(9), 1575–1582. https://doi.org/10.1007/s00402-021-03789-0

[7] Kolcun, J., Ryu, W., & Traynelis, V. C. (2020). Systematic review of telemedicine in spine surgery. Journal of neurosurgery. Spine, 1–10. Advance online publication. https://doi.org/10.3171/2020.6.SPINE20863

[8] Louw, A., Diener, I., Landers, M. R., & Puentedura, E. J. (2014). Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine, 39(18), 1449–1457. https://doi.org/10.1097/BRS.0000000000000444

[9] Huysmans, E., Goudman, L., Van Belleghem, G., De Jaeger, M., Moens, M., Nijs, J., Ickmans, K., Buyl, R., Vanroelen, C., & Putman, K. (2018). Return to work following surgery for lumbar radiculopathy: a systematic review. The spine journal : official journal of the North American Spine Society, 18(9), 1694–1714. https://doi.org/10.1016/j.spinee.2018.05.030