A Personalised eHealth Programme Reduces the Duration Until Return to Work After Gynaecological Surgery: Results of a Multicentre Randomised Trial

Delay in recovery and delayed return-to-work time after gynecological surgery often exceed those expected from a medical perspective and reduce quality of life. This appears to result from a substantial variation in convalescence recommendations for the resumption of work and daily activities between different health care providers and from fragmented perioperative care. To meet the need for well-defined postoperative recovery guidelines and recommendations, a previous study used focus group discussions in women who had undergone gynecological surgery to develop an eHealth program. The aim of this randomized single-blinded controlled trial was to evaluate the effectiveness of the eHealth intervention on recovery and return to work after gynecological surgery. The study was conducted at 7 hospitals in the Netherlands between March 2010 and September 2011. A total of 215 women (aged 18-65 years) who had a hysterectomy and/or laparoscopic adnexal surgery for a benign indication were randomly assigned to the intervention group (n = 110) or the control group (n = 105). Women in the intervention group received an eHealth program that provided detailed personalized tailor-made preoperative and postoperative instructions on resumption of daily activities, including work, and tools to improve self-empowerment as well as communication with care providers and to identify recovery problems. Women in the control group had access to a control Web site in addition to the usual health care. The primary study outcome measure was the duration of sick leave until a full sustainable return to work to the same job. Secondary outcome measures were quality of life (both physical and mental) assessed by the Rand-36 Health Survey, general recovery measured by a validated recovery-specific quality-of-life questionnaire, and pain intensity measured using a visual analog scale. The data were adjusted for type of surgery, complicated surgery, and hospital (prestratification) and analyzed according to intention-to-treat. The eHealth intervention had a positive effect on time to return to work; the adjusted hazard ratio was 1.43, with a 95% confidence interval (CI) of 1.003 to 2.040, P = 0.048. The median duration of sick leave until a full sustainable return to work was shorter in the intervention group than in the control group: 39 days (interquartile range, 20-67 days) versus 48 days (interquartile range, 21-69 days). Compared with the control group at 26 weeks, pain intensity was lower (visual analog scale, cumulative odds ratio, 1.84; 95% CI, 1.04-3.25; P = 0.035), and quality of life was higher (Rand-36 Health Survey, between-group difference, 30; 95% CI, 4-57; P = 0.024) in the intervention group. There was no difference between groups in the general recovery index. These data show that the use of the eHealth intervention by women after gynecological surgery results in a faster return to work, a higher quality of life, and less pain compared with a control intervention.