Benno Rehberg

Background: Approximately 19% of adults in Europe are affected by chronic pain, which reduces the quality of life. Pain-management mobile health (mHealth) apps offer a promising solution for self-management, but user engagement and adherence can limit their clinical impact. User experience design and research play a crucial role in optimizing usability and long-term adoption of digital health interventions. Objective: This study aims to evaluate the user experience of Dolodoc, a mobile app for chronic pain self-management, using a mixed methods approach that assesses acceptability through a content quality survey and examines use by analyzing overall use patterns. Methods: A cross-sectional acceptability study of the main content of Dolodoc was conducted among patients with chronic pain recruited from the Geneva University Hospitals pain center and through snowball sampling. Participants rated 84 evidence-based self-management strategies by using a 5-point Likert scale based on 5 acceptability criteria: understandability, motivation, feasibility, relevance, and alignment with the related quality-of-life dimension. To reduce participant fatigue and avoid random responses, the 84 strategies were randomly divided across survey versions. Use was assessed through metrics collected over 6 months with Piwik PRO Analytics to observe real-world use behaviors among Dolodoc users. Results: In the acceptability study, 33 participants rated the self-management strategies positively across all dimensions. On a scale from –2 to 2, the strategies were well understood (mean 1.47, SD 0.76), motivational (mean 1.12, SD 0.96), feasible (mean 1.01, SD 1.05), relevant (mean 0.99, SD 1.09), and aligned with the dimensions (mean 1.33, SD 0.89). The use study demonstrated that 60% (486/802) of the patients used Dolodoc only once, indicating that long-term adherence remains a challenge. Within Dolodoc, pain tracking, useful links, and medication logging were the most actively used features. Conclusions: This study highlights the gap between acceptability and long-term adherence to mHealth solutions. Improving personalization and accessibility could increase user engagement and long-term adherence. Future iterations of the app should incorporate tailored interventions and real-time feedback mechanisms. In addition, leveraging a digital navigation follow-up could facilitate user adoption and sustained engagement.

Persistent postoperative opioid use (PPOU) is a growing concern, yet European data remain scarce. Switzerland has experienced a rise in opioid prescriptions, yet long-term opioid use after surgery is poorly characterized. This single-center prospective observational cohort included adults undergoing elective surgeries at risk for chronic postsurgical pain at the University Hospitals of Geneva. Opioid consumption (morphine milligram equivalents) was assessed preoperatively, 24 h before discharge, and at 6 months. The primary objective was to quantify PPOU prevalence and trajectories at 6 months; secondary objectives were to identify clinical and psychological predictors of PPOU. Among 338 patients, 19% were preoperative opioid users; 32% of them continued opioids at 6 months. Overall, 8.6% of all patients had persistent opioid consumption, including 3% who were opioid-naïve before surgery. PPOU was most frequent after spine and orthopedic surgery. Preoperative opioid use and type of surgery are key predictors of PPOU, highlighting spine and orthopedic procedures, and patients with preexisting pain, as priority targets for opioid-sparing and multimodal strategies.

This article presents a comprehensive overview of perioperative pain medicine based on recently published recommendations by the Swiss Society of Anaesthesiology and Perioperative Medicine (SSAPM). As it has long been known that improvements in postoperative pain management depend more on organisational structures than on new drugs or techniques, these recommendations focus on the structures and processes of perioperative pain management. The introduction of Acute Pain Services (APS) by anaesthesiology departments in the 1980s marked significant progress. However, APS coverage remains limited and inconsistent across institutions, often lacking sufficient resources. To address these gaps, the SSAPM convened a multiprofessional expert group to develop structural and procedural recommendations. Key structural recommendations emphasise the necessity of interdisciplinary and interprofessional collaboration, with jointly developed and signed protocols between surgical and pain services to clarify responsibilities and prevent care gaps. Hospitals are urged to maintain written, evidence-based standard procedures for multimodal pain management tailored to local conditions. The availability of qualified personnel for pain management is also a key recommendation. Process recommendations highlight the importance of multidisciplinary, multiprofessional approaches and seamless communication between personnel involved in perioperative care, patients, and external care providers. Preoperative patient education, the identification of individuals at risk for complex pain trajectories or chronic postsurgical pain (CPSP), and structured follow-up are essential components. The continuum of care from inpatient to outpatient settings is another key element. Overall, these recommendations aim to standardise and define perioperative pain management as a core element of modern perioperative medicine.

Background: Approximately 19% of adults in Europe are affected by chronic pain, which reduces quality of life. Pain management apps (mHealth) offer a promising solution for self-management, but users engagement and adherence can be a limitation to their clinical impact. User experience design and studies play an important role in optimizing usability and long-term adoption of digital health interventions. Objective: This study aims to evaluate the user experience of Dolodoc, a mobile application for chronic pain self-management, using a mixed-methods approach that evaluates acceptability through a content quality survey and examines usability by analyzing overall usage patterns. Methods: A cross-sectional acceptability study was conducted among chronic pain patients recruited from the Geneva University Hospitals pain center and through snowball sampling. Participants rated 84 evidence-based self-management strategies using a five-point Likert scale based on 5 acceptability criterias: understandability, motivation, feasibility, relevance, and alignment with the related quality-of-life dimension. Usability was assessed through usage metrics that were collected over six months using Piwik PRO analytics to observe the usage behaviors of real-world Dolodoc users. Results: In the acceptability study, a total of 33 participants rated the self-management strategies positively across all dimensions. On a scale from −2 to 2, the strategies were well understood (mean = 1,47), motivational (1.12), feasible(1.01), relevant (0.99), and aligned with the dimensions (1.33). The usability study demonstrated that 60% of patients used Dolodoc only once, indicating that long-term adherence remains a challenge. Within Dolodoc, pain tracking, useful links and medication logging were the most actively used features. Discussion: This study highlights the gap between acceptability and long-term adherence to mHealth solutions. Improving personalization and accessibility could increase user engagement and long-term adherence. Future iterations of the app should incorporate tailored interventions and real-time feedback mechanisms. In addition, taking advantage of a digital navigation follow-up could facilitate user adoption and sustained engagement.

BACKGROUND Approximately 19% of adults in Europe are affected by chronic pain, which reduces the quality of life. Pain-management mobile health (mHealth) apps offer a promising solution for self-management, but user engagement and adherence can limit their clinical impact. User experience design and research play a crucial role in optimizing usability and long-term adoption of digital health interventions. OBJECTIVE This study aims to evaluate the user experience of Dolodoc, a mobile app for chronic pain self-management, using a mixed methods approach that assesses acceptability through a content quality survey and examines use by analyzing overall use patterns. METHODS A cross-sectional acceptability study of the main content of Dolodoc was conducted among patients with chronic pain recruited from the Geneva University Hospitals pain center and through snowball sampling. Participants rated 84 evidence-based self-management strategies by using a 5-point Likert scale based on 5 acceptability criteria: understandability, motivation, feasibility, relevance, and alignment with the related quality-of-life dimension. To reduce participant fatigue and avoid random responses, the 84 strategies were randomly divided across survey versions. Use was assessed through metrics collected over 6 months with Piwik PRO Analytics to observe real-world use behaviors among Dolodoc users. RESULTS In the acceptability study, 33 participants rated the self-management strategies positively across all dimensions. On a scale from –2 to 2, the strategies were well understood (mean 1.47, SD 0.76), motivational (mean 1.12, SD 0.96), feasible (mean 1.01, SD 1.05), relevant (mean 0.99, SD 1.09), and aligned with the dimensions (mean 1.33, SD 0.89). The use study demonstrated that 60% (486/802) of the patients used Dolodoc only once, indicating that long-term adherence remains a challenge. Within Dolodoc, pain tracking, useful links, and medication logging were the most actively used features. CONCLUSIONS This study highlights the gap between acceptability and long-term adherence to mHealth solutions. Improving personalization and accessibility could increase user engagement and long-term adherence. Future iterations of the app should incorporate tailored interventions and real-time feedback mechanisms. In addition, leveraging a digital navigation follow-up could facilitate user adoption and sustained engagement. CLINICALTRIAL

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Chronic pain affects approximately 19% of the European population and poses significant challenges, both in terms of individual suffering and the financial burden on healthcare systems worldwide. While healthcare provider expertise is critical, empowering patients with self-management tools has become increasingly important for addressing long-term pain effectively. Objective: This report details the development and implementation of Dolodoc, a mobile application designed by an R&D team at the University Hospitals of Geneva. Methods: This report is done according to the ICheck-DH guidelines Results: The app allows users to monitor their pain and its impact across seven dimensions of daily life. A virtual coach guides users through the process, offering tailored advice from a corpus of over 80 evidence-based recommendations created by experts. The project, which lasted four years, was completed within budget and highlights the importance of early stakeholder involvement, including pain experts and end-users, to ensure the solution met user needs. Significant efforts were dedicated to ensuring the recommendations were both evidence-based and accessible. While the app has been freely offered to patients who may benefit, one limitation of this initiative is the lack of predefined Key Performance Indicators (KPIs) to measure its success quantitatively. Conclusions: This implementation report serves as a real-world example of leveraging mobile technology in a university hospital setting to address the needs of chronic pain patients and empower them in managing their condition.

Malgré les formations existantes, de nouvelles stratégies pédagogiques sont nécessaires afin d’améliorer les compétences des professionnels concernant la prescription et la dispensation des opiacés. La construction d’un jeu sérieux permet d’expérimenter dans un cadre sécurisant des habilités cliniques. Les modalités de conception du contenu théorique, des aspects interactionnels et ludiques développés sont présentés. Alors que la satisfaction des participants est élevée, les résultats concernant la participation des professionnels montrent les enjeux relatifs au déploiement.

Zusammenfassung. Anhand von drei Beispielen soll in diesem Artikel gezeigt werden, wie die moderne Anästhesie sich von der blossen Bewusstseins- und Schmerzausschaltung hin zu einer Disziplin der perioperativen Medizin gewandelt hat. Am Beispiel der Entwicklung der Muskelrelaxation wird gezeigt, wie die moderne Pharmakologie in der Anästhesie entscheidend zur intra- und postoperativen Patientensicherheit beiträgt. In einem zweiten Beispiel wird anhand der Schmerztherapie demonstriert, dass die perioperative Betreuung durch die Anästhesie zu einer schmerzarmen, sicheren und rascheren Erholung der Patienten postoperativ führt. Das dritte Beispiel zeigt, wie wichtig eine Standardisierung der perioperativen Abläufe einerseits und ein individuelles Patientenmanagement andererseits für die prä-, intra-, und postoperative Betreuung der Patienten ist, und damit eine drastische Reduktion von Komplikationen erreicht werden kann.