Effect of a Mobile Health-Based Remote Interaction Management Intervention on the Quality of Life and Self-Management Behavior of Patients With Low Anterior Resection Syndrome: Randomized Controlled Trial

Background: People who undergo sphincter-preserving surgery have high rates of anorectal functional disturbances, knownas low anterior resection syndrome (LARS). LARS negatively affects patients'quality of life (QoL) and increases their need forself-management behaviors. Therefore, approaches to enhance self-management behavior and QoL are vital. Objective: This study aims to assess the effectiveness of a remote digital management intervention designed to enhance theQoL and self-management behavior of patients with LARS. Methods: From July 2022 to May 2023, we conducted a single-blinded randomized controlled trial and recruited 120 patientswith LARS in a tertiary hospital in Hefei, China. All patients were randomly assigned to the intervention group (using the "e-bowelsafety" applet and monthly motivational interviewing) or the control group (usual care and an information booklet). Our teamprovided a 3-month intervention and followed up with all patients for an additional 3 months. The primary outcome was patientQoL measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30.The secondary outcomes were evaluated using the Bowel Symptoms Self-Management Behaviors Questionnaire, LARS score,and Perceived Social Support Scale. Data collection occurred at study enrollment, the end of the 3-month intervention, and the3-month follow-up. Generalized estimating equations were used to analyze changes in all outcome variables. Results: In the end, 111 patients completed the study. In the intervention group, 5 patients withdrew; 4 patients withdrew inthe control group. Patients in the intervention group had significantly larger improvements in the European Organization forResearch and Treatment of Cancer Quality of Life Questionnaire Core 30 total score (mean difference 11.51; 95% CI 10.68-12.35;Cohen d=1.73) and Bowel Symptoms Self-Management Behaviors Questionnaire total score (mean difference 8.80; 95% CI8.28-9.32; Cohen d=1.94) than those in the control group. This improvement effect remained stable at 3-month follow-up (meandifference 14.47; 95% CI 13.65-15.30; Cohen d=1.58 and mean difference 8.85; 95% CI 8.25-9.42; Cohen d=2.23). The LARSscore total score had significantly larger decreases after intervention (mean difference -3.28; 95% CI -4.03 to -2.54; Cohend=-0.39) and at 3-month follow-up (mean difference -6.69; 95% CI -7.45 to -5.93; Cohen d=-0.69). The Perceived SocialSupport Scale total score had significantly larger improvements after intervention (mean difference 0.47; 95% CI 0.22-0.71;Cohen d=1.81) Conclusions: Our preliminary findings suggest that the mobile health-based remote interaction management interventionsignificantly enhanced the self-management behaviors and QoL of patients with LARS, and the effect was sustained. Mobilehealth-based remote interventions become an effective method to improve health outcomes for many patients with LARS.