Improving the Quality of Bowel Preparation Through an App for Inpatients Undergoing Colonoscopy: A Randomized Controlled Trial

Aims: To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet-based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy.

Design: A prospective, single-blinded, randomized controlled trial.

Methods: We performed a prospective, endoscopist-blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017-March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection.

Results: A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p < .001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p = .029) based on the χ test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group (p < .001) based on the χ test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively (p = .008), based on the χ test.

Conclusion: Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy.

Impact: This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation.

Trial Registration: Chinese clinical trial registration number: ChiCTR1900024666.