{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:30:41Z","timestamp":1764883841723,"version":"3.46.0"},"reference-count":20,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["10390172310021"],"award-info":[{"award-number":["10390172310021"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,22]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preoperative prehabilitation programmes for patients with colorectal cancer have been shown to reduce complications and hospital length of stay. However, supervised weekly physiotherapy is expensive and timeconsuming for both healthcare professionals and patients, leading to suboptimal implementation of prehabilitation programmes. A previous study demonstrated that offering home-based prehabilitation through an app is feasible and leads to outcomes comparable to supervised prehabilitation programmes. This study was conducted at a single hospital. To expand this promising modality nationwide, it is essential to identify key implementation determinants. We therefore initiated this multicentre study involving a more diverse and heterogeneous patient population. The findings of this study will provide valuable input for scaling strategies for prehabilitation programmes in the Netherlands and beyond.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective multicentre cohort study, approximately 300 patients with colorectal cancer scheduled for curative surgery will be enrolled over 12 months. The study adopts a hybrid type 3 design, reporting clinical outcomes while exploring implementation-related factors. Five hospitals with varied profiles (academic, non-academic teaching and general hospitals) and geographical locations (urban and rural, high and low socioeconomic areas) are participating. The primary endpoint is the identification of barriers and facilitators, using both qualitative (interviews) and quantitative (user statistics, questionnaires) data from stakeholders. Secondary endpoints include fitness and clinical outcomes such as complications and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was approved by the METC (Medisch Ethische Toetsings Commissie \/ Dutch Medical Ethics Committee) and was established not to apply to the Medical Research Involving Human Subjects Act (WMO \/ Wet Medisch Wetenschappelijk Onderzoek met mensen); submission was 21 April 2025. The app is proven safe and feasible in earlier studies and is CE certified (Conformit\u00e9 Europ\u00e9enne). Informed consent will be obtained from all patients (Supplement 1). Adverse events will be monitored and reported. Only researchers will have access to the final dataset. Results will be disseminated through publications, patient group briefings and implementation feedback to healthcare workers. Plans for sharing deidentified individual clinical trial participant-level data consist of quotes from interviews held on stakeholders. This study protocol adheres to the SPIRIT guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104649","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:56:28Z","timestamp":1762851388000},"page":"e104649","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["HOPPER: implementation of a home-based prehabilitation programme with app support for patients undergoing colorectal cancer surgery\u2014a study protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9765-9888","authenticated-orcid":false,"given":"Anne","family":"Pannekoek","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands"},{"name":"Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Timmers","sequence":"additional","affiliation":[{"name":"Interactive Studios, Radboud University Nijmegen, \u2019s Hertogenbosch, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3134-487X","authenticated-orcid":false,"given":"Rudolf Bertijn","family":"Kool","sequence":"additional","affiliation":[{"name":"IQ Health Science Department, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermien","family":"Schreurs","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands"},{"name":"Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"2025120413263385000_15.11.e104649.1","unstructured":"Ministerie van Volksgezondheid, Welzijn en Spor . Uw onderzoek: WMO-plichtig of niet? Onderzoekers. Centrale Commissie Mensgebonden Onderzoek; 2023. Available: https:\/\/www.ccmo.nl\/onderzoekers\/wet-en-regelgeving-voor-medisch-wetenschappelijk-onderzoek\/uw-onderzoek-wmo-plichtig-of-niet"},{"key":"2025120413263385000_15.11.e104649.2","unstructured":"SPIRIT 2013 statement: defining standard protocol items for clinical trials. EQUATOR Network; 2013. Available: https:\/\/www.equator-network.org\/reporting-guidelines\/spirit-2013-statement-defining-standard-protocol-items-for-clinical-trials\/"},{"key":"2025120413263385000_15.11.e104649.3","unstructured":"NKR cijfers. 2025 Available: https:\/\/www.iknl.nl\/nkr-cijfers"},{"key":"2025120413263385000_15.11.e104649.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.17310","article-title":"Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality: A Meta-Analysis of Randomized Clinical Trials","volume":"7","author":"Sauro","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2025120413263385000_15.11.e104649.5","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1001\/jamasurg.2023.0198","article-title":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","volume":"158","author":"Molenaar","year":"2023","journal-title":"JAMA Surg"},{"key":"2025120413263385000_15.11.e104649.6","doi-asserted-by":"crossref","unstructured":"Molenaar CJ , van Rooijen SJ , Fokkenrood HJ , et al . Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Libr 2023;2023. doi:10.1002\/14651858.CD013259.pub3","DOI":"10.1002\/14651858.CD013259.pub3"},{"key":"2025120413263385000_15.11.e104649.7","doi-asserted-by":"crossref","first-page":"7440","DOI":"10.1007\/s00464-024-11198-8","article-title":"A randomized controlled clinical trial on multimodal prehabilitation in colorectal cancer patients to improve functional capacity: preliminary results","volume":"38","author":"Pesce","year":"2024","journal-title":"Surg Endosc"},{"key":"2025120413263385000_15.11.e104649.8","doi-asserted-by":"crossref","first-page":"108270","DOI":"10.1016\/j.ejso.2024.108270","article-title":"Multimodal prehabilitation in elective oncological colorectal surgery enhances postoperative functional recovery: A secondary analysis of the PREHAB randomized clinical trial","volume":"50","author":"Ten Cate","year":"2024","journal-title":"Eur J Surg Oncol"},{"key":"2025120413263385000_15.11.e104649.9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1097\/DCR.0000000000001982","article-title":"High World Health Organization Performance Status Is Associated With Short- and Long-term Outcomes After Colorectal Cancer Surgery: A Nationwide Population-Based Study","volume":"64","author":"Bojesen","year":"2021","journal-title":"Dis Colon Rectum"},{"key":"2025120413263385000_15.11.e104649.10","doi-asserted-by":"crossref","first-page":"109691","DOI":"10.1016\/j.ejso.2025.109691","article-title":"Fit4Surgery app: Home-based prehabilitation app for older patients undergoing elective colorectal cancer surgery","volume":"51","author":"Groen","year":"2025","journal-title":"Eur J Surg Oncol"},{"key":"2025120413263385000_15.11.e104649.11","unstructured":"Patient journey app . Taking you into the future of healthcare. 2025 Available: https:\/\/patientjourneyapp.nl\/"},{"key":"2025120413263385000_15.11.e104649.12","unstructured":"Meetinstrumenten in de zorg . 6-minute walk test \/ zes minuten wandeltest \u2013 meetinstrumenten in de zorg. Meetinstrumenten in de Zorg; 2022. Available: https:\/\/meetinstrumentenzorg.nl\/instrumenten\/6-minute-walk-test-zes-minuten-wandeltest\/"},{"key":"2025120413263385000_15.11.e104649.13","unstructured":"Meetinstrumenten in de zorg . Short physical performance battery \u2013 meetinstrumenten in de zorg. Meetinstrumenten in de Zorg; 2024. Available: https:\/\/meetinstrumentenzorg.nl\/instrumenten\/short-physical-performance-battery\/"},{"key":"2025120413263385000_15.11.e104649.14","unstructured":"Meetinstrumenten in de zorg . Handknijpkrachtmeter \/ hand-held dynamometer \u2013 meetinstrumenten in de zorg. Meetinstrumenten in de Zorg; 2023. Available: https:\/\/meetinstrumentenzorg.nl\/instrumenten\/handknijpkrachtmeter-hand-held-dynamometer\/"},{"key":"2025120413263385000_15.11.e104649.15","unstructured":"Meetinstrumenten in de zorg . International physical activity questionnaire \/ internationale vragenlijst in verband met fysieke activiteiten \u2013 meetinstrumenten in de zorg. Meetinstrumenten in de Zorg; 2020. Available: https:\/\/meetinstrumentenzorg.nl\/instrumenten\/internationale-vragenlijst-in-verband-met-fysieke-activiteiten\/"},{"key":"2025120413263385000_15.11.e104649.16","unstructured":"Vrije Universiteit Amsterdam . SNAQ. 2025 Available: https:\/\/palliaweb.nl\/getmedia\/f4c3a9ed-d16a-4af8-9208-fbdcec0b30a0\/Meetinstrument_SNAQ.pdf"},{"key":"2025120413263385000_15.11.e104649.17","unstructured":"Fysieke fitheid van mensen met en na kanker. 2025 Available: https:\/\/richtlijnendatabase.nl\/richtlijn\/fysieke_fitheid_van_mensen_met_en_na_kanker\/casu_stiek.html?utm_source=chatgpt.com"},{"key":"2025120413263385000_15.11.e104649.18","unstructured":"Algemene informatie - kngf kennisplatform fysiotherapie. KNGF Kennisplatform Fysiotherapie. n.d. Available: https:\/\/www.kennisplatformfysiotherapie.nl\/richtlijnen\/oncologie\/algemene-informatie\/"},{"key":"2025120413263385000_15.11.e104649.19","unstructured":"Castagna G . Trimbos-instituut \u2013 voor mentale gezondheid (home). Trimbos-instituut; 2025. Available: https:\/\/www.trimbos.nl\/"},{"key":"2025120413263385000_15.11.e104649.20","unstructured":"ATLAS.ti Scientific Software Development GmbH . ATLAS.ti | the #1 software for qualitative data analysis. ATLAS.ti; 2025. Available: https:\/\/atlasti.com\/?x-source=pmax&x-campaign=pmax-en&x-id=21759486841&x-term=pmax-01&utm_source=google&utm_medium=pmax&utm_campaign=21759486841&utm_term=&utm_content=&utm_adgroup=&device=c&placement=&matchtype=&network=x&gad_source=1&gbraid=0AAAAApc8-YBqReeCJYjRP1_nCqL_J6lYG&gclid=CjwKCAjw5PK_BhBBEiwAL7GTPf6D9fNZ2wgIFm43KUpbN4ET9KpSyqoKCFwxnHdbn2SL_ONiFdS_whoCQ1oQAvD_BwE"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-104649","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:27:53Z","timestamp":1764883673000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-104649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,9]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-104649"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-104649","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}