Enhancing Exercise Adherence Through Mobile-Based Electronic Patient-Reported Symptom Management in Lung Cancer Patients After Video-Assisted Thoracoscopic Surgery: An Interim Analysis of Randomized Controlled Trial (Preprint)

BACKGROUND Postoperative exercise is essential after video-assisted thoracoscopic surgery (VATS), yet adherence to home-based regimens remains suboptimal. Limited continuity of care and inadequate symptom support undermine patients’ perceived capability to engage in prescribed activity, and evidence linking these factors to exercise adherence is still sparse. OBJECTIVE To evaluate the preliminary efficacy of a mobile-based electronic patient-reported outcome (ePRO) remote symptom management system in improving post-discharge exercise adherence among patients undergoing VATS. METHODS In this single-center randomized controlled trial, patients undergoing VATS were randomized 1:1 to an Intervention Group (IG: ePRO alerts with remote clinician feedback) or a Control Group (CG: ePRO without feedback) at discharge. Co-primary outcomes were 4-week exercise adherence (defined as ≥150 min/week) and mean weekly exercise duration. This interim analysis included 268 patients (36% of the target sample), with primary analyses conducted on the per-protocol set (PPS, n = 217) and sensitivity analyses performed on the intention-to-treat (ITT) population. Statistical testing employed the O’Brien–Fleming method to adjust the significance threshold for the interim look, controlling for multiplicity across the joint primary endpoints. Secondary outcomes comprised longitudinal exercise and symptom trajectories, 30-day pulmonary complications, and readmissions. Exploratory subgroup analyses were also conducted. RESULTS In the PPS cohort, IG showed higher adherence than CG (84.4% vs. 66.7%; OR 2.71; 95% CI: 1.41–5.20; p = .002), and greater weekly exercise duration (+26.0 min; 95% CI: 13.4–40.1; p < .001). Symptom score trajectories (cough, disturbed sleep, drowsiness) improved more in the IG group over time. No significant differences were found in complication or readmission rates. Exploratory subgroup analyses suggested stronger adherence benefits among females and patients with symptom alerts. CONCLUSIONS ePRO-based remote symptom management demonstrated statistically significant improvements in postoperative exercise adherence and symptom recovery at this interim stage. These findings support the feasibility of integrating digital monitoring into early rehabilitation and warrant confirmation in the full trial cohort. CLINICALTRIAL ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946