Assessing Feasibility and Usability of Visual Feedback of Continuous Heart Rate Monitoring in Inpatient Rehabilitation

Abstract

<h3>Research Objectives</h3> To measure the number of times clinicians monitor and educate their patients on exercise intensity based on heart rate (HR) or rate of perceived exertion (RPE) in three conditions: (1) before intervention, (2) when clinicians know continuous HR monitoring is occurring, and (3) when clinicians are provided with continuous HR feedback. To assess patient confidence reaching their target exercise intensity. To describe the ease of technology use. <h3>Design</h3> Pre-intervention field observations followed by a pseudorandomized trial. <h3>Setting</h3> Inpatient rehabilitation on a general medical unit within a translational research hospital. <h3>Participants</h3> Pre-trial: 12 inpatient rehabilitation sessions observed. Trial: 48 sessions with 19 patients and 13 clinicians. <h3>Interventions</h3> Patients participated in physical and occupational therapy sessions with Schosche® forearm HR sensors broadcasting HR to television with Heart Zones® software. Color-coded, individualized HR zones were displayed for resting, below, target, and above target intensity. <h3>Main Outcome Measures</h3> Clinician monitoring and feedback of patient's intensity level and provision of verbal feedback regarding exercise intensity. Patient-reported confidence (0-100%) to reach target intensity. Ease of technology use based on session count with technology issues affecting data usability. <h3>Results</h3> Pre-intervention, average count for clinicians monitoring RPE, HR and other vital signs was 3.25±8.89 and providing feedback on RPE/HR zone was 2.75±5.26 times. With HR monitoring without visual feedback, we observed 1.39±2.40 instances of clinician monitoring and 0.77±1.69 instances of verbal feedback. In contrast, we observed 19.25±12.10 instances of monitoring and 7.31±9.44 instances of feedback when continuous visual feedback was provided. Patients receiving feedback rated their confidence as 76.52%±22.28, versus 65.71%±24.41 without feedback. Errors limiting data usability occurred in 4 sessions of 48 (n=2 for consistently underreporting HR, n=1 for an erratic misreporting of HR, and n=1 for software data loss). <h3>Conclusions</h3> HR monitoring with continuous visual feedback may increase clinician attention to HR and exercise intensity and patient confidence reaching their target exercise intensity. If technical challenges are overcome, continuous HR monitoring with personalized target zones may provide actionable data to improve care during therapy. <h3>Author(s) Disclosures</h3> None.