Wearable Activity Monitor Research Articles

Home-based Exercise Rehabilitation Using Remote Monitoring In Left Ventricular Assist Device Recipients: Pilot Data From The Prospective Move-lvad Study

Introduction Home-based exercise rehabilitation (HER), using a wearable activity monitor and smartphone app, may be an alternative to supervised cardiac rehabilitation in new left ventricular assist device (LVAD) recipients. The aim of the MOVE-LVAD study is to provide data on the feasibility, safety, and efficacy of HER. Hypothesis: We hypothesize that HER, compared to usual care (UC), is safe and associated with improved activity levels. Methods MOVE-LVAD is a randomized, controlled study conducted at a single center. We aim to prospectively enroll 30 new HeartMate 3 (HM3) LVAD recipients. Subjects in both the HER and UC groups wear an activity watch continuously to monitor daily steps. Patients in the HER group also use a smartphone app to rate perceived exertion on the Borg scale and complete video calls with an exercise physiologist. Daily steps and Borg rating are used to titrate exercise prescriptions in the HER group. Endpoints include effects of HER, compared to UC, on functional status and healthcare utilization. Results We provide functional and outcome data on the first ten patients enrolled in MOVE-LVAD through April, 2021. Four patients (mean age 66 years) were randomized to HER and six patients (mean age 55 years) to UC. Average daily steps at baseline and during follow-up in the two groups are shown in the Figure. At baseline, median daily steps were similar in the HER and UC groups (535 [IQR 355, 1319] vs. 572 [IQR 217, 1812], respectively; p=1.00). In the HER group, median daily steps were significantly increased from baseline to 8556 (IQR 5081, 12030) at 4-months (p=0.05). In contrast, in the UC group, median daily steps were not significantly different between baseline and 4-months (1078 [IQR 962, 1193] p=0.52). There were no major adverse events associated with HER. One patient in the UC group was rehospitalized for non-VAD infection. Conclusions Our preliminary data from the MOVE-LVAD study suggest that HER using remote monitoring is feasible, safe, and may lead to improved activity levels in newly implanted HM3 LVAD patients. Home-based exercise rehabilitation (HER), using a wearable activity monitor and smartphone app, may be an alternative to supervised cardiac rehabilitation in new left ventricular assist device (LVAD) recipients. The aim of the MOVE-LVAD study is to provide data on the feasibility, safety, and efficacy of HER. Hypothesis: We hypothesize that HER, compared to usual care (UC), is safe and associated with improved activity levels. MOVE-LVAD is a randomized, controlled study conducted at a single center. We aim to prospectively enroll 30 new HeartMate 3 (HM3) LVAD recipients. Subjects in both the HER and UC groups wear an activity watch continuously to monitor daily steps. Patients in the HER group also use a smartphone app to rate perceived exertion on the Borg scale and complete video calls with an exercise physiologist. Daily steps and Borg rating are used to titrate exercise prescriptions in the HER group. Endpoints include effects of HER, compared to UC, on functional status and healthcare utilization. We provide functional and outcome data on the first ten patients enrolled in MOVE-LVAD through April, 2021. Four patients (mean age 66 years) were randomized to HER and six patients (mean age 55 years) to UC. Average daily steps at baseline and during follow-up in the two groups are shown in the Figure. At baseline, median daily steps were similar in the HER and UC groups (535 [IQR 355, 1319] vs. 572 [IQR 217, 1812], respectively; p=1.00). In the HER group, median daily steps were significantly increased from baseline to 8556 (IQR 5081, 12030) at 4-months (p=0.05). In contrast, in the UC group, median daily steps were not significantly different between baseline and 4-months (1078 [IQR 962, 1193] p=0.52). There were no major adverse events associated with HER. One patient in the UC group was rehospitalized for non-VAD infection. Our preliminary data from the MOVE-LVAD study suggest that HER using remote monitoring is feasible, safe, and may lead to improved activity levels in newly implanted HM3 LVAD patients.

Safety and Efficacy of Home-Based Exercise Rehabilitation Using Remote Monitoring in New Left Ventricular Assist Device Recipients

<h3>Purpose</h3> Data on home-based exercise rehabilitation (HER), using a wearable activity monitor and smartphone app, are limited in LVAD recipients. The purpose of the MOVE-LVAD study is to evaluate the feasibility, safety, and effects of HER on activity levels and healthcare utilization in newly implanted HeartMate 3 (HM3) LVAD patients. <h3>Methods</h3> MOVE-LVAD is a randomized study conducted at a single center. We aim to enroll 30 subjects, and here we provide data on the first 14 patients. Subjects in the HER and usual care (UC) groups wear an activity watch to monitor steps. In the HER group, patients also use a smartphone app to rate perceived exertion on the Borg scale and complete video calls with an exercise physiologist. Borg rating and daily steps are used to titrate exercise prescriptions. Endpoints include mean steps and rehospitalization. Mean daily steps are calculated for individual patients during weeks 1, 4, 8, and 12, and averages at each timepoint for the HER and UC groups are calculated separately. <h3>Results</h3> We provide data for the first 14 subjects during 3-month follow-up. 6 patients (mean age 60 years, 83% male) were randomized to HER and 8 (mean age 56 years, 88% male) to UC. During week 1, mean daily steps were 1595 ± 1579 in the HER group and 1436 ± 1031 in the UC group (Figure). During week 12, mean daily steps were 3705 ± 2628 in the HER group and 1669 ± 991 in the UC group. From week 1 to week 12, the average increase in daily steps was 1711 ± 1106 in the HER group and 587 ± 923 in the UC group. HER was not associated with any adverse events. There were 0 rehospitalizations in the HER group and 7 rehospitalizations in the UC group in 4 separate patients. <h3>Conclusion</h3> Initial data from the MOVE-LVAD study suggest that HER with remote monitoring is feasible, safe, and may be associated with a greater increase in daily activity levels and lower rehospitalization rate compared to UC in newly implanted HM3 LVAD patients. Larger studies are needed to determine the effects of HER on long-term outcomes.

Facilitated Health Coaching Improves Activity Level and Chronic Low back Pain Symptoms

ABSTRACT Introduction Behavioral treatments, like increasing physical activity (PA), are recommended for chronic low back pain (CLBP). Finding methods for promoting behavior change with potential for translatability as well as effective behavioral targets remains challenging. Purpose This randomized controlled pilot study evaluated the effectiveness of low-dose facilitated health coaching with activity monitors to improve PA and sedentary behaviors (SB), symptoms, and Patient Global Impression of Change (PGIC) in CLBP. A secondary purpose was identifying behaviors associated with symptom change to inform future trials. Methods Seventy-one adults with CLBP were randomized to receive a wearable activity monitor alone (WAM) or with one primary session of health coaching and two check-ins based on motivational interviewing (WAM + HC) or a wait-list control (WLC) condition for 12 wk. Moderate and vigorous PA (MVPA), light PA (LPA), total and prolonged SB (i.e., sedentary &gt;60 min per bout), and pain (Short Form McGill Pain Questionnaire (MPQ)) were assessed before and after intervention along with PGIC. Regression analyses examined group differences in MVPA, LPA, total and prolonged SB, MPQ, and PGIC after intervention as well as behavioral predictors of symptom improvement (change in MPQ). Results WAM + HC improved MPQ scores (β = −0.25, P = 0.02), LPA (β = 0.23, P = 0.04), MVPA (β = 0.21, P = 0.03), and total SB (β = −0.24, P = 0.03) compared with WLC over time. Both WAM + HC and WAM had significantly higher PGIC compared with WLC (P &lt; 0.05). Change in prolonged SB was the only significant predictor of change in MPQ (β = 0.48, P = 0.01). Conclusions WAM + HC may be effective for changing activity-related behaviors and improving CLBP. Furthermore, reducing prolonged SB may be a meaningful target for future interventions in CLBP. Research focused on reducing prolonged SB including larger samples, and examining changes in symptoms will be important for identifying optimal translational treatment strategies for CLBP.

Wearable technology in orthopedic trauma surgery – An AO trauma survey and review of current and future applications

The use of wearable sensors to track activity is increasing. Therefore, a survey among AO Trauma members was conducted to provide an overview of their current utilization and determine future needs and directions.A cross sectional expert opinion survey was administered to members of AO Trauma. Respondents were surveyed concerning their experience, subspeciality, current use characteristics, as well as future needs concerning wearable technology.Three hundred and thirty-three survey sets were available for analysis (Response Rate 16.2%). 20.7% of respondents already use wearable technology as part of their clinical treatment. The most prevalent technology was accelerometry combined with smartphones (75.4%) to measure general patient activity. To facilitate the use of wearable technology in the future, the most pressing issues were cost, patient compliance and validity of results.Wearable activity monitors are currently being used in trauma surgery. Surgeons employing these technologies mostly measure simple activity or activity associated parameters. Cost was the greatest perceived barrier to implementation. Further research, especially concerning the interpretation of the outcome values obtained, is required to facilitate wearable activity monitoring as an objective patient outcome measurement tool.

Only limited correlations between patient-reported outcomes and objectively monitored physical activity 10-years after THA.

In orthopaedics, patient reported outcomes (PROMs) are designed to quantify changes in pain and to assess physical function, most often after joint arthroplasty. However, PROMs have some disadvantages, most important is their subjective nature. The aim was to investigate how patient-self-reported-outcomes of general health, disease-specific outcome and physical function, joint-awareness and self-perceived activity- levels are correlated with objectively-measured physical-activity (PA) parameters derived from wearable activity-monitors (AM) in subjects with a hip-arthroplasty. A prospective cohort study was conducted in a group of 32 patients, with a mean follow-up of 10 years after total hip arthroplasty. To assess different domains, the SF-36 (general health), HOOS-PS (pain/functional outcome), FJS-12 (joint awareness) and SQUASH (physical activity) were chosen. Activity-monitoring was performed using a 3-axis accelerometer, gyroscope and magnetometer. No significant correlations between PA-parameters and the FJS-12 and SQUASH were found. The HOOS- PS was significant correlated with BMI, the daily time walking and total-time active and the amount of daily steps. The physical functioning-subscale of the SF-36 was significant negative correlated with BMI and time sitting, but significant positive correlated with time walking, total-time active and the amount of daily steps. Considering the value of PA for maintaining general health, the value of using sensor-based AMs to assess efficacy of treatments in this health related dimension or use it as a tool for patient education, awareness and communication, seems very high.

Feasibility and efficacy of enteral tube feeding on weight stability, lean body mass, and patient-reported outcomes in pancreatic cancer cachexia.

BackgroundAdvanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration. This wasting has been linked to poor survival outcomes, alterations in host defenses, decreased functional ability, and diminished health‐related quality of life (HRQOL) in pancreatic cancer patients. There are currently no standardized approaches to the management of pancreatic cancer cachexia. This study explores the feasibility and efficacy of enteral tube feeding of a peptide‐based formula to improve weight stability and patient‐reported outcomes (PROs) in advanced PDAC patients with cachexia.MethodsThis was a single‐institution, single‐arm prospective trial conducted between April 2015 and March 2019. Eligible patients were adults (>18 years) diagnosed with advanced or locally advanced PDAC and cachexia, defined as greater than 5% unexplained weight loss within 6 months from screening. The study intervention included three 28 day cycles of a semi‐elemental peptide‐based formula, administered through a jejunal or gastrojejunal feeding tube. The primary outcome was weight stability at 3 months (Cycle 3), defined as weight change less than 0.1 kg/baseline BMI unit from baseline. Secondary outcomes included changes in lean body mass, appendicular lean mass, bone mineral density, fat mass, and percent body fat, as measured with a DEXA scan, HRQOL (EORTC QLQC30) and NIH PROMIS PROs assessed at each cycle. Daily activity (steps, distance, active minutes, heart rate, and sleep) were remotely monitored using a wearable activity monitor (Fitbit) over the 3 month study period.ResultsThirty‐six patients were screened for eligibility, 31 patients consented onto study and underwent jejunal tube placement, and 16 patients completed treatment: mean age 67 years (SD 9.3), 43.8% male. Among evaluable patients (n = 16), weight stability was achieved in 10 patients (62.5%), thus completing the trial early. Increases in lean body mass (1273.1, SD: 4078, P = 0.01) and appendicular lean mass (0.45, SD: 0.6, P = 0.02) were observed. Statistically significant improvements at Cycle 3 from baseline were also observed for QLQC30 role function [mean difference (MD): 20.1, P = 0.03], appetite (MD: 27.4, P = 0.02), and global health scores (MD: 13.3, P = 0.05) as well as for NIH PROMIS t‐scores for depression (MD: −10.4, P = 0.006) and pain interference (MD: −7.5, P = 0.05). Objectively monitored (Fitbit) activity levels increased, although statistical significance was not reached.ConclusionsOur findings suggest that enteral nutrition support may improve weight stability, lean body mass, appendicular lean mass and PROs in PDAC patients with cachexia who completed treatment, representing a subsample of the study population. The feasibility and role of enteral feeding in routine care remain unclear, and larger and randomized controlled trials are warranted.

The Protocol and Feasibility Results of a Preliminary Instagram-Based Physical Activity Promotion Study

Background: Social media-based interventions are commonly used mode of delivery for physical activity promotion interventions. Instagram is an understudied social media platform and our purpose was to describe a detailed study protocol and report the feasibility of an Instagram-based physical activity promotion intervention. Method: Participants (n = 45) were recruited and randomized to follow one of three Instagram accounts for 3 months. The groups included a control, a popular fitness account, and two intervention groups. Participants were asked to complete weekly surveys for four weeks, at a 2-month follow up, and at a 3-month follow up. Participants were incentivized by being entered into a drawing for a free wearable activity monitor. Results: The intervention rate was 40% while the retention rate after four weeks was 33.3% and 22.2% after three months. Participants in the intervention groups reported higher education from the study account, enjoyment, and satisfaction. Conclusion: Although the study was well-received, more research is needed to determine how to increase retention within an Instagram-based intervention. Researchers should consider methods for participant identification, variations of interactive content, and extending the intervention period when designing their own study.

Objective Assessment of Postoperative Morbidity After Breast Cancer Treatments with Wearable Activity Monitors: The \u201cBRACELET\u201d Study

BackgroundCurrent validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA).MethodsA prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs.ResultsThe analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = −0.506; p < 0.05).ConclusionThis study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity.

Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial.

BackgroundEngaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy.ObjectiveThe purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial.MethodsThe MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools.ResultsRecruitment is ongoing as of January 2021.ConclusionsFindings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain.Trial RegistrationClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001International Registered Report Identifier (IRRID)PRR1-10.2196/29013

Wearable Activity Monitoring in Day-to-Day Stroke Care: A Promising Tool but Not Widely Used.

Physical activity monitoring with wearable technology has the potential to support stroke rehabilitation. Little is known about how physical therapists use and value the use of wearable activity monitors. This cross-sectional study explores the use, perspectives, and barriers to wearable activity monitoring in day-to-day stroke care routines amongst physical therapists. Over 300 physical therapists in primary and geriatric care and rehabilitation centers in the Netherlands were invited to fill in an online survey that was developed based on previous studies and interviews with experts. In total, 103 complete surveys were analyzed. Out of the 103 surveys, 27% of the respondents were already using activity monitoring. Of the suggested treatment purposes of activity monitoring, 86% were perceived as useful by more than 55% of the therapists. The most recognized barriers to clinical implementation were lack of skills and knowledge of patients (65%) and not knowing what brand and type of monitor to choose (54%). Of the non-users, 79% were willing to use it in the future. In conclusion, although the concept of remote activity monitoring was perceived as useful, it was not widely adopted by physical therapists involved in stroke care. To date, skills, beliefs, and attitudes of individual therapists determine the current use of wearable technology.

Defining Valid Activity Monitor Data: A Multimethod Analysis of Weight-Loss Intervention Participants' Barriers to Wear and First 100 Days of Physical Activity.

Despite the popularity of commercially available wearable activity monitors (WAMs), there is a paucity of consistent methodology for analyzing large amounts of accelerometer data from these devices. This multimethod study aimed to inform appropriate Fitbit wear thresholds for physical activity (PA) outcomes assessment in a sample of 616 low-income, majority Latina patients with obesity enrolled in a behavioral weight-loss intervention. Secondly, this study aimed to understand intervention participants' barriers to Fitbit use. We applied a heart rate (HR) criterion (≥10 h/day) and a step count (SC) criterion (≥1000 steps/day) to 100 days of continuous activity monitor data. We examined the prevalence of valid wear and PA outcomes between analytic subgroups of participants who met the HR criterion, SC criterion, or both. We undertook qualitative analysis of research staff notes and participant interviews to explore barriers to valid Fitbit data collection. Overall, one in three participants did not meet the SC criterion for valid wear in Weeks 1 and 13; however, we found the SC criterion to be more inclusive of participants who did not use a smartphone than the HR criterion. Older age, higher body mass index (BMI), barriers to smartphone use, device storage issues, and negative emotional responses to WAM-based self-monitoring may predict higher proportions of invalid WAM data in weight-loss intervention research.

Wearable Activity Monitors in Home Based Exercise Therapy for Patients with Intermittent Claudication: A Systematic Review

Intermittent claudication (IC) can severely limit functional capacity and quality of life. Supervised exercise therapy is the recommended first line management; however, this is often limited by accessibility, compliance and cost. As such, there has been an increased interest in the use of wearable activity monitors (WAMs) in home based telemonitoring exercise programmes for claudicants. This review aims to evaluate the efficacy of WAM as a feedback and monitoring tool in home based exercise programmes for patients with IC. A search strategy was devised. The databases MEDLINE, EMBASE, and Web of Science were searched through to April 2020. Randomised trials and prospective trials were included. Eligible trials had to incorporate WAMs as a feedback tool to target walking/exercise behaviour. The primary outcome was the change in walking ability. Study quality was assessed with risk of bias tool. A total of 1148 records were retrieved. Of these, eight randomised controlled trials and one prospective cohort study, all of which compared a WAM intervention against standard care and/or supervised exercise, met the inclusion criteria. Owing to heterogeneity between studies, no meta-analysis was conducted. WAM interventions improved measures of walking ability (heterogeneous outcomes such as maximum walking distance, claudication distance and six minute walk distance), increased daily walking activity (steps/day), cardiovascular metrics (maximum oxygen consumption), and quality of life. There is some evidence that home based WAM interventions are beneficial for improving walking ability and quality of life in patients with IC. However, existing studies are limited by inadequate sample size, duration, and appropriate power. Achieving consensus on outcome reporting and study methods, as well as maximising device adherence, is needed.

Wearable Activity Monitor Use Is Associated With the Aerobic Physical Activity Guidelines and Walking Among Older Adults

To examine wearable activity monitor (WAM) use and its association with meeting the 2008 aerobic Physical Activity Guidelines (PAG) and walking among older adults. Cross-sectional. FallStyles 2015 national consumer panel survey. 1,317 U.S. adults aged ≥ 60 years. Self-reported WAM use, meeting aerobic PAG, and walking. Covariates included age, sex, race/ethnicity, education level, marital status, annual household income, and geographic region of the country. Chi-square tests to examine associations between WAM use and respondent demographic characteristics. Logistic regressions to explore associations between WAM use and meeting aerobic PAG and walking adjusted for demographics (e.g., education, income). Among older adults, 8.0% were current WAM users and 11.3% were past WAM users. Current WAM use was most prevalent among those aged 65-74 (16.6%), females (9.4%), college graduates (13.8%), and those with incomes $75,000-$99,999 (14.8%). Current WAM users were more likely than never WAM users to report meeting aerobic PAG (OR: 3.98; 95% CI: 2.07, 7.66) and walking (OR: 3.90; 95% CI: 1.57, 9.69). Past and never WAM use were not associated with meeting aerobic PAG or walking. We found current WAM use is associated with meeting the aerobic PAG and walking among older adults. Further longitudinal research is needed to understand whether WAM could promote increased PA among older adults.

Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty

Hip and knee arthroplasty are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial variation in cost and quality. Whether remote monitoring incorporating insights from behavioral science might help improve outcomes and increase value of care remains unknown. To evaluate the effect of activity monitoring and bidirectional text messaging on the rate of discharge to home and clinical outcomes in patients receiving hip or knee arthroplasty. Randomized clinical trial conducted between February 7, 2018, and April 15, 2019. The setting was 2 urban hospitals at an academic health system. Participants were patients aged 18 to 85 years scheduled to undergo hip or knee arthroplasty with a Risk Assessment and Prediction Tool score of 6 to 8. Eligible patients were randomized evenly to receive usual care (n = 153) or remote monitoring (n = 147). Those in the intervention arm who agreed received a wearable activity monitor to track step count, messaging about postoperative goals and milestones, pain score tracking, and connection to clinicians as needed. Patients assigned to receive monitoring were further randomized evenly to remote monitoring alone or remote monitoring with gamification and social support. Remote monitoring was offered before surgery, began at hospital discharge, and continued for 45 days postdischarge. The primary outcome was discharge status (home vs skilled nursing facility or inpatient rehabilitation). Prespecified secondary outcomes included change in average daily step count and rehospitalizations. A total of 242 patients were analyzed (124 usual care, 118 intervention); median age was 66 years (interquartile range, 58-73 years); 78.1% were women, 45.5% were White, 43.4% were Black; and 81.4% in the intervention arm agreed to receive monitoring. There was no significant difference in the rate of discharge to home between the usual care arm (57.3%; 95% CI, 48.5%-65.9%) and the intervention arm (56.8%; 95% CI, 47.9%-65.7%) and no significant increase in step count in those receiving remote monitoring plus gamification and social support compared with remote monitoring alone. There was a statistically significant reduction in rehospitalization rate in the intervention arm (3.4%; 95% CI, 0.1%-6.7%) compared with the usual care arm (12.2%; 95% CI, 6.4%-18.0%) (P = .01). In this study, the remote monitoring program did not increase rate of discharge to home after hip or knee arthroplasty, and gamification and social support did not increase activity levels. There was a significant reduction in rehospitalizations among those receiving the intervention, which may have resulted from goal setting and connection to the care team. ClinicalTrials.gov Identifier: NCT03435549.

A Mobile Health Behavior Intervention to Reduce Pain and Improve Health in Older Adults With Obesity and Chronic Pain: The MORPH Pilot Trial.

Chronic, multisite pain is a common phenomenon in aging and is associated with a host of negative health outcomes. It is a complex and multifaceted condition that may be exacerbated by weight gain and long periods of inactivity. Unfortunately, older adults suffering from chronic pain have unique barriers limiting access to center-based behavior change interventions. The MORPH study first adapted and iteratively refined an evidence-based group-mediated intervention for delivery in the home via mHealth tools (a smartphone app, teleconferencing software, wearable activity monitor, smart weight scale). This was followed by a pilot randomized controlled trial (RCT) meant to assess feasibility of the MORPH intervention, and to examine initial effects on physical function, pain, weight, and sedentary behavior. We recruited low-active and obese older adults with multisite pain to partake in a series of N-of-1 refinement studies (N = 5 total) or a 12-week pilot RCT delivered largely in the home (N = 28 assigned to active intervention or wait-list control). The refinement phase identified several key technological (e.g., selection of a new smart weight scale) and user interface (e.g., clarification of in-app phrasing) modifications that were made before initiating the RCT phase. Analyses of covariance, controlling for baseline values, sex, and age indicated effects favoring the intervention across all domains of interest: there was a substantially clinically meaningful difference in short physical performance battery scores (0.63 points, η2 = 0.08), a moderate-to-large difference in PROMIS pain intensity scores (5.52 points, η2 = 0.12), a large difference in body weight (2.90 kg, η2 = 0.207), and a moderate effect on adjusted ActivPAL-assessed sedentary time (64.90 min, η2 = 0.07) with a small effect on steps (297.7 steps, η2 = 0.01). These results suggest a largely-home delivered movement and weight loss program for older adults with pain is feasible and recommendations are provided for future programs of this nature.Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03377634.

Financial incentives and wearable activity monitors to increase ambulation after cystectomy: A randomized controlled trial

ObjectivesFinancial incentive programs are effective in increasing physical activity for overweight, ambulatory adults. We sought to determine the potential effect size and direction of financial incentives on ambulation after radical cystectomy. Materials and MethodsWe performed a pilot randomized controlled trial of daily financial incentives to meet postoperative step goals among adults with Eastern Cooperative Oncology Group performance status ≤2 who underwent radical cystectomy for bladder cancer at a single center. Step counts were measured over a 3- to 14-day preoperative period and 30-day postoperative period using a wearable activity monitor. Postoperative daily step goals of 10%, 25%, 40%, and 55% of mean preoperative daily step counts were set for postoperative weeks 1 through 4, respectively. The primary outcome was the number of postoperative days on which the step goals were met. Secondary outcomes included the number of daily postoperative steps taken and the length of stay. Participants randomized to the intervention arm received $1.50 for every day the goal was met with a 20% chance of a $100 reward if the step goal was met on >75% of the first 30 postoperative days. Questionnaires assessing self-reported physical activity, disability, and social support were administered preoperatively at 30 days postoperatively. ResultsThirty-three patients were analyzed, 11 in the control and 22 in the intervention arms. There were no statistically significant differences between incentive and control arms for the primary outcome (4.5/30 days vs. 9/30 days, P = 0.53). Results after adjusting for differences in baseline characteristics were similar (RR 1.00, 95% CI 0.24–4.19, P = 1.00). There were also no differences in average daily postoperative steps (median 979 vs. 1191, 95% CI −810 to 1,400, P = 0.59), length of stay (7.5 vs. 7, 95% CI −2.7 to 5.1, P = 0.56), or self-reported measures of disability, activity, and social support. ConclusionsWhile this trial was a pilot study and not powered to detect a difference between groups, there was no suggestion of any clinically important impact of this financial incentive on postoperative ambulation. While a fully-powered trial is feasible, given the small range of plausible benefit, such a trial would be unlikely to influence clinical practice.

Mobile health assessments of geriatric elements in older patients with atrial fibrillation: The Mobile SAGE-AF Study (M-SAGE)

BackgroundGeriatric conditions (eg, cognitive impairment, frailty) are increasingly recognized for their impact on clinical and quality-of-life outcomes in older patients with cardiovascular disease, but are not systematically assessed in the context of clinical visits owing to time constraints.ObjectiveTo examine feasibility of remote monitoring of the physical, cognitive, and psychosocial status of older adults with atrial fibrillation (AF) via a novel smartphone app over 6 months.MethodsForty participants with AF and eligible for anticoagulation therapy (CHA2DS2VASc ≥2) enrolled in an ongoing cohort study participated in a mobile health pilot study. A 6-component geriatric assessment, including validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing, was deployed via a smartphone app and 6-minute walk test was completed using a Fitbit. Adherence to mobile assessments was examined over 6 months.ResultsParticipants were an average of 71 years old (range 65–86 years) and 38% were women. At 1 month, 75% (30/40) of participants completed the app-based geriatric assessment and 63% (25/40) completed the 6-minute walk test. At 6 months, 52% (15/29) completed the geriatric assessment and 28% (8/29) completed the walk test. There were no differences in demographic, clinical, or psychosocial factors between participants who completed the surveys at 6 months and those who did not. Participants, on average, required less than 10 minutes of telephone support over the 6-month period.ConclusionIt is feasible, among smartphone users, to use a mobile health app and wearable activity monitor to conduct serial geriatric assessments in older patients with AF for up to 6 months.

Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep

Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep

TCT CONNECT-145 Wearable Activity Monitoring and the Impact of Frailty on Physical Activity After Transcatheter Aortic Valve Replacement

TCT CONNECT-145 Wearable Activity Monitoring and the Impact of Frailty on Physical Activity After Transcatheter Aortic Valve Replacement

DIGITAL TECHNOLOGIES, DATA, AND ANALYTICS

Lower extremity joint replacement (LEJR) is the most common inpatient surgery for Medicare beneficiaries with substantial variation in cost and quality. Remote monitoring and insights from behavioral science have the potential to improve outcomes and value of care. We evaluated the impact of activity monitoring and bidirectional text messaging on the rate of patient discharge to home and clinical outcomes.This was a three‐arm pragmatic randomized controlled trial conducted between February 2018 and April 2019 at two urban hospitals in a large academic health system (clinicaltrials.gov NCT0335549). Eligible patients were randomized evenly, with a waiver of informed consent, and stratified by hospital location and joint type (knee or hip) to receive (1) usual care, or (2) HomeConnect + . Intervention patients were invited to participate in HomeConnect+ by mailed invitation followed by up to 4 phone calls. Those who agreed received a wearable activity monitor (Withings) to track step counts, pain score tracking, messaging about post‐operative goals and milestones, and connection to clinicians as needed. Those in HomeConnect+ were further randomized evenly to (2a) remote monitoring alone or (2b) remote monitoring with gamification and social support. HomeConnect+ was offered before surgery, began at hospital discharge, and continued for 45 days post‐discharge. The primary outcome was discharge to home. Pre‐specified secondary outcomes included change in average daily step count from week 2 to week 6, rehospitalizations, and outpatient visits.We included patients aged 18‐85 scheduled to undergo lower extremity joint replacement surgery (knee or hip) with a Risk Assessment and Prediction Tool score of 6‐8. We excluded patients with dementia, end‐stage renal disease, cirrhosis, metastatic cancer, and those scheduled for bilateral or revision surgery.A total of 242 patients were included in the analysis (124 usual care, 118 intervention) with a mean age of 66, including 78% female, 46% white, and 43% black patients. 81% in the intervention arm agreed to receive monitoring. There was no significant difference in the rate of discharge to home between the usual care (58%) and intervention (57%) arms; no difference in office visits between arms; and no significant increase in step count in those receiving remote monitoring plus gamification and social support compared to remote monitoring alone. There was a statistically significant reduction in rehospitalization rate in the intervention arm compared to the usual care arm (3.4% vs 12.2%; P = .01).The HomeConnect+ automated hovering program did not increase discharge to home from the hospital after LEJR surgery, and there was no difference in activity levels among those receiving gamification and social support compared to remote monitoring alone. However, there was a significant reduction in rehospitalizations among those receiving the intervention, which may have resulted from goal setting and connection to the care team.Automated hovering was not sufficient to increase discharge to home among patients with a moderate expected rate of facility placement. However, it has the potential to reduce hospitalizations after LEJR surgery, an important quality and value outcome for hospitals and payers.