Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery

Patient Engagement Platforms: How Technology Is Impacting Perioperative Communication and Engagement in Total Hip and Knee Arthroplasty

Orthopedic clinics are becoming strained with clinical volume outpacing resources and personnel. Patient engagement platforms can help bridge the communication and engagement gaps between patients and their healthcare teams as total hip and knee arthroplasty transitions to the outpatient setting. These platforms provide a digital infrastructure that allows patients to participate in their healthcare journey while alleviating the burdens on clinic staff. Multiple forms of patient engagement platforms exist but typically fall into one of 3 groups: patient portals, mobile health applications, and chatbots. They all play an important role in enhancing postoperative rehabilitation, patient engagement, and patient care overall. This article explores the spectrum of available patient engagement platforms and examines their advantages, limitations, and documented benefits on clinical outcomes.

Usability and utility of a remote monitoring system to support physiotherapy for people with Parkinson's disease

Background

Physiotherapy for persons with Parkinson's disease (PwPD) could benefit from objective and continuous tracking of physical activity and falls in daily life.

Objectives

We designed a remote monitoring system for this purpose and describe the experiences of PwPD and physiotherapists who used the system in daily clinical practice.

Methods

Twenty-one PwPD (15 men) wore a sensor necklace to passively record physical activity and falls for 6 weeks. They also used a smartphone app to self-report daily activities, (near-)falls and medication intake. They discussed those data with their PD-specialized physiotherapist (n = 9) during three regular treatment sessions. User experiences and aspects to be improved were gathered through interviews with PwPD and physiotherapists, resulting in system updates. The system was evaluated in a second pilot with 25 new PwPD (17 men) and eight physiotherapists.

Results

We applied thematic analysis to the interview data resulting in two main themes: usability and utility. First, the usability of the system was rated positively, with the necklace being easy to use. However, some PwPD with limited digital literacy or cognitive impairments found the app unclear. Second, the perceived utility of the system varied among PwPD. While many PwPD were motivated to increase their activity level, others were not additionally motivated because they perceived their activity level as high. Physiotherapists appreciated the objective recording of physical activity at home and used the monitoring of falls to enlarge awareness of the importance of falls for PwPD. Based on the interview data of all participants, we drafted three user profiles for PwPD regarding the benefits of remote monitoring for physiotherapy: for profile 1, a monitoring system could act as a flagging dashboard to signal the need for renewed treatment; for profile 2, a monitoring system could be a motivational tool to maintain physical activity; for profile 3, a monitoring system could passively track physical activity and falls at home. Finally, for a subgroup of PwPD the burdens of monitoring will outweigh the benefits.

Conclusions

Overall, both PwPD and physiotherapists underline the potential of a remote monitoring system to support physiotherapy by targeting physical activity and (near-)falls. Our findings emphasize the importance of personalization in remote monitoring technology, as illustrated by our user profiles.

The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature

BACKGROUND

The incidence rate of total joint replacement (TJR) continues to increase due to the aging population and the surgery that is very successful in providing pain relief to and improving function among patients with advanced knee or hip arthritis. Improving patient outcomes and patient satisfaction after TJR remain important goals. Wearable technologies provide a novel way to capture patient function and activity data and supplement clinical measures and patient-reported outcome measures in order to better understand patient outcomes after TJR.

OBJECTIVE

We examined the current literature to evaluate the potential role of wearable devices and compare them with existing methods for monitoring and improving patient rehabilitation and outcomes following TJR.

METHODS

We performed a literature search by using the research databases supported by the University of Massachusetts Chan Medical School's Lamar Soutter Library, including PubMed and Scopus, supplemented with the Google Scholar search engine. A specific search strategy was used to identify articles discussing the use of wearable devices in measuring and affecting postoperative outcomes of patients who have undergone TJR. Selected papers were organized into a spreadsheet and categorized for our qualitative literature review to assess how wearable data correlated with clinical measures and patient-reported outcome measures.

RESULTS

A total of 9 papers were selected. The literature showed the impact of wearable devices on evaluating and improving postoperative functional outcomes. Wearable-collected data could be used to predict postoperative clinical measures, such as range of motion and Timed Up and Go times. When predicting patient-reported outcomes, specifically Hip Disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Scores and Veterans RAND 12-Item Health Survey scores, strong associations were found between changes in sensor-collected data and changes in patient-reported outcomes over time. Further, the step counts of patients who received feedback from a wearable improved over time when compared to those of patients who did not receive feedback.

CONCLUSIONS

These findings suggest that wearable technology has the potential to remotely measure and improve postoperative orthopedic patient outcomes. We anticipate that this review will facilitate further investigation into whether wearable devices are viable tools for guiding the clinical management of TJR rehabilitation.

The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial

BACKGROUND

The PEricapsular Nerve Group (PENG) block is a novel regional analgesia technique that provides improved analgesia in patients undergoing hip surgery while preserving motor function. In this study the PENG block was investigated for analgesia in elective total hip arthroplasty (THA).

METHODS

In this multi-centre double-blinded randomized-controlled trial, in addition to spinal anesthesia and local infiltration analgesia (LIA), THA patients received either a PENG block or a sham block. The primary outcome was pain score (numeric rating scale 0-10) 3 h postoperatively (Day 0). Secondary outcomes were postoperative quadriceps muscle strength, postoperative Day 1 pain scores, opiate use, complications, length of hospital stay, and patient-reported outcome measures.

RESULTS

Sixty patients were randomized and equally allocated between groups. Baseline demographics were similar. Postoperative Day 0, the PENG group experienced less pain compared to the sham group (PENG: 14 (47%) patients no pain, 14 (47%) mild pain, 2 (6%) moderate/severe pain versus sham: 6 (20%) no pain, 14 (47%) mild pain, 10 (33%) moderate/severe pain; p = 0.03). There was no difference in quadriceps muscle strength between groups on Day 0 (PENG: 23 (77%) intact versus sham: 24 (80%) intact; p = 0.24) and there were no differences in other secondary outcomes.

CONCLUSIONS

Patients receiving a PENG block for analgesia in elective THA experience less postoperative pain on Day 0 with preservation of quadriceps muscle strength. Despite these short-term benefits, no quality of recovery or longer lasting postoperative effects were detected.

Relationship between Kinesiophobia and Mobility, Impact of the Disease, and Fear of Falling in Women with and without Fibromyalgia: A Cross-Sectional Study

Background: Kinesiophobia is defined as fear of movement due to the painful experience of it. The main symptom of fibromyalgia is persistent and widespread pain associated with other symptoms. This study analyzes the kinesiophobia between women with fibromyalgia and apparently healthy women and investigates the relationship between kinesiophobia and physical fitness tests, fear of falling, and the impact of the fibromyalgia. Methods: Fifty-one women participated in this study were divided into two groups: (1) women with fibromyalgia and (2) apparently healthy women. Participants completed questionnaires to assess kinesiophobia, fear of falling, and the impact of fibromyalgia. Subsequently, participants completed the physical tests Timed Up and Go, 10-step stair ascent, and handgrip strength. Results: Women with fibromyalgia had significant differences in kinesiophobia and fear of falling compared to apparently healthy women. Similarly, performance in the physical tests was lower, except for the handgrip strength, which maintained similar values to the apparently healthy women. Significant relationships were found only in the fibromyalgia group between kinesiophobia, the impact of the disease, fear of falling, and the Timed Up and Go and 10-step stair ascent tests. Conclusions: Women with fibromyalgia showed higher kinesiophobia scores, worse performance in mobility tests, and higher fear of falling than apparently healthy women. Kinesiophobia score is related to Timed Up and Go performance, the 10-step stair ascent, the fear of falling, and the impact of the disease in women with fibromyalgia.

Quantification of Movement in Stroke Patients under Free Living Conditions Using Wearable Sensors: A Systematic Review

Stroke is a main cause of long-term disability worldwide, placing a large burden on individuals and health care systems. Wearable technology can potentially objectively assess and monitor patients outside clinical environments, enabling a more detailed evaluation of their impairment and allowing individualization of rehabilitation therapies. The aim of this review is to provide an overview of setups used in literature to measure movement of stroke patients under free living conditions using wearable sensors, and to evaluate the relation between such sensor-based outcomes and the level of functioning as assessed by existing clinical evaluation methods. After a systematic search we included 32 articles, totaling 1076 stroke patients from acute to chronic phases and 236 healthy controls. We summarized the results by type and location of sensors, and by sensor-based outcome measures and their relation with existing clinical evaluation tools. We conclude that sensor-based measures of movement provide additional information in relation to clinical evaluation tools assessing motor functioning and both are needed to gain better insight in patient behavior and recovery. However, there is a strong need for standardization and consensus, regarding clinical assessments, but also regarding the use of specific algorithms and metrics for unsupervised measurements during daily life.

Fall Risk Assessment Using Wearable Sensors: A Narrative Review

Recently, fall risk assessment has been a main focus in fall-related research. Wearable sensors have been used to increase the objectivity of this assessment, building on the traditional use of oversimplified questionnaires. However, it is necessary to define standard procedures that will us enable to acknowledge the multifactorial causes behind fall events while tackling the heterogeneity of the currently developed systems. Thus, it is necessary to identify the different specifications and demands of each fall risk assessment method. Hence, this manuscript provides a narrative review on the fall risk assessment methods performed in the scientific literature using wearable sensors. For each identified method, a comprehensive analysis has been carried out in order to find trends regarding the most used sensors and its characteristics, activities performed in the experimental protocol, and algorithms used to classify the fall risk. We also verified how studies performed the validation process of the developed fall risk assessment systems. The identification of trends for each fall risk assessment method would help researchers in the design of standard innovative solutions and enhance the reliability of this assessment towards a homogeneous benchmark solution.

Wearable Sensor-Based Prediction Model of Timed up and Go Test in Older Adults

The Timed Up and Go (TUG) test has been frequently used to assess the risk of falls in older adults because it is an easy, fast, and simple method of examining functional mobility and balance without special equipment. The purpose of this study is to develop a model that predicts the TUG test using three-dimensional acceleration data collected from wearable sensors during normal walking. We recruited 37 older adults for an outdoor walking task, and seven inertial measurement unit (IMU)-based sensors were attached to each participant. The elastic net and ridge regression methods were used to reduce gait feature sets and build a predictive model. The proposed predictive model reliably estimated the participants' TUG scores with a small margin of prediction errors. Although the prediction accuracies with two foot-sensors were slightly better than those of other configurations (e.g., MAPE: foot (0.865 s) > foot and pelvis (0.918 s) > pelvis (0.921 s)), we recommend the use of a single IMU sensor at the pelvis since it would provide wearing comfort while avoiding the disturbance of daily activities. The proposed predictive model can enable clinicians to assess older adults' fall risks remotely through the evaluation of the TUG score during their daily walking.

Validation of Walking Speed Estimation from Trunk Mounted Accelerometers for a Range of Walking Speeds

Walking speed is a strong indicator of the health status of older people and patients. Using algorithms, the walking speed can be estimated from wearable accelerometers, which enables minimally obtrusive (longitudinal) monitoring. We evaluated the performance of two algorithms, the inverted pendulum (IP) algorithm, and a novel adaptation correcting for lateral step movement, which aimed to improve accuracy during slow walking. To evaluate robustness, we gathered data from different groups (healthy adults, elderly, and elderly patients) of volunteers (n = 159) walking under various conditions (over ground, treadmill, using walking aids) at a broad range of speeds (0.11–1.93 m/s). Both of the algorithms showed good agreement with the reference values and similar root-mean-square errors (RMSEs) for walking speeds ≥0.5 m/s, which ranged from 0.09–0.16 m/s for the different positions, in line with the results from others. However, for slower walking, RMSEs were significantly better for the new method (0.06–0.09 m/s versus 0.15–0.19 m/s). Pearson correlation improved for speeds <0.5 m/s (from 0.67–0.72 to 0.73–0.82) as well as higher speeds (0.87–0.97 to 0.90–0.98) with the new method. Overall, we found that IP(-based) walking speed estimation proved to be applicable for a variety of wearing positions, conditions and speeds, indicating its potential value for health assessment applications.

Wearable activity sensors and early pain after total joint arthroplasty

A prospective observational cohort of 20 primary total hip arthroplasty (n = 12) and total knee arthroplasty (n = 8) patients (mean age: 63 ± 6 years) was passively monitored with a consumer-level wearable activity sensor before and 6 weeks after surgery. Patients were clustered by minimal change or decreased activity using sensor data. Decreased postoperative activity was associated with greater pain reduction (−5.5 vs −2.0, P = .03). All patients surpassed minimal clinical benefit thresholds of total joint arthroplasty (TJA) (Hip Disability and Osteoarthritis Score Junior 30.5 vs 20.8, P = .23; Knee Injury and Osteoarthritis Outcome Score Junior 23.3 vs 18.2, P = .77) within 6 weeks. Patients who objectively “take it easy” after TJA may experience less pain with no difference in early subjective outcome. Remote, passive analysis of outpatient wearable sensor data may permit real-time detection of early problems after TJA.

Bend Don't Break: Stretching Improves Scores on a Battery of Fall Assessment Tools in Older Adults

CONTEXT

Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-cause mortality in older adults. The timed up and go and 5 times sit-to-stand tests are two of the 3 most evidence-supported performance measures to assess fall risk.

OBJECTIVE

This study aimed to determine if 5 weeks of flexibility training could increase sitting-rising test, timed up and go, and 5 times sit-to-stand scores in community-dwelling older adults.

PARTICIPANTS

Forty-seven adults aged 60 years and older (mean age = 66.7 y, SD = 4.1) participated in this study. Participants completed a static stretching protocol consisting of 3 weekly 1-hour stretching sessions.

RESULTS

The protocol improved flexibility as seen in sit-and-reach scores and improved scores on all outcome variables. Specifically, there was a significant increase in sitting-rising test scores from preintervention (M = 7.45, SD = 1.45) to postintervention (M = 8.04, SD = 1.36), t(42) = -5.21, P < .001. Timed up and go scores demonstrated a significant decrease from preintervention (M = 8.85, SD = 1.32) to postintervention (M = 8.20, SD = 1.35), t(46) = 5.10, P < .001. Five times sit-to-stand scores demonstrated a significant decrease from preintervention (M = 12.57, SD = 2.68) to postintervention (M = 10.46, SD = 2.06), t(46) = 6.62, P < .001. Finally, significant increases in sit-and-reach scores were associated with improved functional performance (r = -.308, P = .03).

CONCLUSION

Findings suggest that flexibility training can be an effective mode of low-level exercise to improve functional outcomes. Static stretching may help to improve musculoskeletal health, promote autonomy, and decrease mortality in community-dwelling older adults.