Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

Abstract

IMPORTANCE Physical frailty is a key risk factor associated with higher rates of major adverse events (MAEs) after surgery. Assessing physical frailty is often challenging among patients with chronic limb-threatening ischemia (CLTI) who are often unable to perform gait-based assessments because of the presence of plantar wounds. OBJECTIVE To test a frailty meter (FM) that does not rely on gait to determine the risk of occurrence of MAEs after revascularization for patients with CLTI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 184 consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 individuals were excluded, 152 participants were included in the study. Data collection was conducted between May 2018 and June 2019. EXPOSURES Physical frailty measurement within 1 week before limb revascularization and incidence of MAEs for as long as 1 month after surgery. MAIN OUTCOMES AND MEASURES The FM works by quantifying weakness, slowness, rigidity, and exhaustion during a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of physical frailty. RESULTS Of 152 eligible participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) were unable to perform the gait test, while all could perform the FM test. Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI <0.20), prefrail (FI Ն0.20 to <0.35), or frail (FI Ն0.35), respectively. Within 30 days after surgery, 24 (15.7%) developed MAEs, either major adverse cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 [10.5%]). Baseline demographic characteristics were not significantly different between frailty groups. In contrast, the FI was approximately 30% higher in the group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, prefrail and frail groups, respectively (P = .004). The FI distinguished individuals who developed MACE and MALE from those who were MAE free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. CONCLUSIONS AND RELEVANCE In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for CLTI when the administration of gait-based tests is often challenging.

Harnessing Digital Health to Objectively Assess Functional Performance in Veterans with Chronic Obstructive Pulmonary Disease

“…Because of the nature of the Veteran patient population, there were significantly more male patients than female patients receiving care at the hospital. However, we anticipated that the gender imbalance between the 2 groups does not have any significant effect to the results as demonstrated in our previous studies, in which we showed that gender does not affect FM-derived metrics [30-32]. The significant difference in sex distribution of the 2 groups also led to significant differences in height and weight.…”

“…The FM quantifies slowness, rigidity, weakness, and exhaustion by measuring comprehensive functional performance metrics includ-Gerontology 2022;68:829-839 DOI: 10.1159/000520401 ing elbow angular velocity, elbow angular acceleration, elbow flexion-extension range, time to reach full elbow flexion, and time to reach full elbow extension [19]. Our previous studies have demonstrated this FM is efficient in identifying individuals with pre-frailty and frailty [29][30][31][32][33][34]. In this study, we examined the feasibility and effectiveness of the FM to objectively assess functional performance in COPD patients.…”

Mediating Effect of Physical Activity in the Association between Low 25-Hydroxyvitamin D and Frailty Trajectories: The English Longitudinal Study of Ageing

“…The FI also ranged between 0 and 1, where a higher FI means greater frailty. In previous analyses, an FI < 0.20 was considered non-frail, 0.20 ≤ FI < 0.35 was pre-frail, 0.35 ≤ FI < 0.43 was frail and FI ≥ 0.43 was severely frail [ 20 , 21 ].…”

Incorporating Outcomes that Matter to Older Adults into Surgical Research

“…Although there is increasing recognition of the need for a specialized approach to preoperative and postoperative evaluation and management of older patients undergoing surgery, uptake remains low, and there are significant barriers toward implementation. Time and resource constraints still exist in surgical practices, especially in community settings, but newer tools like the enhanced NSQIP calculator, efficient frailty assessments like the Risk Analysis Index, and wearable technology hold promise for overcoming these barriers 23,24 . Multiple evidence‐based interventions exist to reduce delirium, functional decline, falls, and other hospital‐acquired geriatric syndromes.…”

“…overcoming these barriers. 23,24 Multiple evidence-based interventions exist to reduce delirium, functional decline, falls, and other hospital-acquired geriatric syndromes. Implementation research, human-centered design, and consideration of hospital built environments is needed to incorporate these interventions into perioperative settings.…”