Comparing Activity Trackers With vs. Without Alarms to Increase Postoperative Ambulation: A Randomized Control Trial

Abstract

Early ambulation is a key component to postoperative recovery; however, measuring steps taken is often inconsistent and nonstandardized. This study aimed to determine whether an activity tracker with alarms would increase postoperative ambulation in patients after elective colorectal procedures. Forty-eight patients were randomly assigned to either trackers with 5 daily alarms or activity trackers alone. Over 223 total patient days, the trackers recorded a complete data set for 216 patient days (96.9%). Increasing the postoperative day significantly affected the number of steps taken, while age, sex, Risk Analysis Index score, and approach (laparoscopic versus open) did not show a significant effect. The mean steps per day in the intervention group were 1468 (median 495; interquartile range (IQR) 1345) and in the control group was 1645 (median 1014; IQR 2498). The use of trackers with alarms did not significantly affect the number of daily steps compared to trackers alone (ANOVA, P = .93). Although activity trackers with alarms did not increase postoperative ambulation compared with trackers with no alarms, we demonstrated a strategy to operationalize the use of trackers into postoperative care to provide a quantitative value for ambulation. This enables quantification of a key component in the Enhanced Recovery After Surgery protocol.

Accelerometer-Measured Inpatient Physical Activity and Associated Outcomes After Major Abdominal Surgery: Systematic Review

“…All studies used accelerometers during the acute inpatient period (per our inclusion criteria). Of the 15 studies, 12 (80%) applied the device within a day after surgery (n=7, 58%, studies on the day of surgery [ 30 - 32 , 35 , 36 , 38 , 39 ] and n=5, 42%, studies on postoperative day 1 or within 24 hours after surgery [ 27 , 29 , 33 , 37 , 40 ]). Of the 15 studies, 2 (13%) started the device wear after patients were transferred to the floor from the intensive care unit, which occurred on postoperative day 2 or 3 on average [ 28 , 41 ], and 1 (7%) did not report the timing of initiation [ 34 ].…”

“…The mean in-hospital wear duration was 5.2 (SD 2.0; range 3-10) days. Most of the studies (11/15, 73%) described continuous 24-hour device wear with or without brief interruptions for battery charging or patient showering [ 27 - 30 , 32 - 34 , 36 , 38 , 39 , 41 ], whereas others implied continuous measurement but did not explicitly describe it [ 31 , 35 , 37 , 40 ]. Of the 15 studies, 3 (20%) obtained preoperative baseline data, ranging from 2 to 30 days before surgery [ 31 , 35 , 40 ], and 1 (7%) followed patients after discharge until postoperative day 30 [ 35 ].…”

“…Of the 6 RCTs, 4 (67%) evaluated the return of gastrointestinal function; only the study by Ni et al [ 37 ] demonstrated a shorter time to gastrointestinal recovery from a mobility-enhancing intervention (time to flatus: 2.3 vs 3.1 days; P =.04). The remaining RCTs (3/4, 75%), including the well-conducted study by Fiore et al [ 36 ], found no such effect from mobility-enhancing interventions [ 39 , 40 ].…”

“…Of the 15 studies, 4 (27%; n=2, 50% of observational studies [ 27 , 29 ] and n=2, 50% of RCTs [ 36 , 39 ]) analyzed the effect of physical activity on postoperative pulmonary complications. Each study defined postoperative pulmonary complications differently, and the reported incidence rate ranged from 0% to 34%.…”

Wearable devices to monitor recovery after abdominal surgery: scoping review

“…In comparison, a non-randomized trial showed a lower risk of pneumonia and shorter duration of hospital stay in a self-selected group of patients 93 . Feedback from wearable devices had mixed effects; some studies reported increased activity 74 , 94 , whereas others reported no effect 63 , 95 .…”