Using Activity Trackers to Quantify Postpartum Ambulation

Abstract

Background Early postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery. Methods Parturients having first/second cesarean delivery under spinal anesthesia or first/second vaginal delivery under epidural analgesia between July 2015 and December 2016 were recruited. Patients with significant comorbidities or postpartum complications were excluded, and participants received standard multimodal analgesia. Mothers were fitted with wrist-worn activity trackers immediately postdelivery, and the trackers were recollected 24 h later. Rest and dynamic postpartum pain scores at 2, 6, 12, 18, and 24 h and quality of recovery (QoR-15) at 12 and 24 h were assessed. Results The study analyzed 173 patients (cesarean delivery: 76; vaginal delivery: 97). Vaginal delivery was associated with greater postpartum ambulation (44%) compared to cesarean delivery, with means ± SD of 1,205 ± 422 and 835 ± 381 steps, respectively, and mean difference (95% CI) of 370 steps (250, 490; P < 0.0001). Although both groups had similar pain scores and opioid consumption (less than 1.0 mg of morphine), vaginal delivery was associated with superior QoR-15 scores, with 9.2 (0.6, 17.8; P = 0.02) and 8.2 (0.1, 16.3; P = 0.045) differences at 12 and 24 h, respectively. Conclusions This study objectively demonstrates that vaginal delivery is associated with greater early ambulation and functional recovery compared to cesarean delivery. It also establishes the feasibility of using activity trackers to evaluate early postoperative ambulation after neuraxial anesthesia and analgesia.

Comparison of analgesic effects between programmed intermittent epidural boluses and continuous epidural infusion after cesarean section: a randomized controlled study

“…The lower incidence of motor blockade observed in postpartum women using PIEB in this study may be associated with the benefits of early ambulation, as recommended by the Enhanced Recovery After Surgery (ERAS) guidelines [ 22 , 23 ]. Early ambulation is an important clinical indicator for maternal health and neonatal care as it indicates better postoperative recovery and ensures maintenance of maternal independence during the postpartum period [ 24 ].…”

Physical and psychological recovery after vaginal childbirth with and without epidural analgesia: A prospective cohort study

“…Her postpartum course was uncomplicated, and it is unknown if her extremely high level of physical activity was intentional. While previous studies have shown a good accuracy of Fitbit TM devices for step counts [ 11 , 12 , 32 , 33 ], one systematic review suggested that Fitbit TM devices can overestimate steps in free-living settings [ 13 ]. To decrease the risk of overestimation, we conducted a sensitivity analysis to exclude the step count data of this participant.…”

“…Ma et al previously demonstrated that step count during the first 24 hours after vaginal delivery with epidural analgesia was 1,205 ± 422 (mean ± SD) [ 12 ]. Assuming that a 20% difference in the 24-hour step count would be clinically meaningful [ 12 ], we performed a two-sided test of superiority of the 24-hour step count and determined that a sample of at least 31 participants per group will provide 80% power at a 5% significance level (type I error estimate).…”

Enhancing patient mobility following cesarean-delivery – the efficacy of an improved postpartum protocol assessed with pedometers

“…Yet, a limited number of studies have assessed postpartum mobility with their use. In a study by Ma and colleagues, patient mobility during the first 24 h following delivery was assessed with activity trackers [10].…”

“…Immobility, which characterizes the immediate postpartum period, has been previously demonstrated to contribute to the pathogenesis of VTE [7]. Previous studies have addressed post-partum immobilization, and linked it to an increased risk for VTE [8], yet only a limited number have objectively quantified mobility with digital step counters [9][10][11]. Moreover, none of the previous studies have assessed the efficacy of an intervention for reducing post-partum immobilization.…”