Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study

Abstract

Background As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site—the MDT site (n=19)—had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup’s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post–critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID) RR2-10.12968/ijtr.2020.0102

Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study

“…Despite the fact that the control group did not engage in any formal structured rehabilitation, the materials (including handouts, devices, and an app with a health diary) that were provided to the control group and the regular check-ins with the study team may help to explain the similar between-group results [ 7 ]. In the Hunter et al [ 1 ] study on the recovery of COVID-19 survivors, participants indicated that smartwatches motivated them to recover and increase their physical activity levels. This is important, as the use of smartwatches is a relatively low-cost, low-burden, and easily implementable posthospital intervention.…”

“…Our study is among the first to report objective physical activity data (step counts) from COVID-19 survivors. In the only other study that we are aware of, Hunter et al [ 1 ] found that individuals who were recovering from COVID-19 and were admitted to a critical care unit had an average of 4359 (SD 3488) steps per day in the first month after discharge and increased their step counts to an average of 7914 (SD 4146) steps per day at 1 year ( P =.003) [ 1 ]. In our study, participants had a similar median baseline step count of 4928 (IQR 3083-7574) at 1 week after study enrollment (mean 3.5 weeks after hospital discharge), which is below the targets for healthy adults (around 8000-10,000 daily steps) [ 8 ].…”

“…Low physical functioning and physical inactivity are observed among people who were hospitalized with severe COVID-19 [ 1 , 2 ]. Understanding how COVID-19–related hospitalization and subsequent rehabilitation impacts postdischarge physical activity trajectories may inform prognosis and care.…”

“…However, research examining the use of wearables to monitor COVID-19 survivors’ physical activity over the course of recovery is limited. To our knowledge, a study conducted by Hunter et al [ 1 ] is the only study that has used smartwatches to assess step count changes in COVID-19 survivors following critical care hospital admission. They found that, on average, participants took 4359 steps per day in the first month after discharge and that their average step counts increased by 37% between discharge and 3 months after hospitalization and by 82% at 1 year after discharge when compared to baseline [ 1 ].…”

Smartphone Global Positioning System–Based System to Assess Mobility in Health Research: Development, Accuracy, and Usability Study

“…We explicitly see potential for use in interventional studies, as it is a great tool to evaluate interventions that, for instance, focus on promoting out-of-home mobility, fostering new routines, changing mobility habits, or following patients after cardiac rehabilitation. As an individualized/tailored approach is used often (compare [33,34]), we believe it is possible to develop our system even further and add live feedback options for the user. Overall, GPS-based measurements can add great value to various study designs and populations and should be considered and examined more often in health research.…”