Fitbits help track inpatient activity after abdominal cancer surgery

Carissa A. Low

Increased physical activity tracked with a Fitbit during inpatient recovery predicted lower risk for 30- and 60-day hospital readmission after surgery for metastatic peritoneal cancer, according to results of an observational cohort study published in Annals of Behavioral Medicine.

Between 15% and 50% of patients who undergo abdominal cancer surgery are readmitted to the hospital within 30 days of hospital discharge, according to study background.

Although light exercise is a significant component of successful recovery after surgery, postoperative activity “is rarely monitored systematically as part of clinical care or examined as a predictor of important clinical outcomes, such as readmission,” Carissa A. Low, PhD, assistant professor of medicine in the departments of medicine and psychology at University of Pittsburgh, and colleagues wrote. “The recent emergence and growing popularity of commercially available, low-cost, reliable wearable devices, such as Fitbits, permit simple, objective and continuous quantification of physical activity and remote real-time monitoring of patient ambulation, but whether these passively sensed data can predict subsequent clinically important outcomes remains unclear.”

Low and colleagues assessed whether Fitbit step counts tracked during inpatient recovery predicted 30- and 60-day readmission risk after metastatic peritoneal cancer surgery.

Researchers enrolled 71 patients (mean age, 57.14 years; 42% women) at their preoperative clinic visit before surgical resection for metastatic peritoneal cancer. More than half (51%) of study participants had appendiceal cancer.

Once transferred from the ICU after surgery, Fitbits were placed on patients’ wrists and worn for the entire inpatient stay (mean stay, 12.12 days).

Thirty-four percent of patients were readmitted to the hospital within 30 days and 39% were readmitted within 60 days. After adjustments for age, BMI, comorbidity and length of postoperative stay, increased Fitbit average step counts per day predicted lower 30-day and 60-day hospital readmissions.

“These data highlight the possibility that remotely monitoring real-time patient ambulation using Fitbit devices may provide opportunities to improve postoperative clinical care with minimal burden to patients or clinical providers,” the researchers wrote.

HemOnc Today spoke with Low about the study results and their implications, the importance of being able to monitor physical activity levels of patients after surgery, and whether wearing a device like a Fitbit would have the same type of benefit for patients who undergo surgeries for other metastatic cancer types.

 

Question: What prompted this research?

Answer: Patients are encouraged to get out of bed and walk as soon as possible after surgery. It is commonly accepted that walking will speed up recovery. With Fitbits and similar wearable devices, it is very easy and cost-effective now to quantify steps in postoperative recovery. This is what we aimed to do.

 

Q: How did you conduct the research?

A: Patients were recruited before surgery during their preoperative visit. We started measuring their steps when they were moved from the ICU to the surgical oncology floor, which normally occurs 1 or 2 days after a major abdominal surgery. We placed Fitbit devices on their wrists for their duration of hospital stay, which was around 2 weeks for most patients. This allowed us to quantify steps that were taken throughout their inpatient recovery. For this initial study, we simply averaged the number of steps per day over however many days each patient spent in the hospital. We then looked at the relationship between average step counts and the risk for readmission within 30 to 60 days after leaving the hospital after surgery.

 

Q: What did the results show?

A: More than one-third of the patients in our sample had an unplanned hospital readmission within 60 days of discharge. We found that patients who took more steps during their inpatient stay were at a lower risk for both 30- and 60-day readmission. This was true even after adjusting for factors that can influence both activity and readmission risk — age, BMI and comorbidity — and persisted when we adjusted for how frequently patients reported exercising before surgery.

 

Q: What are the clinical implications of these findings?

A: It would be pretty easy to incorporate Fitbits or other similar devices in postoperative care. Visualizing daily step counts on a TV monitor in the room, in electronic medical records or even written on the whiteboard in the room could help the clinical care team see who is less active so they can allocate their resources accordingly.

 

Q: Why is it important to be able to monitor physical activity levels in patients after surgery?

A: Readmissions after cancer surgery are common, expensive, and stressful for patients and their families. Anything we can do to reduce readmission risk is important. If monitoring the activity level can help providers identify patients who might need additional support or identify patients at high risk for readmission is worthwhile, especially given how easy and inexpensive it is to monitor step counts.

 

Q: Were patients receptive to this type of monitoring?

A: Overall, patients were compliant and we had very few complaints about the monitoring devices. Of course, in the study, we provided the devices to the patients and we synced them and made sure that they were charged. So, this was a best-case scenario in terms of minimal burden to patients. Some patients found the devices and information they provided to be very appealing and highly motivating. Some patients wanted to know their step counts every day to see if they were walking more when they recovered. Some wanted to be able to compare their step counts to other patients to see how they were doing, and some patients were interested in tracking their sleep and seeing how many awakenings they had during the night because sleep can be very fragmented in the hospital. There also were patients who did not mind the devices, but did not care to know their step counts. So, there was some variability in how receptive and enthusiastic patients were about wearing Fitbits.

 

Q: Might this have the same type of benefit for patients who are undergoing surgery for other forms of advanced cancer?

A: Yes, I would like to think that monitoring steps can be useful for any surgical population. We focused on our population because the readmission rates are exceptionally high after that type of abdominal cancer resection. Activity is definitely encouraged after other types of cancer and noncancer surgeries.

 

Q: Are there plans for additional research on this topic?

A: We are wrapping up a follow-up study in which patients are wearing these devices before surgery, in the hospital and then after discharge when they go home. We are still seeing excellent compliance rates, but there are a few patients we have to call regularly to remind them to charge the device and to wear it 24 hours per day. By monitoring activity before surgery and after discharge, as well as during inpatient recovery, we hope to understand when physical activity is most beneficial for recovery, as well as the patterns of activity that are related to better outcomes. We also are starting a randomized trial that will use a smartphone and smart watch app to try to increase activity levels before and after surgery. We then will be able to see if increasing steps taken during the perioperative period has any benefit for readmission and other outcomes.

 

Q: Is there anything else that you would like to mention?

A: For our studies, we provide a Fitbit device for participants so we can monitor the account remotely. More of our participants already come in owning a wearable activity monitor or at least have a smartphone that can monitor steps. There is a lot of potential for harnessing the data that patients are already collecting on their own, and to integrate patient-generated data into the EMR and into clinical care. However, we need to do so in a way that makes the data useful and not overwhelming to clinicians. This is a challenge that we and others are actively working on. – by Jennifer Southall

 

Reference:

Low CA, et al. Ann Behav Med. 2018;52:88-92.

 

For more information:

Carissa A. Low, PhD, can be reached at UPMC Hillman Cancer Center, Suite 614, 5200 Centre Ave., Pittsburgh, PA 15232; email: lowca@upmc.edu.

 

Disclosure: Low reports no relevant financial disclosures.

Carissa A. Low

Increased physical activity tracked with a Fitbit during inpatient recovery predicted lower risk for 30- and 60-day hospital readmission after surgery for metastatic peritoneal cancer, according to results of an observational cohort study published in Annals of Behavioral Medicine.

Between 15% and 50% of patients who undergo abdominal cancer surgery are readmitted to the hospital within 30 days of hospital discharge, according to study background.

Although light exercise is a significant component of successful recovery after surgery, postoperative activity “is rarely monitored systematically as part of clinical care or examined as a predictor of important clinical outcomes, such as readmission,” Carissa A. Low, PhD, assistant professor of medicine in the departments of medicine and psychology at University of Pittsburgh, and colleagues wrote. “The recent emergence and growing popularity of commercially available, low-cost, reliable wearable devices, such as Fitbits, permit simple, objective and continuous quantification of physical activity and remote real-time monitoring of patient ambulation, but whether these passively sensed data can predict subsequent clinically important outcomes remains unclear.”

Low and colleagues assessed whether Fitbit step counts tracked during inpatient recovery predicted 30- and 60-day readmission risk after metastatic peritoneal cancer surgery.

Researchers enrolled 71 patients (mean age, 57.14 years; 42% women) at their preoperative clinic visit before surgical resection for metastatic peritoneal cancer. More than half (51%) of study participants had appendiceal cancer.

Once transferred from the ICU after surgery, Fitbits were placed on patients’ wrists and worn for the entire inpatient stay (mean stay, 12.12 days).

Thirty-four percent of patients were readmitted to the hospital within 30 days and 39% were readmitted within 60 days. After adjustments for age, BMI, comorbidity and length of postoperative stay, increased Fitbit average step counts per day predicted lower 30-day and 60-day hospital readmissions.

“These data highlight the possibility that remotely monitoring real-time patient ambulation using Fitbit devices may provide opportunities to improve postoperative clinical care with minimal burden to patients or clinical providers,” the researchers wrote.

HemOnc Today spoke with Low about the study results and their implications, the importance of being able to monitor physical activity levels of patients after surgery, and whether wearing a device like a Fitbit would have the same type of benefit for patients who undergo surgeries for other metastatic cancer types.

 

Question: What prompted this research?

Answer: Patients are encouraged to get out of bed and walk as soon as possible after surgery. It is commonly accepted that walking will speed up recovery. With Fitbits and similar wearable devices, it is very easy and cost-effective now to quantify steps in postoperative recovery. This is what we aimed to do.

 

Q: How did you conduct the research?

A: Patients were recruited before surgery during their preoperative visit. We started measuring their steps when they were moved from the ICU to the surgical oncology floor, which normally occurs 1 or 2 days after a major abdominal surgery. We placed Fitbit devices on their wrists for their duration of hospital stay, which was around 2 weeks for most patients. This allowed us to quantify steps that were taken throughout their inpatient recovery. For this initial study, we simply averaged the number of steps per day over however many days each patient spent in the hospital. We then looked at the relationship between average step counts and the risk for readmission within 30 to 60 days after leaving the hospital after surgery.

 

Q: What did the results show?

A: More than one-third of the patients in our sample had an unplanned hospital readmission within 60 days of discharge. We found that patients who took more steps during their inpatient stay were at a lower risk for both 30- and 60-day readmission. This was true even after adjusting for factors that can influence both activity and readmission risk — age, BMI and comorbidity — and persisted when we adjusted for how frequently patients reported exercising before surgery.

 

Q: What are the clinical implications of these findings?

A: It would be pretty easy to incorporate Fitbits or other similar devices in postoperative care. Visualizing daily step counts on a TV monitor in the room, in electronic medical records or even written on the whiteboard in the room could help the clinical care team see who is less active so they can allocate their resources accordingly.

 

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Q: Why is it important to be able to monitor physical activity levels in patients after surgery?

A: Readmissions after cancer surgery are common, expensive, and stressful for patients and their families. Anything we can do to reduce readmission risk is important. If monitoring the activity level can help providers identify patients who might need additional support or identify patients at high risk for readmission is worthwhile, especially given how easy and inexpensive it is to monitor step counts.

 

Q: Were patients receptive to this type of monitoring?

A: Overall, patients were compliant and we had very few complaints about the monitoring devices. Of course, in the study, we provided the devices to the patients and we synced them and made sure that they were charged. So, this was a best-case scenario in terms of minimal burden to patients. Some patients found the devices and information they provided to be very appealing and highly motivating. Some patients wanted to know their step counts every day to see if they were walking more when they recovered. Some wanted to be able to compare their step counts to other patients to see how they were doing, and some patients were interested in tracking their sleep and seeing how many awakenings they had during the night because sleep can be very fragmented in the hospital. There also were patients who did not mind the devices, but did not care to know their step counts. So, there was some variability in how receptive and enthusiastic patients were about wearing Fitbits.

 

Q: Might this have the same type of benefit for patients who are undergoing surgery for other forms of advanced cancer?

A: Yes, I would like to think that monitoring steps can be useful for any surgical population. We focused on our population because the readmission rates are exceptionally high after that type of abdominal cancer resection. Activity is definitely encouraged after other types of cancer and noncancer surgeries.

 

Q: Are there plans for additional research on this topic?

A: We are wrapping up a follow-up study in which patients are wearing these devices before surgery, in the hospital and then after discharge when they go home. We are still seeing excellent compliance rates, but there are a few patients we have to call regularly to remind them to charge the device and to wear it 24 hours per day. By monitoring activity before surgery and after discharge, as well as during inpatient recovery, we hope to understand when physical activity is most beneficial for recovery, as well as the patterns of activity that are related to better outcomes. We also are starting a randomized trial that will use a smartphone and smart watch app to try to increase activity levels before and after surgery. We then will be able to see if increasing steps taken during the perioperative period has any benefit for readmission and other outcomes.

 

Q: Is there anything else that you would like to mention?

A: For our studies, we provide a Fitbit device for participants so we can monitor the account remotely. More of our participants already come in owning a wearable activity monitor or at least have a smartphone that can monitor steps. There is a lot of potential for harnessing the data that patients are already collecting on their own, and to integrate patient-generated data into the EMR and into clinical care. However, we need to do so in a way that makes the data useful and not overwhelming to clinicians. This is a challenge that we and others are actively working on. – by Jennifer Southall

 

Reference:

Low CA, et al. Ann Behav Med. 2018;52:88-92.

 

For more information:

Carissa A. Low, PhD, can be reached at UPMC Hillman Cancer Center, Suite 614, 5200 Centre Ave., Pittsburgh, PA 15232; email: lowca@upmc.edu.

 

Disclosure: Low reports no relevant financial disclosures.