The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature

Gregory Iovanel, David Ayers, Hua Zheng, Gregory Iovanel, David Ayers, Hua Zheng

Abstract

Background: The incidence rate of total joint replacement (TJR) continues to increase due to the aging population and the surgery that is very successful in providing pain relief to and improving function among patients with advanced knee or hip arthritis. Improving patient outcomes and patient satisfaction after TJR remain important goals. Wearable technologies provide a novel way to capture patient function and activity data and supplement clinical measures and patient-reported outcome measures in order to better understand patient outcomes after TJR.

Objective: We examined the current literature to evaluate the potential role of wearable devices and compare them with existing methods for monitoring and improving patient rehabilitation and outcomes following TJR.

Methods: We performed a literature search by using the research databases supported by the University of Massachusetts Chan Medical School's Lamar Soutter Library, including PubMed and Scopus, supplemented with the Google Scholar search engine. A specific search strategy was used to identify articles discussing the use of wearable devices in measuring and affecting postoperative outcomes of patients who have undergone TJR. Selected papers were organized into a spreadsheet and categorized for our qualitative literature review to assess how wearable data correlated with clinical measures and patient-reported outcome measures.

Results: A total of 9 papers were selected. The literature showed the impact of wearable devices on evaluating and improving postoperative functional outcomes. Wearable-collected data could be used to predict postoperative clinical measures, such as range of motion and Timed Up and Go times. When predicting patient-reported outcomes, specifically Hip Disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Scores and Veterans RAND 12-Item Health Survey scores, strong associations were found between changes in sensor-collected data and changes in patient-reported outcomes over time. Further, the step counts of patients who received feedback from a wearable improved over time when compared to those of patients who did not receive feedback.

Conclusions: These findings suggest that wearable technology has the potential to remotely measure and improve postoperative orthopedic patient outcomes. We anticipate that this review will facilitate further investigation into whether wearable devices are viable tools for guiding the clinical management of TJR rehabilitation.

Keywords: mobility; osteoarthritis; rehabilitation; total joint replacement; wearables.

Conflict of interest statement

Conflicts of Interest: DA is a scientific advisor to Exactech.

©Gregory Iovanel, David Ayers, Hua Zheng. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 12.01.2023.

References

    1. Williams SN, Wolford ML, Bercovitz A. Hospitalization for total knee replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief. 2015 Aug;(210):1–8.
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780–785. doi: 10.2106/JBJS.F.00222.89/4/780
    1. Zagra L. Advances in hip arthroplasty surgery: what is justified? EFORT Open Rev. 2017 May 11;2(5):171–178. doi: 10.1302/2058-5241.2.170008. 10.1302_2058-5241.2.170008
    1. Ko V, Naylor JM, Harris IA, Crosbie J, Yeo AET. The six-minute walk test is an excellent predictor of functional ambulation after total knee arthroplasty. BMC Musculoskelet Disord. 2013 Apr 24;14:145. doi: 10.1186/1471-2474-14-145. 1471-2474-14-145
    1. Collins NJ, Roos EM. Patient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a "good" measure. Clin Geriatr Med. 2012 Aug;28(3):367–394. doi: 10.1016/j.cger.2012.05.007.S0749-0690(12)00051-1
    1. Franklin PD, Lewallen D, Bozic K, Hallstrom B, Jiranek W, Ayers DC. Implementation of patient-reported outcome measures in U.S. Total joint replacement registries: rationale, status, and plans. J Bone Joint Surg Am. 2014 Dec 17;96(Suppl 1):104–109. doi: 10.2106/JBJS.N.00328. 96/Supplement_1/104
    1. Ayers DC. Implementation of patient-reported outcome measures in total knee arthroplasty. J Am Acad Orthop Surg. 2017 Feb;25 Suppl 1:S48–S50. doi: 10.5435/JAAOS-D-16-00631.
    1. Lavallee DC, Chenok KE, Love RM, Petersen C, Holve E, Segal CD, Franklin PD. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff (Millwood) 2016 Apr;35(4):575–582. doi: 10.1377/hlthaff.2015.1362.35/4/575
    1. Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comp Eff Res. 2016 Aug;5(5):507–519. doi: 10.2217/cer-2015-0014.
    1. Zügner R, Tranberg R, Timperley J, Hodgins D, Mohaddes M, Kärrholm J. Validation of inertial measurement units with optical tracking system in patients operated with total hip arthroplasty. BMC Musculoskelet Disord. 2019 Feb 06;20(1):52. doi: 10.1186/s12891-019-2416-4. 10.1186/s12891-019-2416-4
    1. Ianculescu M, Andrei B, Alexandru A. A smart assistance solution for remotely monitoring the orthopaedic rehabilitation process using wearable technology: re.flex system. Studies in Informatics and Control. 2019;28(3):317–326. doi: 10.24846/v28i3y201908.
    1. Smuck M, Odonkor CA, Wilt JK, Schmidt N, Swiernik MA. The emerging clinical role of wearables: factors for successful implementation in healthcare. NPJ Digit Med. 2021 Mar 10;4(1):45. doi: 10.1038/s41746-021-00418-3. doi: 10.1038/s41746-021-00418-3.10.1038/s41746-021-00418-3
    1. Liao Y, Thompson C, Peterson S, Mandrola J, Beg MS. The future of wearable technologies and remote monitoring in health care. Am Soc Clin Oncol Educ Book. 2019 Jan;39:115–121. doi: 10.1200/EDBK_238919.
    1. Argent R, Slevin P, Bevilacqua A, Neligan M, Daly A, Caulfield B. Wearable sensor-based exercise biofeedback for orthopaedic rehabilitation: A mixed methods user evaluation of a prototype system. Sensors (Basel) 2019 Jan 21;19(2):432. doi: 10.3390/s19020432. s19020432
    1. Kwasnicki RM, Ali R, Jordan SJ, Atallah L, Leong JJH, Jones GG, Cobb J, Yang GZ, Darzi A. A wearable mobility assessment device for total knee replacement: A longitudinal feasibility study. Int J Surg. 2015 Jun;18:14–20. doi: 10.1016/j.ijsu.2015.04.032. S1743-9191(15)00142-9
    1. Chiang CY, Chen KH, Liu KC, Hsu SJP, Chan CT. Data collection and analysis using wearable sensors for monitoring knee range of motion after total knee arthroplasty. Sensors (Basel) 2017 Feb 22;17(2):418. doi: 10.3390/s17020418. s17020418
    1. Bendich I, Chung C, Hwang K, Patterson J, Mulvihill J, Barry J, Bini S. Changes in prospectively collected longitudinal patient-generated health data are associated with short-term patient-reported outcomes after total joint arthroplasty: a pilot study. Arthroplast Today. 2019 Mar 14;5(1):61–63. doi: 10.1016/j.artd.2019.01.005. S2352-3441(19)30007-X
    1. Chen KH, Chen PC, Liu KC, Chan CT. Wearable sensor-based rehabilitation exercise assessment for knee osteoarthritis. Sensors (Basel) 2015 Feb 12;15(2):4193–4211. doi: 10.3390/s150204193.s150204193
    1. Battenberg AK, Donohoe S, Robertson N, Schmalzried TP. The accuracy of personal activity monitoring devices. Semin Arthroplasty. 2017 Jun;28(2):71–75. doi: 10.1053/j.sart.2017.07.006.
    1. Toogood PA, Abdel MP, Spear JA, Cook SM, Cook DJ, Taunton MJ. The monitoring of activity at home after total hip arthroplasty. Bone Joint J. 2016 Nov;98-B(11):1450–1454. doi: 10.1302/0301-620X.98B11.BJJ-2016-0194.R1.98-B/11/1450
    1. Saporito S, Brodie MA, Delbaere K, Hoogland J, Nijboer H, Rispens SM, Spina G, Stevens M, Annegarn J. Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery. Physiol Meas. 2019 Apr 03;40(3):035004. doi: 10.1088/1361-6579/ab0d3e.
    1. Van der Walt N, Salmon LJ, Gooden B, Lyons MC, O'Sullivan M, Martina K, Pinczewski LA, Roe JP. Feedback from activity trackers improves daily step count after knee and hip arthroplasty: A randomized controlled trial. J Arthroplasty. 2018 Nov;33(11):3422–3428. doi: 10.1016/j.arth.2018.06.024.S0883-5403(18)30594-1
    1. Kuiken TA, Amir H, Scheidt RA. Computerized biofeedback knee goniometer: acceptance and effect on exercise behavior in post-total knee arthroplasty rehabilitation. Arch Phys Med Rehabil. 2004 Jun;85(6):1026–1030. doi: 10.1016/j.apmr.2003.08.088.S0003-9993(03)01065-7
    1. Farr-Wharton G, Li J, Hussain M, Freyne J. Mobile supported health services: Experiences in orthopaedic care. 2020 IEEE 33rd International Symposium on Computer-Based Medical Systems (CBMS); July 28-30, 2020; Rochester, Minnesota. 2020. Jul 28,
    1. Chatzaki C, Skaramagkas V, Tachos N, Christodoulakis G, Maniadi E, Kefalopoulou Z, Fotiadis DI, Tsiknakis M. The smart-insole dataset: Gait analysis using wearable sensors with a focus on elderly and Parkinson's patients. Sensors (Basel) 2021 Apr 16;21(8):2821. doi: 10.3390/s21082821. s21082821
    1. Cavalleri M, Reni G. Active monitoring insole: A wearable device for monitoring foot load distribution in home-care context. 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; August 20-25, 2008; Vancouver, British Columbia. 2008.
    1. Bahadori S, Immins T, Wainwright TW. A review of wearable motion tracking systems used in rehabilitation following hip and knee replacement. J Rehabil Assist Technol Eng. 2018 Jun 18;5:2055668318771816. doi: 10.1177/2055668318771816. 10.1177_2055668318771816
    1. Chen HC, Chuang TY, Lin PC, Lin YK, Chuang YH. Effects of messages delivered by mobile phone on increasing compliance with shoulder exercises among patients with a frozen shoulder. J Nurs Scholarsh. 2017 Jul;49(4):429–437. doi: 10.1111/jnu.12308.
    1. Chen YP, Lin CY, Tsai MJ, Chuang TY, Lee OKS. Wearable motion sensor device to facilitate rehabilitation in patients with shoulder adhesive capsulitis: Pilot study to assess feasibility. J Med Internet Res. 2020 Jul 23;22(7):e17032. doi: 10.2196/17032. v22i7e17032
    1. Bini SA, Schilling PL, Patel SP, Kalore NV, Ast MP, Maratt JD, Schuett DJ, Lawrie CM, Chung CC, Steele GD. Digital orthopaedics: A glimpse into the future in the midst of a pandemic. J Arthroplasty. 2020 Jul;35(7S):S68–S73. doi: 10.1016/j.arth.2020.04.048. S0883-5403(20)30435-6
    1. Lim MA, Pranata R. Teleorthopedic: A promising option during and after the coronavirus disease 2019 (COVID-19) pandemic. Front Surg. 2020 Aug 28;7:62. doi: 10.3389/fsurg.2020.00062.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj