Abstract
Introduction
The Center for Medicare Services (CMS) recently proposed its phase 3 “Quality metrics” which include a section on patient engagement. CMS uses a fitness monitor as an example of an acceptable way for patients to contribute to the health record. Wearable technology allows measurement of activity, blood glucose, heart rate, sleep, and other health metrics, all of which can be useful in the management of patients in the orthopaedic practice. The purpose of this study is to thoroughly review existing fitness devices; and evaluate their potential uses in orthopaedic practice.
Methods
Several fitness devices exist; we focused on the top 27 based on popularity mentioned in reputable tech review articles. Features of each device were reviewed including type, specifications, interfaces, measurable outcomes (HR, steps, distance, sleep, weight, calorie intake), cost to the patient, barriers to compliance and strengths. Ultimately all these factors were taken into consideration to look into potential uses for orthopaedic surgery. The orthopedic applications of these devices were reviewed. Nonsurgical management applications were: compliance with physiotherapy, distance walked and stairs completed, and compliance with activity restrictions. Preoperative optimization included detection of sleep apnea, blood glucose monitoring, preoperative weight, and preoperative activity level. Postoperative outcomes included postoperative activity level, stairs, and distance walked.
Results
Twenty-seven devices were reviewed of which 26% were targeted for the beginner, 33% for runners and 41% were multipurpose fitness trackers. Most were designed as either a wrist band (26%) or watch (30%). Several used a smartphone as an interface (33%) while the majority (52%) synced automatically via Bluetooth to either the online, mobile device, smartphone or pc application. The majority (37%) had excellent battery life, over 7 days; all were either waterproof (26%) or water resistant (74%), and some (41%) had GPS tracking. A pedometer was included in 85% of devices, 63% monitored HR of which 26% required a separate chest strap or forearm strap, 7% measured respiratory rate and 7% devices measured temperature. Sleep was recorded in 63% of devices, mostly as length of sleep and quality of sleep based on wrist movement. One device was able to differentiate between sleep phases allowing the application of sleep apnea assessment for preoperative testing. Twenty devices monitored weight, twenty two monitored calorie intake, three could monitor glucose readings, seventeen measured distance walked, whereas five measured both stairs and distance walked. A few devices (15%) are already linked to electronic medical records (EMR), the majority allowed for sharing (67%) and 19% are linked to insurance companies which provide incentivized reimbursement rates.
Conclusion
The fitness device technology has yet to be explored or implemented widely in orthopaedic surgery. We demonstrated how fitness devices can assist the orthopaedic surgeon in measurement of basic outcomes and can also assist with preoperative, perioperative and postoperative care. Further research is warranted as the use of these devices increases. Patient privacy issues may come into play as more practices employ these devices for their patients.
