Evaluating the Potential Use of Wearable Fitness Devices as a Measure of Outcomes in Orthopaedics

Category: Sports; Other Introduction/Purpose: Orthopaedic surgeons routinely utilize Patient Reported Outcome Measures (PROMs) to evaluate surgical and nonsurgical treatment outcomes. PROMs can be cumbersome to both patients and surgeons with issues of noncompliance. With the rise of wearable fitness devices and smartphone applications, alternative methods are being explored for a more efficient and objective measurement of outcomes. There is a lack of studies directly comparing PROMs with patient wearable outcome (PWO) methods. This study aims to compare PWOs to PROMs and determine the feasibility of using PWOs as an outcome measurement tool in orthopaedics. The findings of this study could have implications for surgeons to integrate phone application-based technology into orthopaedic care in conjunction with PROMs and the potential to be used independently of PROMs to measure outcomes. Methods: This study is a non-randomized prospective cohort study with a known foot and ankle orthopaedic condition presenting to an orthopaedic clinic. Subjects with any foot and ankle condition over the age of 16 were asked to participate. Standard PROM surveys were administered at enrollment and then at 1 month, 2 month, and 3 month time periods. Surveys utilized were the Foot and Ankle Ability Measure Computerized Adaptive Testing (FAAM CAT), PROMIS physical function, mobility and pain interference scores, and Visual Analog Scale (VAS). A mobile phone application was then installed in subjects’ smartphones that utilized past and future health data including step counts and distance traveled. Statistical analysis was performed to correlate PWOs with PROMs. Results: Our study analyzed 19 participants aged 17 to 77, who complied with the treatment protocol. There were strong positive correlations in step counts across consecutive months, notably from 1-month to 2-month (r = 0.913,95% CI: 0.783 to 0.966) and 1-month to 3-month (r = 0.852, 95% CI: 0.648 to 0.942), indicating consistent physical activity. However, the relationship between activity levels (measured by step counts) and pain perception (Pain-VAS scores) proved complex, with variable moderate correlations (3-month Pain-VAS Score vs 3-month Steps, r= 0.416, 95% CI: −0.245to 0.813) suggesting that higher activity might be associated with greater pain at different time points. Conclusion: This study highlights the potential value of integrating objective physical activity data from wearable devices with PROMs for a more holistic assessment. The variable moderate correlations discovered underscores the challenge of correlating pain directly with physical activity. Despite objective measurements of activity consistency, patient-reported scores on factors like daily living and sport were nuanced, underscoring the complex interplay between physical functioning and subjective experience of pain. A balanced approach considering both objective and subjective data is needed to enhance treatment strategies and improve patient outcomes.