Comparing three wearable accelerometers to measure early activity after cardiac surgery.
Comparing three wearable accelerometers to measure early activity after cardiac surgery.
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DOI：
10.1016/j.xjon.2022.05.011
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发表时间：
2022-09
期刊：
影响因子：
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通讯作者：
Schrack, Jennifer
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作者：
Brown, Charles H 4th;Yanek, Lisa;Healy, Ryan;Tsay, Tiffany;Di, Junrui;Goeddel, Lee;Young, Daniel;Zipunnikov, Vadim;Schrack, Jennifer
可穿戴活动监测器可以提供心脏手术后活动的详细数据，并区分患者对医院结果的风险。然而，缺乏不同监测方法的比较数据以及对临床特征的预测能力。此外，还需要关于活动具体阈值的数据。本研究的目的是比较3种可穿戴活动监测器和1种观察性活动量表在区分3种基于医院的结局的风险方面的差异，并建立临床相关的步数阈值。心脏手术患者于2016年6月至2017年8月期间入组队列研究。通过3个加速度计监测器（StepWatch Amplitude监测器、Fitbit Charge HR和ActiGraph GT 9 X）和1个基于护士的观察量表测量术后活动。这些参数代表一系列特征，包括穿戴位置（脚踝/手腕）、输出（活动计数/步数）、消费者可访问性和成本。主要结果是住院时间>7天，出院到非家庭地点，30天再入院。数据来自193例患者（中位年龄67岁[四分位距，58-72]）。所有术后第2天活动指标（即StepWatch、Fitbit、ActiGraph和观察量表）与住院时间延长和出院到非家庭地点独立相关。只有StepWatch测量的步数与30天再入院独立相关。总体而言，StepWatch提供了最大的区分（所有结果的C统计值为0.71-0.76）。步数阈值在250 - 500步/天之间的患者中，74%-96%的患者具有任何主要结局。来自可穿戴加速度计的数据为基于医院的结局的早期术后风险分层提供了附加价值。这些结果支持并指导心脏手术后的活动监测计划。
Wearable activity monitors can provide detailed data on activity after cardiac surgery and discriminate a patient's risk for hospital-based outcomes. However, comparative data for different monitoring approaches, as well as predictive ability over clinical characteristics, are lacking. In addition, data on specific thresholds of activity are needed. The objective of this study was to compare 3 wearable activity monitors and 1 observational mobility scale in discriminating risk for 3 hospital-based outcomes, and to establish clinically relevant step thresholds. Cardiac surgery patients were enrolled between June 2016 and August 2017 in a cohort study. Postoperative activity was measured by 3 accelerometry monitors (StepWatch Ambulation Monitor, Fitbit Charge HR, and ActiGraph GT9X) and 1 nurse-based observation scale. Monitors represent a spectrum of characteristics, including wear location (ankle/wrist), output (activity counts/steps), consumer accessibility, and cost. Primary outcomes were duration of hospitalization >7 days, discharge to a nonhome location, and 30-day readmission. Data were available from 193 patients (median age 67 years [interquartile range, 58-72]). All postoperative day 2 activity metrics (ie, from StepWatch, Fitbit, ActiGraph, and the observation scale) were independently associated with prolonged hospitalization and discharge to a nonhome location. Only steps as measured by StepWatch was independently associated with 30-day readmission. Overall, StepWatch provided the greatest discrimination (C-statistics 0.71-0.76 for all outcomes). Step thresholds between 250 and 500 steps/day identified between 74% and 96% of patients with any primary outcome. Data from wearable accelerometers provide additive value in early postoperative risk-stratification for hospital-based outcomes. These results both support and provide guidance for activity-monitoring programs after cardiac surgery.