H.C. van Dijk - Huisman1,2, A.T. Weemaes1,2, T.A. Boymans3, A.F. Lenssen1,2, R.A. de Bie2,4
1Maastricht University Medical Center (MUMC+), Department of Physical Therapy, Maastricht, Netherlands, 2Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands, 3Maastricht University Medical Center (MUMC+), Department of Orthopaedic Surgery and Traumatology, Maastricht, Netherlands, 4Maastricht University, Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht, Netherlands

Background: Low physical activity (PA) levels are common in hospitalised patients. mHealth tools could be valuable to prevent the negative effects of inactivity. Hospital Fit consists of a smartphone application connected to an accelerometer. Hospital Fit was developed to offer hospitalised patients and their physiotherapists essential strategies to enhance their PA levels and support their recovery process. It enables objective activity monitoring, provides patients insight in their recovery progress and offers a tailored exercise program.

Purpose: The purpose of this study was to investigate the potential of Hospital Fit to enhance PA levels and functional recovery of hospitalised patients following orthopaedic surgery.

Methods: A pilot study with a non-randomised quasi experimental design was performed at the orthopaedic department of a university hospital. Patients in the control group received usual care postoperative physiotherapy. PA was measured with an accelerometer postoperatively until discharge. Patients in the intervention group used Hospital Fit additionally. Primary outcome: time spent standing and walking per day. Multiple linear regression analysis was performed to determine the association with Hospital Fit use. Secondary outcome: achievement of functional recovery on postoperative day one (POD1) as assessed using the modified Iowa Level of Assistance Scale. Multiple logistic regression analysis was performed to determine the association with Hospital Fit use.

Results: Ninety-seven patients undergoing total knee or hip arthroplasty were recruited. Hospital Fit use, corrected for age, resulted in an average increase of 28.43 minutes (95% confidence interval (CI): 5.55 – 51.32) standing and walking on POD1. The odds of achievement of functional recovery on POD1, corrected for American Society of Anesthesiologists classification, were 3.08 times higher (95% CI: 1.14 – 8.31) with Hospital Fit use.

Conclusion(s): A smartphone app combined with accelerometer demonstrates potential to enhance patients’ PA levels and functional recovery during hospitalisation.

Implications: Continuous PA monitoring as part of usual care will enable creating population norms for PA. In order to determine the effect of Hospital Fit it is recommended that this pilot study should be followed by a randomised controlled trial in a population of hospitalised patients with a longer length of stay. Suggestions for improvements to Hospital Fit are developing a goal setting and reminder function, improving the accelerometer algorithm to enable differentiation between standing and walking, and facilitating data to be available to other healthcare professionals as well by enabling a connection between Hospital Fit and the electronic health record.

Funding, acknowledgements: This research was funded by a Small Business Innovation Research (SBIR) funding, subsidized by the Dutch Government, grant number: SB1AP16010.

Keywords: physical activity, mHealth, arthroplasty

Topic: Orthopaedics

Did this work require ethics approval? Yes
Institution: Maastricht University Medical Center (MUMC+)
Committee: METC of the University Hospital Maastricht and Maastricht University (METC azM/UM)
Ethics number: 2017-0175

All authors, affiliations and abstracts have been published as submitted.

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