Faraj Massouh1, Rachel Martin1,2, Bokman Chan1,2, Julia Ma3,4, Vikita Patel3,5, Michael P Geary3, John G Laffey1,2,6,7, Duminda N Wijeysundera1,6,8,9, Faraj W Abdallah1,2,6,10,11. 1. From the Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. 2. Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 3. Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. 4. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 5. Department of Interdisciplinary Medical Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. 6. Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada. 7. Department of Anesthesia, School of Medicine, National University of Ireland, Galway, Ireland. 8. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 9. Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. 10. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada. 11. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Quality of recovery (QOR) instruments measure patients' ability to return to baseline health status after surgery. Whether, and the extent to which, postoperative ambulation contributes to QOR is unclear, in part due to the lack of valid tools to measure ambulation in clinical settings. This cohort study of the cesarean delivery surgical model examines the accuracy and reliability of activity trackers in quantifying early postoperative ambulation and investigates the correlation between ambulation and QOR. METHODS: A prospective cohort of 200 parturients undergoing cesarean delivery between July 2015 and June 2017 was fitted with wrist-worn activity trackers immediately postpartum. The trackers were collected 24 hours later, along with QOR assessments (QoR-15 scale). The relationship between QOR and various covariates, including ambulation, was explored using multivariable linear regression and Spearman correlation (ρ). Forty-eight parturients fitted with 2 trackers also completed a walk exercise accompanied by a step-counting assessor, to evaluate accuracy, inter-, and intradevice reliability using interclass correlation (ICC). RESULTS: Compared to step counting, activity trackers had high accuracy (ICC = 0.93) and excellent inter- and intradevice reliability (ICC = 0.98 and 0.96, respectively). Correlation analysis suggested that early ambulation is moderately correlated with postcesarean QoR-15 scores, with a ρ (95% confidence interval) equivalent to 0.56 (0.328-0.728). Regression analysis suggested that ambulation is a determinant of postcesarean QoR-15 scores, with an effect estimate (95% confidence interval) equivalent to 0.002 (0.001-0.003). Ambulation was also associated with all QoR-15 domains, except psychological support. The patient's acceptable symptom state (subjective threshold for good ambulation) in the first 24 hours was 287 steps. CONCLUSIONS: This study demonstrated the accuracy and reliability of activity trackers in measuring ambulation in clinical settings and suggested that postoperative ambulation is a determinant of postoperative QOR. A hypothetical implication of our findings is that interventions that improve ambulation may also help to enhance QOR, but further research is needed to establish a causal relationship.
BACKGROUND: Quality of recovery (QOR) instruments measure patients' ability to return to baseline health status after surgery. Whether, and the extent to which, postoperative ambulation contributes to QOR is unclear, in part due to the lack of valid tools to measure ambulation in clinical settings. This cohort study of the cesarean delivery surgical model examines the accuracy and reliability of activity trackers in quantifying early postoperative ambulation and investigates the correlation between ambulation and QOR. METHODS: A prospective cohort of 200 parturients undergoing cesarean delivery between July 2015 and June 2017 was fitted with wrist-worn activity trackers immediately postpartum. The trackers were collected 24 hours later, along with QOR assessments (QoR-15 scale). The relationship between QOR and various covariates, including ambulation, was explored using multivariable linear regression and Spearman correlation (ρ). Forty-eight parturients fitted with 2 trackers also completed a walk exercise accompanied by a step-counting assessor, to evaluate accuracy, inter-, and intradevice reliability using interclass correlation (ICC). RESULTS: Compared to step counting, activity trackers had high accuracy (ICC = 0.93) and excellent inter- and intradevice reliability (ICC = 0.98 and 0.96, respectively). Correlation analysis suggested that early ambulation is moderately correlated with postcesarean QoR-15 scores, with a ρ (95% confidence interval) equivalent to 0.56 (0.328-0.728). Regression analysis suggested that ambulation is a determinant of postcesarean QoR-15 scores, with an effect estimate (95% confidence interval) equivalent to 0.002 (0.001-0.003). Ambulation was also associated with all QoR-15 domains, except psychological support. The patient's acceptable symptom state (subjective threshold for good ambulation) in the first 24 hours was 287 steps. CONCLUSIONS: This study demonstrated the accuracy and reliability of activity trackers in measuring ambulation in clinical settings and suggested that postoperative ambulation is a determinant of postoperative QOR. A hypothetical implication of our findings is that interventions that improve ambulation may also help to enhance QOR, but further research is needed to establish a causal relationship.
Authors: Emily E Sharpe; Jessica L Booth; Timothy T Houle; Peter H Pan; Lynnette C Harris; Carol A Aschenbrenner; James C Eisenach Journal: Pain Date: 2019-10 Impact factor: 7.926
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Authors: Marius Schwab; Niall Brindl; Alexander Studier-Fischer; Thomas Tu; Julia Gsenger; Max Pilgrim; Mirco Friedrich; Pia-Elena Frey; Christina Achilles; Alexander Leuck; Thore Bürgel; Manuel Feisst; Christina Klose; Solveig Tenckhoff; Colette Dörr-Harim; André L Mihaljevic Journal: Trials Date: 2020-03-23 Impact factor: 2.279