Wearables may improve step count per day after arthroplasty

Physical activity interventions using wearable devices—delivered either in-person or remotely, alone or in tandem with education or rehabilitation—seem to be effective in increasing step count per day, especially in patients after joint arthroplasty, according to a recent systematic review.

However, these findings should be viewed with caution, the researchers said, “since it is based on three moderate quality studies. Further research is needed to determine the therapeutic effects of using wearables as an intervention component in patients undergoing other orthopaedic surgical procedures.”

Drawing from the online databases of Embase, PsycINFO, CINAHL, and PubMed, six eligible studies were included in the present analysis. Of the 568 patients undergoing orthopaedic surgery, 406 received total knee arthroplasty and were assessed for relevant outcomes such as physical activity and function, pain, general health, and psychological distress.

Three studies used a Fitbit Zip, one used a Garmin Vivofit 2, one used a Fitbit Flex or Fitbit One, and another a pedometer. Five studies also employed additional intervention components such as motivational interviewing (n=1), goal-setting (n=2), a tailored exercise program (n=2), financial incentives (n=1), a daily step goal sheet (n=1), and a 12-week step goal sheet (n=1). [PLoS One 2022;doi:10.1371/journal.pone.0263562]

Interventions were delivered either in-person through a researcher or licensed physical therapist, or remotely via a health coach or exercise physiologist. Two studies used a hybrid format, with weekly phone calls and periodical in-person one-on-one or group meetings.

Five (83 percent) studies reported within-group improvements in daily physical activity with the device-delivered interventions. Three of these studies, with moderate quality, showed significantly higher improvements in steps per day after total knee or hip arthroplasty. The remaining two were of poor quality but nevertheless reflected similar findings.

The effects of wearable-based interventions on physical function, pain, psychological distress, and general health were less clear. For instance, three studies reported no significant benefit on physical function tests such as 4-metre walk, 6-minute walk test, and timed up-and-go test, though all were of poor methodological quality.

Similarly, only single studies reported notable improvements in patient-reported measures of physical function, general health, and pain, making quantitative analyses impossible.

“The effects of physical activity interventions using wearables, either delivered in-person or remotely, appear promising for increasing steps per day,” the researchers said. “The findings of this review suggest wearables may serve as a tool for healthcare professionals to promote physical activity following total knee or hip arthroplasty.”

However, they cautioned that “the number of study participants was low and there was variability in the intervention duration, precluding the ability to perform meta-analysis.”

“Future high-quality clinical trials, which include comprehensive outcome assessment, blinding of research personnel involved with outcome assessment, and adequate follow-up and intent-to-treat analysis, are needed to investigate the efficacy of wearable-based physical activity interventions on objective and patient-reported outcomes in patients undergoing orthopaedic surgical procedures,” the researchers said.