Monitoring activity of hip injury patients (MoHIP): a sub-study of the world hip trauma evaluation observational cohort study
Armitage L., Chi Y., Santos M., Lawson B., Areia C., Velardo C., Watkinson P., Tarassenko L., Costa M., Farmer A.
Purpose: The aim of this study is to assess the feasibility of using wearable activity monitors to better understand recovery of mobility during the hospital-to-home transition of hip fracture patients, where ongoing care is provided in the community. Methods: This is an observational cohort study of adults admitted to a single centre with hip fracture from May 2018. Participants of the World Hip Trauma Evaluation (WHiTE) cohort study without cognitive impairment were eligible. Participants were recruited during their hospital stay and were asked to wear a CE-marked 3-axis logging accelerometer (Axivity AX3) for 4 months. After discharge, participants received monthly home visits from a primary care research nurse throughout their study participation. Results: A total 427 patients were screened for eligibility between May 2018 and August 2019. Of these 139 were eligible and 28 (20.1%) recruited. The most common reason for non-eligibility was cognitive impairment (n = 192, 66.7%). Of the eligible patients; 57 (41.0%) declined to participate in the study, mostly due to not wanting to wear a monitor on a lanyard (n = 27, 47.4%). Mean age of recruited participants was 75.8 (SD 8.7), with 18 (54.3%) female. At baseline, participant mobility status was as follows: 22 (78.6%) were freely mobile without aids, 4 (14.1%) mobilised outdoors with one aid, 1 (3.6%) mobilised outdoors with 2 aids or a frame and 1 (3.6%) was unable to mobilise outdoors unassisted. Of the 12 participants that have completed the 4-month follow-up period; 8 (66.7%) recovered full mobility and 4 (33.3%) did not. Activity levels captured by activity monitors were significantly different between these groups at 4 months. Conclusion(s): Our research indicates that activity monitors have the capability to capture recovery of activity in patients following a hip fracture and activity levels correlate with patient self-report of mobility. However, future monitoring strategies should be suitable for cognitively impaired patients and use non-intrusive devices. Impact: This knowledge may inform future community-based rehabilitation interventions and personalise care.