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5022
Activity tracker-measured ambulation is an accurate and reliable determinant of quality of recovery after regional anesthesia interventions. A validation study
Session: EX-08
Fri, April 20, 7:30-7:40 am
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Activity tracker-measured ambulation is an accurate and reliable determinant of quality of recovery after regional anesthesia interventions: A validation study

Introduction
•Quality of recovery (QoR) instruments measure patients’ ability to return to baseline health status after surgery
•The impact of postoperative ambulation on QoR is unclear due to lack of valid tools to measure ambulation in clinical settings
•We sought to clarify the correlation between post-operative ambulation and post-partum QoR
•We examined the accuracy and reliability of activity trackers in quantifying postoperative ambulation in women who had regional anesthesia for caesarian delivery
 
Methods
•200 low-risk parturients undergoing caesarian delivery under spinal anesthesia from July 2015 to June 2017 were fitted with wrist-worn activity trackers immediately post-partum
•Quality of Recovery-15 (QoR-15) scores were collected along with the trackers at 24 hours
•The correlation of ambulation with QoR was explored with multivariable linear regression and Spearman correlation
•A subset of 48 parturients were fitted with two trackers and performed a walk exercise test with a step-counting assessor to evaluate accuracy and inter- and intra-device reliability using the inter-class correlation coefficient
•Accuracy was assessed by the total number of steps registered and the actual number of steps counted by an external assessor
•Inter-device reliability was assessed using the steps registered by each of the two trackers worn
•Intra-device reliability was examined through agreement between the steps registered by the activity tracker during each segment walked
 
Results
•Ambulation had the strongest association with the QoR-15 score after caesarian delivery (P<0.0001, ρ=0.560) and was strongly associated with physical independence (P=0.0008, ρ=0.79) and physical comfort (P=0.006, ρ=0.64)
•Tracker device to external assessor-measured ambulation demonstrated near perfect agreement (mean observed difference [95% CI] -2.6 steps [-3.7, 9.0]) Figure 1
•Inter- and Intra-device reliability had ICC values of 0.98 and 0.96 respectively
 
Discussion
•This study provides a novel assessment of activity trackers demonstrating high accuracy and excellent inter- and intra-device reliability in measuring post-operative ambulation
•Variations in the QoR-15 score and its individual domains can mostly be explained by ambulation
•Quality of Recovery instruments could be considered a core outcome health status measure for interventions targeting post-operative ambulation
•Limitations: nested prospective cohort design, limited patient  population, a priori choice of covariates, use of one tracker brand
 
Conclusions
1.Ambulation is strongly correlated to perceived quality of recovery by parturients
2.Activity trackers demonstrate high accuracy, reliability, and precision in measuring ambulation in clinical settings
3.Further investigations to improve post-operative ambulation may enhance QoR for surgical patients
 
 
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