First Results of a Prospective Cohort Study Assessing the Applicability of Step Counts as a Digital Mobility Outcome in Trauma Surgery – a Brief Report

Abstract

Background

The individual and socio-economic burden of delayed rehabilitation after a fracture is high. Early identification of patients with critical healing processes and timely intervention are key factors for successful treatment management. The aim of this study was to demonstrate how step counts, collected via patient-owned wearables, can assist in identifying critical recovery trajectories.

Methods

The study included 56 patients who already had a wearable device. Data on age, gender, injury type, PROMIS – Global Health 10 score at 3 months, and work ability at 3 months were collected. Step counts were recorded both before and after the injury.

Results

Data from 56 patients were analysed. Postoperative healing was reliably monitored using the patients' own wearables for both upper and lower extremities. Significant differences in daily step counts were observed between patients with normal healing and those with delayed rehabilitation. Significant differences were also found in step counts between patients who regained work ability within 3 months and those who did not. PROMIS surveys conducted after 3 months revealed significant differences between daily step counts in patients above the 80th percentile compared to those below the 20th percentile.

Discussion

The analysis demonstrates that monitoring healing progress with patient-owned wearables can effectively estimate the risk of delayed recovery and prolonged work disability, as based on easily accessible personal activity data. Further refinement of the technology and inclusion of additional patients with defined injury types could help identify trauma patients in need of additional care during treatment. Early and targeted interventions could enable a return to pre-injury activity levels and reduce the duration of work disability.

Keywords

wearable - digital mobility outcome - step count - rehabilitation - fracture healing

Publication History

Received: 25 December 2024

Accepted after revision: 24 April 2025

Article published online:
04 June 2025

• References

• 1 Vogel C, Grimm B, Marmor MT. et al. Wearable Sensors in Other Medical Domains with Application Potential for Orthopedic Trauma Surgery – A Narrative Review. J Clin Med 2024; 13: 3134
• 2 Ladha KS, Lu J, McIsaac DI. et al. Peri-Operative Wearables in Elder Recover after Surgery (POWERS) study: a protocol for a multicentre, prospective cohort study to evaluate perioperative activity with postoperative disability in older adults after non-cardiac surgery. BMJ Open 2023; 13: e073612
• 3 Lind CM, Abtahi F, Forsman M. Wearable Motion Capture Devices for the Prevention of Work-Related Musculoskeletal Disorders in Ergonomics-An Overview of Current Applications, Challenges, and Future Opportunities. Sensors 2023; 23: 4259
• 4 Braun BJ, Grimm B, Hanflik AM. et al. Wearable technology in orthopedic trauma surgery – An AO trauma survey and review of current and future applications. Injury 2022; 53: 1961-1965
• 5 Bitkom e. V.. Consumer Technology 2024: Wearables etablieren sich als neuer Trendmarkt. Accessed October 29, 2024 at: https://www.bitkom.org/Presse/Presseinformation/Consumer-Technology-2024-Wearables-als-neuer-Trendmarkt
• 6 Bitkom e. V.. Die Zukunft der Consumer Technology. Accessed October 29, 2024 at: https://www.bitkom.org/Bitkom/Publikationen/Die-Zukunft-der-Consumer-Technology-2024
• 7 Statistisches Bundesamt. Daten aus der EVS zur Ausstattung privater Haushalte mit Informations- und Kommunikationstechnik in Deutschland. 2024 Accessed October 08, 2024 at: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Einkommen-Konsum-Lebensbedingungen/Ausstattung-Gebrauchsgueter/Tabellen/a-evs-infotechnik-d.html
• 8 Chandrasekaran R, Katthula V, Moustakas E. Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey. J Med Internet Res 2020; 22: e22443
• 9 Győrffy Z, Boros J, Döbrössy B. et al. Older adults in the digital health era: insights on the digital health related knowledge, habits and attitudes of the 65 year and older population. BMC Geriatr 2023; 23: 779
• 10 Hameed D, Sodhi N, Dubin J. et al. Integrating Smartphone Applications and Wearable Devices for Postoperative Rehabilitation in Total Knee Arthroplasty: A Critical Review. J Arthroplasty 2024; 39: 2028-2039.e1
• 11 Braun BJ, Histing T, Menger MM. et al. “Bring Your Own Device” – A New Approach to Wearable Outcome Assessment in Trauma. Med Kaunas Lith 2023; 59: 403
• 12 Marmor MT, Grimm B, Hanflik AM. et al. Use of Wearable Technology to Measure Activity in Orthopaedic Trauma Patients: A Systematic Review. Indian J Orthop 2022; 56: 1112-1122
• 13 Hays RD, Bjorner JB, Revicki DA. et al. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009; 18: 873-880
• 14 Geldman M, Moore A, Cheek L. The effect of pre-injury physical fitness on the initial severity and recovery from whiplash injury, at six-month follow-up. Clin Rehabil 2008; 22: 364-376
• 15 Yanagisawa T, Tatematsu N, Horiuchi M. et al. Preoperative physical activity predicts postoperative functional recovery in gastrointestinal cancer patients. Disabil Rehabil 2022; 44: 5557-5562
• 16 Matsumura K, Takami A, Tajima S. et al. Effect of preoperative physical activity on postoperative outcomes in esophageal cancer. J Phys Ther Sci 2024; 36: 557-563
• 17 Punnoose A, Claydon-Mueller LS, Weiss O. et al. Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6: e238050
• 18 Gillis C, Ljungqvist O, Carli F. Prehabilitation, enhanced recovery after surgery, or both? A narrative review. Br J Anaesth 2022; 128: 434-448
• 19 Konnyu KJ, Thoma LM, Cao W. et al. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil 2023; 102: 1-10
• 20 Su W, Zhou Y, Qiu H. et al. The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg 2022; 17: 175
• 21 Krauth C, Bartling T. [Is rehabilitation worth it? Review of economic evaluations of rehabilitation in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 394-401
• 22 Wickert K, Roland M, Andres A. et al. Experimental and virtual testing of bone-implant systems equipped with the AO Fracture Monitor with regard to interfragmentary movement. Front Bioeng Biotechnol 2024; 12: 1370837