Assessment and optimisation of wearable activity monitors within an enhanced recovery framework

Abstract

Enhanced recovery after surgery (ERAS) is a model of care that aims to improve patient recovery after surgery. Wearable activity monitors (WAMs) have the potential to provide possible solutions to a wide range of clinical challenges. The aim of this thesis was to assess whether physical activity, measured by a WAM, can be used as a measurable marker of peri-operative well-being and recovery after surgery, and whether the WAM can therefore be used to assess and help improve recovery after surgery. A wrist-worn WAM was utilised to measure physical activity in a healthy normal cohort showing that it was feasible to monitor continuous physical activity in a healthy cohort in a free-living environment. Activity data were processed both at an individual level and as a group allowing further analysis and comparator with the surgical patient cohort. The WAM was used to measure objective physical activity data for a cohort of patients undergoing colorectal surgery. Activity was assessed pre-operatively at home, post-operatively on the in-patient ward and then on discharge home back into the community. The physical activity data gave insight into patients’ baseline function and their progression and recovery following their surgical procedure, with more detailed analysis showing the WAM’s ability to reflect the daily activities on the ward. There were statistically significant correlations between peri-operative physical activity and post-operative outcomes. The results from the use of WAMs within this thesis provide an opportunity for refining the ERAS concept through continuous, objective physical activity monitoring as well as the potential to enhance patient/clinician communication, leading to more personalised care and an improvement in post-operative outcomes.