Short summary

Elderly patients commonly suffer from proximal femoral fractures. These injuries are associated with a high mortality, however, objective tools to observe the recovery process are lacking. Physical activity is recognized as the key for the recuperation process. Therefore, we hypothesize that activity trackers can reliably monitor the early postoperative follow-up. Standardized step counts are recorded using wearables and analyzed in association with epidemiological characteristics. This facilitates the development of a management-suited reporting system. The regular use of wearables can be part of an individualized treatment coordination in future and add a safety feature.

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Rationale

Proximal femoral fractures are common in elderly patients and are associated with a high mortality of around 25-30% within the first year. This is determined by a variety of factors as co-morbidity and age, which cannot or only partially be altered. An influenceable key factor for a successful re-integration into normal life is the recovery of mobility. If patients succeed to regain their physical activity, they have a higher chance to survive. Unfortunately, an increased age is often accompanied by a decrease of mental capabilities, which makes it difficult to correctly assess the true health and physical status of these elderly patients. Therefore, typical questionnaires as the Oswestry Disability Index or the Euroqol 5D have limited capacities to evaluate this population. Activity trackers that are also known as step counters or wearables have recently been obtained growing interest for surveillance of motion and physical action and have been successfully validated in young people. They were found to be reliable tools for activity measurements, although differences between various manufacturers were found. Until now, a validation for older people and for postoperative monitoring is lacking. Since clinical trials in the elderly are in need of objective evaluation parameters, which can easily be obtained and are not dependent on an active cooperation, activity trackers appear to be ideal tools for this special population. We hypothesize that wearables are able to monitor activity in the elderly and supply personalized information about the need of training and the degree of recovery. Therefore, these devices add a safety feature by controlling individual needs. The level of physical performance is very different comparing young and active with elderly people. This makes it necessary to validate the suitability of activity trackers for this population and to adjust the categories for e.g. low, middle or high activity. In future, activity trackers offer the possibility for an objective evaluation of different operative treatment options that aim to increase mobility, which is in line with personalized concepts and resources oriented therapies.

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Description of the cohort

Inclusion criteria

• Existence of a proximal femoral fracture including the locations AO 31 and 32 (intervention group, n=48)
• Or existence of a forearm fracture including the locations AO 21, 22 and 23 (control group, n=15)
• Above 65 years of age
• Being able to read and understand Danish
• Informed consent

Exclusion criteria

• Open fractures
• Polytrauma
• Colonization with multi-resistant bacteria
• Preoperatively bedridden patients
• Infection of the wound
• Operative revisions because of other reasons

Data and biological material

Timepoint 1 (Day 0)

• Operation (osteosynthesis of a proximal femur fracture or hemiarhroplasty) or controlgroup (treatment of a forarm fracture)

Timepoint 2 (Day 2 +/- 1): 

• Start with informed consent
• Register epidemiological data, pain level, steps, distance and activity calories, pre-fracture Barthel index

Timepoint 3 (Day 8 +/- 2): 

• Pain level, steps, distance and activity calories, EuroQol 5D 3L, Barthel index

Timepoint 4 (discharge):

• Total days of treatment at an ICU, allowed weight bearing, duration of hospital stay, kind of implantat (osteosynthesis or hemiarthoplasty)

Timepoint 5 (6 +/- 1 months)

• Pain levels, steps, distance and activity calories, EuroQol %D 3L, Barthel index

Collaborating researchers and departments

Department of Orthopædics and Traumatology, Odense University Hospital

• Clinical Associate Professor Jens Lauritsen
• Consultant Carsten Fladmose Madsen