Using Consumer-Grade Physical Activity Trackers to Measure Frailty Transitions in Older Critical Care Survivors: Exploratory Observational Study.
BACKGROUND
Critical illness has been suggested as a sentinel event for frailty development in at-risk older adults. Frail critical illness survivors are affected by increased adverse health outcomes, but monitoring the recovery after intensive care unit (ICU) discharge is challenging. Clinicians and funders of health care systems envision an increased role of wearable devices in monitoring clinically relevant measures, as sensor technology is advancing rapidly. The use of wearable devices has also generated great interest among older patients, and they are the fastest growing group of consumer-grade wearable device users. Recent research studies indicate that consumer-grade wearable devices offer the possibility of measuring frailty.


OBJECTIVE
This study aims to examine the data collected from wearable devices for the progression of frailty among critical illness survivors.


METHODS
An observational study was conducted with 12 older survivors of critical illness from Kingston General Hospital in Canada. Frailty was measured using the Clinical Frailty Scale (CFS) at ICU admission, hospital discharge, and 4-week follow-up. A wearable device was worn between hospital discharge and 4-week follow-up. The wearable device collected data on step count, physical activity, sleep, and heart rate (HR). Patient assessments were reviewed, including the severity of illness, cognition level, delirium, activities of daily living, and comorbidity.


RESULTS
The CFS scores increased significantly following critical illness compared with the pre-ICU frailty level (P=.02; d=-0.53). Survivors who were frail over the 4-week follow-up period had significantly lower daily step counts than survivors who were not frail (P=.02; d=1.81). There was no difference in sleep and HR measures. Daily step count was strongly correlated with the CFS at 4-week follow-up (r=-0.72; P=.04). The average HR was strongly correlated with the CFS at hospital discharge (r=-0.72; P=.046). The HR SD was strongly correlated (r=0.78; P=.02) with the change in CFS from ICU admission to 4-week follow-up. No association was found between the CFS and sleep measures. The pattern of increasing step count over the 4-week follow-up period was correlated with worsening of frailty (r=.62; P=.03).


CONCLUSIONS
This study demonstrated an association between frailty and data generated from a consumer-grade wearable device. Daily step count and HR showed a strong association with the frailty progression of the survivors of critical illness over time. Understanding this association could unlock a new avenue for clinicians to monitor and identify a vulnerable subset of the older adult population that might benefit from an early intervention.
['Kim|Ben|B|https://orcid.org/0000-0002-6793-5551', 'Hunt|Miranda|M|https://orcid.org/0000-0001-5086-3291', 'Muscedere|John|J|https://orcid.org/0000-0002-9027-7198', 'Maslove|David M|DM|https://orcid.org/0000-0002-0765-7158', 'Lee|Joon|J|https://orcid.org/0000-0001-8593-9321']
activity trackers frailty heart rate critical care outcomes fitness trackers frail elderly sleep monitoring wearable electronic devices