Use of Activity Tracking in Major Visceral Surgery—the Enhanced Perioperative Mobilization Trial: a Randomized Controlled Trial
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Early mobilization is one essential item within the enhanced recovery after surgery (ERAS) concept, but lacks solid evidence and a standardized assessment. The aim was to monitor and increase the postoperative mobilization of patients after major visceral surgery by providing a continuous step count feedback using activity tracking wristbands.
The study was designed as a randomized controlled single-center trial (NCT02834338) with two arms (open and laparoscopic surgery). Participants were randomized to either receive feedback of their step counts using an activity tracker wristband or not. The primary study endpoint was the mean step count during the first 5 postoperative days (PODs).
A total of 132 patients were randomized. After laparoscopic operations, the average step count during PODs 1–5 was significantly increased by the feedback compared with the control group (P < 0.001); the cumulative step count (9867 versus 6103, P = 0.037) and activity time were also significantly increased. These results could not be confirmed in the open surgery arm. Possible reasons were a higher age and significantly more comorbidities in the open intervention group. Patients who achieved more than the median cumulative step count had a significantly shorter hospital stay and lower morbidity in both arms. The average step count also correlated with the length of hospital stay (R = − 0.341, P < 0.001).
This study is the first randomized controlled trial investigating the use and feasibility of activity tracking to monitor and enhance postoperative mobilization in abdominal surgery. Our results demonstrate that activity tracking can enhance perioperative mobilization after laparoscopic surgery.
KeywordsActivity tracking Postoperative recovery ERAS Fast-track surgery Randomized controlled trial
S.W. designed the study, collected and analyzed the data, and drafted the manuscript. T.M., S.L., B.M., A.B., and A.W. assisted with the data collection. J.W., N.R., and M.D. worked on the study design and the final manuscript. D.S. assisted with the study design. T.W. designed the study and finalized the manuscript.
Compliance with Ethical Standards
All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This study was registered on ClinicalTrials.gov (NCT02834338) and approved by the local Ethics Committee of the TU Dresden (decision number EK226062016). This article does not contain any studies with animals performed by any of the authors.
- 1.Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clinical nutrition. 2012;31(6):783–800. https://doi.org/10.1016/j.clnu.2012.08.013.CrossRefPubMedGoogle Scholar
- 2.Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Archives of surgery. 2009;144(10):961–9. https://doi.org/10.1001/archsurg.2009.170.CrossRefPubMedGoogle Scholar
- 3.Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clinical nutrition. 2012;31(6):801–16. https://doi.org/10.1016/j.clnu.2012.08.012.CrossRefPubMedGoogle Scholar
- 4.Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. The Cochrane database of systematic reviews. 2011(2):CD007635. https://doi.org/10.1002/14651858.CD007635.pub2.
- 6.Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World journal of surgery. 2013;37(8):1909–18. https://doi.org/10.1007/s00268-013-2044-3.CrossRefPubMedGoogle Scholar
- 7.Coolsen MM, Wong-Lun-Hing EM, van Dam RM, van der Wilt AA, Slim K, Lassen K et al. A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2013;15(4):245–51. https://doi.org/10.1111/j.1477-2574.2012.00572.x.CrossRefGoogle Scholar
- 8.Ford SJ, Adams D, Dudnikov S, Peyser P, Rahamim J, Wheatley TJ et al. The implementation and effectiveness of an enhanced recovery programme after oesophago-gastrectomy: a prospective cohort study. International journal of surgery. 2014;12(4):320–4. https://doi.org/10.1016/j.ijsu.2014.01.015.CrossRefPubMedGoogle Scholar
- 9.Shewale JB, Correa AM, Baker CM, Villafane-Ferriol N, Hofstetter WL, Jordan VS et al. Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges. Annals of surgery. 2015;261(6):1114–23. https://doi.org/10.1097/SLA.0000000000000971.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Tang J, Humes DJ, Gemmil E, Welch NT, Parsons SL, Catton JA. Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages. Annals of the Royal College of Surgeons of England. 2013;95(5):323–8. https://doi.org/10.1308/003588413X13629960046039.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. The British journal of surgery. 2005;92(11):1354–62. https://doi.org/10.1002/bjs.5187.CrossRefPubMedGoogle Scholar
- 15.Wind J, Hofland J, Preckel B, Hollmann MW, Bossuyt PM, Gouma DJ et al. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial). BMC surgery. 2006;6:16. https://doi.org/10.1186/1471-2482-6-16.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Cook DJ, Thompson JE, Prinsen SK, Dearani JA, Deschamps C. Functional recovery in the elderly after major surgery: assessment of mobility recovery using wireless technology. The Annals of thoracic surgery. 2013;96(3):1057–61. https://doi.org/10.1016/j.athoracsur.2013.05.092.CrossRefPubMedGoogle Scholar
- 18.Wolk S, Meissner T, Linke S, Mussle B, Wierick A, Bogner A et al. Use of activity tracking in major visceral surgery-the Enhanced Perioperative Mobilization (EPM) trial: study protocol for a randomized controlled trial. Trials. 2017;18(1):77. https://doi.org/10.1186/s13063-017-1782-1.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Scholes S, Bridges S, Ng Fat L, Mindell JS. Comparison of the Physical Activity and Sedentary Behaviour Assessment Questionnaire and the Short-Form International Physical Activity Questionnaire: An Analysis of Health Survey for England Data. PloS one. 2016;11(3):e0151647. https://doi.org/10.1371/journal.pone.0151647.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Castelino T, Fiore JF, Jr., Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery. 2016;159(4):991–1003. https://doi.org/10.1016/j.surg.2015.11.029.CrossRefGoogle Scholar
- 22.Kennedy EP, Grenda TR, Sauter PK, Rosato EL, Chojnacki KA, Rosato FE, Jr. et al. Implementation of a critical pathway for distal pancreatectomy at an academic institution. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2009;13(5):938–44. https://doi.org/10.1007/s11605-009-0803-0.CrossRefGoogle Scholar
- 23.Kennedy EP, Rosato EL, Sauter PK, Rosenberg LM, Doria C, Marino IR et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution--the first step in multidisciplinary team building. Journal of the American College of Surgeons. 2007;204(5):917–23; discussion 23–4. https://doi.org/10.1016/j.jamcollsurg.2007.01.057.CrossRefGoogle Scholar
- 24.Hendry PO, van Dam RM, Bukkems SF, McKeown DW, Parks RW, Preston T et al. Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. The British journal of surgery. 2010;97(8):1198–206. https://doi.org/10.1002/bjs.7120.CrossRefGoogle Scholar
- 25.Koea JB, Young Y, Gunn K. Fast track liver resection: the effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB surgery : a world journal of hepatic, pancreatic and biliary surgery. 2009;2009:271986. https://doi.org/10.1155/2009/271986.CrossRefGoogle Scholar
- 27.Steene-Johannessen J, Anderssen SA, van der Ploeg HP, Hendriksen IJ, Donnelly AE, Brage S et al. Are Self-report Measures Able to Define Individuals as Physically Active or Inactive?. Medicine and science in sports and exercise. 2016;48(2):235–44. https://doi.org/10.1249/MSS.0000000000000760.CrossRefPubMedGoogle Scholar