Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study

Abstract

Background: Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions.

Objective: This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home.

Methods: The physical activity of patients aged ≥70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F₁-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F₁-score for all physical activity patterns together.

Results: The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F₁-score=1) and a 100% correct classification of the 2 most common physical activity patterns.

Conclusions: Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves.

Keywords: continuous ambulatory monitoring; hip fracture rehabilitation; older patients; pattern prediction; physical activity; wearable sensing.

Figure 1

Patterns of overall physical activity in older patients rehabilitating at a skilled nursing home after hip fracture surgery [9]. (A) Upward linear pattern. (B) Hill-shape pattern. (C) S-shape pattern. (D) Cubic curve pattern.

Figure 2

Workflow diagram for pattern prediction.

Figure 3

Feature subset for each time window selected by the CFS method.