Towards a comprehensive digital wearable tracking system of the patient recovery journey after extremity trauma: a narrative review

Abstract

Enabling our patients to recover back to their pre-injury state or beyond is at the core of every treatment in orthopedic trauma surgery. Current methods of assessing functional recovery after extremity trauma largely focus on individual segments of complex, compound activities, or are created for a specific purpose and for specific populations. Such assessment instruments cannot readily account for the effect of limitations in adjacent segments. Equally, the segment-specific instruments use limited domains to assess complex actions and aptitudes. Most traditional functional assessment tools do not accommodate the individual nature of function and only assess function in larger increments during follow-up clinic visits. Recent developments of both commercial and medical-grade wearable systems and associated digital technologies can overcome most of the challenges associated with traditional outcome measures. In this review, we introduce the main technologies and their potential to track patient functional recovery in relation to the treatment phase, both before and after an injury.

Keywords: patient reported outcome measure; simulation; smartphone; wearables.

Figure 1

Ap (A) and lateral (B) radiographs showing the AO fracture monitor applied to a distal femur plate with a healed fracture at the 6-month time point as part of the going-to-market study of the system.

Figure 2

Example of the ability to track the patient recovery process with a personal, patient-owned, consumer-grade wearable device to visualize a surrogate (i.e. step count) for both pre- and post-injury individual activity and overall function.

Figure 3

EMCAT as a tool to obtain a more continuous application of PROM scores (i.e. daily; gray bars) while maintaining a high level of patient compliance during assessment and providing comparable scores to full-length PROM questionnaires applied concurrently (red bars). Adapted from Harrison et al. (59).

Figure 4

Patient recovery journey (A) depicting the individual function before (left of the red arrow labeled ‘Injury’) and after an injury (right of the arrow). Patient expectation of normal function (dotted blue line), as well as different potential recovery trajectories, are shown (green = fast recovery, black = normal recovery, light blue = overload and re-injury, dark blue = recovery with functional deficit, red = non-healer). The x-axis shows the time with pre-injury, acute treatment (red shade), early rehabilitation (yellow shade), and final recovery (green shade) phases. Below the graph (B), the different technologies and approaches are shown, with a graphical representation of when and how continuously they can be applied during the patient recovery process.