Monitoring of Hip Injury Patients (MoHIP): Feasibility of using a wearable activity monitor to better understand recovery of mobility in patients who have sustained a hip fracture.
In 2018, the James Lind Alliance identified the top two research priorities for lower limb fragility fracture as firstly understanding best in-hospital and secondly best out-of-hospital physiotherapy regimes for recovery. However, little is known about the trajectory of recovery in mobility as patients transition from hospital to home, where continuing care is provided by primary care teams. Furthermore, in 2018 the national ‘Hip Sprint’ audit revealed only 20% of hospitals achieved continuity of rehabilitation as patients transitioned to home.We aimed to assess feasibility of using wearable activity monitors to better understand recovery of mobility as patients transition from hospital to home following a hip fracture. Ultimately this knowledge may inform future primary care based interventions and personalise care.
We conducted a hospital-to-home, observational cohort study of patients admitted to the John Radcliffe Hospital, Oxford with a hip fracture from May 2018. Eligible patients were adults, recruited to the World Hip Trauma Evaluation (WHiTE) cohort study and without cognitive impairment. Participants were recruited during their hospital stay and asked to wear a CE-marked 3-axis logging accelerometer (Axivity AX3) contained within a pouch on a lanyard for 4 months from point of recruitment. Participants received monthly visits from a primary care research nurse during the 4 month follow up period.
Between May 2018 and January 2019, 59 of 213 (28%) participants recruited to WHiTE were eligible for recruitment to MoHIP. The most common reason for exclusion was cognitive impairment (n=100, 47%). Of the 59 eligible WHiTE participants, 19 were recruited to MoHIP (32%). Consent was declined by 25 (42%) eligible WHiTE participants, the most common reason being not wanting to wear an activity monitor on a lanyard (n=7). Of the 19 participants, 68% were female and mean age was 75.5 (SD 9.1). All participants were living in their own home prior to admission. Discharge destinations of participants were own home (n=16, 84%) NHS rehabilitation unit (n=2, 11%) and nursing home (n=1, 5%). Five participants (26%) chose to withdraw from the study before completion; citing reasons relating to monitor wear (“gets in the way”, “another thing to worry about”) and inconvenience of study participation in the context of an already high medical burden. Initial activity data is currently under analysis and will be available ahead of conference.
Whilst monitoring recovery from hip fracture over the transition from hospital to home remains a priority area of research, our research demonstrates that future monitoring strategies should be suitable for cognitively impaired patients to ensure outcomes are generalisable and should use non-intrusive devices. Further collaborative work with patients and carers will help identify an acceptable method of wear for activity monitors and address some of the barriers to recruitment and retention seen in this study.