Sensor monitoring-guided rehab programme improves daily functioning after hip fracture
A transitional care rehabilitation programme incorporating occupational therapy (OT) and cognitive behavioural coaching informed by sensor monitoring effectively improves daily functioning at 6 months as compared with usual care among older adults recovering from hip fracture, as shown in a study.
“Our intervention was designed to target fear of falling, boosting self-confidence by exploiting sensor-based information to improve the rehabilitation process,” according to the investigators. “The findings demonstrate that the use of CBT-coaching techniques supported by the use of sensor data can improve daily functioning.”
The present three-armed trial randomly assigned 240 elderly hip fracture patients (mean age, 83.8 years; 80 percent female) to the following interventions: care as usual (n=77), CBT-based OT (n=87) and CBT-based OT with sensor monitoring (n=76). Interventions were conducted once a week during institutionalization, followed by four home visits and four telephone consultations over 3 months.
The primary outcome of patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure (COPM; range, 1–10), increased across the intervention arms: from a mean of 2.92 at baseline to 6.42 with usual care, from 3.09 to 6.42 with CBT–OT, and from 3.09 to 7.59 with CBT–OT plus sensor monitoring. [Age Ageing 2019;doi:10.1093/ageing/afz074]
Upon further analysis, the mean patient-reported daily functioning improvements observed were markedly greater with CBT–OT plus sensor monitoring vs usual care (difference, 1.17, 95 percent CI, 0.47–1.87; p=0.001), but did not significantly differ between CBT–OT and usual care.
Median number of inpatient sessions was 4 in both the usual care and CBT–OT arms and 2.5 in the CBT–OT plus sensor monitoring arm. The median number of OT sessions conducted at home was 2 in the CBT–OT arm and 4 in the arm that employed additional sensor monitoring.
The sensor monitoring system comprised 1) a wearable physical activity monitor, 2) a network of ambient sensors placed in the home of the patient, and 3) a gateway that collects data from the sensors and sends these to the server.
“Sensors that measure daily functioning can inform the rehabilitation of older adults after hip fracture beyond the direct observation of therapists or the self-report by patients,” the investigators said.
They pointed out that sensor data provide objective feedback about patients’ real-time activity levels, which the therapist could use to evaluate progress in daily functioning and to design and execute realistic plans for further improvement in functioning. Without such a data, coaching in the CBT-based occupational therapy relies on patients’ self-reported memories of their activities. In this vein, objective information from sensors could facilitate effective coaching for patients with cognitive restrictions.
“Finally, because patients can follow their own level of activity and progress on a tablet, they may be more engaged in their rehabilitation,” they added.