Low and Maldonado on Leveraging Wearable Devices to Improve Inpatient Ambulation

Wearable step count devices are a promising approach to improving ambulation for patients undergoing autologous stem cell transplant (ASCT), according to Sarah Low RN, MSN, OCN, CMSRN; and Claudia Maldonado-Howell, RN, MSN, FNP, BS. These devices may help create a visual feedback loop, which allows nurses to monitor their patient’s physical activity and help them set goals, they added.

The nurse investigators, both of whom practice at Cedars-Sinai Medical Center, recently presented on improving inpatient ambulation for transplant patients as part of the 48th Annual Oncology Nursing Society Congress. Following their presentation, Low and Maldonado spoke with Oncology Nursing News® to discuss their research and what the implications are for nursing practice.

Physical activity helps prevent deconditioning during hospitalization for this patient population. However, although patients are encouraged to get up and move around, there are no structured programs to incentivize this activity. During a unit practice council, nurses on the inpatient stem cell transplant unit suggested that wearable devices may motivate patients to walk following transplant. A pilot study was developed with the support of the medical director of the Blood and Marrow Transplant Program.

The study enrolled 23 patients and randomly assigned them to an experimental or control arm. Patients in the experimental arm received visual feedback on their daily step count, and encouragement from their nursing team thrice daily to meet their step goal. Patients in the control group did not receive feedback. A 6-minute walking test represented the primary end point and was used to assess physical fitness. Nurses collected patients scores at baseline and discharge. Patients monitored their step counts with the wearable technology.

Ultimately, nurses reported a 24.4% reduction in 6-minute waking tests scores among all at the time of discharge. At admission, the average score was 492 m and at discharge the average score was 372 m.

Patients who received nurse feedback had a statistically significant increase in total steps compared with the control group (38700 vs 23226; P = .048). The difference was most pronounced on days 1 through 6 (4108 vs 2561; P < .01); however, all patients experienced a steep decline in step counts beginning 5 days posttransplant because of severe pancytopenia. No statistically significant improvements in posttransplant 6-minute walking tests were captured.

According to Low and Maldonado, the rise of wearable technology gives nurses more opportunities to creatively interact with and motivate patients. They are optimistic about continuing this area of research and finding new ways to leverage technology to improve patient quality of life.

“If technology can help us, we should use it,” Low told Oncology Nursing News. “Our study definitely suggests that activity monitors might be able to help our patients in a relatively inexpensive way.”

Editor’s Note: This research was supported by the Melamed Foundation.

Reference

Low S, Maldonado-Howeel C, Flores J, Daskivich T, Paquette R. Stepping up: improving inpatient ambulation for autologous stem cell transplant patients. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed April 25, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12764