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A new NIH-funded study will explore whether a wearable device can provide better functional recovery data after surgery for distal radius fracture.
Fractures of the wrist are very common. Yet patient-reported outcomes during recovery, while valuable, don’t always provide the detailed data we need to help everyone regain full function after repair. Our new research, funded by the National Institutes of Health, will explore ways technology could help.
A distal radius fracture (DRF) is a break in one of the forearm bones near the wrist. Most often, a DRF happens when someone falls forward onto an outstretched arm.
The radius is the most frequently broken bone in the arm, and DRFs are most common among children and older people. It accounts for 18% of all fractures in people over age 65.
About 25% of DRFs require surgery, which can involve a combination of metal pins, plates and screws, and a cast or external fixator to stabilize the bones so they can heal. Repairing with plates and screws has become the surgery of choice in most cases.
We use several helpful but outdated methods to ensure patients recover and regain function after surgery. Our research aims to identify a better way.
Measuring with patient-reported outcomes.
Our current methods for tracking patient outcomes are insufficient, mainly because they are too generalized to provide a detailed understanding of specific patients’ challenges.
Surgeons usually see a patient two weeks after DRF repair. We examine the patient’s recovery, asking about pain, observing swelling, and how well they move their fingers. Usually, wrist movement is not even tested, and any deeper evaluation of the surgical recovery is often limited by some remaining swelling and pain.
Other methods we use to track recovery include patient-reported outcomes. These questionnaires ask patients to score how their recovery is going and can provide valuable insights into their experience. Yet these tools are limited in what they can tell us, as they don’t offer detailed, measurable data about function. Instead, they often rely on a patient’s understanding of their recovery, which could be overly optimistic or pessimistic. Plus, patients must be able to read, understand the questions, and write—a task that can be particularly challenging and frustrating after a wrist fracture.
These data do help us know that most patients recover well after DRF repair. For a small subset, however, we need a better tool to help us understand the challenges in their recovery, especially in the first few weeks after surgery.
To help them, we need to gather patient-specific data about how they use their arm. Too often, a questionnaire of their perception of how well they’re recovering isn’t good enough to provide an opportunity to intervene to help patients avoid pain, swelling, and immobility that makes recovery more challenging.
Related reading: Research: Bone Density Impacts Non-Surgical Healing in Wrist Fractures.
Exploring a wearable device to improve data.
Our study seeks a better way to get data on patient function after DRF repair, and we have received an Exploratory/Developmental Research Grant from the NIH. Known as an R21, these grants encourage the development of new ideas, technologies, or methods that can have a significant impact.
In our study, patients who have just had DRF repair will receive an actigraph. This small device is worn around the wrist. Just like a FitBit or Apple Watch, the actigraph measures movement. This produces objective data to measure the purposeful, functional use of the limb.
We’ll be able to get data on limb use in day-to-day activities, walking patterns, and whether the limb is used to pick up and manipulate objects. We will then use complex machine learning analyses to interpret the data and determine how to use the actigraph to decide whether the hand and arm are being used correctly or if the patient is avoiding use, which might indicate a problem.
Understanding whether and how a patient uses their limb is essential because moving and using the limb prevents stiffness and swelling and guides return to use, which are critical parts of the healing process.
For patients experiencing pain and stiffness, actigraph data could allow us to intervene with earlier therapies and more aggressive methods to control pain and swelling. Better data could be critical to helping improve recovery challenges for many patients.
Related reading: Study Examines Procedure to Relieve Neuroma Pain After Hand or Finger Amputation.
Innovating for our patients.
Innovations are essential for MedStar Health Research Institute and MedStar Health patients. If we’re successful, this study could pave the way for revolutionary postoperative rehabilitation opportunities for DRF, the most common fracture of the upper extremities.
Data like these, which we think the actigraph can provide, would allow MedStar Health providers to customize individual treatment plans for patients with DRF, allowing us to intervene for challenged patients.
Moreover, this could enable us to provide individualized care for patients progressing well after surgery. A convenient, wearable device could advance their rehabilitation through more frequent, shorter provider interactions supported by better-quality data. Once we build the proper analyses and data tools, your regular daily wearable (Apple watch, Fitbit, etc.) could also be used to track recovery.
Step by step, we’re improving our understanding of how patients recover from DRF repair. We’re getting more detailed information about healing at home and innovating a relationship with interactive technology that could help improve outcomes for everyone.
