Abstract
Incisional pain is present after abdominal surgeries. An OT used Fitbit devices as a postoperative tool to collect data on patients’ steps walked until their first bowel movement occurred. Did the Fitbit provide motivation? This pilot study may advance the practice of OT in the acute-care setting as a tool that motivates patients and which may decrease length of hospital stay and improve the patient experience.
Primary Author and Speaker: Michele Richards
Contributing Authors: Jonathan Phillips, Chasen Croft, Colleen Counsell
Do electronic pedometers (Fitbit devices) motivate acute care patients after abdominal surgeries for hernia repairs and bowel obstructions? How many steps until post operative bowel function first occurs? Numerous patients undergo abdominal surgeries for hernia repairs and bowel obstructions at the University of Florida Health Shands Hospital. After abdominal surgeries, patients await return of their bowel function. Early mobility and out of bed activities of daily living can lead to less complications. However, incisional pain is typically present and ambulation distances vary for patients. A common postoperative complication is an ileus (a cessation of the gastrointestinal tract). An ileus will increase a patient’s hospital length of stay, delay nutrition, cause nausea and lead to patient discomfort and dissatisfaction. Occupational therapists look for tools to motivate patients after surgery. This research project is beneficial to assess if Fitbit devices can assist in motivating patients after surgery.
An IRB approval was obtained. A prospective, single assignment patient pilot study was conducted with ten patients. The study occurred at UF Health Shands Hospital in the acute care setting. The inclusion criteria consisted of occupational therapy and/or physical therapy orders received, an abdominal surgery for a hernia repair or bowel obstruction occurred, cognitively intact adult patients age 18 to 85, and patients ambulated household distances prior to admission were enrolled after obtaining informed consent. Exclusion criteria included patients who had already ambulated prior to placement of the Fitbit, allergy to nickel, bedrest orders, non-ambulatory patients, patients admitted to the intermediate or intensive care units postoperatively and patients with an ostomy.
Patients wore the Fitbit (calibrated for age/height/weight) on their non-dominant wrist to track the number of steps taken during ambulation. The Fitbit arm had to be free swinging to record the steps. Patients wore the Fitbit until their first post operative bowel movement occurred. The bowel movement time and day was recorded in the electronic medical chart by the nursing staff. Then, the Fitbit was removed and collected. The patients’ steps were uploaded to the Fitbit activity tracker, then imported into the secure REDCap database. The number of steps taken was compared to the number of days the first bowel movement occurred. A questionnaire was issued to the patients to rate the level of motivation the Fitbit provided. The choices on the questionnaire were “no motivation”, “little motivation”, “moderate motivation” or “a lot of motivation”. The questionnaire responses were also recorded in REDCap.
The average number of steps seven patients took was 2,270 for the first bowel movement to occur (of note, three patients were discharged prior to having a bowel movement and their steps were not included). The Fitbit provided two patients with “a lot of motivation”, four patients “moderate motivation” and four patients “no motivation”. The patients that found the Fitbit to be motivating took an average of 2,981 steps and the patients who rated the device as no motivation took an average of 1,149 steps. The six patients who ranked the Fitbit device as motivating had an average length of stay (from surgery to discharge date) of 3.7 days. The four patients who ranked the Fitbit device as no motivation had an average length of stay as 11.3 days.
The Fitbit provided motivation to 60% of patients after surgery. This pilot study may advance the practice of occupational therapy in the acute care setting as a tool that motivates patients which may decrease hospital length of stay and improve the patient experience.
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