Poor Patient Compliance Hinders Study of Validated Wearable Devices

Sleep deprivation is one of the most common symptoms observed in shoulder surgery patients, both before and after surgery. This symptom reduces pain tolerance which can negatively impact patient rehabilitation. That’s why it’s important to monitor sleep patterns and sleep disturbances to better understand the drivers of postoperative fatigue and pain.

Patrick C. McCulloch, MD

To gather insights that may help improve overall recovery after shoulder surgery, Patrick C. McCulloch, MD, John S. Dunn Chair in Orthopedic Surgery and Professor of Clinical Orthopedic Surgery, examined sleep patterns with patient-reported outcomes (PROs) before and after rotator cuff repair and total shoulder arthroplasty. He found that as the study progressed, patients became less likely to wear validated wearable devices (VWD) used to monitor sleep patterns and concluded that poor patient compliance affected the study results, which were published in Arthroscopy, Sports Medicine and Rehabilitation in 2023.

According to the American Academy of Orthopedic Surgeons, about 53,000 people in the U.S. have shoulder replacement surgery every year. These surgeries relieve pain and help patients resume daily activities. VWDs are increasingly being used to monitor sleep metrics after orthopedic procedures. Heart rate, resting heart rate and heart rate variability (measured by VWDs) determine sleep stages. In this study, a WHOOP 2.0 Strap was used to measure sleep duration, assess four-stage of sleep against a high-level sleep study as well as two-stage sleep against high-level sleep disorder assessments. PROs were collected with the aid of three validated outcome survey questionnaires: Patient-Reported Outcomes Measurement Information System Physical Function, American Shoulder and Elbow Surgeons self-evaluation, Disabilities of the Arm, Shoulder and Hand and a visual analog scale.

Patient participation in wearing the VWD decreased by the 2-4 and 4–6 week intervals relative to the preoperative period and was a major detriment to data collection. Patients said they stopped using the device because of poor connectivity between the WHOOP device and the mobile app and irregular charging of the WHOOP device. The reason behind these complications could be the age of the study participants; the mean age was 62 years. Poor patient compliance could be the result of patients experiencing less pain and better sleep after procedures.

Patients said they stopped using the device because of poor connectivity between the WHOOP device and the mobile app and irregular charging of the WHOOP device.

Validated wearable devices allow for monitoring components of sleep that offer insight into potential targets for improving post-operative fatigue, pain, and overall recovery after shoulder surgery. The results of this study support using a validated wearable device in an outpatient setting to collect sleep data to determine which components of the sleep cycle may be most associated with patient-reported outcomes. However, population demographic factors and ease of device use are barriers to optimized patient compliance during data collection.

Patrick C. McCulloch, MD

John S. Dunn Chair in Orthopedic Surgery and Professor of Clinical Orthopedic Surgery

Though poor patient compliance with VWDs was determined, McCulloch concluded that the WHOOP device can be used to assess sleep in outpatient orthopedic settings while exercising caution to monitor and control the factors contributing to poor patient compliance. “Validated wearable devices allow for monitoring components of sleep that offer insight into potential targets for improving post-operative fatigue, pain, and overall recovery after shoulder surgery,” he said. “The results of this study support using a validated wearable device in an outpatient setting to collect sleep data to determine which components of the sleep cycle may be most associated with patient-reported outcomes. However, population demographic factors and ease of device use are barriers to optimized patient compliance during data collection.”

Pranav V Gadangi, Bradley S Lambert, Haley Goble, Joshua D Harris, Patrick C McCulloch. Validated Wearable Device Shows Acute Postoperative Changes in Sleep Patterns Consistent With Patient-Reported Outcomes and Progressive Decreases in Device Compliance After Shoulder Surgery. Arthrosc Sports Med Rehabil. 2023 Aug 14;5(5):100783. doi: 10.1016/j.asmr.2023.100783.

Abanti Chattopadhyay, PhD

January 2024

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