Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas

Abstract

AbstractIntroductionCommon, consumer-grade biosensors mounted on fitness trackers and smartwatches can measure an array of biometrics that have potential utility in post-discharge medical monitoring, especially in remote/rural communities. The feasibility characteristics for wrist-worn biosensors are poorly described for post-COVID conditions and rural populations.MethodsWe prospectively recruited patients in rural communities who were enrolled in an at-home rehabilitation program for post-COVID conditions. They were asked to wear a FitBit Charge 2 device and biosensor parameters were analyzed (e.g. heart rate, sleep, and activity). Electronic patient reported outcome measures (E-PROMS) for mental (bi-weekly) and physical (daily) symptoms were collected using SMS text or email (per patient preference). Exit surveys and interviews evaluated the patient experience.ResultsTen patients were observed for an average of 58 days and half (N=5) were monitored for 8 weeks or more. Five patients (50%) had been hospitalized with COVID (mean stay = 41 days) and 4 (36%) had required mechanical ventilation. As baseline, patients had moderate to severe levels of anxiety, depression, and stress; fatigue and shortness of breath were the most prevalent physical symptoms. Four patients (40%) already owned a smartwatch. In total, 575 patient days of patient monitoring occurred across 10 patients. Biosensor data was usable for 91.3% of study hours and surveys were completed 82.1% and 78.7% of the time for physical and mental symptoms, respectively. Positive correlations were observed between stress and resting heart rate (r=0.360, p<0.01), stress and daily steps (r=0.335, p<0.01), and anxiety and daily steps (r=0.289, p<0.01). There was a trend toward negative correlation between sleep time and physical symptom burden (r=-0.211, p=0.05). Patients reported an overall positive experience and identified the potential for wearable devices to improve medical safety and access to care. Concerns around data privacy/security were infrequent.ConclusionsWe report excellent feasibility characteristics for wrist-worn biosensors and e-PROMS as a possible substrate for multi-modal disease tracking in post-COVID conditions. Adapting consumer-grade wearables for medical use and scalable remote patient monitoring holds great potential.