Counting Patient Steps Predicts Readmissions Risk

In a recent study, commercial activity monitors showed a correlation between the number of inpatient steps and the likelihood of readmission.

Research has linked physical activity with a lower risk of readmissions in medical conditions from COPD to heart failure.

Although every effort is made to get people moving while they're hospitalized, the intentions don't always match the outcomes. In a busy hospital, there are lots of other things competing for clinicians' attention and time.

"I think that people are just really busy," says Carissa Low, PhD, assistant professor of medicine and psychology in the Biobehavioral Oncology Program at the University of Pittsburgh Hillman Cancer Center.

"It's not usually the top priority," she adds. "It's easy for that to fall away."

It addition, physical activity isn't always easy to quantify or record in the EHR.

"It's not something that's tracked systematically," she says.

But electronic step counting might be able to change that.

Low is the lead author of a new study published in the Annals of Behavioral Medicine showing that patient activity during inpatient recovery predicted lower risk of 30- and 60-day readmission after surgery for metastatic peritoneal cancer.

Specifically, the researchers monitored patients using a Fitbit, and found that higher Fitbit step counts forecast better patient outcomes.

"Patients are encouraged to get up and walk as soon as possible after surgery," Low says, but doing so is often hard to keep up with and track.

The researchers wanted to know whether counting steps—which is easy and inexpensive to monitor and visualize—taken during inpatient recovery would predict 30- and 60-day readmission risk after metastatic cancer surgery.

Fitbits were placed on patients' wrists upon transfer from the ICU after surgery and worn for the duration of their inpatient stay. Researchers extracted information about hospital readmission from the patients' EHR. Researchers also helped to make sure the devices remained charged and were synced to the Fitbit server.

"The patients who took more steps during their stay were at lower risk for 30- and 60-day readmissions," Low said, even after statistically adjusting for age, body mass index, comorbidity, and length of postoperative stay.

The study showed that the average number of steps per day of inpatient recovery across all patients combined was 968.

For each 100 additional steps taken per inpatient recovery day over the average of 968, the risk of 30-day readmission was 17% lower and risk of 60-day readmission 18% lower.

It also showed that:

• Mean daily steps were inversely correlated with age
• Steps were not significantly associated with sex, body mass index, diagnosis, preoperative American Society of Anesthesiologists physical status, age-adjusted Charlson comorbidity index, or postoperative length of stay

The study authors write that their findings "suggest that commercial activity monitors may provide clinically meaningful information and that passively monitoring perioperative mobility may identify patients at risk for poor postoperative outcomes."

Low notes that although Fitbits were used in this particular study, there's nothing "magical" about that device in particular. Anything that counts steps could do.

"It's so easy to do now with all these ways of counting your steps; even your phone can count your steps," she says.

In addition, counting steps was a simple and easy way to track activity, but isn't the only way.

"I think there's more sophisticated analyses that can be done," Low says. "Steps, for now, seems to be good enough for this level of research."

She also says that enthusiasm varied among study participants.

"Some people tolerated it but weren't that interested … and some people were really motivated by seeing their step count as they got closer to discharge," she says. "Some patients were really interested in knowing their step count and whether it was increasing."

For patients who are enthusiastic and motivated about step counts, using any device to record them and displaying a daily step count on a whiteboard, for instance, "could be the low-tech way to get this started quickly," Low says.

For their next study, Low and her team are trying to intervene on activity levels by tracking sedentary behavior bouts with monitoring and an app.

For now, though, inpatient step counting is a simple tool.

"Anything we can do to make it easier for everybody involved seems like a great first step," Low says.