Applications and Positive Impacts

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International Journal of Caring Sciences May-August 2020 Volume 13 | Issue 2| Page 1474
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Special Article
Wearable Technologies in Post-Operative Recovery: Clinical
Applications and Positive Impacts
Petros Kolovos, RN, MSc, PhD
Assistant Professor, Laboratory of Integrated Health Care, Department of Nursing, University of
Peloponnese, Tripolis, Greece
Correspondence: Petros Kolovos, Assistant Professor, Laboratory of Integrated Health Care,
Department of Nursing, University of Peloponnese, Tripolis, Greece Email: pkolovos@uop.gr
Abstract
The perioperative setting is a complex and technologically advanced environment and new
technologies have been implemented across the perioperative pathway as a mean to improve the quality
and safety of the surgical care. The aim of the current review was to describe and highlight the clinical
applicability of the wearable devices in postoperative recovery and to provide a comprehensive
synthesis of their positives impacts. Wearable technologies are evident to have an input in the
postoperative period mainly in activity and functional capacity monitoring, as well as in monitoring of
patient’s vital functions. The impact these devices have on the care process, the surgical patient and the
care setting is promising, while further research is needed to establish their clinical efficiency.
Management of postoperative recovery is a major concern for patients undergoing surgical procedures
and for the care organizations. With the support of wearable technologies a patient-centered care is
ensured in postoperative recovery and more evidence‐based practice should be encouraged.
Keywords: wearable technologies, wearable devices, sensors, surgical procedures, postoperative care,
postoperative recovery, rehabilitation, m-health
Introduction
A growing interesting in consumer market
and medical research has emerged over the
last years from the implementation of
wearable technologies or “wearables” in
healthcare settings. Mobile technologies such
as applications (apps), wearable technologies
and medical devices (referred to as mobile
health or mHealth) have been developed to
support health and social care by delivering
health related information, recourses and
remote services. Mobile technologies are
based on the information and communication
technologies and are described with the
broad term e-health (Free et al. 2013; WHO
2016). E-health and the recent advances in
digital technology, have an impact on
reforming the organization culture of health
care systems due to the challenges they face
and should be effectively addressed.
Moreover, e-health facilitates an effective
communication, not only among
interdisciplinary teams, but also between
them and the patients in a complex health
care system and promotes further research
initiatives (WHO; WHO 2016).
Background
Wearable technologies encompass a wind
range of electronic devices that are attached
to the human body via personal equipment or
other devices. Wearables with their basic
components (the hardware, the software and
a mobile phone or a computer application)
possess computational capability with the
ability to retrieve and present the data
collected in real time or retrospectively
(Slade Shantz & Veillette 2014). Based on a
single type or multiple types of sensors,
wearable devices are used for diagnosing and
monitoring. Their capabilities include
applications for physiological, biochemical
and motion sensing (Patel et al. 2012).
Wearable devices have become of growing
interest in the medical encounter and a large
body of literature has been published over
the last decades describing the clinical
applications of these technologies. Most of
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them are used to monitor and provide
feedback among healthy individuals and
group of patients, covering aspects such as
health and wellness, safety, rehabilitation,
assessment of treatment efficacy and early
detection of disorders (Patel et al. 2012;
Wang et al. 2017; Bahadori, Immins &
Wainwright 2018). Remote real time
monitoring during home care and community
care is feasible, which constitutes a
supportive tool for the care providers in the
framework of primary health care and
enhances individual’s independence
(Soniyapriyadarshini, 2013).
Surgical care is an indispensable part of the
healthcare provision and has a pivotal role to
health and welfare improvement of the
individuals. The need for surgical
intervention covers a wind range of diseases
categories which are attributed to conditions
that are treated surgically (Meara et al.
2015). In addition, an increasing demand for
surgical services is expected for elderly
owing to the demographic changes which are
associated with the ageing of the population
(Liu et al. 2004). The perioperative setting is
a complex and technologically advanced
environment and emerging new technologies
have been implemented across the
perioperative pathway as a mean to improve
the quality and safety of the surgical care
(Stabile & Cooper 2013; Kolovos,
Athanasopoulou, Tziaferi 2019). Slade
Shantz and Veillette (2014) pointed out that
wearable technology in surgical practice, has
the potential role to assist, augment and
provide a means of patient assessment.
Based on the growing interest of the
researchers from different backgrounds and
the clinicians for the deployment of wearable
technologies in the context of clinical
applications, this review follows two
objectives: (1) to identify and highlight
domains of clinical applicability of the
wearable devices in postoperative recovery
and (2) to provide a comprehensive synthesis
of these technologies’ positive impacts on
operative period.
Clinical applications
The review of the literature revealed
empirical studies that document the
implementation of the wearable technologies
in postoperative recovery. The main clinical
domains of wearable based technologies’
applicability in postsurgical patients are
describing as follow (Figure 1):
Activity and functional capacity monitoring:
Patients’ functional status after surgery is a
major determinant for recovery and an area
that has most benefited from the
technological advancements. Current
evidence highlight that most studies have
mainly been implemented to adult patients
(Appelboom et al. 2015; Jeldi et al. 2016;
Breteler et al. 2018; Kroll et al. 2017; Kim et
al. 2019) or even elderly (Cook et al. 2013;
Das et al. 2014), while pediatric patients
undergoing elective surgical procedures
(Ghomrawi et al. 2018) have also been in
focus. operative patient population
included patients after elective (Aziz et al.
2011; Carandina et al. 2019; Carmichael et
al. 2019; Wolk et al. 2019) or major (Cook et
al. 2013; Daskivich et al. 2019) surgical
procedures, cancer surgery (Low et al. 2017;
Wu et al. 2019), total hip or knee
arthroplasty surgery (Atallah et al. 2011;
Kwasnicki et al. 2015; Jeldi et al. 2016;
Chiang et al. 2017; Ramkumar et al. 2019),
neurosurgery and spine surgery (Hogaboam
& Daim 2018; Kim et al. 2019) and patients
in post-surgery rehabilitation recovery
(Rajanna et al. 2016; Gupta, Al-Anbuky &
McNair 2018). Most studies conducted to
inpatients during hospital recovery (Cook et
al. 2013; Brown et al. 2014; Hogaboam &
Daim 2018; Jeldi et al. 2016; Weenk et al.
2017; Kroll et al. 2017; Low et al. 2017;
Daskivich et al. 2019; Kim et al. 2019; Wu et
al. 2019), following by outpatients
(Ghomrawi et al. 2018; Carmichael et al.
2019; Ramkumar et al. 2019). Community
(Aziz et al. 2011; Gonzalez-Franco, Gilroy &
Moore 2014; Kwasnicki et al. 2015;
Carandina et al. 2019), as well as
rehabilitation settings postoperatively
(Atallah et al. 2011; Zhu et al. 2012;
Appelboom et al. 2015; Rajanna et al. 2016;
Gupta, Al-Anbuky & McNair 2018) were
also included in the research interest for
studying wearable devices’ feasibility.
Monitoring of vital functions:
Continuous monitoring following surgery
contributes to assess the clinical situation of
the patient and to recognize them whose
health status deteriorates clinically. On the
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other, frequently measurements of the vital
signs increase workload for nursing staff
while being discomfort to patients during
hospitalization (Breteler et al. 2018).
Empirical studies in the literature provide
evidence for the continuous and/or remote
monitoring in operative period with
the use of wearable technologies. The study
population of these studies consisted of
postsurgical patients at average (Brown et al.
2014; Das et al. 2014; Weenk et al. 2017) or
high risk (Breteler et al. 2018) for
complications, patients recovering from
critical illness (Kroll et al. 2017) and postoperative patients discharged after surgery
(Prettz et al. 2017; Carandina et al. 2019).
The setting of these applications included
inpatients (Brown et al. 2014; Das et al.
2014; Weenk et al. 2017; Breteler et al.
2018), critical care (Kroll et al. 2017) and
postoperative follow-up (Prettz et al. 2017;
Carandina et al. 2019).
Positive
recovery
impacts
on
post-operative
Analyzing and synthesizing the results of the
evidence
selected,
wearable-based
technologies postoperatively seem to have a
positive impact on the (Figure 1):
Figure 1. Wearable technologies in post-operative recovery: An outline of the
applications and their impacts
Recovery process: Wearable sensors
constitute reliable continuous measurements
(Cook et al. 2013; Jeldi et al. 2016; Chiang et
al. 2017; Wu et al. 2019) of perioperative
assessing, transforming physiological
parameters to an objective and measurable
ones. They facilitate timely and accurately
measuring and recording of useful clinical
data (Brown et al. 2014; Das et al. 2014;
Prettz et al. 2017; Wu et al. 2019). In
addition, they provide health related
information during the perioperative period
for decision-making, especially for patients
at risk – facilitating early recognition of
clinical changes and treatment, or of those
that need additional either monitoring or
interventions after surgery (Cook et al. 2013;
Low et al. 2017; Agarwal et al. 2018;
Hogaboam & Daim 2018). Moreover,
monitoring in remote settings supports the
recovery process (Das et al. 2014; Breteler et
al. 2018; Ramkumar et al. 2019). They can
wirelessly transmit data and facilitate followup, post-surgery rehabilitation and care in
community settings postoperative (Aziz et al.
2011; Kwasnicki et al. 2015; Rajanna et al.
2016; Gupta, Al-Anbuky & McNair 2018;
Carandina et al. 2019). Finally, these devices
evaluate the process of the care provided and
affect discharge health outcomes
(Brown et al. 2014; Cook et al. 2013; Kroll
et al. 2017; Ghomrawi et al. 2018; Carandina
et al. 2019).
Surgical Patient: Wearable based
technologies in postoperative recovery
Application
Monitoring of vital functions
Recovery process Surgical patient Care setting
Activity & functional capacity monitoring
Inpatient care Outpatients Community
Setting
Impact
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maximize and improve patients’ performance
and increase patients’ compliance leading to
improvements in health outcomes (Cook et
al. 2013; Jeldi et al. 2016; Agarwal et al.
2018; Ramkumar et al. 2019; Wu et al.
2019). The implementation of an
individualized postoperative care plan may
be feasible and increases patient satisfaction
of the receiving care (Breteler et al. 2018;
Carmichael et al. 2019; Kim et al. 2019). In
addition, independence after discharge is
encouraged (Das et al. 2014; Rajanna et al.
2016; Breteler et al. 2018), which in turns
promotes patient participation in self care
activities.
Care Setting: Wireless monitoring has been
in focus of the health care organizations over
the last decades as an attractive model of the
recovery process. Wearable devices support
surgical decision-making providing essential
information for both patients undergoing
surgery and health care providers (Kwasnicki
et al. 2015). Furthermore, the wearable
devices affect the rates of rehospitalization
postoperatively (Atallah et al. 2011; Cook et
al. 2013; Jeldi et al. 2016; Low et al. 2017;
Wu et al. 2019) and have considered to be a
predictor for the presence of complications
and for the length of hospitalization for
patients undergoing surgical procedures
(Brown et al. 2014; Das et al. 2014;
Carandina et al. 2019; Wolk et al. 2019). All
this evidence affect the quality of the care
provided improving the outcomes in
perioperative practice, as well as the
postdischarge outcomes and patient’s followup (Cook et al. 2013; Kwasnicki et al. 2015).
Discussion
Wearable technologies are evident to have
been integrated in post-operative recovery
and have become a remarkable part of
research directions in health care. These
achievements provide a personalized care
experience which in turn has a potential
impact on satisfaction rates of the receiving
services. The clinical efficacy of these
technologies should further be examined in
large scale clinical trials, while the economic
burden for the care organizations remains a
controversial matter that should also be
addressed. In addition, the development of
intelligent architectures for the integration of
different types of sensors and the
management of the clinical data obtained
will be required when considering the needs
for surgical patients in postoperative
recovery. Mechanisms to guarantee a reliable
functioning of the devices (Patel et al. 2012)
and their acceptance should also be ensured.
In their study, Weenk et al. (2017) found that
wearable devices were well accepted from
both patients and nurses which constitute a
prerequisite for their implementation in
clinical practice. Finally, security and
confidentiality remain important aspects
related with the use of m-health technologies
in care settings and should be a priority for
both researchers and clinicians.
Competences and skills for the different staff
categories are also required for the use of the
wearable technologies. Nurses’ role has an
obvious impact on the quality of the care
provided in perioperative care since
management of patient’s mobility after
surgery and recovery monitoring is of crucial
importance for the nursing care. Nursing
profession play a key role in the effort to
integrate and implement these technologies
in postoperative care. As a profession,
Nursing should be willing to be innovative in
the use of new technologies and devices to
achieve quality improvement and patient
safety (Yontz, Zinn & Schumacher 2015).
Conclusion
Management of postoperative recovery is a
major concern for patients undergoing
surgical procedures and care organizations
with substantial implications for the
individuals, the recovery process and the
care setting. In a transforming healthcare
system, there is adequate evidence that
wearable technologies present a promising
challenge to address issues related to the
provision of postoperative feedback in
monitoring both activity and functional
recovery and patient’s vital functions in
terms of feasibility, quality, safety and a
patient-centeredness approach of the care
provided.
Even though the role of these technological
achievements seems optimistic for the health
care organizations in the near future,
strategic priorities for further research for
their efficiency in the perioperative period
and post discharged are needed to establish
clinical significance.
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