Patient-Generated Actigraphy Data as a Novel Outcomes Instrument in Carpal Tunnel Syndrome

Abstract

Background Currently, we lack objective measures to quantify outcomes in carpal tunnel syndrome. Instead, surgeons rely on patient-reported outcomes measures (PROMs) to assess the effect of carpal tunnel release (CTR). We assessed the validity and reliability of wearable activity monitors to objectively characterize the functional and sleep impact of CTR. We hypothesized that actigraphy could detect changes in sleep and activity and would demonstrate short-term impairment due the operative procedure. Methods This pilot, prospective, cohort study compared validated PROMS with actigraphy data obtained via wearable activity monitors (ActiGraph Link; ActiGraph Corp, Pensacola, Fla). Subjects completed baseline questionnaires and wore their device for 1 week preoperatively as a baseline. Subjects then underwent open CTR, wearing actigraphy devices for 4 weeks and completing questionnaires at 2 and 4 weeks postoperatively. Preintervention and postintervention data were compared using paired-sample t test. The Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire data were analyzed in accordance with published PROMIS scoring manuals and raw scores were converted to standardized T scores. Results Twenty subjects (5 males, 15 females) with moderate or severe carpal tunnel syndrome were enrolled. The mean age was 57.7 years. The PROMIS 29 average cumulative T score was 42.9 with average change of −0.072 preoperatively versus postoperatively. Average sleep disturbance T score was 38.9 preoperatively and 41.4 postoperatively. There was no statistically significant difference in T score in any domain. The mean actigraphy activity data demonstrated near immediate return to baseline activity. Actigraphy sleep data demonstrate improvement in sleep fragmentation and decreased duration of awakenings. Conclusions Overall, patient-generated data detected differences in sleep and activity preoperatively versus postoperatively and demonstrated only a short period of activity disruption after CTR, which may be used when counseling patients. These data support actigraphy as a viable adjunct to traditional PROMS to evaluate the impact of surgical intervention and therefore may be useful in the study of other diseases affecting the upper extremity.

Changes in actigraphy metrics associated with PROMIS measures after orthopaedic surgery

“…This longitudinal study not only builds upon earlier cross-sectional investigations with comparable sample sizes that examined the validity of PROMIS measures with actigraphy sleep related data, but also uniquely examines how changes in the immediate postoperative period are associated with longitudinal postoperative outcomes (Fishbein et al, 2020;Hanish et al, 2017;McMahon et al, 2020).…”

“…For example, consensus groups recommend the use of computer adaptive testing enabled Patient Reported Outcome Measurement Information System (PROMIS ® ) to increase the speed and accuracy of postoperative assessments (Broderick et al, 2013;Cook et al, 2014). Previous studies integrating actigraphy and PROMIS measures together have predominately been conducted in paediatric and adolescent patient populations or over a shorter postoperative study period (Fishbein et al, 2020;Hanish et al, 2017;McMahon et al, 2020). Among adults undergoing minor elective surgeries, actigraphy data have been found to be capable of detecting relatively minor differences in sleep and activity, even when PROMIS domain scores related to sleep disturbance lacked statistically significant differences (McMahon et al, 2020).…”

“…Previous studies integrating actigraphy and PROMIS measures together have predominately been conducted in paediatric and adolescent patient populations or over a shorter postoperative study period (Fishbein et al, 2020;Hanish et al, 2017;McMahon et al, 2020). Among adults undergoing minor elective surgeries, actigraphy data have been found to be capable of detecting relatively minor differences in sleep and activity, even when PROMIS domain scores related to sleep disturbance lacked statistically significant differences (McMahon et al, 2020). The limited number of studies further underscores the need for continued research combining actigraphy and PROMIS measures in the perioperative settings.…”

Carpal Tunnel Syndrome Correlated With Medical Leave Of Work

“…In the United States, its incidence varies from 0.1% to 10% of the working population and the medical costs related to the disease are more than US$2 billion, amounting to over 400 to 500,000 carpal tunnel release procedures every year. The average time individuals are away from work is 27 days [4].…”