mHealth Finds a Place for Fitbit in Remote Patient Monitoring Research

Consumer-grade mHealth wearables are finally beginning to make their mark in remote patient monitoring programs.

Researchers at Cedars-Sinai Medical Center and UCLA are reporting that a Fitbit activity tracker can be used in some RPM programs if healthcare providers are aware of the clinical limitations of the mHealth wearable. They charted high adherence and low attrition rates over a 90-day study, and said data from the Fitbit could be used to identify trends that call for clinical intervention.

Los Angeles-based Cedars-Sinai has been one of the more active researchers of consumer-grade wearables, and earlier this year issued a report which found that the mobile health device market hadn’t yet proven itself reliable enough for RPM programs. But this new study, reported in JAMIA, finds that the Fitbit can help providers keep tabs on their patients at home.

In its study, researchers recruited some 200 patients with ischemic heart disease (IHD) and had them wear Fitbit Charge 2 trackers for 90 days.

At the end of that time period, they found that the 186 patients still in the program had an adherence rate of 90 percent, “substantially higher than those previously reported in telemonitoring studies using similar study periods.” And the rate of attrition in adherence was measured at .09 percent per day – meaning most participants were using their Fitbits just as much at the end of the three-month study as they were when it was launched.

“Our study used a single device with high utility, which simplifies the task of remote monitoring for both researchers and patients,” the researchers reported. “The ability of the device to simultaneously record multiple variables such as (heart rate) and accelerometer data also allowed us to more accurately determine the patient’s state, whether he/she is active, sedentary, asleep, or not currently using the device.”

In addition, because researchers were able to easily access activity data, they could spot patients who were beginning to lose interest in wearing their Fitbit and send reminders.

The study also offered clues as to how Fitbit data should be used.

Healthcare providers have traditionally been slow to embrace consumer-grade wearables because they don’t trust the data coming from them and don’t want to make clinical decisions based on what might be inaccurate information. In this study, the researchers focused on consistency rather than accuracy and examined how that data collected over time can be used to spot trends, and how that information might compare to patient surveys.

“The average number of steps recorded per day by subjects in this study correlated significantly with several attributes of the patients’ self-reported states at the conclusion of the study, including their overall health, physical function, fatigue, and KCCQ (Kansas City Cardiomyopathy) and SAQ (Seattle Angina) scores,” the study noted. “These findings are consistent with previous studies that have found relationships between physical activity and health, as well as physical function.”

“Here, the correlation between consumer grade activity tracker data and clinically used patient surveys demonstrates that these devices provide information about a patient’s state, despite the imperfections in the data,” the study added.

Therefore, clinicians monitoring these patients through their Fitbits can get a real-time glimpse of their health and physical function – enough to spot dangerous trends and intervene.

That’s a particularly useful function in RPM programs targeting people with heart conditions like IHD.

“Patients with stable IHD can develop precursor indicators that are not clinically detected, yet may progress to major adverse cardiac events (MACE) if not recognized, a potentially catastrophic and expensive outcome,” the report noted. “There is a pressing need to validate and scale cost-effective techniques to monitor this large population between healthcare visits, and adherence levels relate directly to the feasibility of clinical use.”

by Eric Wicklund,