Evaluating Fitbits for Assessment of Physical Activity and Sleep in Pediatric Pain: Feasibility and Acceptability...

Consumer-grade wearables, such as Fitbits, are a promising, cost-effective methodology for objectively assessing sleep and physical activity in youth with pain.

This study investigated the acceptability and feasibility of implementing Fitbits for youth with acute and chronic pain in and out of hospital settings while maintaining data security and patient confidentiality.

We investigated participant experience of Fitbit use over 3 to 4 weeks for a sample of youth with acute pain undergoing either orthopedic or cardiac surgical procedures (N=34, mean age 14.46, SD 3.70 years, 47.06% [n=36] female) and a sample of youth with chronic pain enrolled in an intensive interdisciplinary pain treatment program (N=28, mean age 15.00, SD 2.33 years, 82.14% [n=23] female). We assessed the acceptability of Fitbit use through survey items probing comfort (0=extremely uncomfortable to 10=extremely comfortable), perceived burdensomeness (0=not burdensome at all to 10=extremely burdensome), and open-ended issues or concerns. Feasibility was assessed by tracking the daily compliant wear of the Fitbit device, which was operationalized as more than 600 minutes of daily wear time. We tested for group differences in acceptability and feasibility between orthopedic and cardiac patients within the acute pain sample and between the acute pain and chronic pain samples. We created an automated data pipeline to ensure data security, patient confidentiality, and quality.

Acceptability findings revealed high levels of reported comfort (acute pain: mean 8.56, SD 1.43; chronic pain: mean 8.27, SD 1.69) and low levels of perceived burdensomeness (acute: mean 0.68, SD 1.17; chronic: mean 1.15, SD 1.38) related to Fitbit wearing in both samples. No significant differences in these acceptability outcomes emerged between orthopedic and cardiac patients or between the acute pain and chronic pain groups (P values>.10). Transient concerns of mild wrist irritation and sleep discomfort were occasionally reported across both samples (15.79% [n=9] of participants). Feasibility findings indicated high feasibility (acute: median compliance rate of 86.67%; chronic: median compliance rate of 96.65%) for the study duration in both samples. Mann-Whitney U tests indicated significantly higher median compliance rates per participant among orthopedic as compared with cardiac patients (U=146.5, P=.04) and significantly higher median compliance rates per participant among the chronic pain group as compared with the acute pain group (U=186, P<.001), including significantly higher median compliant days (U=162, P<.001) and study days (U=234.5, P<.001) per participant.

These findings support the use of Fitbits as an acceptable and feasible method for collecting objective data on sleep and physical activity for youth experiencing pain. Findings also highlight the logistics of implementing consumer-grade wearable devices throughout all stages of the clinical research process.