Utility of Wrist-Wearable Data for Assessing Pain, Sleep, and Anxiety Outcomes After Traumatic Stress Exposure
Authors: Straus Laura D. , An Xinming , Ji Yinyao , McLean Samuel A. , Neylan Thomas C. ,   AURORA Study Group, Cakmak Ayse S. , Richards Anne , Clifford Gari D. , Liu Mochuan , Zeng Donglin , House Stacey L. , Beaudoin Francesca L. , Stevens Jennifer S. , Linnstaedt Sarah D. , Germine Laura T. , Bollen Kenneth A. , Rauch Scott L. , Haran John P. , Storrow Alan B. , Lewandowski Christopher , Musey Paul I. , Hendry Phyllis L. , Sheikh Sophia , Jones Christopher W. , Punches Brittany E. , Kurz Michael C. , Swor Robert A. , Hudak Lauren A. , Seamon Mark J. , Datner Elizabeth M. , Chang Anna M. , Pearson Claire , Peak David A. , Merchant Roland C. , Domeier Robert M. , Rathlev Niels K. , O’Neil Brian J. , Sergot Paulina , Sanchez Leon D. , Bruce Steven E. , Miller Mark W. , Pietrzak Robert H. , Joormann Jutta , Barch Deanna M. , Pizzagalli Diego A. , Sheridan John F. , Harte Steven E. , Elliott James M. , Kessler Ronald C. , Ressler Kerry J. , Koenen Karestan C. 
Published: January 2023

Importance

Adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure are common and have higher incidence among socioeconomically disadvantaged populations. Pain, depression, avoidance of trauma reminders, reexperiencing trauma, anxiety, hyperarousal, sleep disruption, and nightmares have been reported. Wrist-wearable devices with accelerometers capable of assessing 24-hour rest-activity characteristics are prevalent and may have utility in measuring these outcomes.

Objective

To evaluate whether wrist-wearable devices can provide useful biomarkers for recovery after traumatic stress exposure.

Design, Setting, and Participants

Data were analyzed from a diverse cohort of individuals seen in the emergency department after experiencing a traumatic stress exposure, as part of the Advancing Understanding of Recovery After Trauma (AURORA) study. Participants recruited from 27 emergency departments wore wrist-wearable devices for 8 weeks, beginning in the emergency department, and completed serial assessments of neuropsychiatric symptoms. A total of 19 019 patients were screened. Of these, 3040 patients met study criteria, provided informed consent, and completed baseline assessments. A total of 2021 provided data from wrist-wearable devices, completed the 8-week assessment, and were included in this analysis. The data were randomly divided into 2 equal parts (n = 1010) for biomarker identification and validation. Data were collected from September 2017 to January 2020, and data were analyzed from May 2020 to November 2022.

Exposures

Participants were recruited for the study after experiencing a traumatic stress exposure (most commonly motor vehicle collision).

Main Outcomes and Measures

Rest-activity characteristics were derived and validated from wrist-wearable devices associated with specific self-reported symptom domains at a point in time and changes in symptom severity over time.

Results

Of 2021 included patients, 1257 (62.2%) were female, and the mean (SD) age was 35.8 (13.0) years. Eight wrist-wearable device biomarkers for symptoms of adverse posttraumatic neuropsychiatric sequelae exceeded significance thresholds in the derivation cohort. One of these, reduced 24-hour activity variance, was associated with greater pain severity (r = −0.14; 95% CI, −0.20 to −0.07). Changes in 6 rest-activity measures were associated with changes in pain over time, and changes in the number of transitions between sleep and wake over time were associated with changes in pain, sleep, and anxiety. Simple cutoffs for these biomarkers identified individuals with good recovery for pain (positive predictive value [PPV], 0.85; 95% CI, 0.82-0.88), sleep (PPV, 0.63; 95% CI, 0.59-0.67, and anxiety (PPV, 0.76; 95% CI, 0.72-0.80) with high predictive value.

Conclusions and Relevance

These findings suggest that wrist-wearable device biomarkers may have utility as screening tools for pain, sleep, and anxiety symptom outcomes after trauma exposure in high-risk populations.