At-home Walking Cadence Functional Assessment and Recovery Trajectory for Older Adults Undergoing Major Surgery

Study Overview
=================
Brief Summary
-----------------
This is a prospective observational study looking at gait-cadence in older adults who are scheduled to have major abdominal surgery at the University of Chicago. The objective of the study is to evaluate whether gait-cadence, as measured from a patient's mobile device at-home, can provide an accurate assessment of a patient's functional status prior to major abdominal surgery and identify patients at risk of poor functional outcomes.

Detailed Description
-----------------
Over 100,000 older adults undergo elective major abdominal surgeries in the US each year and many experience loss of mobility after surgery that requires post-acute care. Risk of mobility loss is greater for older adults unable to engage in moderate-intensity physical activity before surgery. Additionally, recovery trajectories to baseline mobility remains poorly understood for older adults and may impact readmission. Functional status assessment before surgery can identify interventions to help older adults improve walking capacity and improve recovery trajectories after surgery. However, almost no patients receive objective functional status tests before surgery due to logistical and practical barriers. Remote assessments performed independently by the patient using wearable technology, such as smartphones, may provide a solution. Smartphone accelerometers combined with open-source software can directly measure a patient's gait-cadence, or the number of steps taken per minute. This observational cohort of older adults undergoing major abdominal surgery will use a novel smartphone application to obtain remotely collected gait-cadence from usual and fast paced walks prior to their in-clinic visit. Investigators will then compare the at-home to the in-clinic usual and fast paced walks and measure their recovery trajectory after surgery through weekly at-home walks. Overall mobility will be assessed using ActiGraph accelerometers worn for a 7-day time period before and after surgery. The investigator's hypothesis is that gait-cadence measured during usual and fast pace walks at-home will 1) provide an accurate and easy to use functional assessment 2) identify patients at-risk of mobility loss and 3) determine walking recovery trajectories for older adults after surgery. Results from this study will provide important knowledge on mobility trajectories of older adults after major abdominal surgery and develop a novel approach to identify high-risk older adults. Further, this platform may be leveraged to deliver mobility interventions before surgery to improve patient outcomes after surgery.

Official Title
-----------------
At-home Walking Cadence Functional Assessment and Recovery Trajectory for Older Adults Undergoing Major Surgery

Conditions
-----------------
Gait, Unsteady

Intervention / Treatment
-----------------
* Other: Patients using Step Test Application and Accelerometer


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients > or = 65 years of age and scheduled for major abdominal surgery. Access to a safe walking space roughly 30 ft in length. Safe walking spaces include a long hallway in the home, common use hallway in an apartment building or outside public area. Able to walk independently with or without an assistive device (e.g. cane or walker) Exclusion Criteria: Inability to walk independently Surgery scheduled less than 7-days after APMC appointment Non-English speaking.

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Patients using Step Test Application and Accelerometer|Patients who are scheduled to have surgery at University of Chicago Medical Center (UCMC) who agree to use the step test application and study accelerometer before and after their surgery.|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy of gait-cadence measured from at-home and in-clinic walk tests as measured by ActivPAL accelerometers. | ActivPAL accelerometer will be worn during in-clinic walk tests to serve as reference of steps walked during the at-home walk tests. | Baseline (Before surgery) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in disability, as measured by the World Health Organization Disability Assessment Schedule (WHODAS) 2.0: 12-item. | The simple sum of the scores of the 12-items range from 0 to 48 with higher scores indicating greater disability. | Baseline (Before surgery), 1 month after surgery, 3 months after surgery | 
| Change in functional status, as measured by an interview in which participants will be asked, At the present time, do you need help from another person to (complete the task)? | Interview question will be asked for 13 different tasks. An increased need for personal assistance demonstrates greater functional status decline. | Baseline (Before surgery), 1 month after surgery, 3 months after surgery | 
| Change in global health, as measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Scale v1.2 - Global Health. | Total raw scores are between 4 and 20, and these can be converted to a T-score. Higher scores mean more of the concept being measured. For example, higher scores mean more health. | Baseline (Before surgery), 1 month after surgery, 3 months after surgery | 
| Change in pain interference, as measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Short Form v1.1 - Pain Interference 6a. | Total raw score ranges from 6 to 30, and these can be converted to a T-score. Higher scores indicate greater pain interference on relevant aspects of a participant's life. | Baseline (Before surgery), 1 month after surgery, 3 months after surgery | 
| Change in gait-cadence after surgery | Gait-cadence will be measured at-home after surgery from weekly at-home walking tests from smartphone | Weeks 1-8 after surgical procedure | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Walking Cadence, Activity, Major abdominal surgery, Surgery, Older Adult, Smartphone, Accelerometer, Recovery trajectory, Functional capacity