Background/Objectives: Using a patient’s own wearable sensor to obtain objective outcome data is a growing field in trauma allowing for the assessment of the recovery trajectory back toward the pre-injury performance. The aim of this study was to analyze recruitment characteristics and reasons for declined study participation in an orthopedic trauma study that measures postoperative recovery using wearables. Methods: Data from 225 patients screened for participation in a wearable-sensor-based outcome study were assessed. The influence of age, sex and injury location on study participation was analyzed. Reasons for patients declining to participate were investigated from the screening log. Availability and type of sensor system in patients agreeing to participate were analyzed. Results: Overall, 48% of patients agreed to participate. Age was the only significantly different factor between agreeing and declining patients (p < 0.05). The main reasons to decline study participation were technical difficulties with or inability to use the wearable device, lack of availability of a wearable, and general disinterest to participate in a study. Notably, 7% declined due to data safety concerns. Conclusions: The results show that age, availability of the wearable, and technical ability to use a wearable are the main obstacles impacting objective outcome measurement using a personal wearable device. In studies including geriatric patients, a dedicated device requiring no patient handling can be a valid option to improve enrollment. Understanding the reasons for declining to participate will facilitate the development of future sensor-based studies to address concerns of technical handling through alternative means of data harvesting and increase the inclusion rate. These outcomes will guide future study designs to optimize patient inclusion.

The individual and socio-economic burden of delayed rehabilitation after a fracture is high. Early identification of patients with critical healing processes and timely intervention are key factors for successful treatment management. The aim of this study was to demonstrate how step counts, collected via patient-owned wearables, can assist in identifying critical recovery trajectories. The study included 56 patients who already had a wearable device. Data on age, gender, injury type, PROMIS – Global Health 10 score at 3 months, and work ability at 3 months were collected. Step counts were recorded both before and after the injury. Data from 56 patients were analysed. Postoperative healing was reliably monitored using the patients' own wearables for both upper and lower extremities. Significant differences in daily step counts were observed between patients with normal healing and those with delayed rehabilitation. Significant differences were also found in step counts between patients who regained work ability within 3 months and those who did not. PROMIS surveys conducted after 3 months revealed significant differences between daily step counts in patients above the 80th percentile compared to those below the 20th percentile. The analysis demonstrates that monitoring healing progress with patient-owned wearables can effectively estimate the risk of delayed recovery and prolonged work disability, as based on easily accessible personal activity data. Further refinement of the technology and inclusion of additional patients with defined injury types could help identify trauma patients in need of additional care during treatment. Early and targeted interventions could enable a return to pre-injury activity levels and reduce the duration of work disability.

Background: Fractures of the lower extremity are commonly associated with impaired mobility, whereas injuries of the upper extremity primarily affect limb-specific function. Wearable devices allow the objective and continuous monitoring of physical activity and may therefore provide additional insight into postoperative recovery processes under real-world conditions. This exploratory study aimed to compare postoperative trajectories of daily step count following surgical treatment of upper versus lower extremity fractures and to explore possible associations with general health status and return to work. Methods: In this prospective observational study, 38 patients with upper extremity fractures and 55 patients with lower extremity fractures were included. Daily step counts were recorded postoperatively. Patient-reported general health (PROMIS Global Health) and work status at three months were assessed. Results: During the early postoperative period, patients with lower extremity injuries recorded lower daily step counts than patients with upper extremity injuries. Within three months, 89% of patients with upper extremity injuries and 49% of patients with lower extremity injuries had returned to work. Conclusions: In this exploratory cohort, postoperative step count trajectories differed between surgically treated upper and lower extremity fractures during the early postoperative period. Return-to-work rates at three months also differed between groups. Interpretation of these findings is limited by the real-world use of heterogeneous consumer wearable devices and the exploratory study design. These findings should be considered preliminary and hypothesis-generating.