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Recovery of physical activity after cesarean delivery and its relationship with pain
Abstract Number: T-24
Abstract Type: Original Research
Introduction: Relatively little is known about recovery of physical activity after cesarean delivery (CD), yet early return to normal physical activity may improve sense of well-being, and reduce the risk of postpartum depression, anxiety, deep venous thrombosis.(1) Wearable fitness trackers have been used to objectively assess functional recovery in the elderly while in hospital after cardiac surgery(2) but recovery from physical inactivity after hospital discharge from major surgery including CD has not been reported.
Materials and Methods: Following IRB approval and informed consent, 55 parturients scheduled for elective CD have been enrolled. (All patients are enrolled and the study will be completed on April 14 and we anticipate presenting data on 50 patients at the meeting). Demographic information and preoperative questionnaires were completed. Anesthetic management was routine. Patients were instructed to wear a Fitbit™ wireless accelerometer on the first postoperative day and daily activity was tracked via Web interface for 60 days. Resting and evoked pain were assessed 24 hr after surgery using a visual analog scale 0-100 and average and worst daily pain were recorded until 60 days postoperatively. At that time, patients completed the Edinburgh Postnatal Depression Screening. Activity and pain were modeled to several functions.
Results: To date, 20 of 27 parturients who could have completed the study did so. Steps/day and pain were both best fit to ln(time) functions (Figure 1). Dotted lines in the figure represent 95% confidence intervals. A subject’s current day level of activity accounted for 7% of the variance in their current pain (p<.001). A subject’s yesterday activity accounted for an additional 6% of the variance in current day pain (p<.001). At the time of presentation, we will also determine predictors of physical activity using time-series regression analysis.
Conclusions: These data suggest that daily tracking of pain and activity following CD is feasible. Preliminarily, they suggest that recovery in these domains after surgery occurs within populations with a predictable form. Traditionally, persistent pain and disability are defined as dichotomous measures at single points in time, and these data suggest growth curve modeling may provide a more appropriate method to assess interventions to speed recovery.
References: 1)Obstet Gynecol Surv 2014; 69:407-14; 2)Ann Thorac Surg 2013; 96:1057-61
Supported in part by R37 GM48085 to JCE