W-Ward is a feasibility study of a wrist worn accelerometer to characterise the physical activity of patients with end-stage renal disease.
More than 2.6 million patients in the UK have end-stage renal disease (ESRD) and the rate continues to rise with the median age of patients requiring haemodialysis increasing. Stratifying patient “risk” on purely age criteria is very crude and takes no account of the relative physical function and level of frailty of patients. At Cambridge University Hospitals NHS Foundation Trust, the dialysis centre has introduced a policy of assessing all new patients referred to the low clearance clinic and on dialysis for their level of frailty – Frailty Assessment in Renal Patients (FAIR) – to allow a more patient-centred level of care.
The FAIR includes clinical measures in the clinic, such as handgrip strength and walk test, assessment of cognitive impairment, reported weight loss, and self-reported questions to assess ability to do activities of daily living, exhaustion and physical activity levels. However, the existing measures involve face-to-face assessment of patients and currently where feasible, clinical appointments are being conducted via telephone to reduce COVID-19 infection risk. It can also be challenging to conduct some of the measurements in the clinic due to limited space (for example the walking speed assessment in a corridor).
This study explores the application of wrist-worn accelerometers to objectively quantify physical activity remotely whilst ESRD patients are at home doing their usual activities over 7-days. This may give a more holistic assessment of a patient’s activity levels and patterns than a questionnaire on specific types of activity and time spent in those activities, which are often difficult to recall and quantify. Accelerometry measured activity patterning has the potential to be a valuable tool as part of the growing drive for remote monitoring of patients and identifying patients most at risk that require further frailty assessment.
This feasibility study aims to assess the acceptability of the use of a wrist-worn accelerometer to objectively measure physical activity in ESRD patients and whether it could be used to better characterise frailty risk as part of the frailty assessment in patients from the low clearance and dialysis clinic.
Starting in September 2021 we will recruit 40 patients from Addenbrooke’s hospital dialysis centre; 20 patients on dialysis and 20 low clearance pre-dialysis patients referred to the Low Clearance Clinic