A Personalized Prehabilitation Intervention In Elective Joint Replacement Surgery

The fiscal burden estimated at $164 billion annually in the US alone, with delirium often
leading to significant increases in hospital length of stay. The pathophysiology of delirium
is multifactorial and incompletely understood. Disruption of circadian rhythms, with
subsequent impairment of alertness, and increased inflammation including neuroinflammation,
is common in hospital environments, and is associated with poorer outcome, particularly in
the elderly.

An intriguing new therapeutic concept currently emerging in the area of elective surgery is
prehabilitation, a form of exercise training, which when pre-emptively administered in the
weeks prior to admission, has the potential to improve postoperative cognitive status,
mobility and recovery, thereby minimizing complications such as delirium. Our team has
recently developed a novel personalized medicine intervention that uses wearable devices
(smartwatches) to create an individualized exercise regimen for older adults that can
facilitate prehabilitation and monitor adherence to the prehabilitation regimen while the
patient is at home. In one sense, prehabilitation can be conceptualized as bouts of physical
exercise performed at home prior to admission, which, when adequately timed using guidance by
a wrist-worn biometric mobile device (smartwatch), augment the robustness of circadian
rhythms, particularly in the elderly. This intervention has the potential to have a high
impact because of its low cost, personalized nature, and ability to monitor adherence to
confirm maximization of functional status prior to admission.

Inclusion Criteria:

- Adults scheduled for elective arthroplasty;

- ≥55 years of age;

- Capable of giving informed consent;

- Willing to comply either to undergo prehabilitation (cases) or standard preoperative
care (control);

- Own a smartphone.

Exclusion Criteria:

- Patients with bilateral or revision surgeries;

- Diagnosis of pre-existing dementia;

- Test result of <20 in the MoCA indicating moderate to severe dementia;

- Diagnosis of acute stroke;

- Diagnosis of neurologic injury;

- Current alcohol (more than 2 drinks a day with last drink within the past 3 days) or
substance abuse (positive urine dip test for illicit drugs) history at risk of
postoperative withdrawal;

- Active diagnosis of alcohol or substance abuse;

- Recent travel across more than two (2) time zones (within the past month);

- Planned travel across more than two (2) time zones during the planned study
activities;

- Subjects, who have received an experimental drug, used an experimental medical device
within 30 days prior to screening, or who gave a blood donation of ≥ one pint within 8
weeks prior to screening;

- Subjects without access to WiFi in their or close to home or at work.