{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:57:22Z","timestamp":1785452242269,"version":"3.56.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T00:00:00Z","timestamp":1721001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T00:00:00Z","timestamp":1721001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The aim of this study is to determine the validity of consumer grade step counter devices during the early recovery period after knee replacement surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twenty-three participants wore a Fitbit Charge or Apple Watch Series 4 smart watch and performed a walking test along a 50-metre hallway. There were 9 males and 14 females included in the study with an average age of 68.5 years and BMI of 32. Each patient wore both the Fitbit Charge and Apple Watch while completing the walking test and an observer counted the ground truth value using a thumb-push tally counter. This test was repeated pre-operatively with no gait aid, immediately post operatively with a walker, at 6 weeks follow up with a cane and at 6 months with no gait aid. Bland-Altman plots were performed for all walking tests to compare the agreement between measurement techniques.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Mean overall agreement of step count for pre-operative and at 6 months for subjects walking without gait aids was excellent for both the Apple Watch vs. actual and Fitbit vs. actual with bias values ranging from \u2212\u20090.87 to 1.36 with limits of agreement (LOA) ranging between \u2212\u200910.82 and 15.91. While using a walker both devices showed extremely little agreement with the actual step count with bias values between 22.5 and 24.37 with LOA between 11.7 and 33.3. At 6 weeks post-op while using a cane, both the Apple Watch and Fitbit devices had a range of bias values between \u2212\u20092.8 and 5.73 with LOA between \u2212\u200913.51 and 24.97.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>These devices show poor validity in the early post operative setting, especially with the use of gait aids, and therefore results should be interpreted with caution.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-024-04892-9","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T03:08:44Z","timestamp":1721012924000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Commercially available activity monitors such as the fitbit charge and apple watch show poor validity in patients with gait aids after total knee arthroplasty"],"prefix":"10.1186","volume":"19","author":[{"given":"Paul","family":"Kooner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya","family":"Baskaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Gibbs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Wein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Dimentberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Albers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,15]]},"reference":[{"key":"4892_CR1","volume-title":"Hip and knee replacements in Canada: CJRR Annual statistics Summary, 2021\u20132022","author":"Canadian Institute for Health Information","year":"2020","unstructured":"Canadian Institute for Health Information. Hip and knee replacements in Canada: CJRR Annual statistics Summary, 2021\u20132022. Ottawa, ON: CIHI; 2020."},{"key":"4892_CR2","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1007\/s11999-013-3034-3","volume":"472","author":"KJ Bozic","year":"2014","unstructured":"Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res. 2014;472:188\u201393.","journal-title":"Clin Orthop Relat Res"},{"key":"4892_CR3","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13102-015-0018-5","volume":"7","author":"TJ Kooiman","year":"2015","unstructured":"Kooiman TJ, Dontje ML, Sprenger SR, Krijnen WP, van der Schans CP, de Groot M. Reliability and validity of ten consumer activity trackers. BMC Sports Sci Med Rehabil. 2015;7:24.","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"4892_CR4","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1177\/2047487316634883","volume":"23","author":"M Alharbi","year":"2016","unstructured":"Alharbi M, Bauman A, Neubeck L, Gallagher R. Validation of fitbit-flex as a measure of free-living physical activity in a community-based phase III cardiac rehabilitation population. Eur J Prev Cardiol. 2016;23:1476\u201385.","journal-title":"Eur J Prev Cardiol"},{"key":"4892_CR5","doi-asserted-by":"crossref","unstructured":"Brickwood KJ, Watson G, O\u2019Brien J, Williams AD. (2019) Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis. JMIR mHealth uHealth, 7 e11819.","DOI":"10.2196\/11819"},{"key":"4892_CR6","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1097\/00003086-200012000-00005","volume":"381","author":"TP Schmalzried","year":"2000","unstructured":"Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa\u2019ave F, McKellop HA, McClung CD, Martell J, Moreland JR, Amstutz HC. The John Charley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;381:36\u201346.","journal-title":"Clin Orthop Relat Res"},{"key":"4892_CR7","doi-asserted-by":"publisher","first-page":"222","DOI":"10.2522\/ptj.20120525","volume":"94","author":"GD Fulk","year":"2013","unstructured":"Fulk GD, Combs SA, Danks KA, Nirider CD, Raja B, Reisman DS. Accuracy of 2 activity monitors in detecting steps in people with stroke and traumatic brain injury. Phys Ther. 2013;94:222\u20139.","journal-title":"Phys Ther"},{"issue":"10","key":"4892_CR8","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1080\/09593985.2017.1354412","volume":"33","author":"SD Schaffer","year":"2017","unstructured":"Schaffer SD, Holzapfel SD, Fulk G, Bosch PR. Step counter accuracy and reliability of two activity tracking devices in people after stroke. Physiother Theory Pract. 2017;33(10):788\u201396.","journal-title":"Physiother Theory Pract"},{"key":"4892_CR9","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1097\/00005768-200203000-00002","volume":"34","author":"RF Macko","year":"2002","unstructured":"Macko RF, Haeuber E, Shaughnessy M. Microprocessor-based ambulatory activity monitoring in stroke patients. Med Sci Sports Exerc. 2002;34:394\u20139.","journal-title":"Med Sci Sports Exerc"},{"key":"4892_CR10","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1016\/j.apmr.2007.07.039","volume":"88","author":"S Mudge","year":"2007","unstructured":"Mudge S, Stott NS, Walt SE. Criterion validity of the stepwatch activity monitor as a measure of walking activity in patients after stroke. Arch Phys Med Rehabil. 2007;88:1710\u20135.","journal-title":"Arch Phys Med Rehabil"},{"issue":"6","key":"4892_CR11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-2352.R1","volume":"103\u2013B","author":"DA Crawford","year":"2021","unstructured":"Crawford DA, Duwelius PJ, Sneller MA, Morris MJ, Hurst JM, Berend KR, Lombardi AV. Mark Coventry Award: Use of a smartphone-based care platform after primary partial and total knee arthroplasty: a prospective randomized controlled trial. Bone Joint J. 2021;103\u2013B(6):3\u201312.","journal-title":"Bone Joint J"},{"key":"4892_CR12","doi-asserted-by":"publisher","first-page":"3888","DOI":"10.1016\/j.arth.2021.08.007","volume":"36","author":"KR Tripuraneni","year":"2021","unstructured":"Tripuraneni KR, Foran JRH, Munson NR, Racca NE, Carothers JT. A smartwatch paired with a mobile application provides postoperative self-directed rehabilitation without compromising total knee arthroplasty outcomes: a randomized controlled trial. J Arthroplasty. 2021;36:3888\u201393.","journal-title":"J Arthroplasty"},{"issue":"3","key":"4892_CR13","doi-asserted-by":"publisher","first-page":"e011742","DOI":"10.1136\/bmjopen-2016-011742","volume":"7","author":"C Thorup","year":"2017","unstructured":"Thorup C, Andreasen J, S\u00f8rensen E, Gr\u00f8nkj\u00e6r M, Dinesen B, Hansen J. Accuracy of a step counter during treadmill and daily life walking by healthy adults and patients with cardiac disease. BMJ Open. 2017;7(3):e011742.","journal-title":"BMJ Open"},{"key":"4892_CR14","doi-asserted-by":"publisher","first-page":"1979","DOI":"10.1016\/j.apmr.2005.04.016","volume":"86","author":"F Pitta","year":"2005","unstructured":"Pitta F, Troosters T, Spruit MA, Decramer M, Gosselink R. Activity monitoring for assessment of physical activities in daily life in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2005;86:1979\u201385.","journal-title":"Arch Phys Med Rehabil"},{"key":"4892_CR15","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1136\/thx.2008.112102","volume":"64","author":"D Langer","year":"2009","unstructured":"Langer D, Gosselink R, Sena R, Burtin C, Decramer M, Troosters T. Validation of two activity monitors in patients with COPD. Thorax. 2009;64:641\u20132.","journal-title":"Thorax"},{"key":"4892_CR16","doi-asserted-by":"crossref","unstructured":"Larkin L, Nordgren B, Purtill H, Brand C, Fraser A, Kennedy N. Criterion validity of the activPAL activity monitor for sedentary and physical activity patterns in people who have rheumatoid arthritis. Phys Ther; 2015.","DOI":"10.2522\/ptj.20150281"},{"key":"4892_CR17","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.5435\/JAAOS-D-18-00319","volume":"28","author":"R Goel","year":"2020","unstructured":"Goel R, Danoff JR, Blevins K, Purtill JJ, Chen AF. A step in the right direction: body location determines activity tracking device accuracy in total knee and hip arthroplasty patients. J Am Acad Orthop Surg. 2020;28:e77\u201385.","journal-title":"J Am Acad Orthop Surg"},{"key":"4892_CR18","first-page":"1","volume":"13","author":"P Kooner","year":"2021","unstructured":"Kooner P, Schubert T, Howard JL, Lanting BA, Teeter MG, Vasarhelyi EM. Evaluation of the effect of gait aids, such as canes, crutches, and walkers, on the accuracy of step counters in healthy individuals. Orthop Res Reviews. 2021;13:1\u20138.","journal-title":"Orthop Res Reviews"},{"issue":"8","key":"4892_CR19","doi-asserted-by":"publisher","first-page":"e10527","DOI":"10.2196\/10527","volume":"6","author":"LM Feehan","year":"2018","unstructured":"Feehan LM, Geldman J, Sayre EC, Park C, Ezzat AM, Yoo JY, Hamilton CB, Li LC. Accuracy of Fitbit devices: systematic review and narrative of synthesis of quantitative data. JMIR Mhealth Uhealth. 2018;6(8):e10527.","journal-title":"JMIR Mhealth Uhealth"},{"key":"4892_CR20","doi-asserted-by":"crossref","unstructured":"Karabulut M, Crouter SE, Bassett DR Jr. Comparison of two waist-mounted and two ankle-mounted electronic pedometers (2005). Eur J Appl Physiol, 95(4):335\u201343.","DOI":"10.1007\/s00421-005-0018-3"},{"key":"4892_CR21","doi-asserted-by":"publisher","first-page":"4317","DOI":"10.3390\/s20154317","volume":"20","author":"HC van Dijk-Huisman","year":"2020","unstructured":"van Dijk-Huisman HC, Weemaes ATR, Boymans TAEJ, Lenssen AF, de Bie RA. Smartphone app with an accelerometer enhances patients\u2019 physical activity following elective orthopedic surgery: a pilot study. Sensors. 2020;20:4317.","journal-title":"Sensors"},{"key":"4892_CR22","doi-asserted-by":"publisher","first-page":"e2028328","DOI":"10.1001\/jamanetworkopen.2020.28328","volume":"3","author":"SJ Mehta","year":"2020","unstructured":"Mehta SJ, Hume E, Troxel AB, Reitz C, Norton L, Lacko H, McDonald C, Freeman J, Marcus N, Volpp KG. Effect of remote monitoring on discharge to home, return to activity, and rehospitalization after hip and knee arthroplasty: a randomized clinical trial. JAMA Netw Open. 2020;3:e2028328.","journal-title":"JAMA Netw Open"},{"key":"4892_CR23","doi-asserted-by":"publisher","first-page":"e16415","DOI":"10.2196\/16415","volume":"8","author":"Y Pronk","year":"2020","unstructured":"Pronk Y, Peters MCWM, Sheombar A, Brinkman JM. Effectiveness of a mobile ehealth app in guiding patients in pain control and opiate use after total knee replacement: randomized controlled trial. JMIR mHealth uHealth. 2020;8:e16415.","journal-title":"JMIR mHealth uHealth"},{"key":"4892_CR24","doi-asserted-by":"publisher","first-page":"3422","DOI":"10.1016\/j.arth.2018.06.024","volume":"33","author":"N Van der Walt","year":"2018","unstructured":"Van der Walt N, Salmon LJ, Gooden B, Lyons MC, O\u2019Sullivan M, Martina K, Pinczewski LA, Roe JP. Feedback from activity trackers improves daily step count after knee and hip arthroplasty: a randomized controlled trial. J Arthroplasty. 2018;33:3422\u20138.","journal-title":"J Arthroplasty"},{"key":"4892_CR25","doi-asserted-by":"publisher","first-page":"5553","DOI":"10.3390\/s20195553","volume":"20","author":"MS Renani","year":"2020","unstructured":"Renani MS, Myers CA, Zandie R, Mahoor MH, Davidson BS, Clary CW. Deep learning in gait parameter prediction for OA and TKA patients wearing IMU sensors. Sensors. 2020;20:5553.","journal-title":"Sensors"},{"key":"4892_CR26","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.3390\/s18051577","volume":"18","author":"IH Youn","year":"2018","unstructured":"Youn IH, Youn JH, Zeni JA, Knarr BA. Biomechanical gait variable estimation using wearable sensors after unilateral total knee arthroplasty. Sensors. 2018;18:1577.","journal-title":"Sensors"},{"key":"4892_CR27","unstructured":"https:\/\/www.prnewswire.com\/news-releases\/zimmer-biomet-and-canary-medical-announce-fda-de-novo-classification-grant-and-authorization-to-market-the-worlds-first-and-only-smart-knee-implant-301364874.html."},{"key":"4892_CR28","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1249\/01.MSS.0000113476.62469.98","volume":"36","author":"EV Cyarto","year":"2004","unstructured":"Cyarto EV, Myers AM, Tudor-Locke C. Pedometer accuracy in nursing home and community-dwelling older adults. Med Sci Sports Exerc. 2004;36:205\u20139.","journal-title":"Med Sci Sports Exerc"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04892-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-024-04892-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04892-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T03:13:29Z","timestamp":1721013209000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-024-04892-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,15]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4892"],"URL":"https:\/\/doi.org\/10.1186\/s13018-024-04892-9","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,15]]},"assertion":[{"value":"21 March 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics committee of McGill University (Sept 16, 2021; SMHC-21-05).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent was obtained by all individual participants in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"404"}}