Wrist-Wearable Devices Can Identify Adverse Changes in Trauma Survivors

For individuals who have experienced trauma, wrist-wearable devices can be used as screening tools to identify adverse changes in pain, sleep and anxiety. These biomarkers may be used in the future to identify trauma survivors who need further evaluation, according to researchers led by Laura D. Straus, Ph.D., of the San Francisco VA Medical Center and the University of California, San Francisco Department of Psychiatry.

The findings were published in JAMA Psychiatry.

The researchers used data from wrist-wearable devices for a socioeconomically disadvantaged adult population presenting to emergency departments (EDs) after traumatic stress exposure. They noted that while most people who experience at least one traumatic event (up to 90% of individuals) recover, adverse posttraumatic neuropsychiatric sequelae (APNS), such as pain, depression, anxiety and sleep disruption, are common and can produce morbidity.

“These symptoms are associated with negative consequences, including emotional distress, functional impairments, and reduced quality of life,” the researchers noted.

The Advancing Understanding of Recovery After Trauma (AURORA) study assessed 10 common neuropsychiatric symptom domains using smartphone-based questionnaires. The survey items were administered 6 times over the first 8 weeks after the individual presented to the ED for the traumatic event. Individuals enrolled in the study had to have presented to one of 27 Eds within 72 hours of the event. The qualifying events included motor vehicle collision, physical assault, sexual assault, a fall of more than 10 feet and a mass casualty incident.

A total of 2021 patients (62.2% female) were included in the study. The mean age was 35.8 years and 50.2% were Black. The majority of participants did not have a college degree (79.3%) and earned $35,000 a year or less (64.2%). The most common traumatic experience was motor vehicle collision (75.2%).

Participants had to wear the research watch at least 21 hours a day for a total of eight weeks. A total of nine APNS biomarkers were validated. A total of seven biomarkers were associated with changes in pain symptom severity while one was associated with changes in sleep quality and one was associated with changes in anxiety.

Reduced daily activity variance was rest-activity biomarker for increased pain, while there were 6 activity-related biomarkers that changed with pain: increased maximum daily activity over time, increased average activity of the individual’s most active 10 hours, increased daily activity, increased baseline activity, increased variation in daily activity and increased peak activity. Number of transitions between sleep and wake was associated with outcomes in pain, sleep and anxiety.

“Simple biomarker or symptom change cutoffs suggest that these biomarkers might have utility as initial screening tools to identify individuals with potential good recovery in these domains who might not need further evaluation,” the authors wrote.

Among the limitations was the generalizability of these findings to people who experience trauma who do not present to the ED. In addition, with the majority of participants in this study being survivors of motor vehicle collisions, the findings might not be generalizable to survivors of other types of trauma. Since the study took place over 8 weeks, future studies are needed to examine biomarker associations with symptoms and symptom changes over a longer period of time.

Overall, the researchers noted that the wrist-wearable devices were able to provide useful information for the purposes of screening trauma survivors with high pain levels or poor pain, sleep or anxiety recovery.

“Such biomarkers might also be useful to help clinicians and patients evaluate their responses to treatment interventions for pain, sleep, or anxiety and to help patients understand how their activity, rest, and sleep affect their health,” the authors concluded.