Background/Purpose:

Although physical activity is a key component of optimal arthritis self-management, levels of physical activity typically fall below expert recommendations among persons with arthritis.[1] Wearable technologies could support persons with arthritis to be physically active; however, questions remain about potential burden that persons with arthritis may experience in the context of their daily lives if wearables are to be integrated into self-management.[2] We aim to broaden understanding of ethical issues in using wearables to support physical activity from the perspectives of persons living with arthritis.

Methods:

An exhaustive search of 5 electronic databases (including Medline, CINAHL and Embase) from inception to Jan 2018 was carried out using the SPIDER (Sample, Phenomenon of interest, Design, Evaluation, Research type). We also performed hand-searching of reference lists of included studies. Title/abstract and full-text screening were conducted independently by 4 reviewers. Qualitative studies were eligible if they examined the use of physical activity wearables from the perspectives of persons with arthritis. Eligible articles were appraised using the McMaster Critical Review Form. All relevant data were extracted from eligible articles and coded inductively with thematic analysis.

Results:

From a search yield of 4750 records, 63 were read in full and 5 papers from 4 studies met inclusion criteria. Studies were conducted in Canada, Australia, UK and Ireland. Sample included 74 persons with arthritis (62 women, 12 men, aged 43-85). 57 live with osteoarthritis and 17 live with inflammatory arthritis. At least 53 participants have some experience of using a wearable. Across the 4 studies, preliminary themes are: 1) Becoming more aware: Participants identified that use of a wearable had made them more aware of their inactivity. While some participants felt motivated to be more active, others highlighted greater awareness alone would not guarantee increased activity; 2) Seeking appropriate supports: Participants described seeking appropriate supports (e.g, written instructions) that could guide their early use of wearables, but commonly felt “limited” when these supports were not readily available; 3) Improving patient-doctor communication?: Many participants anticipated that their wearable data would better equip them to improve communication (e.g., by supporting mutual understanding during assessments) with their health professionals.

Conclusion:

Themes speak to relational ethics as they direct attention to situations within which autonomy is exercised in daily life.[3] For example, greater awareness of inactivity may empower some persons with arthritis to be more active, and some persons with arthritis may feel a sense of underachievement if their use of wearables is unaccompanied by appropriate supports. Findings also pose questions about how wearables may impact ways of respecting another’s autonomy in patient-doctor interactions.

1. Wallis J et al. Osteoarthritis Cartilage 2013; (21): 1648-59.
2. Bravata DM et al. JAMA 2007; (298): 2296-2304.
3. Austin et al. Approaches to Ethics 2003; 45-52.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/emerging-ethical-issues-in-physical-activity-monitoring-of-persons-living-with-arthritis-a-qualitative-evidence-synthesis/