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The FUSE Study – Fitness band Used in Shoulder Evaluation

Completed Research
The FUSE Study (Fitness band Used in Shoulder Evaluation)


Stiffness and loss of motion are major complaints both before and after treatment of shoulder pathology.

Motion is important to overall shoulder function and patient satisfaction and is easily measured in a clinical setting. However, documentation of shoulder use in daily activities is reliant on patient rated outcomes measures.

Most of the commonly used patient rated activity measures focus on shoulder symptoms/pain and function or the difficulty in performing certain activities rather than the amount of activity engaged in by an injured shoulder 1. One shoulder questionnaire focuses on measuring how often a patient engages in certain activities 2 however this questionnaire is focused on sporting activities and does not include arm motion most common in daily living. Additionally, all patient rated outcomes measures are subject to individual biases as well as recall bias.

Fitness trackers have been utilized to overcome patient bias in activity measuring in other orthopaedic conditions including total hip arthroplasty 3,4, knee arthritis 5, and arthrogryposis 6. These have yielded important conclusions related to activity changes following intervention, or baseline activity levels that were previously not possible to accurately monitor with patient-questionnaires alone.

Fitness trackers are designed to measure the amount of step-activity that occurs during usage. Newer versions of these fitness trackers are worn on the wrist rather than the belt or foot.

Previous studies have found that activity monitors are not completely reliable in accurately monitoring step count compared to manually counting steps 7. This was found to be higher in simulated free-living activities and may be related to arm motion in the absence of steps with tracking devices worn on the wrist. In our experience, these fitness trackers record angular motion of the arm. This makes it possible for us to monitor arm usage over a number of days with normal activity with simple relatively inexpensive devices.

Research Question

We will utilize fitness tracking bands to determine the amount of daily shoulder use in shoulder pathology before and after treatment. Through this, we hope to determine the effectiveness of our treatment as well as the impact and duration of disability caused by shoulder pathology and recovery from its treatment. Fitness tracking bands will also provide important objective measures of shoulder pathology.


Our primary objective is to determine the amount of daily shoulder use in shoulder pathology before and after treatment.

The secondary objectives of the study are:

  • To determine the effectiveness of different treatments for shoulder pathology
  • To determine the timeline for expected return to normal daily activity levels.
  • To determine if there is a correlation between patient rated-outcomes measures including activity estimates and objective measurements of daily shoulder activity.


This is a prospective observational comparative study.

Study Procedure

Patients presenting to an elective orthopaedic consultation with a shoulder complaint and meeting inclusion criteria will be recruited for this Study, after having agreed with the patient information sheet and signed the consent form. Patients will wear a fitness tracking band on each wrist for seven days before and after treatment for their shoulder condition. Their treatment will not be modified for the purposes of this Study. Patient characteristics, such as age, sex, pain duration, and treatment, will also be recorded for subsequent statistical analysis. Patients will also undergo routine physical examination and complete outcomes questionnaires (Constant Score, American Shoulder and Elbow Society Scale and EuroQol).

Inclusion Criteria

  • Any patient presenting with shoulder pathology
  • Patients who are capable of and have given informed consent to their participation in the Study

Exclusion Criteria

  • Patients with bilateral shoulder pathology necessitating treatment

Study Procedure

Difference between side-to-side motion will be calculated to determine the percentage decrease motion the injured extremity has. This will then be compared to the percentage difference following treatment.

Ethics and Governance

Approved by North Shore Private Ethics Committee to be undertaken. HREC reference NSPHEC 2016-LNR-003.


Recruitment began in April 2016. Early stage data collection. Results not expected until late 2016 or early 2017 – watch this space.


  • Smith M, Calfee R, Baumgarten K, Brophy R, Wright R. Upper extremity-specific measure of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am 2012; 94(3):277-85.
  • Brophy R, Beauvais R, Jones E, Cordasco F, Marx R. Measurement of shoulder activity level. Clin Orthop Relat Res 2005;439:101-8.
  • Kuhn M, Harris-Hayes M, Steger-May K, Pashos G, Clohisy J. Total hip arthroplasty in patients 50 years or less: Do we improve activity profiles. J Arthroplasty 2013;28(5):872-6.
  • Zahiri C, Schmalzried T, Szuszczewicz E, Amstutz H. Assessing activity in joint replacement patients. J Arthorplasty 1998;13(8):890-5.
  • Verlaan L, Bolink S, Van Laarhoven S, Lipperts M, Heyligers I, Grimm B, Senden R. Accelerometer-based physical activity monitoring in patients with knee osteoarthritis: objective and ambulatory assessment of actual physical activity during daily life circumstances. The Open Biomedical Engineering Journal. 2015;9:157-63.
  • Braun S, Dillon E, Sheiko M, Kang M, Bjornson K, Song K. Reliably estimating ambulatory activity in youth with arthrogryposis. Disability and Rehabilitation. 2015 Jul; early online.
  • Hickey A, John D, Sasaki J, Mavilia M, Freedson P. Validity of activity monitor step detection is related to movement patterns. J Phys Act Health. 2015 Jun 23; [Epub ahead of print].
  • Storm F, Heller B, Mazza C. Step detection and activity recognition accuracy of seven physical activity monitors. PLOS one. 2015 March.


Lead Investigator:

Dr Benjamin Cass






Shoulder and Elbow Society of Australia Meeting, 2018


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