Evolving to an integrated smart self-assessment *Fatigability in Outcomes to monitor Resilience Targets in Older persons* (FORTO) measurement & monitoring platform.

Personalisation of treatment requires a balanced judgement of present health
risks or diseases and the resilience of the individual to prevent that disease
or recover from it. This judgement is now largely based on the clinical
judgement of the physician. However, in the context of frailty and
multimorbidity, judging the person*s recovery capacity can be challenging.
Muscle fatiguability appears to be a useful marker for changes in health and
recovery capacity. In this study, we aim to evaluate whether fatiguability
measured during hospital admission is a good predictor for recovery capacity in
older adults admitted to the geriatric medicine department.

Traditionally, muscle fatiguability is measured using an anologue vigorimeter.
This method requires a trained professional and is sensitive to measurement
error. This makes this method less suitable for recurrent completion in the
context of daily care at a busy clinical ward. Therefore, in this study we use
the FORTO system, which comprises of a rubber balloon connected with an app on
a smartphone and cloud platform for data storage and monitoring. The app
coaches the patient and care professional through the steps of the measurement
protocol, displays the test results and automatically stores the data.

This study aims to evaluate the predictive ability of the muscle fatiguability
test to predict recovery in older adults admitted to the department of
geriatric medicine. Recovery is defined as length of stay, daily functioning
after 3 and 6 months and mortality.

The current study is an extension to the Bedside Resilience Registry, an
ongoing study that aims to develop and validate indicators of resilience in
patients admitted to the geriatrics ward. In this ongoing study,
questionnaires are completed twice daily on mood, fatigue and mobility. Three
and six months after discharge, patients are asked to complete a brief
follow-up questionnaire via telephone. For the current FORTO study, muscle
fatiguability measurements will be added. These measurements will be conducted
twice daily during admission supervised by a researcher.

Patients who possess a smartphone and are able to independently (or with
support of a spouse or kin) complete the fatiguability test using the FORTO
system, will be asked if they are willing to continue the FORTO measurements at
home. If willing, the app will be installed on their phone and they will
receive a device to continue the measurements twice per week for one month post
discharge.

The ongoing registry has been approved as not-WMO compulsory. In that study, we
daily ask participants to complete a questionnaire. The baseline questionnaire
takes approximately 30 minutes; the follow-up questionnaires takes
approximately 10 minutes each time. For the current project, we add the
fatiguability tests, which take an additional 3-8 minutes (duration depends on
the time the patient is able to continue to squeeze, thus the tests takes
longer for a fitter patient). The questionnaires and tests are administered by
the researcher at the patients* ward. Three and six months post discharge, the
researcher will contact the patient by phone to complete a brief follow-up
questionnaire (approx 15 minutes). General data (e.g. disease history) will be
derived from the medical records to minimise the burden for the patient.
Continuation of the fatiguability measurements post discharge is optional.
Prior research with the FORTO system on our ward sowed that patients are
capable of, and can endure, completing the test with supervision of the
researcher. Patients appreciated obtaining insight in their physical recovery.
The risks are low. In case of an injury (e.g. wrist fracture) or pain (e.g.
rheumatoid arthritis) in the hands, the test will be omitted.