1
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Liao YT, Chou YJ, Wu CT, Liu YH, Liang JT, Lai F, Shun SC. Wearable mobile health device for monitoring postoperative ambulation among patients with colorectal cancer undergoing minimally invasive surgery: A prospective comparison study. Int J Med Robot 2024; 20:e2626. [PMID: 38517612 DOI: 10.1002/rcs.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND This study aimed to evaluate the feasibility of using mHealth devices for monitoring postoperative ambulation among patients with colorectal cancer undergoing minimally invasive surgery (MIS). METHODS Patients with colorectal cancer undergoing MIS were prospectively recruited to wear mHealth devices for recording postoperative ambulation between October 2018 and January 2021. The primary outcome was the compliance by evaluating the weekly submission rate of step counts. The secondary outcome was the association of weekly step counts and postoperative length of stay. RESULTS Of 107 eligible patients, 53 patients wore mHealth devices, whereas 54 patients did not. The average weekly submission rate was 72.6% for the first month after surgery. The total step counts <4000 or >10 000 in the postoperative week one were negatively associated with postoperative length of stay (β = -2.874, p = 0.038). CONCLUSIONS mHealth devices provide an objective assessment of postoperative ambulation among patients with colorectal cancer undergoing MIS. CLINICAL TRIAL REGISTRATION NCT03277235.
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Affiliation(s)
- Yu-Tso Liao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yun-Jen Chou
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Tung Wu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsin Liu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Feipei Lai
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Shiow-Ching Shun
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University - Yangming Campus, Taipei, Taiwan
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2
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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3
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Leung T, Nahar van Venrooij LMW, Verdaasdonk EGG. Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study. JMIR Perioper Med 2022; 5:e40352. [PMID: 36512385 PMCID: PMC9795396 DOI: 10.2196/40352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake. OBJECTIVE This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery. METHODS This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range -100 to +100). RESULTS In total, 28 persons were included (n=16, 57% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and-7 (postoperative). CONCLUSIONS The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased.
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de Leeuwerk ME, Botjes M, van Vliet V, Geleijn E, de Groot V, van Wegen E, van der Schaaf M, Tuynman J, Dickhoff C, van der Leeden M. Self-monitoring of Physical Activity After Hospital Discharge in Patients Who Have Undergone Gastrointestinal or Lung Cancer Surgery: Mixed Methods Feasibility Study. JMIR Cancer 2022; 8:e35694. [PMID: 35749165 PMCID: PMC9270713 DOI: 10.2196/35694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews. Results The percentage of patients willing to participate in the study (68/90, 76%) and the final participation rate (57/90, 63%) were considered good. The retention rate was acceptable (41/57, 72%), whereas the rate of missing accelerometer data was relatively high (31%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved. Conclusions Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies.
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Affiliation(s)
- Marijke Elizabeth de Leeuwerk
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Martine Botjes
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vincent van Vliet
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Edwin Geleijn
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vincent de Groot
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Erwin van Wegen
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Rehabilitation Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Jurriaan Tuynman
- General Surgery, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands
| | - Chris Dickhoff
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands.,Cardio-Thoracic Surgery, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marike van der Leeden
- Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Ageing & Vitality, Amsterdam Movement Sciences, Amsterdam, Netherlands
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5
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Restrepo A, Saha AK, Khanna AK, Huang E, Clark CJ. Use of a Multi-Sensor Monitoring Device in an Early Post-operative Mobilization Program. Am Surg 2022; 88:1861-1867. [PMID: 35430918 DOI: 10.1177/00031348221087196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current study aimed to evaluate the validity and feasibility of using a multi-sensor device to monitor patient mobility in a large postoperative population. METHODS In this IRB-approved study, postoperative patient posture was recorded using a multi-sensor monitoring device (ViSi Mobile®) and compared with direct observations of patient physical activity. Retrospective cohort analysis of postoperative patient posture data from January to December 2019 was then performed. Patterns of postoperative mobilization were evaluated. RESULTS Multi-sensor real-time posture monitoring with the ViSi Mobile® system consistently differentiate between rest and upright posture (sensitivity and specificity, both 100%). During observation of ambulatory events, ViSi Mobile® system correctly recorded a patient's position as upright at each validation time point in 72.7% (8 of 11) of walks. Clinical data from 562 postoperative patients were linked with posture monitoring data. Median duration of posture monitoring was 64 hours (IQR 52.5) and median number of posture positions recorded per patient was 15,370 (IQR 12,685). Median duration of upright position per day was 148.6 minutes (IQR 192.8). Duration in active upright position per day was not associated with risk of readmission (P > .05). CONCLUSION Real-time posture data from a multi-sensor monitoring device (ViSi Mobile®) was shown to consistently differentiate rest and active upright position. This novel technology can provide useful insight into adherence and clinical benefit of early mobilization programs.
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Affiliation(s)
| | - Amit K Saha
- Department of Anesthesiology, 544415Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, 544415Wake Forest School of Medicine, Winston-Salem, NC, USA.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Emily Huang
- Department of Mathematics and Statistics, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Clancy J Clark
- Department of Surgery, 12279Wake Forest School of Medicine, Winston-Salem, NC
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6
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Huhn S, Axt M, Gunga HC, Maggioni MA, Munga S, Obor D, Sié A, Boudo V, Bunker A, Sauerborn R, Bärnighausen T, Barteit S. The Impact of Wearable Technologies in Health Research: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e34384. [PMID: 35076409 PMCID: PMC8826148 DOI: 10.2196/34384] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. Methods We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US $570), or obtrusive smart clothing. Results We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost <€200 (US $228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations—wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%). Conclusions Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends.
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Affiliation(s)
- Sophie Huhn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Miriam Axt
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Centre de Recherche en Santé Nouna, Nouna, Burkina Faso
| | | | - Aditi Bunker
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Harvard Center for Population and Development Studies, Cambridge, MA, United States.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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7
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Iida H, Maehira H, Mori H, Takebayashi K, Kojima M, Ueki T, Kaida S, Miyake T, Tomida K, Shimizu T, Tani M. Usefulness of measuring temporal changes in physical activity levels using an accelerometer for prediction and early detection of postoperative complications after hepatectomy. HPB (Oxford) 2022; 24:57-64. [PMID: 34158231 DOI: 10.1016/j.hpb.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This research aimed to determine whether patterns of temporal changes in activity levels can indicate postoperative complications following hepatectomy. METHODS Between December 2016 and December 2019, 147 patients wore an accelerometer to measure their physical activity levels after hepatectomy until postoperative day 7. Patterns of changes in activity levels were categorized as follows: upward slope type (n = 88), wherein activity levels gradually increased; bell curve type (n = 13), wherein activity levels initially increased but subsequently decreased; and flat type (n = 46), wherein there was no apparent increase in activity levels. Patient characteristics and postoperative complications were compared for each group. RESULTS Postoperative complications occurred in 4.5% of patients in the upward slope group, in 76.9% in the bell curve group, and in 65.2% in the flat group (p < 0.001). Surgical site infections (SSI), refractory pleural effusion, and ascites were more common in the bell curve group, while pneumonia was only observed in the flat group. CONCLUSION SSI, pleural effusion, and ascites should be considered when previously increasing activity levels decline during the postoperative period. In addition, there is a high risk of SSI and pneumonia when activity levels do not increase at all after surgery.
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Affiliation(s)
- Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Japan.
| | | | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Japan
| | | | - Masatsugu Kojima
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Tomoyuki Ueki
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Kaori Tomida
- Cancer Center, Shiga University of Medical Science Hospital, Japan
| | - Tomoharu Shimizu
- Medical Safety Section, Shiga University of Medical Science Hospital, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Japan
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Wells CI, Xu W, Penfold JA, Keane C, Gharibans AA, Bissett IP, O’Grady G. OUP accepted manuscript. BJS Open 2022; 6:6564495. [PMID: 35388891 PMCID: PMC8988014 DOI: 10.1093/bjsopen/zrac031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation. Methods A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion. Results A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety. Conclusion Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.
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Affiliation(s)
- Cameron I. Wells
- Correspondence to: Cameron Wells, Department of Surgery, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, New Zealand (e-mail:)
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - James A. Penfold
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Armen A. Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ian P. Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Greg O’Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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9
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Finley DJ, Stevens CJ, Emond JA, Batsis JA, Fay KA, Darabos C, Sacks OA, Cook SB, Lyons KD. Potential effectiveness of a surgeon-delivered exercise prescription and an activity tracker on pre-operative exercise adherence and aerobic capacity of lung cancer patients. Surg Oncol 2021; 37:101525. [PMID: 33813267 PMCID: PMC8217197 DOI: 10.1016/j.suronc.2021.101525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/10/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pre-operative exercise may improve functional outcomes for lung cancer patients, but barriers associated with cost, resources, and burden make it challenging to deliver pre-operative exercise programs. The goal of this proof-of-concept study was to determine level of moderate-vigorous physical activity (MVPA) and change in aerobic capacity after participation in a home-based pre-operative exercise intervention. MATERIALS AND METHODS Eighteen patients scheduled for surgery for suspected stage I-III lung cancer received an exercise prescription from their surgeon and wore a commercially-available device that tracked their daily MVPA throughout the pre-operative period. Descriptive statistics were used to calculate adherence to the exercise prescription. A one-sample t-test was used to explore change in aerobic capacity from baseline to the day of surgery. RESULTS Participants exhibited a mean of 20.4 (sd = 46.2) minutes of MVPA per day during the pre-operative period. On average, the sample met the goal of 30 min of MVPA on 16.4% of the days during the pre-operative period. The mean distance achieved at baseline for the 6-min walk test was 456.7 m (sd = 72.9), which increased to 471.1 m (sd = 88.4) on the day of surgery. This equates to a mean improvement of 13.8 m (sd = 37.0), but this difference was not statistically different from zero (p = 0.14). Eight of the 17 participants (47%) demonstrated a clinically significant improvement of 14 m or more. CONCLUSION A surgeon-delivered exercise prescription plus an activity tracker may promote clinically significant improvement in aerobic capacity and MVPA engagement among patients with lung cancer during the pre-operative period, but may need to be augmented with more contact with and support from practitioners over time to maximize benefits. TRIAL REGISTRATION The study protocol was registered with ClinicalTrials.gov prior to initiating participant recruitment (NCT03162718).
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Affiliation(s)
- David J Finley
- Department of Surgery, Section Thoracic Surgery, Dartmouth-Hitchcock Health, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Health, Dartmouth Centers for Health & Aging, 46 Centerra Parkway, Lebanon, NH, 03756, USA.
| | - Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - John A Batsis
- Department of Medicine, Dartmouth-Hitchcock Health, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Health, 1 Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Christian Darabos
- Information, Technology and Consulting, Dartmouth College, 4 Currier Place, Hanover, NH, 03748, USA; Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Olivia A Sacks
- Department of Surgery, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, 02118, USA.
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, 124 Main Street, Durham, NH, 03824, USA.
| | - Kathleen Doyle Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Health, 1 Medical Center Dr., Lebanon, NH, 03756, USA.
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10
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Levels of Physical Activity and Sedentary Behavior During and After Hospitalization: A Systematic Review. Arch Phys Med Rehabil 2020; 102:1368-1378. [PMID: 33347891 DOI: 10.1016/j.apmr.2020.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To systematically review and synthesize the evidence on physical activity and sedentary behavior during and after hospitalization. DATA SOURCES Electronic databases and reference lists of relevant articles were searched from 2000 to April 2020. STUDY SELECTION Studies which continuously monitored physical activity and/or sedentary behavior in hospitalized adults across 2 settings (ie, without a break in measurement between settings). Monitoring could occur from an acute to a subacute or rehabilitation hospital setting, an acute setting to home, or from a subacute or rehabilitation setting to home. DATE EXTRACTION Data extraction and methodological quality assessments were independently performed by 2 reviewers using standardized checklists. DATA SYNTHESIS A total of 15 of the 5579 studies identified were included. The studies were composed of heterogenous patient populations. All studies monitored patients with either an accelerometer and/or pedometer and reported a variety of measures, including steps per day, sedentary time, and activity counts. The majority of studies (12 of 15) showed that patients engaged in 1.3 to 5.9 times more physical activity and up to 67% less daily sedentary behavior at home after discharge from acute or subacute settings. CONCLUSIONS Patients engaged in more physical activity and less sedentary behavior at home compared to both the acute and subacute hospital settings. This may reflect the natural course of recovery or the effect of setting on activity levels. Enabling early discharge home through the implementation of home-hospitalization models may result in increased patient physical activity and reduced sedentary behavior. Further experimental studies are required investigating the effect of home-based models of care on physical activity and sedentary behavior.
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Melstrom LG, Rodin AS, Rossi LA, Fu P, Fong Y, Sun V. Patient generated health data and electronic health record integration in oncologic surgery: A call for artificial intelligence and machine learning. J Surg Oncol 2020; 123:52-60. [PMID: 32974930 DOI: 10.1002/jso.26232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
In this review, we aim to assess the current state of science in relation to the integration of patient-generated health data (PGHD) and patient-reported outcomes (PROs) into routine clinical care with a focus on surgical oncology populations. We will also describe the critical role of artificial intelligence and machine-learning methodology in the efficient translation of PGHD, PROs, and traditional outcome measures into meaningful patient care models.
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Affiliation(s)
- Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Andrei S Rodin
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Lorenzo A Rossi
- Applied AI and Data Science Department, City of Hope National Medical Center, Duarte, California, USA
| | - Paul Fu
- Department of Pediatrics, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Virginia Sun
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA.,Department of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
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