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Randriambelonoro M, Perrin Franck C, Herrmann F, Carmona GA, Geissbuhler A, Graf C, Frangos E. Gamified Physical Rehabilitation for Older Adults With Musculoskeletal Issues: Pilot Noninferiority Randomized Clinical Trial. JMIR Rehabil Assist Technol 2023; 10:e39543. [PMID: 36877563 PMCID: PMC10029857 DOI: 10.2196/39543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/31/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization. OBJECTIVE The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues. METHODS A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps. RESULTS A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group×time interaction (SPPB_I_t1=-0.77, 95% CI -2.03 to 0.50, P=.23; SPPB_I_t2=0.21, 95% CI -1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95% CI -0.72 to 5.37, P=.13; Left: 2.43 kg, 95% CI -0.18 to 4.23, P=.07) for the patient from the intervention group was observed. CONCLUSIONS Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities. TRIAL REGISTRATION ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454.
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Affiliation(s)
- Mirana Randriambelonoro
- HI5Lab, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Caroline Perrin Franck
- HI5Lab, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François Herrmann
- Division of Rehabilitation and Geriatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Gorki Antonio Carmona
- Division of Rehabilitation and Geriatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Antoine Geissbuhler
- HI5Lab, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christophe Graf
- Division of Rehabilitation and Geriatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Emilia Frangos
- Division of Rehabilitation and Geriatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Validity of the activPAL monitor to measure stepping activity and activity intensity: A systematic review. Gait Posture 2022; 97:165-173. [PMID: 35964334 DOI: 10.1016/j.gaitpost.2022.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accumulating step counts and engaging in moderate-to-vigorous intensity physical activity is positively associated with numerous health benefits. The activPAL is a thigh-worn monitor that is frequently used to measure physical activity. RESEARCH QUESTION Can the activPAL accurately measure stepping activity and identify physical activity intensity? METHODS We systematically reviewed validation studies examining the accuracy of activPAL physical activity outcomes relative to a criterion measure in adults (>18 years). Citations were not restricted to language or date of publication. Sources were searched up to May 16, 2021 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. The study was pre-registered in Prospero (ID# CRD42021248240). Study quality was determined using a modified Hagströmer Bowles checklist. RESULTS Thirty-nine studies (20 laboratory arms, 17 semi-structured arms, 11 uncontrolled protocol arms; 1272 total participants) met the inclusion criteria. Most studies demonstrated a high validity of the activPAL to measure steps across laboratory (12/15 arms), semi-structured (10/13 arms) and uncontrolled conditions (5/7 arms). Studies that demonstrated low validity were generally conducted in unhealthy populations, included slower walking speeds, and/or short walking distances. Few studies indicated that the activPAL accurately measured physical activity intensity across laboratory (0/6 arms), semi-structured (0/5 arms) and uncontrolled conditions (2/5 arms). Using the default settings, the activPAL overestimates light-intensity activity but underestimates moderate-to-vigorous intensity activity. The overall study quality was 11.5 ± 2.0 out of 19. CONCLUSION Despite heterogeneous methodological and statistical approaches, the included studies generally provide supporting evidence that the activPAL can accurately detect stepping activity but not physical activity intensity. Strategies that use alternative data processing methods have been developed to better characterize physical activity intensity, but all methods still underestimate vigorous-intensity activity.
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Step Count in Patients With Lumbar Spinal Stenosis: Accuracy During Walking and Nonwalking Activities. Spine (Phila Pa 1976) 2022; 47:1203-1211. [PMID: 35867584 DOI: 10.1097/brs.0000000000004385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a method development and validation study. OBJECTIVES The purpose of this study was to develop and test a method for step detection using accelerometer data in patients with lumbar spinal stenosis (LSS). There are 2 objectives: (1) to describe a method for step detection from accelerations measured at the wrist, hip, lower back, thigh and ankle; (2) to assess the accuracy of the method during walking with and without walking aids and during nonwalking activities. SUMMARY OF BACKGROUND DATA Loss of walking ability is one of the main symptoms of LSS, and there is no validated measure to assess walking activity in daily living in patients with LSS. MATERIALS AND METHODS Thirty patients with LSS performed a standardized movement protocol that included walking with and without walking aids and performing nonwalking activities while wearing accelerometers on five different wear-sites. After the walking tests, a method was designed for optimal step detection and compared with a gold standard of observed step count. RESULTS The method for step detection applied to accelerations from the lower back, hip, thigh, and ankle provided an accurate step counts during continuous walking without walking aids. Accuracy diminished at all wear-sites when walking with walking aids, except the ankle. The wrist provided the most inaccurate step count, and the accelerometers on the thigh and ankle were prone to falsely detecting steps during bicycling. CONCLUSION The ankle-worn accelerometer provided the most accurate step count, but wrongly registered steps during nonwalking activities. The developed step detection method shows potential as a measure of walking activity why further development and testing under free-living conditions should be performed.
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Naughton C, Cummins H, de Foubert M, Barry F, McCullagh R, Wills T, Skelton DA, Dahly D, Palmer B, Murphy A, McHugh S, O'Mahony D, Tedesco S, O Sullivan B. Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13473.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.
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Vavasour G, Giggins OM, Moran O, Doyle J, Kelly D. Quantifying Steps During a Timed Up and Go Test Using a Wearable Sensor System: A Laboratory-Based Validation Study in Healthy Young and Older Volunteers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6945-6948. [PMID: 34892701 DOI: 10.1109/embc46164.2021.9631036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mobility is an important factor in maintaining health and independence in an aging population. Facilitating community-dwelling older adults to independently identify signs of functional decline could help reduce disability and frailty development. Step-count from a body-worn sensor system was compared with a criterion measure in healthy young (n = 10) and healthy older adults (n = 10) during a Timed Up and Go test under different conditions. Spearman's rank correlation coefficient indicated strong agreement between the sensor-obtained step-count and that of the criterion measure in both age groups, in all mobility tests. A body-worn sensor system can provide objective, quantitative measures of step-count over short distances in older adults. Future research will examine if step-count alone can be used to identify functional decline and risk of frailty.Clinical Relevance-This demonstrates the correlation between step-count derived from a wearable sensor and a criterion measure over a short distance in older adults.
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Fry BA, Singh Rajput K, Selvaraj N. Patient Ambulations Predict Hospital Readmission. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7506-7510. [PMID: 34892829 DOI: 10.1109/embc46164.2021.9629647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Improved functional ability and physical activity are strongly associated with a broad range of positive health outcomes including reduced risk of hospital readmission. This study presents an algorithm for detecting ambulations from time-resolved step counts gathered from remote monitoring of patients receiving hospital care in their homes. It examines the statistical power of these ambulations in predicting hospital readmission. A diverse demographic cohort of 233 patients of age 70.5±16.8 years are evaluated in a retrospective analysis. Eleven statistical features are derived from raw time series data, and their F-statistics are assessed in discriminating between patients who were and were not readmitted within 30 days of discharge. Using these features, logistic regression models are trained to predict readmission. The results show that the fraction of days with at least one ambulation was the strongest feature, with an F-statistic of 17.2. The models demonstrate AUROC performances of 0.741, 0.766 and 0.769 using stratified 5-fold train-test splits in all included patients (n=233), congestive heart failure (CHF, n=105) and non-CHF (n=128) patient subgroups, respectively. This study suggests that patient ambulation metrics derived from wearable sensors can offer powerful predictors of adverse clinical outcomes such as hospital readmission, even in the absence of other features such as physiological vital signs.Index Terms-readmission, ambulation, step count, heart failure, physical activity, regression, actigraphy, accelerometer.
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Digital Health Interventions among People Living with Frailty: A Scoping Review. J Am Med Dir Assoc 2021; 22:1802-1812.e21. [PMID: 34000266 DOI: 10.1016/j.jamda.2021.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population. DESIGN Scoping review with PRISMA guidelines based on Population, Concept, and Context. SETTING AND PARTICIPANTS We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science). MEASURES We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design. RESULTS We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies. CONCLUSIONS AND IMPLICATIONS There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.
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McCullagh R, Darren D, Horgan NF, Timmons S. Factors Associated With Walking in Older Medical Inpatients. Arch Rehabil Res Clin Transl 2021; 2:100038. [PMID: 33543067 PMCID: PMC7853347 DOI: 10.1016/j.arrct.2020.100038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. Design A cohort study. Setting Acute hospitalized care. Participants Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. Interventions Not applicable. Main Outcome Measures Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. Results Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (−29%, −9 to −44), and instructed bedrest (−69%, −55 to −79). Conclusion Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.
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Affiliation(s)
- Ruth McCullagh
- Centre for Gerontology and Rehabilitation, St Finbarr's Hospital, College of Medicine and Health, University College Cork, Cork
| | - Dahly Darren
- School of Public Health, College of Medicine and Health, University College Cork, Cork.,Clinical Research Facility Cork, University College Cork, Cork
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, St Finbarr's Hospital, College of Medicine and Health, University College Cork, Cork
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Carlin T, Vuillerme N. Step and Distance Measurement From a Low-Cost Consumer-Based Hip and Wrist Activity Monitor: Protocol for a Validity and Reliability Assessment. JMIR Res Protoc 2021; 10:e21262. [PMID: 33439138 PMCID: PMC7840275 DOI: 10.2196/21262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Self-tracking via wearable and mobile technologies is becoming an essential part of personal health management. At this point, however, little information is available to substantiate the validity and reliability of low-cost consumer-based hip and wrist activity monitors, with regard more specifically to the measurements of step counts and distance traveled while walking. Objective The aim of our study is to assess the validity and reliability of step and distance measurement from a low-cost consumer-based hip and wrist activity monitor specific in various walking conditions that are commonly encountered in daily life. Specifically, this study is designed to evaluate whether and to what extent validity and reliability could depend on the sensor placement on the human body and the walking task being performed. Methods Thirty healthy participants will be instructed to wear four PBN 2433 (Nakosite) activity monitors simultaneously, with one placed on each hip and each wrist. Participants will attend two experimental sessions separated by 1 week. During each experimental session, two separate studies will be performed. In study 1, participants will be instructed to complete a 2-minute walk test along a 30-meter indoor corridor under 3 walking speeds: very slow, slow, and usual speed. In study 2, participants will be required to complete the following 3 conditions performed at usual walking speed: walking on flat ground, upstairs, and downstairs. Activity monitor measured step count and distance values will be computed along with the actual step count (determined from video recordings) and distance (measured using a measuring tape) to determine validity and reliability for each activity monitor placement and each walking condition. Results Participant recruitment and data collection began in January 2020. As of June 2020, we enrolled 8 participants. Dissemination of study results in peer-reviewed journals is expected in spring 2021. Conclusions To the best of our knowledge, this is the first study that examines the validity and reliability of step and distance measurement during walking using the PBN 2433 (Nakosite) activity monitor. Results of this study will provide beneficial information on the effects of activity monitor placement, walking speed, and walking tasks on the validity and reliability of step and distance measurement. We believe such information is of utmost importance to general consumers, clinicians, and researchers. International Registered Report Identifier (IRRID) DERR1-10.2196/21262
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Affiliation(s)
- Thomas Carlin
- AGEIS, University Grenoble Alpes, Grenoble, France.,LabCom Telecom4Health, University Grenoble Alpes & Orange Labs, Grenoble, France
| | - Nicolas Vuillerme
- AGEIS, University Grenoble Alpes, Grenoble, France.,LabCom Telecom4Health, University Grenoble Alpes & Orange Labs, Grenoble, France.,Institut Universitaire de France, Paris, France
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Puppala VK, Hofeld BC, Anger A, Tyagi S, Strath SJ, Fox J, Berger MG, Ahn KW, Widlansky ME. Pacemaker detected active minutes are superior to pedometer-based step counts in measuring the response to physical activity counseling in sedentary older adults. BMC Geriatr 2020; 20:162. [PMID: 32375676 PMCID: PMC7201960 DOI: 10.1186/s12877-020-01559-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In patients with permanent pacemakers (PPM), physical activity (PA) can be monitored using embedded accelerometers to measure pacemaker detected active hours (PDAH), a strong predictor of mortality. We examined the impact of a PA Counseling (PAC) intervention on increasing activity as measured by PDAH and daily step counts. METHODS Thirteen patients (average age 80 ± 6 years, 84.6% women) with implanted Medtronic PPMs with a ≤ 2 PDAH daily average were included in this study. Patients were randomized to Usual Care (UC, N = 6) or a Physical Activity Counseling Intervention (PACI, N = 7) groups. Step count and PDAH data were obtained at baseline, following a 12-week intervention, then 12 weeks after intervention completion. Data were analyzed using independent t-tests, Pearson's r, chi-square, and general linear models for repeated measures. RESULTS PDAH significantly differed by time point for all subject combined (P = 0.01) but not by study group. Subjects with baseline gait speeds of > 0.8 m/sec were responsible for the increases in PDAH observed. Step counts did not differ over time in the entire cohort or by study group. Step count and PDAH significantly correlated at baseline (r = 0.60, P = 0.03). This correlation disappeared by week 12. CONCLUSION(S) PDAH can be used to monitor PA and PA interventions and may be superior to hip-worn pedometers in detecting activity. A significant increase in PA, regardless of treatment group, suggests that patient awareness of the ability to monitor PA through a PPM increases PA in these patients, particularly in patients with gait speeds of < 0.8 m/sec. TRIAL REGISTRATION ClincalTrials.gov NCT03052829. Date of Registration: 2/14/2017.
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Affiliation(s)
- Venkata K Puppala
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Benjamin C Hofeld
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amberly Anger
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sudhi Tyagi
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Scott J Strath
- College of Health Sciences Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Judith Fox
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcie G Berger
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang Woo Ahn
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael E Widlansky
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Pharmacology, Division of Cardiovascular Medicine, Medical College of Wisconsin, Hub for Collaborative Medicine 5th Floor 8701 W Watertown Plank Road, Milwaukee, WI, USA.
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Jeong IC, Healy R, Bao B, Xie W, Madeira T, Sussman M, Whitman G, Schrack J, Zahradka N, Hoyer E, Brown C, Searson PC. Assessment of Patient Ambulation Profiles to Predict Hospital Readmission, Discharge Location, and Length of Stay in a Cardiac Surgery Progressive Care Unit. JAMA Netw Open 2020; 3:e201074. [PMID: 32181827 PMCID: PMC7078761 DOI: 10.1001/jamanetworkopen.2020.1074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Promoting patient mobility during hospitalization is associated with improved outcomes and reduced risk of hospitalization-associated functional decline. Therefore, accurate measurement of mobility with high-information content data may be key to improved risk prediction models, identification of at-risk patients, and the development of interventions to improve outcomes. Remote monitoring enables measurement of multiple ambulation metrics incorporating both distance and speed. OBJECTIVE To evaluate novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients. DESIGN, SETTING, AND PARTICIPANTS This prognostic cohort study of the mobility of 100 patients after cardiac surgery in a progressive care unit at Johns Hopkins Hospital was performed using a real-time location system. Enrollment occurred between August 29, 2016, and April 4, 2018. Data analysis was performed from June 2018 to December 2019. MAIN OUTCOMES AND MEASURES Outcome measures included 30-day readmission, discharge location, and length of stay. Digital records of all voluntary ambulations were created where each ambulation consisted of multiple segments defined by distance and speed. Ambulation profiles consisted of 19 parameters derived from the digital ambulation records. RESULTS A total of 100 patients (81 men [81%]; mean [SD] age, 63.1 [11.6] years) were evaluated. Distance and speed were recorded for more than 14 000 segments in 840 voluntary ambulations, corresponding to a total of 127.8 km (79.4 miles) using a real-time location system. Patient ambulation profiles were predictive of 30-day readmission (sensitivity, 86.7%; specificity, 88.2%; C statistic, 0.925 [95% CI, 0.836-1.000]), discharge to acute rehabilitation (sensitivity, 84.6%; specificity, 86.4%; C statistic, 0.930 [95% CI, 0.855-1.000]), and length of stay (correlation coefficient, 0.927). CONCLUSIONS AND RELEVANCE Remote monitoring provides a high-information content description of mobility, incorporating elements of step count (ambulation distance and related parameters), gait speed (ambulation speed and related parameters), frequency of ambulation, and changes in parameters on successive ambulations. Ambulation profiles incorporating multiple aspects of mobility enables accurate prediction of clinically relevant outcomes.
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Affiliation(s)
- In cheol Jeong
- inHealth, Johns Hopkins Individualized Health Initiative, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Healy
- Department of Critical Care and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin Bao
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - William Xie
- Department of Computer Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tim Madeira
- Department of Critical Care and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc Sussman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Glenn Whitman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer Schrack
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole Zahradka
- inHealth, Johns Hopkins Individualized Health Initiative, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles Brown
- Department of Critical Care and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter C. Searson
- inHealth, Johns Hopkins Individualized Health Initiative, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland
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12
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Randriambelonoro M, Perrin C, Blocquet A, Kozak D, Fernandez JT, Marfaing T, Bolomey E, Benhissen Z, Frangos E, Geissbuhler A, Graf C. Hospital-to-Home Transition for Older Patients: Using Serious Games to Improve the Motivation for Rehabilitation – a Qualitative Study. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09274-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractTraditional physiotherapy is often perceived as repetitive and boring by patients, leading to issues in maintaining their interest and performing the required exercises. This paper investigates older patients’ engagement and motivation for physical activity using a serious game-based rehabilitation compared to a control group using a standard care therapy, during hospitalization. We conducted a randomized clinical trial with 57 geriatric patients and demonstrated that the serious game-based rehabilitation was as efficient as the standard rehabilitation program in terms of improving their functional capacity. In this paper, we mainly focus on reporting qualitative analysis of the patient’s behavior change thorough the intervention. The intervention lasted 3 weeks. Semi-structured interviews, including all the participants, were conducted before and after the intervention. Patients’ attitudes towards rehabilitation process, physical activity and innovation technology were investigated. Motivation to be active following the intervention were explored. Participants admitted feeling bored at the hospital and only following along the care process routine. Enthusiasm towards the progress brought by technological solution was observed. At the end of the hospital stay, the serious game-based rehabilitation received positive feedback. Patients felt more active and observed significant improvement of their general condition. The analysis suggests that patients participating in the gamified rehabilitation are more motivated. Several recommendations on designing serious game for elderly rehabilitation are proposed.
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Theou O, Kehler DS, Godin J, Mallery K, MacLean MA, Rockwood K. Upright time during hospitalization for older inpatients: A prospective cohort study. Exp Gerontol 2019; 126:110681. [PMID: 31382011 DOI: 10.1016/j.exger.2019.110681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/28/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to examine: a) how long and how frequently older hospitalized patients spend upright; b) whether duration and frequency of upright time change by time of the day, the day of the week, and during hospitalization; and c) whether these relationships differ based on the mobility level of patients at admission. METHODS This prospective cohort study included 111 patients (82.2 ± 8 years old, 52% female) from the Emergency Department and a Geriatric Assessment Unit who were at least 60 years old and had an anticipated length of stay of at least three days. The main outcomes were accelerometer-measured total upright time and number of bouts of upright time during awake hours. RESULTS Patients were upright 15.9 times/day (interquartile range (IQR): 8.4-27.4) for a total of 54.2 min/day (IQR: 17.8-88.9) during awake hours. Time of day and day of week had little impact on the outcomes. Patients who walked independently at admission had 151.5 min (95% CI: 87.7-215.3) of upright time on hospital day 1 and experienced a decline of 4.5 min/day (-7.2 to -1.8). Those who needed personal mobility assistance or were bedridden had 29.5 min (-38.5-97.4) and 25 min (-48.3-100.3) of upright time on day 1, and demonstrated an increase of 3.6 (1.3-5.9) and 2.4 (0.05-4.5) min/day, respectively. CONCLUSION Hospitalized older adults spend only 6% of their awake hours upright while in hospital. Patients who can walk independently are more active but experience a decline in their upright time during hospitalization.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - D Scott Kehler
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Judith Godin
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kayla Mallery
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mark A MacLean
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Tedesco S, Sica M, Ancillao A, Timmons S, Barton J, O’Flynn B. Accuracy of consumer-level and research-grade activity trackers in ambulatory settings in older adults. PLoS One 2019; 14:e0216891. [PMID: 31112585 PMCID: PMC6529154 DOI: 10.1371/journal.pone.0216891] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022] Open
Abstract
Wrist-worn activity trackers have experienced a tremendous growth lately and studies on the accuracy of mainstream trackers used by older adults are needed. This study explores the performance of six trackers (Fitbit Charge2, Garmin VivoSmart HR+, Philips Health Watch, Withings Pulse Ox, ActiGraph GT9X-BT, Omron HJ-72OITC) for estimating: steps, travelled distance, and heart-rate measurements for a cohort of older adults. Eighteen older adults completed a structured protocol involving walking tasks, simulated household activities, and sedentary activities. Less standardized activities were also included, such as: dusting, using a walking aid, or playing cards, in order to simulate real-life scenarios. Wrist-mounted and chest/waist-mounted devices were used. Gold-standards included treadmill, ECG-based chest strap, direct observation or video recording according to the activity and parameter. Every tracker showed a decreasing accuracy with slower walking speed, which resulted in a significant step under-counting. A large mean absolute percentage error (MAPE) was found for every monitor at slower walking speeds with the lowest reported MAPE at 2 km/h being 7.78%, increasing to 20.88% at 1.5 km/h, and 44.53% at 1 km/h. During household activities, the MAPE climbing up/down-stairs ranged from 8.38–19.3% and 10.06–19.01% (dominant and non-dominant arm), respectively. Waist-worn devices showed a more uniform performance. However, unstructured activities (e.g. dusting, playing cards), and using a walking aid represent a challenge for all wrist-worn trackers as evidenced by large MAPE (> 57.66% for dusting, > 67.32% when using a walking aid). Poor performance in travelled distance estimation was also evident during walking at low speeds and climbing up/down-stairs (MAPE > 71.44% and > 48.3%, respectively). Regarding heart-rate measurement, there was no significant difference (p-values > 0.05) in accuracy between trackers placed on the dominant or non-dominant arm. Concordant with existing literature, while the mean error was limited (between -3.57 bpm and 4.21 bpm), a single heart-rate measurement could be underestimated up to 30 beats-per-minute. This study showed a number of limitations of consumer-level wrist-based activity trackers for older adults. Therefore caution is required when used, in healthcare or in research settings, to measure activity in older adults.
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Affiliation(s)
- Salvatore Tedesco
- Tyndall National Institute, University College Cork, Cork, Ireland
- * E-mail:
| | - Marco Sica
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Andrea Ancillao
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - John Barton
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Brendan O’Flynn
- Tyndall National Institute, University College Cork, Cork, Ireland
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Fujika Y, Hamada H, Sekikawa K, Kajiwara T, Yamamoto H, Kamikawa N. Effect of body weight support on predicted locomotive physical activity. J Phys Ther Sci 2018; 30:759-763. [PMID: 29950760 PMCID: PMC6016286 DOI: 10.1589/jpts.30.759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/08/2018] [Indexed: 11/27/2022] Open
Abstract
[Purpose] This study aimed to evaluate the effect of body weight support with an
assistive device on predicted locomotive physical activity measured using triaxial
accelerometers in healthy young subjects. [Subjects and Methods] Sixteen healthy subjects
aged 21.9 ± 1.1 years walked on a treadmill at speeds of 45 and 55 meters/min under 0%,
10%, 20%, and 30% body weight support conditions. Predicted metabolic equivalents and
number of steps were evaluated using triaxial accelerometers. Measured metabolic
equivalents and number of steps were evaluated using a metabolic system and observers,
respectively. Raw data of synthetic accelerations were also obtained. [Results] Predicted
metabolic equivalents and number of steps and raw data of synthetic accelerations
decreased with increasing amounts of body weight support. [Conclusion] These findings
suggest that accelerometers may underestimate locomotive physical activity with increasing
amounts of body weight support using assistive devices. Thus, it is important to consider
the amount of body weight support when assessing physical activities in subjects using
assistive devices for mobility.
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Affiliation(s)
- Yoshiya Fujika
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kiyokazu Sekikawa
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Teruki Kajiwara
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Hikaru Yamamoto
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Norimichi Kamikawa
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Self-Reported Functional Mobility, Balance Confidence, and Prosthetic Use Are Associated With Daily Step Counts Among Individuals With a Unilateral Transtibial Amputation. J Phys Act Health 2018; 15:423-429. [DOI: 10.1123/jpah.2017-0196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Weeks DL, Sprint GL, Stilwill V, Meisen-Vehrs AL, Cook DJ. Implementing Wearable Sensors for Continuous Assessment of Daytime Heart Rate Response in Inpatient Rehabilitation. Telemed J E Health 2018; 24:1014-1020. [PMID: 29608421 PMCID: PMC6299796 DOI: 10.1089/tmj.2017.0306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is unclear whether wearable heart rate (HR) sensors can be worn continuously in inpatient rehabilitation to assess cardiorespiratory training response. If feasible, these sensors offer a low-cost low-maintenance method for assessing HR response in this setting. We determined feasibility of wearable sensors for assessing HR response to daytime therapy activities in inpatient rehabilitation within a cardiorespiratory training zone equal to 55-80% of maximal HR (target HR [THR]) for at least two 10-min bouts, 3-5 days per week. Secondarily, we determined episodes of excessive HR (EHR >80% of maximal HR). MATERIALS AND METHODS Subjects 44-80 years of age with diagnoses of stroke, cardiac disorders, orthopedic disorders, medically complex conditions, or pulmonary disorders wore wrist-mounted HR sensors day and night throughout inpatient rehabilitation. The proportion of subjects meeting THR thresholds and experiencing EHR episodes was quantified. Multiple regression predicted THR and EHR outcomes from age, sex, length of stay, and motor function at admission and discharge. RESULTS Across subjects, 97,800 min of HR data were analyzed. Sixty percent of subjects met THR thresholds for cardiorespiratory benefit. Age was the single significant predictor of percent of days meeting the THR threshold (R = 0.58, p = 0.024). Forty-seven percent of subjects experienced EHR episodes on at least 1 day. No subjects experienced sensor-related adverse events, and no protocol deviations occurred from inadvertent sensor removal. CONCLUSIONS Most subjects experienced HR increases sufficient to obtain cardiorespiratory benefit. Likewise, most subjects had episodes of EHR. Wearable sensors were feasible for continuously assessing HR response, suggesting expanded opportunity in inpatient rehabilitation research and treatment.
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Affiliation(s)
- Douglas L. Weeks
- Clinical Research Department, St. Luke's Rehabilitation Institute, Spokane, Washington
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Gina L. Sprint
- Department of Computer Science, Gonzaga University, Spokane, Washington
| | - Virgeen Stilwill
- Clinical Research Department, St. Luke's Rehabilitation Institute, Spokane, Washington
| | - Amy Lou Meisen-Vehrs
- Clinical Research Department, St. Luke's Rehabilitation Institute, Spokane, Washington
| | - Diane J. Cook
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, Washington
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Poier PH, Godke F, Foggiatto JA, Ulbricht L. Development and evaluation of low-cost walker with trunk support for senior citizen. Rev Esc Enferm USP 2017; 51:e03252. [PMID: 29019531 DOI: 10.1590/s1980-220x2016020103252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 04/24/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Develop and evaluate a low-cost walker with trunk support for senior citizens. METHOD Two-stage descriptive study: development of a walker with trunk support and evaluation with fourth age senior citizens. RESULTS Twenty-three fourth age senior citizens were selected. The evaluated criteria were the immediate influence of the walker on the static stabilometry with baropodometer and the evaluation of gait with accelerometers monitoring time and amplitude of the hip movement. There was a significant decrease in the body oscillation of senior citizens with the use of the developed walker, and there were changes in the joint amplitudes of the hip, but they were not significant. CONCLUSION Using low-cost materials, it was possible to develop and equipment that met resistance and effectiveness requirements. The walker interfered in the balance of the senior citizens, reducing significantly the static body oscillation.
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Affiliation(s)
- Paloma Hohmann Poier
- Universidade Tecnológica Federal do Paraná, Programa de Pós Graduação em Engenharia Mecânica e de Materiais, Curitiba, PR, Brazil
| | - Francisco Godke
- Universidade Tecnológica Federal do Paraná, Departamento de Mecânica, Curitiba, PR, Brazil
| | - José Aguiomar Foggiatto
- Universidade Tecnológica Federal do Paraná, Programa de Pós Graduação em Engenharia Mecânica e de Materiais, Curitiba, PR, Brazil
| | - Leandra Ulbricht
- Universidade Tecnológica Federal do Paraná, Programa de Pós-Graduação em Engenharia Biomédica, Curitiba, PR, Brazil
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