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Bartos O, Trenner M. Wearable technology in vascular surgery: Current applications and future perspectives. Semin Vasc Surg 2024; 37:281-289. [PMID: 39277343 DOI: 10.1053/j.semvascsurg.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/17/2024]
Abstract
The COVID-19 pandemic exposed the vulnerabilities of global health care systems, underscoring the need for innovative solutions to meet the demands of an aging population, workforce shortages, and rising physician burnout. In recent years, wearable technology has helped segue various medical specialties into the digital era, yet its adoption in vascular surgery remains limited. This article explores the applications of wearable devices in vascular surgery and explores their potential outlets, such as enhancing primary and secondary prevention, optimizing perioperative care, and supporting surgical training. The integration of artificial intelligence and machine learning with wearable technology further expands its applications, enabling predictive analytics, personalized care, and remote monitoring. Despite the promising prospects, challenges such as regulatory complexities, data security, and interoperability must be addressed. As the digital health movement unfolds, wearable technology could play a pivotal role in reshaping vascular surgery while offering cost-effective, accessible, and patient-centered care.
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Affiliation(s)
- Oana Bartos
- Department of Vascular Medicine, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Matthias Trenner
- Department of Vascular Medicine, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany; School of Medicine, Technical University of Munich, Munich, Germany.
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Stevenin G, Canonge J, Gervais M, Fiore A, Lareyre F, Touma J, Desgranges P, Raffort J, Sénémaud J. e-Health and environmental sustainability in vascular surgery. Semin Vasc Surg 2024; 37:333-341. [PMID: 39277350 DOI: 10.1053/j.semvascsurg.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/17/2024]
Abstract
e-Health technology holds great promise for improving the management of patients with vascular diseases and offers a unique opportunity to mitigate the environmental impact of vascular care, which remains an under-investigated field. The innovative potential of e-Health operates in a complex environment with finite resources. As the expansion of digital health will increase demand for devices, contributing to the environmental burden of electronics and energy use, the sustainability of e-Health technology is of crucial importance, especially in the context of increasing prevalence of cardiovascular diseases. This review discusses the environmental impact of care related to vascular surgery and e-Health innovation, the potential of e-Health technology to mitigate greenhouse gas emissions generated by the health care sector, and to provide leads to research promoting e-Heath technology sustainability. A multifaceted approach, including ethical design, validated eco-audits methodology and reporting standards, technological refinement, electronic and medical devices reuse and recycling, and effective policies is required to provide a sustainable and optimal level of care to vascular patients.
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Affiliation(s)
- Gabrielle Stevenin
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Jennifer Canonge
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Marianne Gervais
- Université Paris-Est, Créteil, France; Institut Mondor de Recherche Biomédicale, U955 INSERM, Créteil, France
| | - Antonio Fiore
- Université Paris-Est, Créteil, France; Department of Cardiac Surgery, Henri Mondor University Hospital, Créteil, France
| | - Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France,; Université Côte d'Azur, Le Centre National de la Recherche Scientifique, UMR7370, LP2M, Nice, France; Fédération Hospitalo-Universitaire Plan&Go, Nice, France
| | - Joseph Touma
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Juliette Raffort
- Université Côte d'Azur, Le Centre National de la Recherche Scientifique, UMR7370, LP2M, Nice, France; Fédération Hospitalo-Universitaire Plan&Go, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France
| | - Jean Sénémaud
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France; Laboratory for Vascular Translational Science, U1148 INSERM, Paris, France.
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Rezvani F, Heider D, König HH, Herbarth L, Steinisch P, Schuhmann F, Böbinger H, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, Härter M, Dirmaier J. Telephone Health Coaching and Remote Exercise Monitoring (TeGeCoach) in Peripheral Arterial Occlusive Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:323-330. [PMID: 38269534 DOI: 10.3238/arztebl.m2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Supervised exercise programs are used to treat intermittent claudication (IC). Home-based exercise programs have been developed to lower barriers to participation. We studied the effects of one such exercise program (TeGeCoach) on self-reported walking ability in patients with IC. METHODS In a pragmatic multicenter randomized controlled trial (registration number NCT03496948), 1982 patients with symp - tomatic IC insured by one of three German statutory health insurance funds received either telephone health coaching with remote exercise monitoring (TeGeCoach; n = 994) or routine care (n = 988). The primary outcome was the change in Walking Impairment Questionnaire (WIQ) scores after 12 and 24 months in the intention-to-treat population. The secondary outcomes were healthrelated quality of life, symptoms of depression or anxiety, health competence, patient activation, alcohol use, and nicotine depen - dence. RESULTS There was a significant group difference in WIQ score in favor of TeGeCoach (p < 0.0001), amounting to 6.30 points at 12 months (Bonferroni-corrected 95% CI [4.02; 8.59], Cohen's d = 0.26) and 4.55 points at 24 months ([2.20; 6.91], d = 0.19). Some of the secondary outcomes also showed positive results in favor of TeGeCoach at 12 months with small effect sizes (d ≥ 0.20), including physical health-related quality of life and patient activation. The average daily step count was not higher in the TeGeCoach group. CONCLUSION Significant improvements regarding symptom burden demonstrate the benefit of a home-based exercise program and thus expand the opportunities for guideline-oriented treatment of IC. Future studies should additionally address the effect of home-based exercise programs on clinical variables by means of, for example, the 6-minute walk test.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf; KKH Health Insurance Fund, Hanover; TK Technicians' Health Insurance Fund, Hamburg; mhplus Health Insurance Fund, Ludwigsburg; IEM GmbH, Aachen; Philips GmbH Market DACH, Hamburg; Robert Bosch Society for Medical Research, Bosch Health Campus GmbH, Stuttgart
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Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise therapy for chronic symptomatic peripheral artery disease. Eur Heart J 2024; 45:1303-1321. [PMID: 38461405 DOI: 10.1093/eurheartj/ehad734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.
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Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Ch. de Mont-Paisible 18, Lausanne 1011, Switzerland
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, France
- EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Center of Cardiology, Department of Cardiology III-Angiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Ch. de Mont-Paisible 18, Lausanne 1011, Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University, Bratislava, Slovakia
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
- INSERM CIC 1414, Université de Rennes, Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
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Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise therapy for chronic symptomatic peripheral artery disease. VASA 2024; 53:87-108. [PMID: 38461401 DOI: 10.1024/0301-1526/a001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.
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Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Centre, Helsinki University Hospital, Finland
- University of Helsinki, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, France
- EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Centre of Cardiology, Department of Cardiology III-Angiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University, Bratislava, Slovakia
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, France
- INSERM CIC 1414, Université de Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
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Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise Therapy for Chronic Symptomatic Peripheral Artery Disease: A Clinical Consensus Document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in Collaboration With the European Society of Vascular Medicine and the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2024; 67:S1078-5884(24)00011-X. [PMID: 38467522 DOI: 10.1016/j.ejvs.2024.01.009] [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: 03/13/2024]
Abstract
All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.
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Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland.
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki; Department of Vascular Surgery, University of Helsinki, Helsinki
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital; EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Centre of Cardiology, Department of Cardiology III-Angiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University; National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France; INSERM CIC 1414, Université de Rennes, Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
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Longhini J, Marzaro C, Bargeri S, Palese A, Dell'Isola A, Turolla A, Pillastrini P, Battista S, Castellini G, Cook C, Gianola S, Rossettini G. Wearable Devices to Improve Physical Activity and Reduce Sedentary Behaviour: An Umbrella Review. SPORTS MEDICINE - OPEN 2024; 10:9. [PMID: 38219269 PMCID: PMC10788327 DOI: 10.1186/s40798-024-00678-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic. OBJECTIVE We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults. METHODS We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size. RESULTS Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as 'critically low methodological quality'. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627-1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals). CONCLUSIONS Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components.
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Affiliation(s)
- Jessica Longhini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alvisa Palese
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrea Dell'Isola
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Battista
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Chad Cook
- Department of Orthopaedics, Division of Physical Therapy, Duke University, Durham, NC, USA
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Verona, Italy
- Department of Human Neurosciences, University of Roma "Sapienza Roma", Rome, Italy
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón 28670, Spain
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Aronow WS, Avanesova AA, Frishman WH, Shamliyan TA. Inconsistent Benefits From Mobile Information Communication Technology in Adults With Peripheral Arterial Disease. Cardiol Rev 2024; 32:12-17. [PMID: 35674708 DOI: 10.1097/crd.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Quality of evidence regarding telemedicine in adults with peripheral arterial disease has not been systematically appraised. OBJECTIVES To explore benefits and harms from mobile information communication technology devices and applications in peripheral arterial disease. METHODS Systematic rapid evidence review and appraisal with the grading of recommendations assessment, development, and evaluation working group approach. RESULTS Sixteen randomized controlled clinical trials (RCT) examined various self-monitoring devices, telemedicine platforms, and individualized telephone counseling. Low-quality evidence suggested that the odds of treatment failure (pooled Peto odds ratio 0.8; 95% CI, 0.4-1.7; 5 RCTs), adverse effects (pooled Peto odds ratio 0.9; 95% CI, 0.5-1.5; 2 RCTs), and physical performance (standardized mean difference in 6-minute walking test 0.2; 95% CI, -0.3-0.7; 4 RCTs) did not differ between mobile interventions and usual care. Single RCTs suggested large but inconsistent improvement in the quality of life: EuroQol5D standardized mean difference = 5.0 (95% CI, 4.4-5.7; 1 RCT) after telehealth program for promoting patient self-management and standardized mean difference = 1.4 (95% CI, 0.4-2.3; 1 RCT) after structured rehabilitation with mobile self-monitoring. Inconsistent reporting of patient-centered outcomes and small sample sizes hampered the quality of evidence. CONCLUSIONS Improved quality of life after specific mobile applications should be confirmed in powered RCTs and large postmarketing studies.
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Affiliation(s)
- Wilbert S Aronow
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Anna A Avanesova
- North-Caucasus Federal University, Stavropol, Russian Federation
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Gardner AW, Montgomery PS, Wang M, Liang M. Effects of Long-Term Home Exercise in Participants With Peripheral Artery Disease. J Am Heart Assoc 2023; 12:e029755. [PMID: 37929770 PMCID: PMC10727372 DOI: 10.1161/jaha.122.029755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background This randomized controlled trial compared long-term changes in peak walking time (PWT) and exercise time-to-minimum calf muscle oxygen saturation (StO2) in symptomatic participants with peripheral artery disease following a long-term home exercise program (HEP), a short-term supervised exercise therapy (SET) program that transitioned to a long-term HEP (SET/HEP), and a control intervention. Methods and Results For the first 3 months, HEP and SET/HEP groups performed intermittent walking to mild-to-moderate claudication pain, whereas the control group performed light resistance training. For the subsequent 15 months, the HEP group continued their exercise program, the SET/HEP group transitioned from SET to the HEP program, and the control group transitioned to only receive walking advice. PWT increased significantly from baseline to month 18 in the HEP group (408±279 meters to 814±393 meters, P<0.001) and in the SET/HEP group (457±288 meters to 818±313 meters, P<0.001). Exercise time-to-minimum calf muscle StO2 increased significantly from baseline to month 18 in the HEP group (238±241 seconds to 497±485 seconds, P<0.05) and in the SET/HEP group (296±289 seconds to 620±450 seconds, P<0.001). These changes in PWT and exercise time-to-minimum calf muscle StO2 were greater than in the control group (P<0.001 and P<0.01, respectively). Additionally, the change in exercise time-to-minimum calf muscle StO2 was correlated with the change in PWT in both exercise groups combined (r=0.601, P=0.0015). Conclusions Long-term HEP and SET/HEP were efficacious in improving PWT and exercise time-to-minimum calf muscle StO2 in symptomatic participants with peripheral artery disease, and these changes were correlated with each other. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00618670.
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Affiliation(s)
| | | | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of MedicineCase Western Reserve UniversityClevelandOHUSA
| | - Menglu Liang
- Department of Epidemiology and Biostatistics, School of Public HealthUniversity of MarylandCollege ParkMDUSA
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Sandberg A, Nordanstig J, Cider Å, Jivegård L, Hagströmer M, Bäck M. The Impact of Nordic Pole Walk Advice Alone or in Combination With Exercise Strategies on Daily Physical Activity in Patients With Intermittent Claudication: A Randomized Clinical Trial. Phys Ther 2023; 103:pzad086. [PMID: 37459237 PMCID: PMC10630612 DOI: 10.1093/ptj/pzad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/21/2023] [Accepted: 05/22/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication. METHODS In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30 min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7 days at baseline and at 3, 6, and 12 months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30 minutes and >60 minutes. RESULTS At 1 year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3 months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (-3.20 [SD = 6.24] min). At 6 months, the number of sitting bouts (>60 min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] vs -0.23 [SD = 0.81]). CONCLUSION This study indicates that the addition of 6 months of HSEP or SEP does not improve PA at 1 year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation. IMPACT At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
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Affiliation(s)
- Anna Sandberg
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Cider
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jivegård
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Health Technology Assessment Centre Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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12
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Lareyre F, Nasr B, Chaudhuri A, Di Lorenzo G, Carlier M, Raffort J. Comprehensive Review of Natural Language Processing (NLP) in Vascular Surgery. EJVES Vasc Forum 2023; 60:57-63. [PMID: 37822918 PMCID: PMC10562666 DOI: 10.1016/j.ejvsvf.2023.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/13/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
Objective The use of Natural Language Processing (NLP) has attracted increased interest in healthcare with various potential applications including identification and extraction of health information, development of chatbots and virtual assistants. The aim of this comprehensive literature review was to provide an overview of NLP applications in vascular surgery, identify current limitations, and discuss future perspectives in the field. Data sources The MEDLINE database was searched on April 2023. Review methods The database was searched using a combination of keywords to identify studies reporting the use of NLP and chatbots in three main vascular diseases. Keywords used included Natural Language Processing, chatbot, chatGPT, aortic disease, carotid, peripheral artery disease, vascular, and vascular surgery. Results Given the heterogeneity of study design, techniques, and aims, a comprehensive literature review was performed to provide an overview of NLP applications in vascular surgery. By enabling identification and extraction of information on patients with vascular diseases, such technology could help to analyse data from healthcare information systems to provide feedback on current practice and help in optimising patient care. In addition, chatbots and NLP driven techniques have the potential to be used as virtual assistants for both health professionals and patients. Conclusion While Artificial Intelligence and NLP technology could be used to enhance care for patients with vascular diseases, many challenges remain including the need to define guidelines and clear consensus on how to evaluate and validate these innovations before their implementation into clinical practice.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
- Université Côte d'Azur, Inserm, U1065, C3M, Nice, France
| | - Bahaa Nasr
- Department of Vascular and Endovascular Surgery, Brest University Hospital, Brest, France
- INSERM, UMR 1101, LaTIM, Brest, France
| | - Arindam Chaudhuri
- Bedfordshire - Milton Keynes Vascular Centre, Bedfordshire Hospitals, NHS Foundation Trust, Bedford, UK
| | - Gilles Di Lorenzo
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
| | - Mathieu Carlier
- Department of Urology, University Hospital of Nice, Nice, France
| | - Juliette Raffort
- Université Côte d'Azur, Inserm, U1065, C3M, Nice, France
- Institute 3IA Côte d’Azur, Université Côte d’Azur, France
- Clinical Chemistry Laboratory, University Hospital of Nice, France
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13
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Twomey A, Khan Z. Home-Based Exercise Therapy in the Management of Intermittent Claudication: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e39206. [PMID: 37384085 PMCID: PMC10294279 DOI: 10.7759/cureus.39206] [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] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
The current literature strongly supports the use of supervised exercise therapy (SET) as the first-line treatment for symptomatic peripheral arterial disease (PAD) such as intermittent claudication (IC). However, this form of treatment remains underutilised in clinical practice. The home-based exercise therapy (HBET), in which patients must conduct themselves unsupervised is generally less effective than SET in terms of improving functional walking capacity. Nevertheless, it may be a useful alternative where SET is unavailable. The objective of this systematic review is to determine the effectiveness of HBET in reducing symptoms of IC in patients with PAD. Studies eligible for inclusion in this systematic review were parallel-group randomised controlled trials (RCTs) published in the English language that compared the effect of HBET to a comparator arm (SET or no exercise/attention control) in adults with PAD and IC. Studies were eligible if outcome measures were available at baseline and at 12 weeks of follow-up or more. The electronic databases PubMed, Google Scholar, and the Cochrane Library were searched from the earliest records up to January 2021. The Cochrane Collaboration risk of bias tool for RCTs (RoB 2) was used to assess the risk of bias in individual studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification system was used to appraise the quality of evidence for each outcome across all studies. The primary investigator independently collected, pooled, and analysed the data. The data was then entered into the ReviewManager 5 (RevMan 5) software, and a meta-analysis was performed by using a fixed or random effects model depending on the presence or absence of statistical heterogeneity. The review author identified seven RCTs involving a total of 754 patients which were included in this study. Overall, the risk of bias in the included studies was moderate. Even though the results were variable, this analysis supported the ability of HBET to improve functional walking capacity and self-reported quality of life (QoL) to an extent. This review shows that a home-based exercise intervention with regular professional support and encouragement is beneficial in improving functional walking capacity as well as some aspects of QoL in patients with PAD and IC when compared to no exercise. However, when HBET is compared to hospital-based supervised exercise intervention, SET yields greater benefits.
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Affiliation(s)
- Alice Twomey
- Podiatry, Homerton University Hospital NHS Foundation Trust, London, GBR
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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14
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Sivagangan P, Harwood AE, Stather PW. Patient and Healthcare Professional Priorities for a Mobile Phone Application for Patients With Peripheral Arterial Disease. Cureus 2023; 15:e33993. [PMID: 36824553 PMCID: PMC9941040 DOI: 10.7759/cureus.33993] [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] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Supervised exercise therapy (SET) is the first-line treatment for the peripheral arterial disease (PAD), however, access and compliance are low. An alternative method of delivering this therapy is through mobile health applications, which can be more accessible and convenient for patients. The aim of this study is to evaluate patient, public and healthcare professional (HCP) priorities with regard to a dedicated mobile phone application to deliver remote SET. Methods Bespoke questionnaires were designed for patients and HCPs to assess app functionality and prioritisations for development. These were distributed through social media and the Norfolk and Norwich University Hospital. Results Functionality questionnaires were completed by 62 patients and 44 HCPs. Eighty-four per cent of patients wanted their therapy to be monitored by their vascular team with the majority (78%) interested in measuring walking distances. Most patients (76%) were interested in watching exercise videos. These views were shared by HCPs. A communication platform was prioritised for messaging and pictures by the patient (74% and 68% respectively), but not so by HCPs (40%). Documenting other forms of physical activity and the use of wearable technology was less valuable to patients but favoured by HCPs (50%). The ability to interact with other users was not prioritised by either group. Conclusion Delivery of a mobile phone application to deliver health programmes for SET in patients with PAD is an acceptable method for patients and HCPs. This data will enable the next stages of mobile phone application development to be appropriately prioritised, focusing on building exercise videos, a communication platform and further walking tests.
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Affiliation(s)
| | - Amy E Harwood
- Centre for Sports, Exercise and Life Sciences, Coventry University, Coventry, GBR
| | - Philip W Stather
- Vascular Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
- Norwich Medical School, University of East Anglia, Norwich, GBR
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15
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Alam S, Zhang M, Harris K, Fletcher LM, Reneker JC. The Impact of Consumer Wearable Devices on Physical Activity and Adherence to Physical Activity in Patients with Cardiovascular Disease: A Systematic Review of Systematic Reviews and Meta-Analyses. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sabrina Alam
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
| | - Mengna Zhang
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
| | - Kisa Harris
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
| | - Lauren M. Fletcher
- Rowland Medical Library; University of Mississippi Medical Center, Jackson, Mississippi, USA
- John D. Rockefeller Library, Brown University, Providence, Rhode Island, USA
| | - Jennifer C. Reneker
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
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16
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Thanigaimani S, Jin H, Silva MT, Golledge J. Network Meta-Analysis of Trials Testing If Home Exercise Programs Informed by Wearables Measuring Activity Improve Peripheral Artery Disease Related Walking Impairment. SENSORS (BASEL, SWITZERLAND) 2022; 22:8070. [PMID: 36298419 PMCID: PMC9611238 DOI: 10.3390/s22208070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Background: This study aimed to investigate whether home exercise programs informed by wearable activity monitors improved walking ability of patients with peripheral artery disease (PAD). Methods: A systematic literature search was performed to identify randomised controlled trials (RCT) testing home exercise that were or were not informed by wearable activity monitors. The primary outcome was the change in walking distance measured by a six-minute walking test or treadmill test over the course of the trial. Network meta-analysis (NMA) was performed using the gemtc R statistical package. The risk of bias was assessed using Cochrane tool for assessing risk of bias in RCTs (RoB 2.0). Results: A total of 14 RCTs involving 1544 participants were included. Nine trials used wearable activity monitors to inform the home exercise program tested, while five trials did not use wearable activity monitors to inform the home exercise program tested. Overall quality assessment showed 12 trials to be at low risk of bias and two trials at high risk of bias. Home exercise programs informed by wearable activity monitors significantly improved walking distance compared to non-exercise controls (Mean difference, MD: 32.8 m [95% credible interval, CrI: 6.1, 71.0]) but not compared to home exercise programs not informed by wearable activity monitors (MD: 4.7 m [95% CrI: -38.5, 55.4]). Conclusions: Home exercise informed by wearable activity monitors improve walking ability of patients with PAD. It is, however, unclear if activity monitoring informed exercise programs are more effective than exercise programs not using activity monitors.
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Affiliation(s)
- Shivshankar Thanigaimani
- The Queensland Research Centre for Peripheral Vascular Disease (QRC-PVD), College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - Harry Jin
- The Queensland Research Centre for Peripheral Vascular Disease (QRC-PVD), College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD 4814, Australia
| | - Munasinghe Tharindu Silva
- The Queensland Research Centre for Peripheral Vascular Disease (QRC-PVD), College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD 4814, Australia
| | - Jonathan Golledge
- The Queensland Research Centre for Peripheral Vascular Disease (QRC-PVD), College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD 4814, Australia
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17
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De Santis KK, Jahnel T, Matthias K, Mergenthal L, Al Khayyal H, Zeeb H. Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review. JMIR Public Health Surveill 2022; 8:e37820. [PMID: 35604757 PMCID: PMC9171604 DOI: 10.2196/37820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Background Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated. Objective We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies. Methods A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data. Results Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews. Conclusions The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field. International Registered Report Identifier (IRRID) RR2-10.2196/35332
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.,Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany
| | - Tina Jahnel
- Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany.,Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Lea Mergenthal
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Hatem Al Khayyal
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.,Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany.,Faculty of Engineering and Mathematics, Bielefeld University of Applied Science, Bielefeld, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.,Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany.,Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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18
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Building your Peripheral Artery Disease Tool Kit: Medical Management of PAD in 2022. Can J Cardiol 2022; 38:634-644. [DOI: 10.1016/j.cjca.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 12/24/2022] Open
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19
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Denton F, Power S, Waddell A, Birkett S, Duncan M, Harwood A, McGregor G, Rowley N, Broom D. Is It Really Home-Based? A Commentary on the Necessity for Accurate Definitions across Exercise and Physical Activity Programmes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179244. [PMID: 34501833 PMCID: PMC8431042 DOI: 10.3390/ijerph18179244] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
Background: There is wide discrepancy in how published research defines and reports home-based exercise programmes. Studies consisting of fundamentally different designs have been labelled as home-based, making searching for relevant literature challenging and time consuming. This issue has been further highlighted by an increased demand for these programmes following the COVID-19 pandemic and associated government-imposed lockdowns. Purpose: To examine what specifically constitutes home-based exercise by: (1) developing definitions for a range of terms used when reporting exercise and physical activity programmes and (2) providing examples to contextualise these definitions for use when reporting exercise and physical activity programmes. Methods: A literature search was undertaken to identify previous attempts to define home-based exercise programmes. A working document, including initial definitions and examples were developed, which were then discussed between six experts for further refinement. Results: We generated definitions for universal key terms within three domains (and subdomains) of programme design: location (home-based, community/centre-based, or clinical setting), prescription (structured or unstructured) and delivery (supervised, facilitated, or unsupervised). Examples for possible combinations of design terms were produced. Conclusions: Definitions will provide consistency when using reporting tools and the intention is to discuss the issues presented as part of a Delphi study. This is of paramount importance due to the predicted increase in emerging research regarding home-based exercise.
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Affiliation(s)
- Francesca Denton
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
| | - Sofie Power
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
| | - Alexander Waddell
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
| | - Stefan Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston PR1 2HE, UK;
| | - Michael Duncan
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
| | - Amy Harwood
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
| | - Gordon McGregor
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Nikita Rowley
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
| | - David Broom
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK; (F.D.); (S.P.); (A.W.); (M.D.); (A.H.); (G.M.); (N.R.)
- Correspondence:
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