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Tumuhimbise W, Theuring S, Kaggwa F, Atukunda EC, Rubaihayo J, Atwine D, Sekandi JN, Musiimenta A. Enhancing the Implementation and Integration of mHealth Interventions in Resource-Limited Settings: A Scoping Review. RESEARCH SQUARE 2024:rs.3.rs-4757157. [PMID: 39070627 PMCID: PMC11275990 DOI: 10.21203/rs.3.rs-4757157/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions. Methods We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions. Results We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged. Conclusion The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings.
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Affiliation(s)
- Wilson Tumuhimbise
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara Uganda
| | - Stefanie Theuring
- Institute of International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Fred Kaggwa
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara Uganda
| | - Esther C Atukunda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara Uganda
| | - John Rubaihayo
- Faculty of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | | | | | - Angella Musiimenta
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara Uganda, Angels Compassion Research and Development Initiative, Mbarara Uganda
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Miller AE, Lang CE, Bland MD, Lohse KR. Quantifying the effects of sleep on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment. J Neuroeng Rehabil 2024; 21:86. [PMID: 38807245 PMCID: PMC11131201 DOI: 10.1186/s12984-024-01384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite the promise of wearable sensors for both rehabilitation research and clinical care, these technologies pose significant burden on data collectors and analysts. Investigations of factors that may influence the wearable sensor data processing pipeline are needed to support continued use of these technologies in rehabilitation research and integration into clinical care settings. The purpose of this study was to investigate the effect of one such factor, sleep, on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment and across a two-day wearing period. METHODS This was a secondary analysis of data collected during a prospective, longitudinal cohort study (n = 127 individuals, 62 with upper limb impairment and 65 without). Participants wore a wearable sensor on each wrist for 48 h. Five upper limb sensor variables were calculated over the full wear period (sleep included) and with sleep time removed (sleep excluded): preferred time, non-preferred time, use ratio, non-preferred magnitude and its standard deviation. Linear mixed effects regression was used to quantify the effect of sleep on each sensor variable and determine if the effect differed between people with and without upper limb impairment and across a two-day wearing period. RESULTS There were significant differences between sleep included and excluded for the variables preferred time (p < 0.001), non-preferred time (p < 0.001), and non-preferred magnitude standard deviation (p = 0.001). The effect of sleep was significantly different between people with and without upper limb impairment for one variable, non-preferred magnitude (p = 0.02). The effect of sleep was not substantially different across wearing days for any of the variables. CONCLUSIONS Overall, the effects of sleep on sensor-derived variables of upper limb accelerometry are small, similar between people with and without upper limb impairment and across a two-day wearing period, and can likely be ignored in most contexts. Ignoring the effect of sleep would simplify the data processing pipeline, facilitating the use of wearable sensors in both research and clinical practice.
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Affiliation(s)
- Allison E Miller
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA.
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [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: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Weaver RG, White J, Finnegan O, Nelakuditi S, Zhu X, Burkart S, Beets M, Brown T, Pate R, Welk GJ, de Zambotti M, Ghosal R, Wang Y, Armstrong B, Adams EL, Reesor-Oyer L, Pfledderer CD, Bastyr M, von Klinggraeff L, Parker H. A Device Agnostic Approach to Predict Children's Activity from Consumer Wearable Accelerometer Data: A Proof-of-Concept Study. Med Sci Sports Exerc 2024; 56:370-379. [PMID: 37707503 PMCID: PMC10841245 DOI: 10.1249/mss.0000000000003294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
INTRODUCTION This study examined the potential of a device agnostic approach for predicting physical activity from consumer wearable accelerometry compared with a research-grade accelerometry. METHODS Seventy-five 5- to 12-year-olds (58% male, 63% White) participated in a 60-min protocol. Children wore wrist-placed consumer wearables (Apple Watch Series 7 and Garmin Vivoactive 4) and a research-grade device (ActiGraph GT9X) concurrently with an indirect calorimeter (COSMED K5). Activity intensities (i.e., inactive, light, moderate-to-vigorous physical activity) were estimated via indirect calorimetry (criterion), and the Hildebrand thresholds were applied to the raw accelerometer data from the consumer wearables and research-grade device. Epoch-by-epoch (e.g., weighted sensitivity, specificity) and discrepancy (e.g., mean bias, absolute error) analyses evaluated agreement between accelerometry-derived and criterion estimates. Equivalence testing evaluated the equivalence of estimates produced by the consumer wearables and ActiGraph. RESULTS Estimates produced by the raw accelerometry data from ActiGraph, Apple, and Garmin produced similar criterion agreement with weighted sensitivity = 68.2% (95% confidence interval (CI), 67.1%-69.3%), 73.0% (95% CI, 71.8%-74.3%), and 66.6% (95% CI, 65.7%-67.5%), respectively, and weighted specificity = 84.4% (95% CI, 83.6%-85.2%), 82.0% (95% CI, 80.6%-83.4%), and 75.3% (95% CI, 74.7%-75.9%), respectively. Apple Watch produced the lowest mean bias (inactive, -4.0 ± 4.5; light activity, 2.1 ± 4.0) and absolute error (inactive, 4.9 ± 3.4; light activity, 3.6 ± 2.7) for inactive and light physical activity minutes. For moderate-to-vigorous physical activity, ActiGraph produced the lowest mean bias (1.0 ± 2.9) and absolute error (2.8 ± 2.4). No ActiGraph and consumer wearable device estimates were statistically significantly equivalent. CONCLUSIONS Raw accelerometry estimated inactive and light activity from wrist-placed consumer wearables performed similarly to, if not better than, a research-grade device, when compared with indirect calorimetry. This proof-of-concept study highlights the potential of device-agnostic methods for quantifying physical activity intensity via consumer wearables.
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Affiliation(s)
| | | | | | | | | | | | | | - Trey Brown
- University of South Carolina, Columbia, SC
| | - Russ Pate
- University of South Carolina, Columbia, SC
| | | | | | | | - Yuan Wang
- University of South Carolina, Columbia, SC
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Bland MD, Holleran CL, Newman CA, Fahey M, Nordahl TJ, DeAngelis TR, Ellis TD, Reisman DS, Earhart GM, Lang CE. ICF classification of therapeutic goals for outpatient episodes of neurorehabilitation in post-stroke and Parkinson disease. Disabil Rehabil 2023:1-7. [PMID: 38059563 PMCID: PMC11156790 DOI: 10.1080/09638288.2023.2290201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF). MATERIALS AND METHODS Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life. RESULTS 776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life. CONCLUSIONS While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this.
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Affiliation(s)
- Marghuretta D Bland
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Carey L Holleran
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | - Teresa D Ellis
- Department of Physical Therapy, Boston University, Boston, MA
| | - Darcy S Reisman
- Department of Physical Therapy, University of DE, Newark, Delaware
| | - Gammon M Earhart
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Carter L, Ford CD. Promoting physical activity in clinical practice through wearable technology. J Am Assoc Nurse Pract 2023; 35:765-769. [PMID: 37249382 DOI: 10.1097/jxx.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 05/31/2023]
Abstract
ABSTRACT The negative health consequences of physical inactivity continue to be a global problem that must be addressed from the highest levels of government down to local primary care providers. Physical activity has been identified as a useful patient vital sign in health care. Advanced practice nurses should aggressively prescribe physical activity as an evidence-based intervention to help mitigate the increased mortality and morbidity associated with a sedentary lifestyle. A focused literature review was conducted using PubMed, CINAHL, and the Cochrane online databases. Fitness wearables and mobile health trackers are a catalyst for lifestyle behavior change and cultivate a health care partnership between the patient and their provider. The evolution of fitness wearables into mainstream health care hinges on the ability of devices to integrate into electronic health records, uniformity of manufacturer standards, intuitiveness, and the assurance of user privacy and security. It is incumbent on nurse practitioners to educate themselves about the reliability and practicality of fitness trackers for their patient population. Future research should focus on adopting quality standards for all consumer devices, the seamless integration of device data into electronic health records and ensuring personal privacy and security.
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Affiliation(s)
- LaGary Carter
- College of Nursing and Health Sciences, Valdosta State University, Valdosta, Georgia
| | - Cassandra D Ford
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama
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Ullah M, Hamayun S, Wahab A, Khan SU, Rehman MU, Haq ZU, Rehman KU, Ullah A, Mehreen A, Awan UA, Qayum M, Naeem M. Smart Technologies used as Smart Tools in the Management of Cardiovascular Disease and their Future Perspective. Curr Probl Cardiol 2023; 48:101922. [PMID: 37437703 DOI: 10.1016/j.cpcardiol.2023.101922] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. The advent of smart technologies has significantly impacted the management of CVD, offering innovative tools and solutions to improve patient outcomes. Smart technologies have revolutionized and transformed the management of CVD, providing innovative tools to improve patient care, enhance diagnostics, and enable more personalized treatment approaches. These smart tools encompass a wide range of technologies, including wearable devices, mobile applications,3D printing technologies, artificial intelligence (AI), remote monitoring systems, and electronic health records (EHR). They offer numerous advantages, such as real-time monitoring, early detection of abnormalities, remote patient management, and data-driven decision-making. However, they also come with certain limitations and challenges, including data privacy concerns, technical issues, and the need for regulatory frameworks. In this review, despite these challenges, the future of smart technologies in CVD management looks promising, with advancements in AI algorithms, telemedicine platforms, and bio fabrication techniques opening new possibilities for personalized and efficient care. In this article, we also explore the role of smart technologies in CVD management, their advantages and disadvantages, limitations, current applications, and their smart future.
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Affiliation(s)
- Muneeb Ullah
- Department of Pharmacy, Kohat University of Science and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Shah Hamayun
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Abdul Wahab
- Department of Pharmacy, Kohat University of Science and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Shahid Ullah Khan
- Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, 22080, Khyber Pakhtunkhwa, Pakistan
| | - Mahboob Ur Rehman
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Zia Ul Haq
- Department of Public Health, Institute of Public Health Sciences, Khyber Medical University, Peshawar 25120, Pakistan
| | - Khalil Ur Rehman
- Department of Chemistry, Institute of chemical Sciences, Gomel University, Dera Ismail Khan, KPK, Pakistan
| | - Aziz Ullah
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea
| | - Aqsa Mehreen
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Punjab, Pakistan
| | - Uzma A Awan
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Punjab, Pakistan
| | - Mughal Qayum
- Department of Pharmacy, Kohat University of Science and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Naeem
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Punjab, Pakistan.
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Pedersen K, Schlichter BR. Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review. Interact J Med Res 2023; 12:e40205. [PMID: 37471129 PMCID: PMC10401197 DOI: 10.2196/40205] [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: 06/10/2022] [Revised: 11/01/2022] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society. OBJECTIVE This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations. METHODS The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature. RESULTS In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations. CONCLUSIONS The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.
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Affiliation(s)
- Keld Pedersen
- Information Systems, Department of Management, Aarhus University, Aarhus C, Denmark
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Keats MR, Yu X, Sweeney Magee M, Forbes CC, Grandy SA, Sweeney E, Dummer TJB. Use of Wearable Activity-Monitoring Technologies to Promote Physical Activity in Cancer Survivors: Challenges and Opportunities for Improved Cancer Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4784. [PMID: 36981693 PMCID: PMC10048707 DOI: 10.3390/ijerph20064784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The aim of this review was to explore the acceptability, opportunities, and challenges associated with wearable activity-monitoring technology to increase physical activity (PA) behavior in cancer survivors. A search of Medline, Embase, CINAHL, and SportDiscus was conducted from 1 January 2011 through 3 October 2022. The search was limited to English language, and peer-reviewed original research. Studies were included if they reported the use of an activity monitor in adults (+18 years) with a history of cancer with the intent to motivate PA behavior. Our search identified 1832 published articles, of which 28 met inclusion/exclusion criteria. Eighteen of these studies included post-treatment cancer survivors, eight were on active cancer treatment, and two were long-term cancer survivor studies. ActiGraph accelerometers were the primary technology used to monitor PA behaviors, with Fitbit as the most commonly utilized self-monitoring wearable technology. Overall, wearable activity monitors were found to be an acceptable and useful tool in improving self-awareness, motivating behavioral change, and increasing PA levels. Self-monitoring wearable activity devices have a positive impact on short-term PA behaviors in cancer survivors, but the increase in PA gradually attenuated through the maintenance phase. Further study is needed to evaluate and increase the sustainability of the use of wearable technologies to support PA in cancer survivors.
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Affiliation(s)
- Melanie R. Keats
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Medical Oncology, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, NS B3H 4R2, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada
| | - Xing Yu
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Molly Sweeney Magee
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Cynthia C. Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Scott A. Grandy
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Medical Oncology, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, NS B3H 4R2, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Ellen Sweeney
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Trevor J. B. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Ruyobeza B, Grobbelaar SS, Botha A. Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review. Syst Rev 2022; 11:179. [PMID: 36042505 PMCID: PMC9427160 DOI: 10.1186/s13643-022-02033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact. AIM The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability. METHODS A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases. RESULTS Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof. CONCLUSION The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.
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Affiliation(s)
- Barimwotubiri Ruyobeza
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - Sara S Grobbelaar
- Department of Industrial Engineering, Stellenbosch University, South Africa AND DSI-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Stellenbosch University, Stellenbosch, South Africa.
| | - Adele Botha
- Department of Industrial Engineering, Stellenbosch University and CSIR Next Generation Enterprises and Institutions, Stellenbosch, South Africa
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Bai Y, Burns R, Gell N, Byun W. A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients. J Sports Sci 2022; 40:1648-1657. [PMID: 35830497 DOI: 10.1080/02640414.2022.2099179] [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: 10/17/2022]
Abstract
The purpose of the pilot study was to determine the effectiveness of wearable activity trackers alone or in combination with behaviour change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. A sample of 44 adults (68% female and mean age 55) were randomized to receive either a Fitbit Charge HR 3 alone (FB) or the Fitbit in combination with behaviour change strategies (i.e., goal setting, behaviour goal review, adaptive feedback) delivered by a trained health coach (FB+) for 12 weeks. Moderate and vigorous PA (MVPA), steps, and sedentary time (ST) were assessed using ActiGraph wGT3X-BT. The FB+ group significantly increased PA [+1854 (2518) steps/day, p < .01] and MVPA [+26 (34) mins/day, p < .05], and decreased their ST [-63 (73) mins/day, p < .01]. The FB group significantly increased MVPA [+11 (16) mins/day, p < .05], and decreased their ST [-87 (117) mins/day, p < .01]. Participants in FB+ had a significantly greater increase in MVPA/day compared to FB only with a between-group effect size of 0.6 (p < .05). Using Fitbit for self-monitoring is effective in increasing PA and reducing ST among pre-hypertensive and hypertensive participants. Additional behaviour change support amplified the intervention effectiveness for promoting MVPA.
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Affiliation(s)
- Yang Bai
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA.,Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Ryan Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Nancy Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Wonwoo Byun
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
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12
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Monitoring of Cardiovascular Diseases: An Analysis of the Mobile Applications Available in the Google Play Store. ELECTRONICS 2022. [DOI: 10.3390/electronics11121881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cardiovascular diseases have always been here, but there has been an increase in their numbers over time. Even though there are in the digital world a few applications to help with this kind of problem, there are not enough to fulfill the needs of the patients. This study reviews mobile applications that allow patients to monitor and report cardiovascular diseases. It presents a review of 14 mobile applications that were free to download in Portugal and classified and compared according to their characteristics. The selection criteria combined the following keywords: “patient”, “cardiac/or heart”, “report”, and (“tracking” or “monitoring”). Based on the analysis, we point out the errors of the applications and present some solutions. To finish, we investigated how mobile applications can help patients track and self-report cardiovascular diseases.
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13
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"Listen to Your Immune System When It's Calling for You": Monitoring Autoimmune Diseases Using the iShU App. SENSORS 2022; 22:s22103834. [PMID: 35632243 PMCID: PMC9147288 DOI: 10.3390/s22103834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022]
Abstract
The immune system plays a key role in protecting living beings against bacteria, viruses, and fungi, among other pathogens, which may be harmful and represent a threat to our own health. However, for reasons that are not fully understood, in some people this protective mechanism accidentally attacks the organs and tissues, thus causing inflammation and leads to the development of autoimmune diseases. Remote monitoring of human health involves the use of sensor network technology as a means of capturing patient data, and wearable devices, such as smartwatches, have lately been considered good collectors of biofeedback data, owing to their easy connectivity with a mHealth system. Moreover, the use of gamification may encourage the frequent usage of such devices and behavior changes to improve self-care for autoimmune diseases. This study reports on the use of wearable sensors for inflammation surveillance and autoimmune disease management based on a literature search and evaluation of an app prototype with fifteen stakeholders, in which eight participants were diagnosed with autoimmune or inflammatory diseases and four were healthcare professionals. Of these, six were experts in human–computer interaction to assess critical aspects of user experience. The developed prototype allows the monitoring of autoimmune diseases in pre-, during-, and post-inflammatory crises, meeting the personal needs of people with this health condition. The findings suggest that the proposed prototype—iShU—achieves its purpose and the overall experience may serve as a foundation for designing inflammation surveillance and autoimmune disease management monitoring solutions.
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14
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Wearable Devices for Physical Monitoring of Heart: A Review. BIOSENSORS 2022; 12:bios12050292. [PMID: 35624593 PMCID: PMC9138373 DOI: 10.3390/bios12050292] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/19/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally. An effective strategy to mitigate the burden of CVDs has been to monitor patients’ biomedical variables during daily activities with wearable technology. Nowadays, technological advance has contributed to wearables technology by reducing the size of the devices, improving the accuracy of sensing biomedical variables to be devices with relatively low energy consumption that can manage security and privacy of the patient’s medical information, have adaptability to any data storage system, and have reasonable costs with regard to the traditional scheme where the patient must go to a hospital for an electrocardiogram, thus contributing a serious option in diagnosis and treatment of CVDs. In this work, we review commercial and noncommercial wearable devices used to monitor CVD biomedical variables. Our main findings revealed that commercial wearables usually include smart wristbands, patches, and smartwatches, and they generally monitor variables such as heart rate, blood oxygen saturation, and electrocardiogram data. Noncommercial wearables focus on monitoring electrocardiogram and photoplethysmography data, and they mostly include accelerometers and smartwatches for detecting atrial fibrillation and heart failure. However, using wearable devices without healthy personal habits will cause disappointing results in the patient’s health.
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15
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Neumann D, Tiberius V, Biendarra F. Adopting wearables to customize health insurance contributions: a ranking-type Delphi. BMC Med Inform Decis Mak 2022; 22:112. [PMID: 35477495 PMCID: PMC9044726 DOI: 10.1186/s12911-022-01851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/13/2022] [Indexed: 01/03/2023] Open
Abstract
Background Wearables, as small portable computer systems worn on the body, can track user fitness and health data, which can be used to customize health insurance contributions individually. In particular, insured individuals with a healthy lifestyle can receive a reduction of their contributions to be paid. However, this potential is hardly used in practice.
Objective This study aims to identify which barrier factors impede the usage of wearables for assessing individual risk scores for health insurances, despite its technological feasibility, and to rank these barriers according to their relevance. Methods To reach these goals, we conduct a ranking-type Delphi study with the following three stages. First, we collected possible barrier factors from a panel of 16 experts and consolidated them to a list of 11 barrier categories. Second, the panel was asked to rank them regarding their relevance. Third, to enhance the panel consensus, the ranking was revealed to the experts, who were then asked to re-rank the barriers. Results The results suggest that regulation is the most important barrier. Other relevant barriers are false or inaccurate measurements and application errors caused by the users. Additionally, insurers could lack the required technological competence to use the wearable data appropriately. Conclusion A wider use of wearables and health apps could be achieved through regulatory modifications, especially regarding privacy issues. Even after assuring stricter regulations, users’ privacy concerns could partly remain, if the data exchange between wearables manufacturers, health app providers, and health insurers does not become more transparent.
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16
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Anand S, Ziolkowski SL, Bootwala A, Li J, Pham N, Cobb J, Lobelo F. Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial. Kidney Med 2021; 3:951-961.e1. [PMID: 34939004 PMCID: PMC8664706 DOI: 10.1016/j.xkme.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale & Objective We aimed to test interventions to improve physical activity in persons with advanced chronic kidney disease not yet receiving dialysis. Study Design Randomized controlled trial with parallel-group design. Setting & Participants We embedded a pragmatic referral to exercise programming in high-volume kidney clinics servicing diverse populations in San Jose, CA, and Atlanta, GA. We recruited 56 participants with estimated glomerular filtration rates < 45 mL/min/1.73 m2. Interventions We randomly assigned participants to a mobile health (mHealth) group—wearable activity trackers and fitness professional counseling, or an Exercise is Medicine intervention framework (EIM) group—mHealth components plus twice-weekly small-group directed exercise sessions customized to persons with kidney disease. We performed assessments at baseline, 8 weeks at the end of active intervention, and 16 weeks after passive follow-up and used multilevel mixed models to assess between-group differences. Outcomes Activity tracker total daily step count. Results Of 56 participants, 86% belonged to a racial/ethnic minority group; randomly assigned groups were well balanced on baseline step count. In intention-to-treat analyses, the EIM and mHealth groups both experienced declines in daily step counts, but there was an attenuated reduction in light intensity physical activity (standard error 0.2 [5.8] vs −8.5 [5.4] min/d; P = 0.08) in the EIM compared with the mHealth group at 8 weeks. In as-treated analyses, total daily step count, distance covered, and light and moderate-vigorous activity minutes per day improved in the EIM group and declined in the mHealth group at 8 weeks (standard error +335 [506] vs −884 [340] steps per day; P = 0.05; P < 0.05 for secondary measures), but group differences faded at 16 weeks. There were no differences in quality-of-life and mental health measures during the study. Limitations Small sample size, limited duration of study, assessment of intermediate outcomes (steps per day). Conclusions A clinic-integrated referral to small-group exercise sessions is feasible, safe, and moderately effective in improving physical activity in an underserved population with high comorbid conditions. Funding Normon S Coplon Applied Pragmatic Clinical Research program. Trial Registration NCT03311763
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Affiliation(s)
- Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Susan L Ziolkowski
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Ahad Bootwala
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jianheng Li
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nhat Pham
- Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA
| | - Jason Cobb
- Renal Division, Emory University School of Medicine, Atlanta, GA
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
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17
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Weber MB, Ziolkowski S, Bootwala A, Bienvenida A, Anand S, Lobelo F. Perceptions of physical activity and technology enabled exercise interventions among people with advanced chronic kidney disease: a qualitative study. BMC Nephrol 2021; 22:373. [PMID: 34758729 PMCID: PMC8579645 DOI: 10.1186/s12882-021-02591-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise improves health outcomes and quality of life in persons with chronic kidney disease (CKD). The numbers of persons with advanced CKD meeting physical activity guidelines however is low. We undertook a qualitative study of men and women aged 36-74 from various race/ethnic populations with advanced CKD not requiring dialysis to describe their experiences and opinions around prior physical activity, motivating factors for and barriers to exercise, and perceptions of exercise-promoting technology and group-based programming designed to improve physical activity levels. METHODS Nineteen persons with advanced CKD not requiring dialysis were interviewed at two high volume nephrology clinics enriched with racial/ethnic minority patients (Emory University and Santa Clara Valley Medical Center). We used thematic analysis to identify dominant themes (n = 4) and subthemes (n = 19) around exercise experience, barriers, motivators, views, and preferences. RESULTS Four dominant themes and 19 subthemes were identified. The most common motivators to exercise included physical and mental health benefits, appearance, improvement in energy levels, and potential social interaction in group-based programs. Common barriers included health concerns, particularly complications related to other co-morbidities, as well as time and transportation constraints. Participants were skeptical of exercise programs solely reliant on technology. CONCLUSIONS The use of group-based exercise programs may motivate persons with CKD to increase exercise levels, while programs entirely based on technology may be less effective.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, MS 1518-002-7BB, Atlanta, GA, USA.
| | - Susan Ziolkowski
- Division of Nephrology, Stanford University School of Medicine, Stanford, USA
| | - Ahad Bootwala
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, MS 1518-002-7BB, Atlanta, GA, USA.,Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alan Bienvenida
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, MS 1518-002-7BB, Atlanta, GA, USA.,Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Stanford, USA
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, MS 1518-002-7BB, Atlanta, GA, USA.,Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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18
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Vargemidis D, Gerling K, Abeele VV, Geurts L, Spiel K. Irrelevant Gadgets or a Source of Worry. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2021. [DOI: 10.1145/3473463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Wearable activity trackers are routinely applied in physical activity (PA) interventions in late life, but there is little research that focuses on older adults' perspectives on the technology. We conducted a qualitative study with 24 older persons to explore their perspective on wearables and PA. First, we discussed their relationship with PA and wearable trackers during focus groups. Next, nine participants crafted prototypes for wearables during co-design sessions. Through Thematic Analysis, we identified two main themes: (1) PA is personal in terms of preferred activities and reasons for PA, and (2) wearables are an emotional technology, causing negative emotions when resembling medical trackers or pressurizing to perform. We followed upon these results through a survey with 41 participants, which further highlighted individual differences in the perception of wearables. We conclude with questions to guide the design of wearables and reflect on their role to support PA in late life.
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19
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Vemuri A, Decker K, Saponaro M, Dominick G. Multi Agent Architecture for Automated Health Coaching. J Med Syst 2021; 45:95. [PMID: 34562163 DOI: 10.1007/s10916-021-01771-2] [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: 06/10/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
For software applications in health coaching domains to be effective, it is vital that they address issues of privacy, modularity, scalability, individualization, data integration, transferability, coordination and flexibility. In this paper, we propose a novel generic multi-agent architecture which serves as a template for health coaching applications involving wearable sensors. Analyzer and communication modules allow different functionalities like goal formation, planning, scheduling, event detection, learning, inter-agent + human communication and long-term data collection, based on the capabilities of the underlying sensor platforms. To show the flexibility of our proposed architecture, we have successfully built two different health coaching systems with the proposed architecture: (1) a static system based on the Fitbit platform where the coaching is done at specific preset times to encourage increased physical activity, and (2) a dynamic system based on the Apple Watch platform where the smart coach adapts and learns when to intervene to encourage physical activity and reduce sedentary behavior.
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Affiliation(s)
- Ajith Vemuri
- Computer & Information Sciences, University of Delaware, Newark, USA.
| | - Keith Decker
- Computer & Information Sciences, University of Delaware, Newark, USA
| | | | - Gregory Dominick
- Behavioral Health and Nutrition, University of Delaware, Newark, USA
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20
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Das SK, Miki AJ, Blanchard CM, Sazonov E, Gilhooly CH, Dey S, Wolk CB, Khoo CSH, Hill JO, Shook RP. Perspective: Opportunities and Challenges of Technology Tools in Dietary and Activity Assessment: Bridging Stakeholder Viewpoints. Adv Nutr 2021; 13:1-15. [PMID: 34545392 PMCID: PMC8803491 DOI: 10.1093/advances/nmab103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.
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Affiliation(s)
| | - Akari J Miki
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Caroline M Blanchard
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL, USA
| | - Cheryl H Gilhooly
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sujit Dey
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Colton B Wolk
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Chor San H Khoo
- Institute for the Advancement of Food and Nutrition Sciences, Washington, DC, USA
| | - James O Hill
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA,Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin P Shook
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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21
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Telemonitoring of Real-World Health Data in Cardiology: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179070. [PMID: 34501659 PMCID: PMC8431660 DOI: 10.3390/ijerph18179070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
Background: New sensor technologies in wearables and other consumer health devices open up promising opportunities to collect real-world data. As cardiovascular diseases remain the number one reason for disease and mortality worldwide, cardiology offers potent monitoring use cases with patients in their out-of-hospital daily routines. Therefore, the aim of this systematic review is to investigate the status quo of studies monitoring patients with cardiovascular risks and patients suffering from cardiovascular diseases in a telemedical setting using not only a smartphone-based app, but also consumer health devices such as wearables and other sensor-based devices. Methods: A literature search was conducted across five databases, and the results were examined according to the study protocols, technical approaches, and qualitative and quantitative parameters measured. Results: Out of 166 articles, 8 studies were included in this systematic review; these cover interventional and observational monitoring approaches in the area of cardiovascular diseases, heart failure, and atrial fibrillation using various app, wearable, and health device combinations. Conclusions: Depending on the researcher’s motivation, a fusion of apps, patient-reported outcome measures, and non-invasive sensors can be orchestrated in a meaningful way, adding major contributions to monitoring concepts for both individual patients and larger cohorts.
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22
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Pricing through health apps generated data-Digital dividend as a game changer: Discrete choice experiment. PLoS One 2021; 16:e0254786. [PMID: 34310618 PMCID: PMC8312968 DOI: 10.1371/journal.pone.0254786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 07/02/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives The objective of this paper is to study under which circumstances wearable and health app users would accept a compensation payment, namely a digital dividend, to share their self-tracked health data. Methods We conducted a discrete choice experiment alternative, a separated adaptive dual response. We chose this approach to reduce extreme response behavior, considering the emotionally-charged topic of health data sales, and to measure willingness to accept. Previous experiments in lab settings led to demands for high monetary compensation. After a first online survey and two pre-studies, we validated four attributes for the final online study: monthly bonus payment, stakeholder handling the data (e.g., health insurer, pharmaceutical or medical device companies, universities), type of data, and data sales to third parties. We used a random utility framework to evaluate individual choice preferences. To test the expected prices of the main study for robustness, we assigned respondents randomly to one of two identical questionnaires with varying price ranges. Results Over a period of three weeks, 842 respondents participated in the main survey, and 272 respondents participated in the second survey. The participants considered transparency about data processing and no further data sales to third parties as very important to the decision to share data with different stakeholders, as well as adequate monetary compensation. Price expectations resulting from the experiment were high; pharmaceutical and medical device companies would have to pay an average digital dividend of 237.30€/month for patient generated health data of all types. We also observed an anchor effect, which means that people formed price expectations during the process and not ex ante. We found a bimodal distribution between relatively low price expectations and relatively high price expectations, which shows that personal data selling is a divisive societal issue. However, the results indicate that a digital dividend could be an accepted economic incentive system to gather large-scale, self-tracked data for research and development purposes. After the COVID-19 crisis, price expectations might change due to public sensitization to the need for big data research on patient generated health data. Conclusion A continuing success of existing data donation models is highly unlikely. The health care sector needs to develop transparency and trust in data processing. An adequate digital dividend could be an effective long-term measure to convince a diverse and large group of people to share high-quality, continuous data for research purposes.
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23
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Domin A, Spruijt-Metz D, Theisen D, Ouzzahra Y, Vögele C. Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years. JMIR Mhealth Uhealth 2021; 9:e24308. [PMID: 34287209 PMCID: PMC8339983 DOI: 10.2196/24308] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/12/2021] [Accepted: 04/16/2021] [Indexed: 01/19/2023] Open
Abstract
Background Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions. Objective The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume. Methods We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy. Results Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines. Conclusions Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions.
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Affiliation(s)
- Alex Domin
- Research Group: Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Donna Spruijt-Metz
- USC mHealth Collaboratory, Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
| | - Daniel Theisen
- ALAN - Maladies Rares Luxembourg, Kockelscheuer, Luxembourg
| | - Yacine Ouzzahra
- Research Support Department, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Claus Vögele
- Research Group: Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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24
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Masterson Creber R, Turchioe MR. Returning Cardiac Rhythm Data to Patients: Opportunities and Challenges. Card Electrophysiol Clin 2021; 13:555-567. [PMID: 34330381 PMCID: PMC8328196 DOI: 10.1016/j.ccep.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spurred by federal legislation, professional organizations, and patients themselves, patient access to data from electronic cardiac devices is increasingly transparent. Patients can collect data through consumer devices and access data traditionally shared only with health care providers. These data may improve screening, self-management, and shared decision-making for cardiac arrhythmias, but challenges remain, including patient comprehension, communication with providers, and sustained engagement. Ways to address these challenges include leveraging visualizations that support comprehension, involving patients in designing and developing patient-facing digital tools, and establishing clear practices and goals for data exchange with health care providers.
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Affiliation(s)
- Ruth Masterson Creber
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA.
| | - Meghan Reading Turchioe
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA
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25
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Pottebaum E, Warmoth A, Ayyappan S, Dickens DS, Jethava Y, Modi A, Tomasson MH, Carr LJ, Bates ML. Wearable Monitors Facilitate Exercise in Adult and Pediatric Stem Cell Transplant. Exerc Sport Sci Rev 2021; 49:205-212. [PMID: 33927164 DOI: 10.1249/jes.0000000000000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematopoietic stem cell transplant (HSCT) is a potentially curative treatment for hematopoietic malignancies, complicated by decreased performance status and quality of life. Exercise therapy improves outcomes in HSCT, but several barriers have prevented exercise from becoming routine clinical practice. Based on existing data that wearable technologies facilitate exercise participation in other sedentary and chronic illness populations, we propose the novel hypothesis that wearable technologies are a valuable tool in transcending barriers and developing exercise therapy programs for HSCT patients.
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Kelley MM, Kue J, Brophy L, Peabody AL, Foraker RE, Yen PY, Tucker S. Mobile Health Applications, Cancer Survivors, and Lifestyle Modification: An Integrative Review. Comput Inform Nurs 2021; 39:755-763. [PMID: 34074873 PMCID: PMC8578050 DOI: 10.1097/cin.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer survivors' well-being is threatened by the risk of cancer recurrence and the increased risk of chronic diseases resulting from cancer treatments. Improving lifestyle behaviors attenuates these risks. Traditional approaches to lifestyle modification (ie, counseling) are expensive, require significant human resources, and are difficult to scale. Mobile health interventions offer a novel alternative to traditional approaches. However, to date, systematic reviews have yet to examine the use of mobile health interventions for lifestyle behavior improvement among cancer survivors. The objectives of this integrative review were to synthesize research findings, critically appraise the scientific literature, examine the use of theory in intervention design, and identify survivors' preferences in using mobile health interventions for lifestyle improvement. Nineteen articles met eligibility requirements. Only two studies used quantitative methods. Study quality was low, and only one study reported the use of theory in app design. Unfortunately, the evidence has not yet sufficiently matured, in quality or in rigor, to make recommendations on how to improve health behaviors or outcomes. However, six themes emerged as important considerations for intervention development for cancer survivors (app features/functionality, social relationships/support, provider relationships/support, app content, app acceptability, and barriers to use). These findings underscored the need for rigorous, efficacy studies before the use of mobile health interventions can be safely recommended for cancer survivors.
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Affiliation(s)
- Marjorie M Kelley
- Author Affiliations: College of Nursing, The Ohio State University (Drs Kelley, Kue, and Tucker); James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center (Brophy); and EngageHealth, Inc (Peabody), Columbus, OH; and Institute for Informatics, Washington University School of Medicine (Drs Foraker and Yen); Department of Internal Medicine, Washington University (Dr Foraker); Department of Medicine, Washington University School of Medicine (Dr Yen); and Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare (Dr Yen), St Louis, MO
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Claudel SE, Tamura K, Troendle J, Andrews MR, Ceasar JN, Mitchell VM, Vijayakumar N, Powell-Wiley TM. Comparing Methods to Identify Wear-Time Intervals for Physical Activity With the Fitbit Charge 2. J Aging Phys Act 2021; 29:529-535. [PMID: 33326935 PMCID: PMC8493649 DOI: 10.1123/japa.2020-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/22/2020] [Accepted: 08/26/2020] [Indexed: 01/28/2023]
Abstract
There is no established method for processing data from commercially available physical activity trackers. This study aims to develop a standardized approach to defining valid wear time for use in future interventions and analyses. Sixteen African American women (mean age = 62.1 years and mean body mass index = 35.5 kg/m2) wore the Fitbit Charge 2 for 20 days. Method 1 defined a valid day as ≥10-hr wear time with heart rate data. Method 2 removed minutes without heart rate data, minutes with heart rate ≤ mean - 2 SDs below mean and ≤2 steps, and nighttime. Linear regression modeled steps per day per week change. Using Method 1 (n = 292 person-days), participants had 20.5 (SD = 4.3) hr wear time per day compared with 16.3 (SD = 2.2) hr using Method 2 (n = 282) (p < .0001). With Method 1, participants took 7,436 (SD = 3,543) steps per day compared with 7,298 (SD = 3,501) steps per day with Method 2 (p = .64). The proposed algorithm represents a novel approach to standardizing data generated by physical activity trackers. Future studies are needed to improve the accuracy of physical activity data sets.
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Ozkaynak M, Valdez R, Hannah K, Woodhouse G, Klem P. Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study. J Med Internet Res 2021; 23:e17590. [PMID: 33629657 PMCID: PMC7952231 DOI: 10.2196/17590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. OBJECTIVE The aim of this study is to characterize gaps (from the patient's perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). METHODS Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. RESULTS The causes of gaps included clinician recommendations not fitting into patients' daily routines, recommendations not fitting into patients' living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. CONCLUSIONS Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado
- Anschutz Medical Campus, Aurora, CO, United States
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Katia Hannah
- College of Nursing, University of Colorado
- Anschutz Medical Campus, Aurora, CO, United States
| | - Gina Woodhouse
- University of Colorado Hospital, Aurora, CO, United States
| | - Patrick Klem
- University of Colorado Hospital, Aurora, CO, United States
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Aguillard K, Garson A. Patient Use of Cardiovascular Devices and Apps: Are We Getting Our Money's Worth? Methodist Debakey Cardiovasc J 2021; 16:291-295. [PMID: 33500757 DOI: 10.14797/mdcj-16-4-291] [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] [Indexed: 11/08/2022] Open
Abstract
The evolution of technology makes it likely that a large number of people will invest in and use health-related mobile applications and wearable devices. Yet the question remains: Do these technology-based interventions modify health behavior and improve health…and are we getting our money's worth? The vast majority of studies concerning health-related apps and wearable devices have small sample sizes and short time spans of 6 months or less, so it is not clear if these durations were determined by lack of consistent use over time. Furthermore, many of the most popular applications have not been subjected to randomized trials. Overall, the small demonstrated improvements in outcomes are often associated with professional involvement from clinicians, coaches, or diabetes educators provided in conjunction with use of mobile health (mHealth) platforms. This paper explores the use of mHealth technologies that address cardiovascular disease/prevention (eg, diabetes, diet, physical activity, and associated weight loss) and discusses the lack of adequate evidence to support even minimal patient investment in mobile applications or wearable devices at this time.
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Affiliation(s)
| | - Arthur Garson
- UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH, HOUSTON, TEXAS
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Hilty DM, Armstrong CM, Edwards-Stewart A, Gentry MT, Luxton DD, Krupinski EA. Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:252-277. [PMID: 33501372 PMCID: PMC7819828 DOI: 10.1007/s41347-020-00190-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023]
Abstract
Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.
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Affiliation(s)
- Donald M. Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, Washington, DC USA
| | | | - Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN US
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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Sjöberg V, Westergren J, Monnier A, Lo Martire R, Hagströmer M, Äng BO, Vixner L. Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study. JMIR Mhealth Uhealth 2021; 9:e24806. [PMID: 33433391 PMCID: PMC7838001 DOI: 10.2196/24806] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Physical activity is evidently a crucial part of the rehabilitation process for patients with chronic pain. Modern wrist-worn activity tracking devices seemingly have a great potential to provide objective feedback and assist in the adoption of healthy physical activity behavior by supplying data of energy expenditure expressed as metabolic equivalent of task units (MET). However, no studies of any wrist-worn activity tracking devices' have examined criterion validity in estimating energy expenditure, heart rate, or step count in patients with chronic pain. OBJECTIVE The aim was to determine the criterion validity of wrist-worn activity tracking devices for estimations of energy expenditure, heart rate, and step count in a controlled laboratory setting and free-living settings for patients with chronic pain. METHODS In this combined laboratory and field validation study, energy expenditure, heart rate, and step count were simultaneously estimated by a wrist-worn activity tracker (Fitbit Versa), indirect calorimetry (Jaeger Oxycon Pro), and a research-grade hip-worn accelerometer (ActiGraph GT3X) during treadmill walking at 3 speeds (3.0 km/h, 4.5 km/h, and 6.0 km/h) in the laboratory setting. Energy expenditure and step count were also estimated by the wrist-worn activity tracker in free-living settings for 72 hours. The criterion validity of each measure was determined using intraclass and Spearman correlation, Bland-Altman plots, and mean absolute percentage error. An analysis of variance was used to determine whether there were any significant systematic differences between estimations. RESULTS A total of 42 patients (age: 25-66 years; male: 10/42, 24%; female: 32/42, 76%), living with chronic pain (duration, in years: mean 9, SD 6.72) were included. At baseline, their mean pain intensity was 3.5 (SD 1.1) out of 6 (Multidimensional Pain Inventory, Swedish version). Results showed that the wrist-worn activity tracking device (Fitbit Versa) systematically overestimated energy expenditure when compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X). Poor agreement and poor correlation were shown between Fitbit Versa and both Jaeger Oxycon Pro and ActiGraph GT3X for estimated energy expenditure at all treadmill speeds. Estimations of heart rate demonstrated poor to fair agreement during laboratory-based treadmill walks. For step count, the wrist-worn devices showed fair agreement and fair correlation at most treadmill speeds. In free-living settings; however, the agreement for step count between the wrist-worn device and waist-worn accelerometer was good, and the correlation was excellent. CONCLUSIONS The wrist-worn device systematically overestimated energy expenditure and showed poor agreement and correlation compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X), which needs to be considered when used clinically. Step count measured with a wrist-worn device, however, seemed to be a valid estimation, suggesting that future guidelines could include such variables in this group with chronic pain.
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Affiliation(s)
- Veronica Sjöberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jens Westergren
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Andreas Monnier
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Military Academy Karlberg, Swedish Armed Forces, Solna, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Riccardo Lo Martire
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Björn Olov Äng
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Linda Vixner
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Cernian A, Tiganoaia B, Sacala I, Pavel A, Iftemi A. PatientDataChain: A Blockchain-Based Approach to Integrate Personal Health Records. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6538. [PMID: 33207620 PMCID: PMC7697358 DOI: 10.3390/s20226538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022]
Abstract
Currently there is not a single trusted infrastructure used for the exchange and storage of medical data along the healthcare value chain and, thus, there is no platform used for monitoring patients' traceability within the entire healthcare chain. This situation leads to difficult communication and increased procedural costs, and thus it limits healthcare players from developing a better understanding and know-how of patients' traceability that could further boost innovation and development of the best-fitted health services. PatientDataChain blockchain-based technology is a novel approach, based on a decentralized healthcare infrastructure that incorporates a trust layer in the healthcare value chain. Our aim was to provide an integrated vision based on interoperability principles, that relies on the usage of specific sensors from various wearable devices, allowing us to collect specific data from patients' medical records. Interconnecting different healthcare providers, the collected data is integrated into a unitary personal health records (PHR) system, where the patient is the owner of his/her data. The decentralized nature of PatientDataChain, based on blockchain technology, leveraged the proper context to create a novel and improved data-sharing and exchange system, which is secure, flexible, and reliable. This approach brings increased benefits to data confidentiality and privacy, while providing secure access to patient medical records. This paper presents the design, implementation, and experimental validation of our proposed system, called PatientDataChain. The original contributions of our paper include the definition of the concept of unifying the entire healthcare value chain, the design of the architectural model of the system, the development of the system components, as well as the validation through a proof of concept (PoC) conducted with a medical clinic from Bucharest, using a dataset of 100 patients and over 1000 transactions. The proof of concept demonstrated the feasibility of the model in integrating the personal health records from heterogeneous sources (healthcare systems and sensors) in a unified, decentralized PHR system, with enhanced data exchange among healthcare players.
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Affiliation(s)
- Alexandra Cernian
- Faculty of Automatic Control and Computers, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Bogdan Tiganoaia
- Faculty of Entrepreneurship, Business Engineering and Management, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Ioan Sacala
- Faculty of Automatic Control and Computers, University Politehnica of Bucharest, 060042 Bucharest, Romania;
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Heidel A, Hagist C. Potential Benefits and Risks Resulting From the Introduction of Health Apps and Wearables Into the German Statutory Health Care System: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e16444. [PMID: 32965231 PMCID: PMC7542416 DOI: 10.2196/16444] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/26/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Germany is the first country worldwide that has introduced a digital care act as an incentive system to enhance the use of digital health devices, namely health apps and wearables, among its population. The act allows physicians to prescribe statutory financed and previously certified health apps and wearables to patients. This initiative has the potential to improve treatment quality through better disease management and monitoring. Objective The aim of this paper was to outline the key concepts related to the potential risks and benefits discussed in the current literature about health apps and wearables. Furthermore, this study aimed to answer the research question: Which risks and benefits may result from the implementation of the digital care act in Germany? Methods We conducted the scoping study by searching the databases PubMed, Google Scholar, and JMIR using the keywords health apps and wearables. We discussed 55 of 136 identified articles published in the English language from 2015 to March 2019 in this paper using a qualitative thematic analysis approach. Results We identified four key themes within the articles: Effectivity of health apps and wearables to improve health; users of health apps and wearables; the potential of bring-your-own, self-tracked data; and concerns and data privacy risks. Within these themes, we identified three main stages of benefits for the German health care system: Usage of health apps and wearables; continuing to use health apps and wearables; and sharing bring-your-own; self-tracked data with different agents in the health care sector. Conclusions The digital care act could lead to an improvement in treatment quality through better patient monitoring, disease management, personalized therapy, and better health education. However, physicians should play an active role in recommending
and supervising health app use to reach digital-illiterate or health-illiterate people. Age must not be an exclusion criterion. Yet, concerns about data privacy and security are very strong in Germany. Transparency about data processing should be provided at all times for continuing success of the digital care act in Germany.
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Affiliation(s)
- Alexandra Heidel
- Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Vallendar, Germany
| | - Christian Hagist
- Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Vallendar, Germany
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Prescribing Physical Activity in Parks and Nature: Health Care Provider Insights on Park Prescription Programs. J Phys Act Health 2020; 17:958-967. [PMID: 32866945 DOI: 10.1123/jpah.2019-0479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 05/26/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health care providers (HCPs) promoting physical activity (PA) through programs such as Park Prescriptions (ParkRx) are gaining momentum. However, it is difficult to realize provider PA practices and program interest, and differences in program success exist by provider type (eg, primary vs secondary). This study explored HCPs' (1) PA counseling practices, (2) knowledge/interest in ParkRx, (3) barriers and resources needed to implement PA counseling and ParkRx programs, and (4) differences in primary versus secondary HCPs. METHODS An e-survey administered in Spring/Summer 2018 to HCPs in 3 states examined study objectives. RESULTS Respondents (n = 278) were mostly primary (58.3%) HCPs. The majority asked about patient PA habits and offered PA counseling (mean = 5.0, SD = 1.5; mean = 4.8, SD = 1.5), but few provided written prescriptions (mean = 2.5, SD = 1.6). Providers were satisfied with their PA counseling knowledge (mean = 3.8, SD = 1.0) but not with prescribing practices (mean = 3.2, SD = 1.1). Secondary HCPs placed higher importance (P = .012) and provided significantly more written PA prescriptions (P = .005). Time was a common barrier to prescribing PA (mean = 3.4, SD = 1.2), though more so for primary HCPs (P = .000). Although few HCPs knew about ParkRx programs, 81.6% expressed interest. Access to park information and community partnerships was an important resource for program implementation. CONCLUSIONS HCPs underutilize PA prescriptions. Despite little awareness, HCPs were interested in ParkRx programs.
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Farivar S, Abouzahra M, Ghasemaghaei M. Wearable device adoption among older adults: A mixed-methods study. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2020; 55:102209. [PMID: 32834339 PMCID: PMC7402656 DOI: 10.1016/j.ijinfomgt.2020.102209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022]
Abstract
Using a mixed-methods approach, we analyzed the adoption of wearable devices among older adults. Perceived complexity of devices (specifically interpreting the outputs) is the most salient deterrent of adoption. The effect of cognitive age on adoption is moderated by subjective well-being (SWB). Cognitive age negatively (vs. positively) impacts the older adults’ adoption intention when their SWB is high (vs. low).
Recently, the popularity of smart wearable technologies, such as Fitbit, has significantly increased. There are numerous potential benefits in using these devices, especially among seniors. Yet, little is known about seniors’ adoption behavior. Through a mixed-methods approach, this study investigates the factors that impact seniors’ intention to use wearable devices. Results from an online survey and interviews showed that seniors’ perception of the complexity of working with these devices is a barrier to their adoption decisions. Looking more deeply into the role of complexity revealed that seniors’ concern about the complexity of reading and interpreting the output of wearable devices is the main deterring element. Furthermore, we explored the role of two important elements: seniors’ cognitive age, and the influence of their subjective well-being on their adoption behavior. Results demonstrated that cognitive age does not significantly impact use intention by itself; nonetheless, subjective well-being moderates its effect. This result revealed an interesting finding, which is that the influence of cognitive age on seniors’ use intention depends on seniors’ level of subjective well-being. When seniors’ subjective well-being is low, surprisingly, cognitive age increases seniors’ intention to use the device. These findings provide interesting implications for practice and future research.
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Affiliation(s)
- Samira Farivar
- Sprott School of Business, Carleton University, Ottawa, Ontario, Canada
| | - Mohamed Abouzahra
- College of Business, California State University, Monterey Bay, United States
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Bollinger C, Duong TA, Genain G, Almaric N, Moga A, Richard W, Vandier S. Metrology and sensors as dermo-cosmetic technology opportunities for a change of paradigm. Skin Res Technol 2020; 27:257-265. [PMID: 32729174 DOI: 10.1111/srt.12931] [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: 05/17/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Metrology and measures are changing the way patients and consumers behave and help find new, more effective solutions. METHODS This Review and Prospective Paper identifies applications in the field of dermatology and beauty tech. RESULTS The review of skincare as well as dermatological applications and analysis provides a comprehensive picture of the dynamics in the process of impacting the complete value chain in the field of dermo-cosmetics, as well as the opportunities offered by a strict approach around new and innovative measures, especially in the field of better patient/consumer knowledge, understanding, and personalized solution offering. It identifies the new business models or opportunities for the cosmetic industry. CONCLUSION Adapting metrology and measures to skincare is a significant opportunity to change the way things are done today.
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Affiliation(s)
| | - Tu Anh Duong
- Department of Dermatology, Hôpital Henri Mondor AP-HP, Créteil, France.,Chaire Avenir Santé Numérique Equipe 8 IMRB, INSERM, Université Paris Est Créteil, Créteil, France
| | - Gilles Genain
- WB Technologies, Paris, France.,Beauty Product Consulting - BPC, Paris, France
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Nadal C, Sas C, Doherty G. Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement. J Med Internet Res 2020; 22:e17256. [PMID: 32628122 PMCID: PMC7381045 DOI: 10.2196/17256] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Designing technologies that users will be interested in, start using, and keep using has long been a challenge. In the health domain, the question of technology acceptance is even more important, as the possible intrusiveness of technologies could lead to patients refusing to even try them. Developers and researchers must address this question not only in the design and evaluation of new health care technologies but also across the different stages of the user's journey. Although a range of definitions for these stages exists, many researchers conflate related terms, and the field would benefit from a coherent set of definitions and associated measurement approaches. OBJECTIVE This review aims to explore how technology acceptance is interpreted and measured in mobile health (mHealth) literature. We seek to compare the treatment of acceptance in mHealth research with existing definitions and models, identify potential gaps, and contribute to the clarification of the process of technology acceptance. METHODS We searched the PubMed database for publications indexed under the Medical Subject Headings terms "Patient Acceptance of Health Care" and "Mobile Applications." We included publications that (1) contained at least one of the terms "acceptability," "acceptance," "adoption," "accept," or "adopt"; and (2) defined the term. The final corpus included 68 relevant studies. RESULTS Several interpretations are associated with technology acceptance, few consistent with existing definitions. Although the literature has influenced the interpretation of the concept, usage is not homogeneous, and models are not adapted to populations with particular needs. The prevalence of measurement by custom surveys suggests a lack of standardized measurement tools. CONCLUSIONS Definitions from the literature were published separately, which may contribute to inconsistent usage. A definition framework would bring coherence to the reporting of results, facilitating the replication and comparison of studies. We propose the Technology Acceptance Lifecycle, consolidating existing definitions, articulating the different stages of technology acceptance, and providing an explicit terminology. Our findings illustrate the need for a common definition and measurement framework and the importance of viewing technology acceptance as a staged process, with adapted measurement methods for each stage.
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Affiliation(s)
- Camille Nadal
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Corina Sas
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Polhemus AM, Novák J, Ferrao J, Simblett S, Radaelli M, Locatelli P, Matcham F, Kerz M, Weyer J, Burke P, Huang V, Dockendorf MF, Temesi G, Wykes T, Comi G, Myin-Germeys I, Folarin A, Dobson R, Manyakov NV, Narayan VA, Hotopf M. Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study. JMIR Mhealth Uhealth 2020; 8:e16043. [PMID: 32379055 PMCID: PMC7243134 DOI: 10.2196/16043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite the increasing use of remote measurement technologies (RMT) such as wearables or biosensors in health care programs, challenges associated with selecting and implementing these technologies persist. Many health care programs that use RMT rely on commercially available, "off-the-shelf" devices to collect patient data. However, validation of these devices is sparse, the technology landscape is constantly changing, relative benefits between device options are often unclear, and research on patient and health care provider preferences is often lacking. OBJECTIVE To address these common challenges, we propose a novel device selection framework extrapolated from human-centered design principles, which are commonly used in de novo digital health product design. We then present a case study in which we used the framework to identify, test, select, and implement off-the-shelf devices for the Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) consortium, a research program using RMT to study central nervous system disease progression. METHODS The RADAR-CNS device selection framework describes a human-centered approach to device selection for mobile health programs. The framework guides study designers through stakeholder engagement, technology landscaping, rapid proof of concept testing, and creative problem solving to develop device selection criteria and a robust implementation strategy. It also describes a method for considering compromises when tensions between stakeholder needs occur. RESULTS The framework successfully guided device selection for the RADAR-CNS study on relapse in multiple sclerosis. In the initial stage, we engaged a multidisciplinary team of patients, health care professionals, researchers, and technologists to identify our primary device-related goals. We desired regular home-based measurements of gait, balance, fatigue, heart rate, and sleep over the course of the study. However, devices and measurement methods had to be user friendly, secure, and able to produce high quality data. In the second stage, we iteratively refined our strategy and selected devices based on technological and regulatory constraints, user feedback, and research goals. At several points, we used this method to devise compromises that addressed conflicting stakeholder needs. We then implemented a feedback mechanism into the study to gather lessons about devices to improve future versions of the RADAR-CNS program. CONCLUSIONS The RADAR device selection framework provides a structured yet flexible approach to device selection for health care programs and can be used to systematically approach complex decisions that require teams to consider patient experiences alongside scientific priorities and logistical, technical, or regulatory constraints.
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Affiliation(s)
- Ashley Marie Polhemus
- Merck Research Labs Information Technology, Merck Sharpe & Dohme, Prague, Czech Republic
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Jan Novák
- Merck Research Labs Information Technology, Merck Sharpe & Dohme, Prague, Czech Republic
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
| | - Jose Ferrao
- Merck Research Labs Information Technology, Merck Sharpe & Dohme, Prague, Czech Republic
| | - Sara Simblett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marta Radaelli
- Neurology Services, San Raffaele Hospital Multiple Sclerosis Centre, Milan, Italy
| | - Patrick Locatelli
- Department of Engineering and Applied Science, University of Bergamo, Bergamo, Italy
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Maximilian Kerz
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janice Weyer
- Patient Advisory Board, Remote Assessment of Disease and Relapse Research Program, King's College London, London, United Kingdom
| | - Patrick Burke
- Patient Advisory Board, Remote Assessment of Disease and Relapse Research Program, King's College London, London, United Kingdom
| | - Vincy Huang
- Merck Research Labs Information Technology, Merck Sharpe & Dohme, Singapore, Singapore
| | - Marissa Fallon Dockendorf
- Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co, Inc, Kenilworth, NJ, United States
| | - Gergely Temesi
- Merck Research Labs Information Technology, Merck Sharpe & Dohme, Prague, Czech Republic
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Giancarlo Comi
- Neurology Services, San Raffaele Hospital Multiple Sclerosis Centre, Milan, Italy
| | - Inez Myin-Germeys
- Department for Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Amos Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Richard Dobson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Vaibhav A Narayan
- Research and Development Information Technology, Janssen Research & Development, LLC, Titusville, NJ, United States
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Lobelo F, Muth ND, Hanson S, Nemeth BA. Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics 2020; 145:peds.2019-3992. [PMID: 32094289 DOI: 10.1542/peds.2019-3992] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.
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Affiliation(s)
| | - Natalie D Muth
- Children's Primary Care Medical Group, Carlsbad, California; and
| | - Sara Hanson
- Nutrition and Health Sciences Program, Laney Graduate School and Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Blaise A Nemeth
- American Family Children's Hospital and School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Barnett A, Campbell KL, Mayr HL, Keating SE, Macdonald GA, Hickman IJ. Liver transplant recipients' experiences and perspectives of a telehealth-delivered lifestyle programme: A qualitative study. J Telemed Telecare 2020; 27:590-598. [PMID: 31986966 DOI: 10.1177/1357633x19900459] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. METHODS Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. RESULTS In total, 19 liver transplant recipients participated in the study (25-68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) 'broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) 'impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) 'adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) 'increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. DISCUSSION A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.
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Affiliation(s)
- Amandine Barnett
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Australia.,Bond University Nutrition and Dietetics Research Group, Bond University, Australia
| | - Katrina L Campbell
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Australia.,Bond University Nutrition and Dietetics Research Group, Bond University, Australia.,Translational Research Institute, Australia
| | - Hannah L Mayr
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Australia.,Bond University Nutrition and Dietetics Research Group, Bond University, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
| | - Graeme A Macdonald
- Translational Research Institute, Australia.,Queensland Liver Transplant Service, Princess Alexandra Hospital, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Australia.,Translational Research Institute, Australia.,Mater Research Institute, The University of Queensland, Australia
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Welk GJ, Bai Y, Lee JM, Godino J, Saint-Maurice PF, Carr L. Standardizing Analytic Methods and Reporting in Activity Monitor Validation Studies. Med Sci Sports Exerc 2020; 51:1767-1780. [PMID: 30913159 PMCID: PMC6693923 DOI: 10.1249/mss.0000000000001966] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION A lack of standardization with accelerometry-based monitors has made it hard to advance applications for both research and practice. Resolving these challenges is essential for developing methods for consistent, agnostic reporting of physical activity outcomes from wearable monitors in clinical applications. METHODS This article reviewed the literature on the methods used to evaluate the validity of contemporary consumer activity monitors. A rationale for focusing on energy expenditure as a key outcome measure in validation studies was provided followed by a summary of the strengths and limitations of different analytical methods. The primary review included 23 recent validation studies that collectively reported energy expenditure estimates from 58 monitors relative to values from appropriate criterion measures. RESULTS The majority of studies reported weak indicators such as correlation coefficients (87%), but only half (52%) reported the recommended summary statistic of mean absolute percent error needed to evaluate actual individual error. Fewer used appropriate tests of agreement such as equivalence testing (22%). CONCLUSIONS The use of inappropriate analytic methods and incomplete reporting of outcomes is a major limitation for systematically advancing research with both research grade and consumer-grade activity monitors. Guidelines are provided to standardize analytic methods and reporting in these types of studies to enhance the utility of the devices for clinical mHealth applications.
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Affiliation(s)
- Gregory J Welk
- Department of Kinesiology, Iowa State University, Ames, IA
| | - Yang Bai
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
| | - Jung-Min Lee
- College of Physical Education, Kyung Hee University, Yong-in, KOREA
| | - Job Godino
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA
| | | | - Lucas Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
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Villarreal V, Berbey-Alvarez A. Evaluation of mHealth Applications Related to Cardiovascular Diseases: a Systematic Review. Acta Inform Med 2020; 28:130-137. [PMID: 32742066 PMCID: PMC7382776 DOI: 10.5455/aim.2020.28.130-137] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Currently, with the widespread penetration of mobile devices with Internet access, including smartphones, they can allow specific and/or complementary activities in the health field as well as in other commercial sectors. Aim: This systematic review examined the impact of mHealth-based for cardiovascular research. The specific aims of the systematic review are to (1) classification of the studies according to the type of research (scientific articles and master’s and doctoral theses) and (2) relationship of studies with topics associated with cardiovascular diseases. Results: This review corresponds to information in scientific journals of high impact. This review intends to respond to the following question: How these research works have evaluated the performance of health mobile applications, with a special interest in cardiac issues? This review of these searches corresponds to an analysis by 14 categories, being these: 1) Scientific paper; 2) Doctoral Thesis; 3) Master thesis; 4) Telemedicine; 5) m-sssshealth, e-health; 6) cardiovascular, coronary diseases, heart failures, cardiopulmonary, cardiac rehabilitation; 7) rural health; 8) prevention and control, protection; 9) wearables; 10) mobile, web applications, app, smartphone, software, platform; 11) mhealth education, training, promotion, formative process; 12) self-management; 13) Multiple Vital Sign Monitoring, medical device, heart rate measurement, health care information systems; 14) health regulatory. It provides evidence of how some apps have been evaluated, and in some cases, the effectiveness of the estimated accuracy is not in line with the real situation. Conclusion: The analysis of these studies allows us to locate the sources of the development of mobile health projects. It also guides us to discover some needs that require new technology implementations.
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Affiliation(s)
- Vladimir Villarreal
- Computer Systems Engineering Department, Technological University of Panama, El Dorado, Panama City, Republic of Panama.,Research Group in Emerging Computational Technologies, Technological University of Panama, El Dorado, Panama City, Republic of Panama
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Emerging Technology in Promoting Physical Activity and Health: Challenges and Opportunities. J Clin Med 2019; 8:jcm8111830. [PMID: 31683951 PMCID: PMC6912378 DOI: 10.3390/jcm8111830] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
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Menghini L, Gianfranchi E, Cellini N, Patron E, Tagliabue M, Sarlo M. Stressing the accuracy: Wrist-worn wearable sensor validation over different conditions. Psychophysiology 2019; 56:e13441. [PMID: 31332802 DOI: 10.1111/psyp.13441] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/29/2019] [Accepted: 06/24/2019] [Indexed: 01/26/2023]
Abstract
Wearable sensors are promising instruments for conducting both laboratory and ambulatory research in psychophysiology. However, scholars should be aware of their measurement error and the conditions in which accuracy is achieved. This study aimed to assess the accuracy of a wearable sensor designed for research purposes, the E4 wristband (Empatica, Milan, Italy), in measuring heart rate (HR), heart rate variability (HRV), and skin conductance (SC) over five laboratory conditions widely used in stress reactivity research (seated rest, paced breathing, orthostatic, Stroop, speech task) and two ecological conditions (slow walking, keyboard typing). Forty healthy participants concurrently wore the wristband and two gold standard measurement systems (i.e., electrocardiography and finger SC sensor). The wristband accuracy was determined by evaluating the signal quality and the correlations with and the Bland-Altman plots against gold standard-derived measurements. Moreover, exploratory analyses were performed to assess predictors of measurement error. Mean HR measures showed the best accuracy over all conditions. HRV measures showed satisfactory accuracy in seated rest, paced breathing, and recovery conditions but not in dynamic conditions, including speaking. Accuracy was diminished by wrist movements, cognitive and emotional stress, nonstationarity, and larger wrist circumferences. Wrist SC measures showed neither correlation nor visual resemblance with finger SC signal, suggesting that the two sites may reflect different phenomena. Future studies are needed to assess the responsivity of wrist SC to emotional and cognitive stress. Limitations and implications for laboratory and ambulatory research are discussed.
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Affiliation(s)
- Luca Menghini
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Nicola Cellini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Elisabetta Patron
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Michela Sarlo
- Department of General Psychology, University of Padova, Padova, Italy
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Saripalle RK. Leveraging FHIR to Integrate Activity Data with Electronic Health Record. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00316-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ellingson LD, Lansing JE, DeShaw KJ, Peyer KL, Bai Y, Perez M, Phillips LA, Welk GJ. Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults' Activity Levels: Randomized Intervention. JMIR Mhealth Uhealth 2019; 7:e10988. [PMID: 30762582 PMCID: PMC6393778 DOI: 10.2196/10988] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/04/2018] [Accepted: 10/20/2018] [Indexed: 02/02/2023] Open
Abstract
Background While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. Objective This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. Methods A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. Results Regression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=–.49, P=.01) and lack of previous experience with pedometers (beta=–.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). Conclusions This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity. Trial Registration ClinicalTrials.gov NCT03837366; https://clinicaltrials.gov/ct2/show/NCT03837366
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Affiliation(s)
- Laura D Ellingson
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Jeni E Lansing
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Kathryn J DeShaw
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Karissa L Peyer
- Department of Health and Human Performance, University of Tennessee-Chatanooga, Chattanooga, TN, United States
| | - Yang Bai
- Deparment of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, United States
| | - Maria Perez
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - L Alison Phillips
- Department of Psychology, Iowa State University, Ames, IA, United States
| | - Gregory J Welk
- Department of Kinesiology, Iowa State University, Ames, IA, United States
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van Haasteren A, Gille F, Fadda M, Vayena E. Development of the mHealth App Trustworthiness checklist. Digit Health 2019; 5:2055207619886463. [PMID: 31803490 PMCID: PMC6876327 DOI: 10.1177/2055207619886463] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/03/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile health applications (mHealth apps) currently lack a consensus on substantial quality and safety standards. As such, the number of individuals engaging with untrustworthy mHealth apps continues to grow at a steady pace. OBJECTIVE The purpose of this study was to investigate end-users' opinions on the features or actions necessary for trustworthy mHealth apps; and to convey this information to app developers via a succinct but informative checklist: the mHealth app trustworthiness checklist. METHODS The checklist was formulated in three stages: (a) a literature review of studies identified the desirable features of the most prolific mHealth apps (health and fitness apps); (b) four focus group sessions with past or current users of these apps (n = 20); and (c) expert feedback on whether the checklist items are conceivable in a real-life setting (n = 6). RESULTS Five major themes emerged from the focus group discussions: informational content, organizational attributes, societal influence, technology-related features, and user control factors. The mHealth app trustworthiness checklist was developed to incorporate these five themes and subsequently modified following expert consultation. In addition to the trustworthiness themes, we identified features that lie between trust and mistrust (limited digital literacy and indifference) as well as 10 features and actions that cause end-users to mistrust mHealth apps. CONCLUSION This study contributes to the evidence base on the attributes of trustworthy mHealth apps. The mHealth app trustworthiness checklist is a useful tool in advancing continued efforts to ensure that health technologies are trustworthy.
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Affiliation(s)
- Afua van Haasteren
- Department of Health Sciences and Technology (D-HEST), ETH Zürich, Switzerland
| | - Felix Gille
- Department of Health Sciences and Technology (D-HEST), ETH Zürich, Switzerland
| | - Marta Fadda
- Department of Health Sciences and Technology (D-HEST), ETH Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology (D-HEST), ETH Zürich, Switzerland
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Jagannathan R, Ziolkowski SL, Weber MB, Cobb J, Pham N, Long J, Anand S, Lobelo F. Physical activity promotion for patients transitioning to dialysis using the "Exercise is Medicine" framework: a multi-center randomized pragmatic trial (EIM-CKD trial) protocol. BMC Nephrol 2018; 19:230. [PMID: 30208854 PMCID: PMC6136167 DOI: 10.1186/s12882-018-1032-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/02/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients on dialysis are physically inactive, with most reporting activity levels below the fifth percentile of healthy age-matched groups. Several small studies have reported efficacy of diverse exercise interventions among persons with CKD and those on dialysis. However, no single intervention has been widely adopted in real-world practice, despite a clear need in this vulnerable population with high rates of mortality, frailty, and skilled nursing hospitalizations. METHODS/DESIGN We describe a pragmatic clinical trial for an exercise intervention among patients transitioning to dialysis. We will use an existing framework - Exercise is Medicine (EIM) - developed by the American College of Sports Medicine. After undertaking formative qualitative research to tailor the EIM framework to the advanced CKD population (eGFR < 30 ml/min/1.73m2), we will randomize 96 patients from two regions-Atlanta and Bay Area-in two intervention arms with incremental levels of clinical-community integration: physical activity assessment during Nephrology clinical visit, brief counseling at pre-dialysis education, and physical activity wearable (group 1) versus group 1 intervention components plus a referral to a free, EIM practitioner-led group exercise program over 16 weeks (group 2; 8 week core intervention; 8-week follow up). We will assess efficacy by comparing between group differences in minutes/week of objectively measured moderate intensity physical activity. To evaluate implementation, we will use questionnaires for assessing barriers to referral, participation and retention along the path of the intervention. Further we will have a plan for dissemination of the intervention by partnering with relevant stakeholders. DISCUSSION The overall goal is to inform the development of a practical, cost-conscious intervention "package" that addresses barriers and challenges to physical activity commonly faced by patients with advanced CKD and can be disseminated amongst interested practices. TRIAL REGISTRATION ClinicalTrials.gov identifier (Dated:10/17/2017): NCT03311763 .
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Affiliation(s)
- Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA
| | | | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA
| | - Jason Cobb
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nhat Pham
- Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jin Long
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA.
- Exercise is Medicine Global Research and Collaboration Center, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA.
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The Need for Local, Multidisciplinary Collaborations to Promote Advances in Physical Activity Research and Policy Change: The Creation of the Boston Physical Activity Resource Collaborative (BPARC). ACTA ACUST UNITED AC 2018; 3:74-77. [PMID: 30310876 DOI: 10.12691/jpar-3-2-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This commentary describes the development, vision, and initial progress of the newly-founded Boston Physical Activity Resource Collaborative (BPARC). Our aims are to move the field of physical activity forward, with broader dissemination and translation, by creating a local Boston and Massachusetts hub for researchers, practitioners, advocates, and policymakers. Participants come from multiple academic and medical centers, local advocacy groups, and government agencies, all of whom are working on components of physical activity promotion. We have had initial success in collaborating on study design, methodology, and grant applications. Future endeavors aim to produce streamlined methods and products with maximal impact for the field of physical activity research, policy, and practice.
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Feldman DI, Theodore Robison W, Pacor JM, Caddell LC, Feldman EB, Deitz RL, Feldman T, Martin SS, Nasir K, Blaha MJ. Harnessing mHealth technologies to increase physical activity and prevent cardiovascular disease. Clin Cardiol 2018; 41:985-991. [PMID: 29671879 DOI: 10.1002/clc.22968] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/04/2018] [Accepted: 04/16/2018] [Indexed: 11/11/2022] Open
Abstract
Research into prevention of cardiovascular disease has increasingly focused on mobile health (mHealth) technologies and their efficacy in helping individuals adhere to heart-healthy recommendations, including daily physical activity levels. By including the use of mHealth technologies in the discussion of physical activity recommendations, clinicians empower patients to play an active daily role in modifying their cardiovascular risk-factor profile. In this review, we critically evaluate the mHealth and physical activity literature to determine how these tools may lower cardiovascular risk while providing real-time tracking, feedback, and motivation on physical activity levels. We analyze the various domains-including user knowledge, social support, behavioral change theory, and self-motivation-that potentially influence the effectiveness of smartphone applications to impact individual physical activity levels. In doing so, we hope to provide a thorough overview of the mHealth landscape, in addition to highlighting many of the administrative, reimbursement, and patient-privacy challenges of using these technologies in patient care. Finally, we propose a behavioral change model and checklist for clinicians to assist patients in utilizing mHealth technology to best achieve meaningful changes in daily physical activity levels.
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Affiliation(s)
- David I Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - W Theodore Robison
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin M Pacor
- Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Luke C Caddell
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Erica B Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Rachel L Deitz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Theodore Feldman
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
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