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Creagh AP, Hamy V, Yuan H, Mertes G, Tomlinson R, Chen WH, Williams R, Llop C, Yee C, Duh MS, Doherty A, Garcia-Gancedo L, Clifton DA. Digital health technologies and machine learning augment patient reported outcomes to remotely characterise rheumatoid arthritis. NPJ Digit Med 2024; 7:33. [PMID: 38347090 PMCID: PMC10861520 DOI: 10.1038/s41746-024-01013-y] [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: 11/16/2022] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
Digital measures of health status captured during daily life could greatly augment current in-clinic assessments for rheumatoid arthritis (RA), to enable better assessment of disease progression and impact. This work presents results from weaRAble-PRO, a 14-day observational study, which aimed to investigate how digital health technologies (DHT), such as smartphones and wearables, could augment patient reported outcomes (PRO) to determine RA status and severity in a study of 30 moderate-to-severe RA patients, compared to 30 matched healthy controls (HC). Sensor-based measures of health status, mobility, dexterity, fatigue, and other RA specific symptoms were extracted from daily iPhone guided tests (GT), as well as actigraphy and heart rate sensor data, which was passively recorded from patients' Apple smartwatch continuously over the study duration. We subsequently developed a machine learning (ML) framework to distinguish RA status and to estimate RA severity. It was found that daily wearable sensor-outcomes robustly distinguished RA from HC participants (F1, 0.807). Furthermore, by day 7 of the study (half-way), a sufficient volume of data had been collected to reliably capture the characteristics of RA participants. In addition, we observed that the detection of RA severity levels could be improved by augmenting standard patient reported outcomes with sensor-based features (F1, 0.833) in comparison to using PRO assessments alone (F1, 0.759), and that the combination of modalities could reliability measure continuous RA severity, as determined by the clinician-assessed RAPID-3 score at baseline (r2, 0.692; RMSE, 1.33). The ability to measure the impact of the disease during daily life-through objective and remote digital outcomes-paves the way forward to enable the development of more patient-centric and personalised measurements for use in RA clinical trials.
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Affiliation(s)
- Andrew P Creagh
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
- Big Data Institute, University of Oxford, Oxford, UK.
| | | | - Hang Yuan
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gert Mertes
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | - Aiden Doherty
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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2
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Hamy V, Llop C, Yee CW, Garcia-Gancedo L, Maxwell A, Chen WH, Tomlinson R, Bobbili P, Bendelac J, Landry J, DerSarkissian M, Yenikomshian M, Mody EA, Duh MS, Williams R. Patient-centric assessment of rheumatoid arthritis using a smartwatch and bespoke mobile app in a clinical setting. Sci Rep 2023; 13:18311. [PMID: 37880288 PMCID: PMC10600111 DOI: 10.1038/s41598-023-45387-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Rheumatoid arthritis (RA) is a fluctuating progressive disease requiring frequent symptom assessment for appropriate management. Continuous tracking using digital technologies may provide greater insights of a patient's experience. This prospective study assessed the feasibility, reliability, and clinical utility of using novel digital technologies to remotely monitor participants with RA. Participants with moderate to severe RA and non-RA controls were monitored continuously for 14 days using an iPhone with an integrated bespoke application and an Apple Watch. Participants completed patient-reported outcome measures and objective guided tests designed to assess disease-related impact on physical function. The study was completed by 28 participants with RA, 28 matched controls, and 2 unmatched controls. Completion rates for all assessments were > 97% and were reproducible over time. Several guided tests distinguished between RA and control cohorts (e.g., mean lie-to-stand time [seconds]: RA: 4.77, control: 3.25; P < 0.001). Participants with RA reporting greater stiffness, pain, and fatigue had worse guided test performances (e.g., wrist movement [P < 0.001] and sit-to-stand transition time [P = 0.009]) compared with those reporting lower stiffness, pain, and fatigue. This study demonstrates that digital technologies can be used in a well-controlled, remote clinical setting to assess the daily impact of RA.
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Affiliation(s)
- Valentin Hamy
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK.
| | | | | | | | - Aoife Maxwell
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK
| | | | | | | | | | | | | | | | - Elinor A Mody
- Rheumatology Department, Reliant Medical Group, Auburn, USA
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Keogh A, Alcock L, Brown P, Buckley E, Brozgol M, Gazit E, Hansen C, Scott K, Schwickert L, Becker C, Hausdorff JM, Maetzler W, Rochester L, Sharrack B, Vogiatzis I, Yarnall A, Mazzà C, Caulfield B. Acceptability of wearable devices for measuring mobility remotely: Observations from the Mobilise-D technical validation study. Digit Health 2023; 9:20552076221150745. [PMID: 36756644 PMCID: PMC9900162 DOI: 10.1177/20552076221150745] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to explore the acceptability of a wearable device for remotely measuring mobility in the Mobilise-D technical validation study (TVS), and to explore the acceptability of using digital tools to monitor health. Methods Participants (N = 106) in the TVS wore a waist-worn device (McRoberts Dynaport MM + ) for one week. Following this, acceptability of the device was measured using two questionnaires: The Comfort Rating Scale (CRS) and a previously validated questionnaire. A subset of participants (n = 36) also completed semi-structured interviews to further determine device acceptability and to explore their opinions of the use of digital tools to monitor their health. Questionnaire results were analysed descriptively and interviews using a content analysis. Results The device was considered both comfortable (median CRS (IQR; min-max) = 0.0 (0.0; 0-20) on a scale from 0-20 where lower scores signify better comfort) and acceptable (5.0 (0.5; 3.0-5.0) on a scale from 1-5 where higher scores signify better acceptability). Interviews showed it was easy to use, did not interfere with daily activities, and was comfortable. The following themes emerged from participants' as being important to digital technology: altered expectations for themselves, the use of technology, trust, and communication with healthcare professionals. Conclusions Digital tools may bridge existing communication gaps between patients and clinicians and participants are open to this. This work indicates that waist-worn devices are supported, but further work with patient advisors should be undertaken to understand some of the key issues highlighted. This will form part of the ongoing work of the Mobilise-D consortium.
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Affiliation(s)
- Alison Keogh
- Insight Centre for Data Analytics, O’Brien Science Centre,
University
College Dublin, Dublin, Ireland,School of Public Health, Physiotherapy and Sports Science,
University
College Dublin, Dublin, Ireland,Alison Keogh, Insight Centre for Data
Analytics, 3rd Floor Science Centre East, University College Dublin, Ireland
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical
Sciences, Newcastle
University, Newcastle upon Tyne, UK
| | - Philip Brown
- Physiotherapy
Department, The Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Newcastle Upon Tyne, UK
| | - Ellen Buckley
- INSIGNEO Institute for in silico Medicine,
The University
of Sheffield, Sheffield, UK,Department of Mechanical Engineering,
The University
of Sheffield, Sheffield, UK
| | - Marina Brozgol
- Center for the Study of Movement, Cognition and Mobility,
Neurological Institute, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility,
Neurological Institute, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein
Campus Kiel, Kiel, Germany
| | - Kirsty Scott
- INSIGNEO Institute for in silico Medicine,
The University
of Sheffield, Sheffield, UK,Department of Mechanical Engineering,
The University
of Sheffield, Sheffield, UK
| | - Lars Schwickert
- Gesellschaft für Medizinische Forschung,
Robert-Bosch
Foundation GmbH, Stuttgart, Germany
| | - Clemens Becker
- Gesellschaft für Medizinische Forschung,
Robert-Bosch
Foundation GmbH, Stuttgart, Germany
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility,
Neurological Institute, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel,Department of Physical Therapy, Sackler Faculty of Medicine &
Sagol School of Neuroscience, Tel Aviv
University, Tel Aviv, Israel
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein
Campus Kiel, Kiel, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical
Sciences, Newcastle
University, Newcastle upon Tyne, UK,Physiotherapy
Department, The Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Newcastle Upon Tyne, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational
Neuroscience BRC, Sheffield
Teaching Hospitals NHS Foundation Trust,
Sheffield, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation,
Northumbria
University Newcastle, Newcastle upon Tyne,
UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical
Sciences, Newcastle
University, Newcastle upon Tyne, UK
| | - Claudia Mazzà
- INSIGNEO Institute for in silico Medicine,
The University
of Sheffield, Sheffield, UK,Department of Mechanical Engineering,
The University
of Sheffield, Sheffield, UK
| | - Brian Caulfield
- Insight Centre for Data Analytics, O’Brien Science Centre,
University
College Dublin, Dublin, Ireland,School of Public Health, Physiotherapy and Sports Science,
University
College Dublin, Dublin, Ireland
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Vega J, Li M, Aguillera K, Goel N, Joshi E, Khandekar K, Durica KC, Kunta AR, Low CA. Reproducible Analysis Pipeline for Data Streams: Open-Source Software to Process Data Collected With Mobile Devices. Front Digit Health 2021; 3:769823. [PMID: 34870271 PMCID: PMC8636712 DOI: 10.3389/fdgth.2021.769823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023] Open
Abstract
Smartphone and wearable devices are widely used in behavioral and clinical research to collect longitudinal data that, along with ground truth data, are used to create models of human behavior. Mobile sensing researchers often program data processing and analysis code from scratch even though many research teams collect data from similar mobile sensors, platforms, and devices. This leads to significant inefficiency in not being able to replicate and build on others' work, inconsistency in quality of code and results, and lack of transparency when code is not shared alongside publications. We provide an overview of Reproducible Analysis Pipeline for Data Streams (RAPIDS), a reproducible pipeline to standardize the preprocessing, feature extraction, analysis, visualization, and reporting of data streams coming from mobile sensors. RAPIDS is formed by a group of R and Python scripts that are executed on top of reproducible virtual environments, orchestrated by a workflow management system, and organized following a consistent file structure for data science projects. We share open source, documented, extensible and tested code to preprocess, extract, and visualize behavioral features from data collected with any Android or iOS smartphone sensing app as well as Fitbit and Empatica wearable devices. RAPIDS allows researchers to process mobile sensor data in a rigorous and reproducible way. This saves time and effort during the data analysis phase of a project and facilitates sharing analysis workflows alongside publications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Carissa A. Low
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Keogh A, Argent R, Anderson A, Caulfield B, Johnston W. Assessing the usability of wearable devices to measure gait and physical activity in chronic conditions: a systematic review. J Neuroeng Rehabil 2021; 18:138. [PMID: 34526053 PMCID: PMC8444467 DOI: 10.1186/s12984-021-00931-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Health Organisation's global strategy for digital health emphasises the importance of patient involvement. Understanding the usability and acceptability of wearable devices is a core component of this. However, usability assessments to date have focused predominantly on healthy adults. There is a need to understand the patient perspective of wearable devices in participants with chronic health conditions. METHODS A systematic review was conducted to identify any study design that included a usability assessment of wearable devices to measure mobility, through gait and physical activity, within five cohorts with chronic conditions (Parkinson's disease [PD], multiple sclerosis [MS], congestive heart failure, [CHF], chronic obstructive pulmonary disorder [COPD], and proximal femoral fracture [PFF]). RESULTS Thirty-seven studies were identified. Substantial heterogeneity in the quality of reporting, the methods used to assess usability, the devices used, and the aims of the studies precluded any meaningful comparisons. Questionnaires were used in the majority of studies (70.3%; n = 26) with a reliance on intervention specific measures (n = 16; 61.5%). For those who used interviews (n = 17; 45.9%), no topic guides were provided, while methods of analysis were not reported in over a third of studies (n = 6; 35.3%). CONCLUSION Usability of wearable devices is a poorly measured and reported variable in chronic health conditions. Although the heterogeneity in how these devices are implemented implies acceptance, the patient voice should not be assumed. In the absence of being able to make specific usability conclusions, the results of this review instead recommends that future research needs to: (1) Conduct usability assessments as standard, irrespective of the cohort under investigation or the type of study undertaken. (2) Adhere to basic reporting standards (e.g. COREQ) including the basic details of the study. Full copies of any questionnaires and interview guides should be supplied through supplemental files. (3) Utilise mixed methods research to gather a more comprehensive understanding of usability than either qualitative or quantitative research alone will provide. (4) Use previously validated questionnaires alongside any intervention specific measures.
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Affiliation(s)
- Alison Keogh
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
| | - Rob Argent
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | | | - Brian Caulfield
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - William Johnston
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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6
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Keogh A, Johnston W, Ashton M, Sett N, Mullan R, Donnelly S, Dorn JF, Calvo F, Mac Namee B, Caulfield B. "It's Not as Simple as Just Looking at One Chart": A Qualitative Study Exploring Clinician's Opinions on Various Visualisation Strategies to Represent Longitudinal Actigraphy Data. Digit Biomark 2020; 4:87-99. [PMID: 33442583 DOI: 10.1159/000512044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background Data derived from wearable activity trackers may provide important clinical insights into disease progression and response to intervention, but only if clinicians can interpret it in a meaningful manner. Longitudinal activity data can be visually presented in multiple ways, but research has failed to explore how clinicians interact with and interpret these visualisations. In response, this study developed a variety of visualisations to understand whether alternative data presentation strategies can provide clinicians with meaningful insights into patient's physical activity patterns. Objective To explore clinicians' opinions on different visualisations of actigraphy data. Methods Four visualisations (stacked bar chart, clustered bar chart, linear heatmap and radial heatmap) were created using Matplotlib and Seaborn Python libraries. A focus group was conducted with 14 clinicians across 2 hospitals. Focus groups were audio-recorded, transcribed and analysed using inductive thematic analysis. Results Three major themes were identified: (1) the importance of context, (2) interpreting the visualisations and (3) applying visualisations to clinical practice. Although clinicians saw the potential value in the visualisations, they expressed a need for further contextual information to gain clinical benefits from them. Allied health professionals preferred more granular, temporal information compared to doctors. Specifically, physiotherapists favoured heatmaps, whereas the remaining members of the team favoured stacked bar charts. Overall, heatmaps were considered more difficult to interpret. Conclusion The current lack of contextual data provided by wearables hampers their use in clinical practice. Clinicians favour data presented in a familiar format and yet desire multi-faceted filtering. Future research should implement user-centred design processes to identify ways in which all clinical needs can be met, potentially using an interactive system that caters for multiple levels of granularity. Irrespective of how data is displayed, unless clinicians can apply it in a manner that best supports their role, the potential of this data cannot be fully realised.
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Affiliation(s)
- Alison Keogh
- Insight Centre of Data Analytics, University College, Dublin, Ireland.,UCD School of Public Health, Physiotherapy and Sports Science, University College, Dublin, Ireland
| | - William Johnston
- Insight Centre of Data Analytics, University College, Dublin, Ireland.,UCD School of Public Health, Physiotherapy and Sports Science, University College, Dublin, Ireland
| | - Mitchell Ashton
- Insight Centre of Data Analytics, University College, Dublin, Ireland
| | - Niladri Sett
- Insight Centre of Data Analytics, University College, Dublin, Ireland.,UCD School of Computer Science, University College, Dublin, Ireland
| | - Ronan Mullan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - Brian Mac Namee
- Insight Centre of Data Analytics, University College, Dublin, Ireland.,UCD School of Computer Science, University College, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre of Data Analytics, University College, Dublin, Ireland.,UCD School of Public Health, Physiotherapy and Sports Science, University College, Dublin, Ireland
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