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Barata F, Shim J, Wu F, Langer P, Fleisch E. The Bitemporal Lens Model-toward a holistic approach to chronic disease prevention with digital biomarkers. JAMIA Open 2024; 7:ooae027. [PMID: 38596697 PMCID: PMC11000821 DOI: 10.1093/jamiaopen/ooae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/22/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
Objectives We introduce the Bitemporal Lens Model, a comprehensive methodology for chronic disease prevention using digital biomarkers. Materials and Methods The Bitemporal Lens Model integrates the change-point model, focusing on critical disease-specific parameters, and the recurrent-pattern model, emphasizing lifestyle and behavioral patterns, for early risk identification. Results By incorporating both the change-point and recurrent-pattern models, the Bitemporal Lens Model offers a comprehensive approach to preventive healthcare, enabling a more nuanced understanding of individual health trajectories, demonstrated through its application in cardiovascular disease prevention. Discussion We explore the benefits of the Bitemporal Lens Model, highlighting its capacity for personalized risk assessment through the integration of two distinct lenses. We also acknowledge challenges associated with handling intricate data across dual temporal dimensions, maintaining data integrity, and addressing ethical concerns pertaining to privacy and data protection. Conclusion The Bitemporal Lens Model presents a novel approach to enhancing preventive healthcare effectiveness.
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Affiliation(s)
- Filipe Barata
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Jinjoo Shim
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Fan Wu
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Patrick Langer
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
- Centre for Digital Health Interventions, University of St. Gallen, St. Gallen, St. Gallen, 9000, Switzerland
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Toledano-Shubi A, Hel-Or H, Sarig Bahat H. Remote versus face-to-face fall risk assessment in home dwelling older adults: a reliability study. Physiother Theory Pract 2024:1-9. [PMID: 38881165 DOI: 10.1080/09593985.2024.2367516] [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: 04/17/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Falls are a leading cause of severe injury and death in older adults. Remote screening of fall risk may prevent falls and hence, advance health and wellness of older adults. While remote health care is becoming a common practice, we question if remote evaluation of fall risk is as reliable as face-to-face (FTF). OBJECTIVE To assess the inter-tester reliability of synchronized remote and FTF fall risk assessment. METHODS This inter-format, inter-rater reliability study included 48 home dwelling older adults aged 65 and over. Five valid functional and balance tests were conducted: 30 Second Sit-to-Stand (STS), MiniBESTest, Timed up and go (TUG), 4-Meter Walk (4MWT), and Berg Balance Scale (BBS). Instructions were provided via videoconferencing, and two physiotherapists scored performance simultaneously, one remotely, and one in the room. Inter-rater reliability between remote and FTF scores was analyzed using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC95) and Bland and Altman analysis. RESULTS Excellent ICCs were found for STS, MiniBESTest, TUG, and BBS (0.90-0.99), and moderate for 4MWT (0.74). SEM and MDC95 values were STS (0.37,1.03 repetitions), MiniBESTest (1.43,3.97 scores), TUG (1.22,3.37 seconds), 4MWT (0.17,0.47 m/second), and BBS (1.79,4.95 scores). The Bland and Altman analysis showed excellent agreement between remote and FTF assessments of the STS. All other tests showed low to moderate agreement. Mean difference ± SD and 95%LOA were as follows: STS (-0.11 ± 0.52), (-1.13,0.91) repetitions, MiniBESTest (0.45 ± 1.98), (-3.43,4.32) scores, TUG (-0.35 ± 1.54), (-3.37,2.67) seconds, 4MWT (-0.08 ± 0.22), (-0.35,0.51) meter/second, and BBS (0.04 ± 2.53), (-4.93,5.01) scores. CONCLUSIONS The findings support the responsible integration of remote fall risk assessment in clinical practice, enabling large-scale screenings and referrals for early intervention to promote healthy aging and fall prevention.
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Affiliation(s)
- Adi Toledano-Shubi
- Department of Physical Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hagit Hel-Or
- Department of Computer Science, The Herta and Paul Amir Faculty of Social Science, University of Haifa, Haifa, Israel
| | - Hilla Sarig Bahat
- Department of Physical Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Center of research and study of aging, University of Haifa, Haifa, Israel
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de Graaf D, de Vries NM, van de Zande T, Schimmel JJP, Shin S, Kowahl N, Barman P, Kapur R, Marks WJ, van 't Hul A, Bloem B. Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e55452. [PMID: 38713508 PMCID: PMC11109858 DOI: 10.2196/55452] [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: 12/13/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life. OBJECTIVE We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test. METHODS This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ≥18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT. RESULTS In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024. CONCLUSIONS The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options. TRIAL REGISTRATION ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55452.
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Affiliation(s)
- Debbie de Graaf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Nienke M de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Tessa van de Zande
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Janneke J P Schimmel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Sooyoon Shin
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Nathan Kowahl
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Poulami Barman
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Ritu Kapur
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
- Verily Life Sciences, South San Fransisco, CA, United States
| | - William J Marks
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Alex van 't Hul
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, Nijmegen, Netherlands
| | - Bastiaan Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
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Mouselimis D, Tsarouchas A, Vassilikos VP, Mitsas AC, Lazaridis C, Androulakis E, Briasoulis A, Kampaktsis P, Papadopoulos CE, Bakogiannis C. The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature. Hellenic J Cardiol 2024; 77:81-92. [PMID: 37926237 DOI: 10.1016/j.hjc.2023.11.001] [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: 08/08/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients.
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Affiliation(s)
- Dimitrios Mouselimis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos C Mitsas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Androulakis
- Heart Imaging Centre, Royal Brompton, and Harefield Hospitals, London, United Kingdom
| | - Alexandros Briasoulis
- University of Iowa Hospitals & Clinics and the National and Kapodistrian University of Athens, Athens, Greece
| | - Polydoros Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
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Lippi L, Desimoni F, Canonico M, Massocco G, Turco A, Polverelli M, de Sire A, Invernizzi M. System for Tracking and Evaluating Performance (Step-App®): validation and clinical application of a mobile telemonitoring system in patients with knee and hip total arthroplasty. A prospective cohort study. Eur J Phys Rehabil Med 2024; 60:349-360. [PMID: 38298025 PMCID: PMC11131591 DOI: 10.23736/s1973-9087.24.08128-0] [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: 07/09/2023] [Revised: 10/25/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Technological advances and digital solutions have been proposed to overcome barriers to sustainable rehabilitation programs in patients with musculoskeletal disorders. However, to date, standardized telemonitoring systems able to precisely assess physical performance and functioning are still lacking. AIM To validate a new mobile telemonitoring system, named System for Tracking and Evaluating Performance (Step-App®), to evaluate physical performance in patients undergone knee and hip total arthroplasty. DESIGN Prospective cohort study. METHODS A consecutive series of older adults with knee and hip total arthroplasty participated in a comprehensive rehabilitation program. The Step-App®, a mobile telemonitoring system, was used to remotely monitor the effects of rehabilitation, and the outcomes were assessed before (T0) and after the rehabilitation treatment (T1). The primary outcomes were the 6-Minute Walk Test (6MWT), the 10-Meter Walk Test (10MWT), and the 30-Second Sit-To-Stand Test (30SST). RESULTS Out of 42 patients assessed, 25 older patients were included in the present study. The correlation analysis between the Step-App® measurements and the traditional in-person assessments demonstrated a strong positive correlation for the 6MWT (T0: r2=0.9981, P<0.0001; T1: r2=0.9981, P<0.0001), 10MWT (T0: r2=0.9423, P<0.0001; T1: r2=0.8634, P<0.0001), and 30SST (T0: r2=1, P<0.0001; T1: r2=1, P<0.0001). The agreement analysis, using Bland-Altman plots, showed a good agreement between the Step-App® measurements and the in-person assessments. CONCLUSIONS Therefore, we might conclude that Step-App® could be considered as a validated mobile telemonitoring system for remote assessment that might have a role in telemonitoring personalized rehabilitation programs for knee and hip replacement patients. CLINICAL REHABILITATION IMPACT Our findings might guide clinicians in remote monitoring of physical performance in patients with musculoskeletal conditions, providing new insight into tailored telerehabilitation programs.
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Affiliation(s)
- Lorenzo Lippi
- Unit of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Unit of Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesco Desimoni
- Computer Science Institute, Department of Sciences and Technological Innovation, University of Eastern Piedmont, Alessandria, Italy
| | - Massimo Canonico
- Computer Science Institute, Department of Sciences and Technological Innovation, University of Eastern Piedmont, Alessandria, Italy
| | - Gregorio Massocco
- Unit of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Alessio Turco
- Unit of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Marco Polverelli
- Unit of Rehabilitation, Department of Rehabilitation, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy -
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Marco Invernizzi
- Unit of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Unit of Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Simmich J, Andrews NE, Claus A, Murdoch M, Russell TG. Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study. JMIR Form Res 2024; 8:e46820. [PMID: 38498031 PMCID: PMC10985605 DOI: 10.2196/46820] [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: 02/27/2023] [Revised: 02/06/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. OBJECTIVE The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. METHODS People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. RESULTS The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI -2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and -77.6 (95% CI -107.7 to -61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. CONCLUSIONS In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.
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Affiliation(s)
- Joshua Simmich
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Nicole Emma Andrews
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
- The Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- Occupational Therapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Andrew Claus
- The Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Megan Murdoch
- The Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Trevor Glen Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
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Harber MP, Myers J, Bonikowske AR, Muntaner-Mas A, Molina-Garcia P, Arena R, Ortega FB. Assessing cardiorespiratory fitness in clinical and community settings: Lessons and advancements in the 100th year anniversary of VO 2max. Prog Cardiovasc Dis 2024; 83:36-42. [PMID: 38417771 DOI: 10.1016/j.pcad.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
Cardiorespiratory fitness (CRF) is a well-established biomarker that has applications to all adults across the health and disease spectrum. Despite overwhelming evidence supporting the prognostic utility of CRF, it remains vastly underutilized. CRF is optimally measured via cardiopulmonary exercise testing which may not be feasible to implement on a large scale. Therefore, it is prudent to develop ways to accurately estimate CRF that can be applied in clinical and community settings. As such, several prediction equations incorporating non-exercise information that is readily available from routine clinical encounters have been developed that provide an adequate reflection of CRF that could be implemented to raise awareness of the importance of CRF. Further, technological advances in smartphone apps and consumer-grade wearables have demonstrated promise to provide reasonable estimates of CRF that are widely available, which could enhance the utilization of CRF in both clinical and community settings.
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Affiliation(s)
- Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, USA
| | | | - Adria Muntaner-Mas
- GICAFE "Physical Activity and Exercise Sciences Research Group", Faculty of Education, University of Balearic Islands, 07122 Palma, Spain
| | | | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America
| | - Francisco B Ortega
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
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Lai B, Wadsworth D, Spring K, Jones CS, Mintz M, Malone LA, Kim Y, Wilroy J, Lee H. Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study. JMIR Rehabil Assist Technol 2024; 11:e50582. [PMID: 38345838 PMCID: PMC10897795 DOI: 10.2196/50582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities. OBJECTIVE The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration. METHODS The study enrolled 19 ambulatory youth: 9 (47%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots. RESULTS The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05). CONCLUSIONS This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability.
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Affiliation(s)
- Byron Lai
- Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danielle Wadsworth
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Katherine Spring
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
- Pennington Biomedical Research Center, Division of Population and Public Health Science, Pediatric Obesity and Health Behavior Laboratory, Baton Rouge, LA, United States
| | - Chloe S Jones
- Exercise Adherence and Obesity Prevention Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Madison Mintz
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laurie A Malone
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Holim Lee
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
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Lebleu J, Daniels K, Pauwels A, Dekimpe L, Mapinduzi J, Poilvache H, Bonnechère B. Incorporating Wearable Technology for Enhanced Rehabilitation Monitoring after Hip and Knee Replacement. SENSORS (BASEL, SWITZERLAND) 2024; 24:1163. [PMID: 38400321 PMCID: PMC10892564 DOI: 10.3390/s24041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Osteoarthritis (OA) poses a growing challenge for the aging population, especially in the hip and knee joints, contributing significantly to disability and societal costs. Exploring the integration of wearable technology, this study addresses the limitations of traditional rehabilitation assessments in capturing real-world experiences and dynamic variations. Specifically, it focuses on continuously monitoring physical activity in hip and knee OA patients using automated unsupervised evaluations within the rehabilitation process. We analyzed data from 1144 patients who used a mobile health application after surgery; the activity data were collected using the Garmin Vivofit 4. Several parameters, such as the total number of steps per day, the peak 6-minute consecutive cadence (P6MC) and peak 1-minute cadence (P1M), were computed and analyzed on a daily basis. The results indicated that cadence-based measurements can effectively, and earlier, differ among patients with hip and knee conditions, as well as in the recovery process. Comparisons based on recovery status and type of surgery reveal distinctive trajectories, emphasizing the effectiveness of P6MC and P1M in detecting variations earlier than total steps per day. Furthermore, cadence-based measurements showed a lower inter-day variability (40%) compared to the total number of steps per day (80%). Automated assessments, including P1M and P6MC, offer nuanced insights into the patients' dynamic activity profiles.
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Affiliation(s)
- Julien Lebleu
- moveUp, 1000 Brussels, Belgium; (J.L.); (A.P.); (L.D.)
| | - Kim Daniels
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
| | | | - Lucie Dekimpe
- moveUp, 1000 Brussels, Belgium; (J.L.); (A.P.); (L.D.)
| | - Jean Mapinduzi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Filière de Kinésithérapie et Réadaptation, Département des Sciences Clinique, Institut National de la Santé Publique, 6807 Bujumbura, Burundi
| | - Hervé Poilvache
- Orthopedic Surgery Department, CHIREC, 1420 Braine-l’Alleud, Belgium
| | - Bruno Bonnechère
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, 3590 Diepenbeek, Belgium
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10
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Mostovov A, Jacobs D, Farid L, Dhellin P, Baille G. Test-retest reliability of the six-minute walking distance measurements using FeetMe insoles by completely unassisted healthy adults in their homes. PLOS DIGITAL HEALTH 2023; 2:e0000262. [PMID: 37992015 PMCID: PMC10664940 DOI: 10.1371/journal.pdig.0000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
Wearable technology provides an opportunity for new ways of monitoring patient gait remotely, through at-home self-administered six-minute walk tests (6MWTs). The purpose of this study was to evaluate the test-retest reliability of FeetMe insoles, a wearable gait assessment device, for measuring the six-minute walking distance (6MWD) during tests conducted with a one-week interval by completely unassisted healthy adults in their homes. Participants (n = 21) performed two 6MWTs at home while wearing the FeetMe insoles, and two 6MWTs at hospital while wearing FeetMe insoles and being assessed by a rater. All assessments were performed with a one-week interval between tests, no assistance was provided to the participants at home. The agreement between the 6MWD measurements made at baseline and at Week 1 was good for all test configurations and was highest for the at-home FeetMe measurements, with an intraclass correlation coefficient (ICC) of 0.95, standard error of the measurement (SEM) of 15.02 m and coefficient of variation (CV) of 3.33%, compared to ICCs of 0.79 and 0.78, SEMs of 25.65 and 26.65 and CVs of 6.24% and 6.10% for the rater and FeetMe measurements at hospital, respectively. Our work demonstrates that the FeetMe system could provide a reliable solution allowing individuals to self-administer 6MWTs independently at home.
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Affiliation(s)
| | | | - Leila Farid
- FeetMe SAS, 157 bd. MacDonald, Paris, France
| | | | - Guillaume Baille
- Neurology department, Delafontaine Hospital Center, Saint-Denis, France
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11
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Stubbs H, Lua S, Ingram J, Jani BD, Brewis M, Church C, Johnson M. Remote exercise testing in pulmonary hypertension (PHRET). Pulm Circ 2023; 13:e12325. [PMID: 38148951 PMCID: PMC10749888 DOI: 10.1002/pul2.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023] Open
Abstract
Remote exercise tests for patients with pulmonary hypertension (PH) would improve the telemedicine strategies in this disease. The PHRET study assessed the validity and feasibility of four remote exercise tests performed by PH patients at home. Participants undergoing diagnostic assessment for PH were included. At baseline, patients completed a 6MWT followed by a range of study tests including a Timed Up and Go (TUG) test, a Sit-to-Stand (STS), a Step Test (ST), and a tele-6MWT (T6MWT) performed outside using a GPS-enabled smartphone. Patients performed these tests at home following discharge and at first follow-up. Analysis focused on comparing the results of study tests to the standard 6MWT. The discontinuation rate was 15%. Ninety-seven percent of patients were able to complete a TUG, 92% a STS, 73% a ST, and 49% a T6MWT. At baseline, correlation between the standard 6MWT and study tests, respectively, was T6MWT 0.93, ST 0.78, STS 0.71, and TUG -0.76 (p < 0.001). Direction of change in the study test agreed with the standard 6MWT in 68% of the follow-up ST, 68% of the STS, 71% of the TUG, and 79% of the T6MWT. Patients were able to complete the tests at home, there were no adverse incidents and ≥92% of patients were happy to continue performing home tests. Remote exercise testing is feasible. The T6MWT was a valid remote measure of exercise capacity, but could only be performed by a limited number of patients. The high discontinuation rate may impact the utility of remote tests.
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Affiliation(s)
- Harrison Stubbs
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Stephanie Lua
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
| | - Jamie Ingram
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
| | - Bhautesh D. Jani
- General Practice and Primary Care, School of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Melanie Brewis
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Colin Church
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Martin Johnson
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
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12
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Golbus JR, Gupta K, Stevens R, Jeganathan VSE, Luff E, Shi J, Dempsey W, Boyden T, Mukherjee B, Kohnstamm S, Taralunga V, Kheterpal V, Murphy S, Klasnja P, Kheterpal S, Nallamothu BK. A randomized trial of a mobile health intervention to augment cardiac rehabilitation. NPJ Digit Med 2023; 6:173. [PMID: 37709933 PMCID: PMC10502072 DOI: 10.1038/s41746-023-00921-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Mobile health (mHealth) interventions may enhance positive health behaviors, but randomized trials evaluating their efficacy are uncommon. Our goal was to determine if a mHealth intervention augmented and extended benefits of center-based cardiac rehabilitation (CR) for physical activity levels at 6-months. We delivered a randomized clinical trial to low and moderate risk patients with a compatible smartphone enrolled in CR at two health systems. All participants received a compatible smartwatch and usual CR care. Intervention participants received a mHealth intervention that included a just-in-time-adaptive intervention (JITAI) as text messages. The primary outcome was change in remote 6-minute walk distance at 6-months stratified by device type. Here we report the results for 220 participants enrolled in the study (mean [SD]: age 59.6 [10.6] years; 67 [30.5%] women). For our primary outcome at 6 months, there is no significant difference in the change in 6 min walk distance across smartwatch types (Intervention versus control: +31.1 meters Apple Watch, -7.4 meters Fitbit; p = 0.28). Secondary outcomes show no difference in mean step counts between the first and final weeks of the study, but a change in 6 min walk distance at 3 months for Fitbit users. Amongst patients enrolled in center-based CR, a mHealth intervention did not improve 6-month outcomes but suggested differences at 3 months in some users.
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Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, USA.
| | - Kashvi Gupta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Rachel Stevens
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - V Swetha E Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jieru Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, Grand Rapids, MI, USA
| | | | - Sarah Kohnstamm
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Susan Murphy
- Departments of Statistics & Computer Science, Harvard University, Boston, MA, USA
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, USA
- The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
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13
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Mekritthikrai N, Yuenyongchaiwat K, Thanawattano C. Concurrent validity and reliability of new application for 6-min walk test in healthy adults. Heliyon 2023; 9:e17854. [PMID: 37539231 PMCID: PMC10395284 DOI: 10.1016/j.heliyon.2023.e17854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023] Open
Abstract
Background Evaluation assessments for physical performance, such as walking tests, are important for measuring a person's well-being. As of current, medical technology is primarily used to administer these assessments. However, medical devices are not easily accessible and are intended for research purposes only, and hence inconvenient for clinical use. Therefore, we aimed to develop a prototype physical performance assessor device with a mobile application and explored concurrent validity and reliability between the standard 6-min walk test (6MWT) and wearable sensor 6MWT using 6-min walk distance in healthy adults. Methods Sixty healthy males and females, above 18 years of age, were required to attach a sensor to their dominant ankle while the standard protocol for 6MWT was performed. After completing the walking test, the distance from the wearable sensor 6MWT with a mobile application and the standard 6MWT were recorded and compared. Results There was no significant difference between the distance between the standard 6MWT (410.12 ± 74.03 m) and the distance obtained with the wearable sensor. Concurrent validity was found to be moderate, and Cronbach's alpha was 0.79, which indicated good internal consistency. Conclusion The innovative prototype wearable walking sensor with a mobile application can effectively evaluate physical performance in healthy individuals.Clinical trial registration number: TCTR20220801002.
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Affiliation(s)
- Nuttawuth Mekritthikrai
- Department of Physiotherapy, Faculty of Allied Health Sciences, Thammasat University, Thailand
| | - Kornanong Yuenyongchaiwat
- Department of Physiotherapy, Faculty of Allied Health Sciences, Thammasat University, Thailand
- Thammasat University Research Unit in Physical Therapy in Cardiovascular and Respiratory Systems, Thailand
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14
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Li B, Gillmeyer KR, Molloy-Paolillo B, Vimalananda VG, Elwy AR, Wiener RS, Rinne ST. Scoping Review of Pulmonary Telemedicine Consults: Current Knowledge and Research Gaps. Ann Am Thorac Soc 2023; 20:456-465. [PMID: 36490386 PMCID: PMC9993154 DOI: 10.1513/annalsats.202205-404oc] [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: 05/09/2022] [Accepted: 12/09/2022] [Indexed: 12/13/2022] Open
Abstract
Rationale: Telemedicine consults, including video consults, telephone consults, electronic consults, and virtual conferences, may be particularly valuable in the management of chronic pulmonary diseases, but there is limited guidance on best practices for pulmonary telemedicine consults. Objectives: This scoping review aims to identify, characterize, and analyze gaps in the published literature on telemedicine consults health providers use to manage patients with chronic pulmonary diseases. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library from database origin through July 10, 2021. We included manuscripts describing applications of telemedicine consults for patients with chronic pulmonary diseases (asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease). We restricted our review to full-length articles published in English about provider-led (as opposed to nurse-led) telemedicine consults. Results: Our search yielded 3,118 unique articles; 27 articles met the inclusion criteria. All telemedicine consult modalities and chronic pulmonary conditions were well represented in the review except for pulmonary hypertension and interstitial lung disease, which were represented by one and no articles, respectively. Most articles described a small, single-center, observational study that focused on the acceptability, feasibility, use, and/or clinical effectiveness of the telemedicine consult. Few studies had objectively measured clinical outcomes or included a comparator group, and none compared telemedicine consult modalities against one another. Conclusions: Our scoping review identified limited literature describing pulmonary telemedicine consults and highlighted several gaps in the literature that warrant increased attention. Providers treating chronic pulmonary diseases are left with limited guidance on best practices for telemedicine consults.
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Affiliation(s)
| | | | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - Varsha G. Vimalananda
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island; and
| | - Renda Soylemez Wiener
- The Pulmonary Center, and
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Seppo T. Rinne
- The Pulmonary Center, and
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
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15
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Cano-de-la-Cuerda R, Jiménez-Antona C, Melián-Ortiz A, Molero-Sánchez A, Gil-de Miguel Á, Lizcano-Álvarez Á, Hernández-Barrera V, Varillas-Delgado D, Laguarta-Val S. Construct Validity and Test-Retest Reliability of a Free Mobile Application to Evaluate Aerobic Capacity and Endurance in Post-COVID-19 Syndrome Patients-A Pilot Study. J Clin Med 2022; 12:jcm12010131. [PMID: 36614932 PMCID: PMC9821392 DOI: 10.3390/jcm12010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction: Disability associated with the symptoms of post-COVID-19 syndrome is one of its main features and can have a considerable impact on care and rehabilitation units. This, linked to a decreased aerobic capacity and endurance in post-COVID-19 syndrome patients, increases interest in studying the potential of mobile applications to assess performance capacity. The purpose of this research was to study how a free mobile application assesses aerobic capacity and endurance and its relationship with aerobic capacity, test-retest reliability, and endurance evaluated by a conventional test, along with fatigue and health-related quality of life. Methods: An observational study was conducted. RUNZI®, a free mobile application, was used by mounting a Samsung Galaxy S8 smartphone using a strap on the right forearm while all participants simultaneously performed a 6-Minute Walking Test (6MWT). Construct validity between the 6MWT and the total distance performed evaluated by RUNZI® was explored. Additionally, evaluation scales to assess fatigue (MFIS) and health-related quality of life (SF-36) were used to analyze the construct validity of RUNZI®. For test−retest reliability of the app, the same instructions about the 6MWT and procedure with the app were given to all participants at two different time periods. Results: A total of 16 post-COVID-19 syndrome patients (15 females and 1 male) completed the procedure. Distance measured with the RUNZI® showed an excellent correlation with the 6MWT assessed conventionally (p < 0.0001; r = 0.851). No statistical correlations were found between the distance assessed by the RUNZI® app with MFIS and the SF-36. Test−retest reliability was found to be close to statistical significance (p = 0.058) for distance (m) measured by RUNZI® with an ICC of 0.482. Conclusions: Instrumental 6MWT assessed by the RUNZI® app for the Android® operating system showed an excellent correlation with conventional 6MWT, indicating its construct validity in post-COVID-19 syndrome patients. Further, values for the test−retest reliability for the free mobile application were close to statistical significance with a reliability considered poor in an indoor setting.
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Affiliation(s)
- Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
- Movement Analysis Laboratoy (LAMBECOM), Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
| | - Carmen Jiménez-Antona
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
- Correspondence: ; Tel.: + 34-91-488-86-50
| | - Alberto Melián-Ortiz
- Faculty of Nursing and Physiotherapy, Universidad Pontificia de Salamanca, 28040 Madrid, Spain
| | - Alberto Molero-Sánchez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
- Movement Analysis Laboratoy (LAMBECOM), Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
| | - Ángel Gil-de Miguel
- Medical Specialties and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
| | - Ángel Lizcano-Álvarez
- Department of Nursing and Stomatology, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
| | - Valentín Hernández-Barrera
- Medical Specialties and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
| | - David Varillas-Delgado
- Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Sofía Laguarta-Val
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain
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16
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Jansson AK, Lubans DR, Duncan MJ, Smith JJ, Bauman A, Attia J, Plotnikoff RC. Validity of muscular fitness self-assessments in the ecofit smartphone application: A correlation study. PLoS One 2022; 17:e0278374. [PMID: 36454865 PMCID: PMC9714846 DOI: 10.1371/journal.pone.0278374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mobile app-based interventions have the potential for wide-reach and therefore may be a useful tool in up-scaling physical activity interventions. In larger-scale interventions, face-to-face assessments are less cost-effective, and researchers often rely on surveys or activity trackers to assess outcomes. However, there is limited evidence of valid muscular fitness assessments that can be self-administered within mHealth interventions. As such, this study will evaluate the concurrent validity of upper and lower body muscular fitness that have been independently assessed by participants via the ecofit app, and face-to-face assessments conducted by a trained researcher. METHODS This study compared baseline data from two muscular fitness tests from the ecofit two-armed randomised controlled trial and self-assessed data collected via the ecofit smartphone app (i.e., validated 90-degree push-up and 60-second sit-to-stand test). To assess the concurrent validity, the self-assessed push-up and sit-to-stand tests (i.e., collected via the ecofit app) were correlated using Spearman's correlation coefficient against the researcher-assessed results (i.e., objective results collected during baseline assessment for the ecofit trial). Bland-Altman plots were also used to allow visualisation of the differences between the self- and research-assessed tests. RESULTS Participants (N = 54) completed the push-up (24.1%) and sit-to-stand (100%) tests within 14-days of receiving the app. The results revealed a strong significant correlation for the push-up test (0.83, p<0.001) and a moderate significant correlation for the sit-to-stand test (0.63, p<0.001). CONCLUSION This study provides support for the concurrent validity of self-reported upper and lower body muscular fitness assessments (i.e., the push-up and sit-to-stand tests) in mHealth. While these tests may be a feasible option for large scale physical activity interventions, more research is needed to determine the generalisability of these results.
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Affiliation(s)
- Anna K. Jansson
- Centre for Active Living and Learning, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - David R. Lubans
- Centre for Active Living and Learning, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mitch J. Duncan
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jordan J. Smith
- Centre for Active Living and Learning, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Ronald C. Plotnikoff
- Centre for Active Living and Learning, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- * E-mail:
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17
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Xu Z, Zahradka N, Ip S, Koneshloo A, Roemmich RT, Sehgal S, Highland KB, Searson PC. Evaluation of physical health status beyond daily step count using a wearable activity sensor. NPJ Digit Med 2022; 5:164. [PMID: 36352062 PMCID: PMC9646807 DOI: 10.1038/s41746-022-00696-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
Physical health status defines an individual's ability to perform normal activities of daily living and is usually assessed in clinical settings by questionnaires and/or by validated tests, e.g. timed walk tests. These measurements have relatively low information content and are usually limited in frequency. Wearable sensors, such as activity monitors, enable remote measurement of parameters associated with physical activity but have not been widely explored beyond measurement of daily step count. Here we report on results from a cohort of 22 individuals with Pulmonary Arterial Hypertension (PAH) who were provided with a Fitbit activity monitor (Fitbit Charge HR®) between two clinic visits (18.4 ± 12.2 weeks). At each clinical visit, a maximum of 26 measurements were recorded (19 categorical and 7 continuous). From analysis of the minute-to-minute step rate and heart rate we derive several metrics associated with physical activity and cardiovascular function. These metrics are used to identify subgroups within the cohort and to compare to clinical parameters. Several Fitbit metrics are strongly correlated to continuous clinical parameters. Using a thresholding approach, we show that many Fitbit metrics result in statistically significant differences in clinical parameters between subgroups, including those associated with physical status, cardiovascular function, pulmonary function, as well as biomarkers from blood tests. These results highlight the fact that daily step count is only one of many metrics that can be derived from activity monitors.
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Affiliation(s)
- Zheng Xu
- Measurement Corps, In Health, Johns Hopkins University School of Medicine, Baltimore, MA, USA.,Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, MA, USA
| | - Nicole Zahradka
- Measurement Corps, In Health, Johns Hopkins University School of Medicine, Baltimore, MA, USA.,Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, MA, USA
| | - Seyvonne Ip
- Measurement Corps, In Health, Johns Hopkins University School of Medicine, Baltimore, MA, USA.,Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, MA, USA
| | - Amir Koneshloo
- Measurement Corps, In Health, Johns Hopkins University School of Medicine, Baltimore, MA, USA.,Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, MA, USA
| | - Ryan T Roemmich
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MA, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Sameep Sehgal
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Peter C Searson
- Measurement Corps, In Health, Johns Hopkins University School of Medicine, Baltimore, MA, USA. .,Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, MA, USA. .,Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MA, USA. .,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MA, USA. .,Department of Materials Science & Engineering, Johns Hopkins University, Baltimore, MA, USA.
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18
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Kondapalli L, Arora G, Hawi R, Andrikopoulou E, Estes C, Patel N, Lenneman CG. Innovations in Cardio-oncology Resulting from the COVID-19 Pandemic. Curr Treat Options Oncol 2022; 23:1288-1302. [PMID: 35969312 PMCID: PMC9376567 DOI: 10.1007/s11864-022-00997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
The COVID pandemic has transformed our approach to patient care, research, and training in cardio-oncology. While the early phases of the COVID pandemic were exceptionally frightening, we now can reflect on the innovative changes that brought more effective and patient-centered care to our doorsteps: expansion of telemedicine, integration of digital health, wider adoption of cardiac biomarkers, consolidation, and coordination of cardio-oncology testing. Normally, it takes years for health care systems to adopt new technology or modify patient care pathways; however, COVID pushed healthcare providers and the health systems to change at warp speed. All of these innovations have improved our efficacy and provided a more “patient-centered” approach for our cardio-oncology patients. The changes we have made in cardio-oncology will likely remain well beyond the pandemic and continue to grow improving the cardiovascular care of oncology patients.
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Affiliation(s)
- Lavanya Kondapalli
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Garima Arora
- University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Riem Hawi
- University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, AL, USA
| | | | - Courtney Estes
- University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Nirav Patel
- University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Carrie G Lenneman
- University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, AL, USA.
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Morgan A, Bégin D, Heisz J, Tang A, Thabane L, Richardson J. Measurement Properties of Remotely or Self-Administered Lower Extremity Mobility Performance Measures in Adults: A Systematic Review. Phys Ther 2022; 102:6609701. [PMID: 35713530 DOI: 10.1093/ptj/pzac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/26/2022] [Accepted: 04/24/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For individuals who face barriers to care assessment, there is a need for remote administration or self-administration of physical performance measures that assess mobility to determine current functional status and to monitor and predict future changes in functional status. The primary purpose of this review is to evaluate the available measurement properties of scores for remotely or self-administered lower extremity mobility performance measures in adults. This review also outlines the test procedures and population suitability of these measures. METHODS Data sources were Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL, Ovid AMED, and Cochrane CENTRAL-which were searched from inception to January 26, 2021-and the reference lists of relevant studies. Two individuals independently screened studies that assessed at least 1 prespecified measurement property of scores for a remote and/or self-administered lower extremity physical performance measure assessing mobility in an adult population. Two individuals independently extracted data on study characteristics, measurement properties, feasibility, and interpretability using piloted extraction forms. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk of Bias tool was used to assess methodological quality. Data were qualitatively summarized, and results were compared against COSMIN's criteria for good measurement properties. Level of evidence was determined using COSMIN's modified GRADE approach. RESULTS Fourteen studies detailing 19 outcome measures were included. Many studies displayed "sufficient" measurement properties based on COSMIN's criteria; however, risk of bias for most of the included studies was rated adequate or doubtful. CONCLUSION Clinicians and researchers can consider the measurement properties of scores and feasibility of different approaches presented in this review when determining how to assess or monitor mobility in adult populations. IMPACT Assessing mobility via remote or self-administered physical performance measures in adult populations appears to be feasible using a variety of methods including simple tools (chair, stopwatch), videoconferencing, and smartphone applications. This strategy may be particularly valuable for self-management of chronic conditions and decreasing barriers to accessing care.
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Affiliation(s)
- Ashley Morgan
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diane Bégin
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Heisz
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,St Joseph's Healthcare, Hamilton, Hamilton, Ontario, Canada.,Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
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Rubin DS, Ranjeva SL, Urbanek JK, Karas M, Madariaga MLL, Huisingh-Scheetz M. Smartphone-Based Gait Cadence to Identify Older Adults with Decreased Functional Capacity. Digit Biomark 2022; 6:61-70. [PMID: 36156872 PMCID: PMC9386413 DOI: 10.1159/000525344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Functional capacity assessment is a critical step in the preoperative evaluation to identify patients at increased risk of cardiac complications and disability after major noncardiac surgery. Smartphones offer the potential to objectively measure functional capacity but are limited by inaccuracy in patients with poor functional capacity. Open-source methods exist to analyze accelerometer data to estimate gait cadence (steps/min), which is directly associated with activity intensity. Here, we used an updated Step Test smartphone application with an open-source method to analyze accelerometer data to estimate gait cadence and functional capacity in older adults. <b><i>Methods:</i></b> We performed a prospective observational cohort study within the Frailty, Activity, Body Composition and Energy Expenditure in Aging study at the University of Chicago. Participants completed the Duke Activity Status Index (DASI) and performed an in-clinic 6-min walk test (6MWT) while using the Step Test application on a study smartphone. Gait cadence was measured from the raw accelerometer data using an adaptive empirical pattern transformation method, which has been previously validated. A 6MWT distance of 370 m was used as an objective threshold to identify patients at high risk. We performed multivariable logistic regression to predict walking distance using a priori explanatory variables. <b><i>Results:</i></b> Sixty patients were enrolled in the study. Thirty-seven patients completed the protocol and were included in the final data analysis. The median (IQR) age of the overall cohort was 71 (69–74) years, with a body mass index of 31 (27–32). There were no differences in any clinical characteristics or functional measures between participants that were able to walk 370 m during the 6MWT and those that could not walk that distance. Median (IQR) gait cadence for the entire cohort was 110 (102–114) steps/min during the 6MWT. Median (IQR) gait cadence was higher in participants that walked more than 370 m during the 6MWT 112 (108–118) versus 106 (96–114) steps/min; <i>p</i> = 0.0157). The final multivariable model to identify participants that could not walk 370 m included only median gait cadence. The Youden’s index cut-point was 107 steps/min with a sensitivity of 0.81 (95% CI: 0.77, 0.85) and a specificity of 0.57 (95% CI: 0.55, 0.59) and an AUCROC of 0.69 (95% CI: 0.51, 0.87). <b><i>Conclusions:</i></b> Our pilot study demonstrates the feasibility of using gait cadence as a measure to estimate functional capacity. Our study was limited by a smaller than expected sample size due to COVID-19, and thus, a prospective study with preoperative patients that measures outcomes is necessary to validate our findings.
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Affiliation(s)
- Daniel S. Rubin
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois, USA
- *Daniel S. Rubin,
| | - Sylvia L. Ranjeva
- Department of Anesthesia, Massachusetts General Hospital, Harvard, Boston, Massachusetts, USA
| | - Jacek K. Urbanek
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marta Karas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria Lucia L. Madariaga
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, Chicago, Illinois, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics, University of Chicago, Chicago, Illinois, USA
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Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension. Vascul Pharmacol 2022; 145:107024. [PMID: 35716991 PMCID: PMC9212864 DOI: 10.1016/j.vph.2022.107024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Background COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH). Main body The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities. Conclusion Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools.
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22
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Home-based and remote functional exercise testing in cardiac conditions, during the covid-19 pandemic and beyond: a systematic review. Physiotherapy 2022; 115:27-35. [PMID: 35180642 PMCID: PMC8694378 DOI: 10.1016/j.physio.2021.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/29/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the change in healthcare to one that adopts a greater reliance on remote delivery, guidance regarding functional exercise testing, either in-person in the home or performed remotely, is urgently needed for people with cardiac conditions. OBJECTIVES To identify functional exercise tests that have been conducted in the home or remotely in patients with cardiac conditions. DATA SOURCES A search was undertaken across four electronic databases and grey literature for English language publications without time restrictions. STUDY ELIGIBILITY CRITERIA Studies of any designs were selected if they reported an exercise test conducted at home or remotely in patients with cardiac conditions. STUDY APPRAISAL AND SYNTHESIS Studies were independently screened and graded by two reviewers according to the Downs and Black checklist. A narrative synthesis of the included studies was undertaken. RESULTS Five studies (six articles) were included, with a total of 438 patients with cardiac conditions. Tests used at home or remotely were the 6-minute walk test (6MWT, five studies) and the timed up and go test (one study). No studies reported the use of step tests in the home or remotely. The 6MWTs were administered via a smartphone application, rope, videoconferencing and accelerometer and proved to be feasible, valid and reliable. CONCLUSIONS Despite a marked demand for home-based exercise programs, the 6MWT remains the most commonly administered functional exercise test for people with cardiac conditions. Surprisingly few studies have explored alternative tests for this patient population that may be more suitable for home or remote performance. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42020219512.
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Jeganathan VS, Golbus JR, Gupta K, Luff E, Dempsey W, Boyden T, Rubenfire M, Mukherjee B, Klasnja P, Kheterpal S, Nallamothu BK. Virtual AppLication-supported Environment To INcrease Exercise (VALENTINE) during cardiac rehabilitation study: Rationale and design. Am Heart J 2022; 248:53-62. [PMID: 35235834 DOI: 10.1016/j.ahj.2022.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In-person, exercise-based cardiac rehabilitation improves physical activity and reduces morbidity and mortality for patients with cardiovascular disease. However, activity levels may not be optimized and decline over time after patients graduate from cardiac rehabilitation. Scalable interventions through mobile health (mHealth) technologies have the potential to augment activity levels and extend the benefits of cardiac rehabilitation. METHODS The VALENTINE Study is a prospective, randomized-controlled, remotely-administered trial designed to evaluate an mHealth intervention to supplement cardiac rehabilitation for low- and moderate-risk patients (ClinicalTrials.gov NCT04587882). Participants are randomized to the control or intervention arms of the study. Both groups receive a compatible smartwatch (Fitbit Versa 2 or Apple Watch 4) and usual care. Participants in the intervention arm of the study additionally receive a just-in-time adaptive intervention (JITAI) delivered as contextually tailored notifications promoting low-level physical activity and exercise throughout the day. In addition, they have access to activity tracking and goal setting through the mobile study application and receive weekly activity summaries via email. The primary outcome is change in 6-minute walk distance at 6-months and, secondarily, change in average daily step count. Exploratory analyses will examine the impact of notifications on immediate short-term smartwatch-measured step counts and exercise minutes. CONCLUSIONS The VALENTINE study leverages innovative techniques in behavioral and cardiovascular disease research and will make a significant contribution to our understanding of how to support patients using mHealth technologies to promote and sustain physical activity.
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Affiliation(s)
- V Swetha Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI.
| | - Kashvi Gupta
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, Grand Rapids, MI
| | - Melvyn Rubenfire
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI
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Shah VV, Curtze C, Sowalsky K, Arpan I, Mancini M, Carlson-Kuhta P, El-Gohary M, Horak FB, McNames J. Inertial Sensor Algorithm to Estimate Walk Distance. SENSORS 2022; 22:s22031077. [PMID: 35161822 PMCID: PMC8838103 DOI: 10.3390/s22031077] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
The “total distance walked” obtained during a standardized walking test is an integral component of physical fitness and health status tracking in a range of consumer and clinical applications. Wearable inertial sensors offer the advantages of providing accurate, objective, and reliable measures of gait while streamlining walk test administration. The aim of this study was to develop an inertial sensor-based algorithm to estimate the total distance walked using older subjects with impaired fasting glucose (Study I), and to test the generalizability of the proposed algorithm in patients with Multiple Sclerosis (Study II). All subjects wore two inertial sensors (Opals by Clario-APDM Wearable Technologies) on their feet. The walking distance algorithm was developed based on 108 older adults in Study I performing a 400 m walk test along a 20 m straight walkway. The validity of the algorithm was tested using a 6-minute walk test (6MWT) in two sub-studies of Study II with different lengths of a walkway, 15 m (Study II-A, n = 24) and 20 m (Study II-B, n = 22), respectively. The start and turn around points were marked with lines on the floor while smaller horizontal lines placed every 1 m served to calculate the manual distance walked (ground truth). The proposed algorithm calculates the forward distance traveled during each step as the change in the horizontal position from each foot-flat period to the subsequent foot-flat period. The total distance walked is then computed as the sum of walk distances for each stride, including turns. The proposed algorithm achieved an average absolute error rate of 1.92% with respect to a fixed 400 m distance for Study I. The same algorithm achieved an absolute error rate of 4.17% and 3.21% with respect to an averaged manual distance for 6MWT in Study II-A and Study II-B, respectively. These results demonstrate the potential of an inertial sensor-based algorithm to estimate a total distance walked with good accuracy with respect to the manual, clinical standard. Further work is needed to test the generalizability of the proposed algorithm with different administrators and populations, as well as larger diverse cohorts.
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Affiliation(s)
- Vrutangkumar V. Shah
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; (I.A.); (M.M.); (P.C.-K.); (F.B.H.)
- Correspondence:
| | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, 6001 Dodge St., Omaha, NE 68182, USA;
| | - Kristen Sowalsky
- APDM Wearable Technologie—A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA; (K.S.); (M.E.-G.); (J.M.)
| | - Ishu Arpan
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; (I.A.); (M.M.); (P.C.-K.); (F.B.H.)
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; (I.A.); (M.M.); (P.C.-K.); (F.B.H.)
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; (I.A.); (M.M.); (P.C.-K.); (F.B.H.)
| | - Mahmoud El-Gohary
- APDM Wearable Technologie—A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA; (K.S.); (M.E.-G.); (J.M.)
| | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; (I.A.); (M.M.); (P.C.-K.); (F.B.H.)
- APDM Wearable Technologie—A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA; (K.S.); (M.E.-G.); (J.M.)
| | - James McNames
- APDM Wearable Technologie—A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA; (K.S.); (M.E.-G.); (J.M.)
- Department of Electrical and Computer Engineering, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA
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Self-Administered Six-Minute Walk Test Using a Free Smartphone App in Asymptomatic Adults: Reliability and Reproducibility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031118. [PMID: 35162141 PMCID: PMC8834251 DOI: 10.3390/ijerph19031118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022]
Abstract
Background: The 6-min walk test (6MWT) is a simple, inexpensive, reliable, and reproducible test that provides a reasonable estimate of the cardiorespiratory fitness (CRF). We aimed to assess the reliability and reproducibility of a self-administered 6MWT in asymptomatic adults using a free smartphone app. Methods: In the 1st phase, 93 participants underwent a supervised 6MWT (6MWTsup) in a 30 m indoor corridor, using a triaxial accelerometer and their smartphones to compare the total step counts and to develop a 6-min walk distance (6MWD) prediction equation. In the 2nd phase, 25 participants performed the 6MWTsup and two self-administered 6MWTs outdoors (6MWTsa1 and 6MWTsa2, at least 48 h apart) using a free smartphone app. Results: The agreement between accelerometer- and app-based total step counts was limited (mean difference, −58.7 steps (−8.7%): 95% confidence interval, −326.5 (−46.8%) to 209.1 (29.3%)). The best algorithm for predicting the 6MWTsupm included: 795.456 + (0.815 heightm app-steps) − (1.620 ageyears) − (3.005 weightkg) − (1.155 app-steps), R2 = 0.609). The intraclass correlation coefficient between 6MWTsa2 and 6MWTsa1 was excellent (0.91: 0.81–0.96). The coefficient of variation was 6.4%. The agreement between the two self-administered tests was narrow (−1.9 (0.2%) meters: −57.4 (−9.5%) to 61.3 (9.9%)). Conclusions: The self-administered 6MWT has excellent reliability and reproducibility in asymptomatic adults, being a valuable tool for assessing CRF in community-based interventions.
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Madhavan S, Sivaramakrishnan A, Bowden MG, Chumbler NR, Field-Fote EC, Kesar T. Commentary: Remote assessments of gait and balance - Implications for research during and beyond Covid-19. Top Stroke Rehabil 2022; 29:74-81. [PMID: 33596774 PMCID: PMC8371083 DOI: 10.1080/10749357.2021.1886641] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The COVID-19 pandemic has disrupted non-essential in-person research activities that require contact with human subjects. While guidelines are being developed for ramping up human subjects research, one component of research that can be performed remotely is participant screening for lower limb function and gait impairments. In this commentary, we summarize evidence-supported clinical assessments that have potential to be conducted remotely in a safe manner, to make an initial determination of the functional mobility status of persons with neurological disorders. We present assessments that do not require complex or costly equipment, specialized software, or trained personnel to administer. We provide recommendations to implement remote functional assessments for participant recruitment and continuation of lower limb neurorehabilitation research as a rapid response to the COVID-19 pandemic and for utilization beyond the current pandemic. We also highlight critical research gaps related to feasibility and measurement characteristics of remote lower limb assessments, providing opportunities for future research to advance tele-assessment and tele-rehabilitation.
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Affiliation(s)
- Sangeetha Madhavan
- Department of Physical Therapy, The University of Illinois at Chicago, Chicago, IL 60612
| | - Anjali Sivaramakrishnan
- Graduate Program in Rehabilitation Science, The University of Illinois at Chicago, Chicago, IL 60612
| | - Mark G. Bowden
- Division of Physical Therapy and Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425
| | - Neale R. Chumbler
- Department of Rehabilitation and Health Services, University of North Texas, College of Health and Public Service, 1155 Union Circle #311340, Denton, TX 76203
| | - Edelle C. Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, Division of Physical Therapy, Emory University School of Medicine, 30322
| | - Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30322
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Lin II, Chen YL, Chuang LL. Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study. JMIR Form Res 2021; 5:e28040. [PMID: 34657835 PMCID: PMC8701670 DOI: 10.2196/28040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Poor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring. OBJECTIVE The aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults. METHODS A total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland-Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively. RESULTS The relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland-Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland-Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments. CONCLUSIONS Home-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229.
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Affiliation(s)
- I-I Lin
- Recovery Plus Inc, Chengdu, China
| | | | - Li-Ling Chuang
- School of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Automated Analysis of the Two-Minute Walk Test in Clinical Practice Using Accelerometer Data. Brain Sci 2021; 11:brainsci11111507. [PMID: 34827506 PMCID: PMC8615930 DOI: 10.3390/brainsci11111507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
Abstract
One of the core problems for people with multiple sclerosis (pwMS) is the impairment of their ability to walk, which can be severely restrictive in everyday life. Therefore, monitoring of ambulatory function is of great importance to be able to effectively counteract disease progression. An extensive gait analysis, such as the Dresden protocol for multidimensional walking assessment, covers several facets of walking impairment including a 2-min walk test, in which the distance taken by the patient in two minutes is measured by an odometer. Using this approach, it is questionable how precise the measuring methods are at recording the distance traveled. In this project, we investigate whether the current measurement can be replaced by a digital measurement method based on accelerometers (six Opal sensors from the Mobility Lab system) that are attached to the patient’s body. We developed two algorithms using these data and compared the validity of these approaches using the results from 2-min walk tests from 562 pwMS that were collected with a gold-standard odometer. In 48.4% of pwMS, we detected an average relative measurement error of less than 5%, while results from 25.8% of the pwMS showed a relative measurement error of up to 10%. The algorithm had difficulties correctly calculating the walking distances in another 25.8% of pwMS; these results showed a measurement error of more than 20%. A main reason for this moderate performance was the variety of pathologically altered gait patterns in pwMS that may complicate the step detection. Overall, both algorithms achieved favorable levels of agreement (r = 0.884 and r = 0.980) with the odometer. Finally, we present suggestions for improvement of the measurement system to be implemented in the future.
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Smith-Turchyn J, Adams SC, Sabiston CM. Testing of a Self-administered 6-Minute Walk Test Using Technology: Usability, Reliability and Validity Study. JMIR Rehabil Assist Technol 2021; 8:e22818. [PMID: 34554105 PMCID: PMC8498894 DOI: 10.2196/22818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The need to attend a medically supervised hospital- or clinic-based appointment is a well-recognized barrier to exercise participation. The development of reliable and accurate home-based functional tests has the potential to decrease the burden on the health care system while enabling support, information, and assessment. OBJECTIVE This study aims to explore the usability (ie, acceptability, satisfaction, accuracy, and practicality) of the EasyMeasure app to self-administer the 6-minute walk test (6MWT) in young, healthy adults and determine parallel form reliability and construct validity of conducting a self-administered 6MWT using technology. METHODS We used a usability study design. English-speaking, undergraduate university students who had access to an iPhone or iPad device running iOS 10 or later and self-reported ability to walk for 6 minutes were recruited for this study. Consenting participants were randomized to either a standard 6MWT group (ie, supervised without the use of the app) or a technology 6MWT group (ie, unsupervised with the app to mimic independent implementation of the test). All participants performed a maximal treadmill test. Participants in the 6MWT group completed the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire and a satisfaction questionnaire after completing the assessment. Parallel form reliability of the 6MWT using technology was analyzed by comparing participant self-administered scores and assessor scores using Pearson correlation coefficients across and between trials. Construct validity was assessed by comparing participant 6MWT scores (both standard and using technology) with maximum treadmill test variables (peak oxygen uptake and ventilatory threshold [VT]). RESULTS In total, 20 university students consented to participate in the study. All but 2 participants (8/10, 80%) in the technology 6MWT group had deviations that prevented them from accurately conducting the 6MWT using the app, and none of the participants were able to successfully score the 6MWT. However, a significantly strong correlation was found (r=.834; P=.003) when comparing participants' scores for the 6MWT using technology with the assessors' scores. No significant correlations were found between maximal treadmill test peak oxygen uptake scores and 6MWT prediction equations using standard 6MWT scores (equation 1: r=0.119; P=.78; equation 2: r=0.095; P=.82; equation 3: r=0.119; P=.78); however, standard 6MWT scores were significantly correlated with VT values (r=0.810; P=.02). The calculated submaximal treadmill scores and assessor 6MWT scores using technology also demonstrated a significant correlation (r=0.661; P=.04). CONCLUSIONS This study demonstrated significant usability concerns regarding the accuracy of a self-administered 6MWT using the EasyMeasure app. However, the strong and significant correlation between the 6MWT and VT values demonstrates the potential of the 6MWT to measure functional capacity for community-based exercise screening and patient monitoring.
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Affiliation(s)
| | - Scott C Adams
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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Sokas D, Paliakaitė B, Rapalis A, Marozas V, Bailón R, Petrėnas A. Detection of Walk Tests in Free-Living Activities Using a Wrist-Worn Device. Front Physiol 2021; 12:706545. [PMID: 34456748 PMCID: PMC8397518 DOI: 10.3389/fphys.2021.706545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
Exercise testing to assess the response to physical rehabilitation or lifestyle interventions is administered in clinics thus at best can be repeated only few times a year. This study explores a novel approach to collecting information on functional performance through walk tests, e.g., a 6-min walk test (6MWT), unintentionally performed in free-living activities. Walk tests are detected in step data provided by a wrist-worn device. Only those events of minute-to-minute variation in walking cadence, which is equal or lower than the empirically determined maximal SD (e.g., 5-steps), are considered as walk test candidates. Out of detected walk tests within the non-overlapping sliding time interval (e.g., 1-week), the one with the largest number of steps is chosen as the most representative. This approach is studied on a cohort of 99 subjects, assigned to the groups of patients with cardiovascular disease (CVD) and healthy subjects below and over 40-years-old, who were asked to wear the device while maintaining their usual physical activity regimen. The total wear time was 8,864 subject-days after excluding the intervals of occasionally discontinued monitoring. About 82% (23/28) of patients with CVD and 88% (21/24) of healthy subjects over 40-years-old had at least a single 6MWT over the 1st month of monitoring. About 52% of patients with CVD (12/23) and 91% (19/21) of healthy subjects over 40-years-old exceeded 500 m. Patients with CVD, on average, walked 46 m shorter 6MWT distance (p = 0.04) compared to healthy subjects. Unintentional walk testing is feasible and could be valuable for repeated assessment of functional performance outside the clinical setting.
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Affiliation(s)
- Daivaras Sokas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Birutė Paliakaitė
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Andrius Rapalis
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.,Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.,Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
| | - Raquel Bailón
- Biomedical Signal Interpretation & Computational Simulation (BSICoS) Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Andrius Petrėnas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.,Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
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Wearable Cardioverter Defibrillator-Guided 6-Min Walk Test Performed at Home Is Accurate and Reliable: RESULTS OF THE TRENDS STUDY. J Cardiopulm Rehabil Prev 2021; 40:E14-E17. [PMID: 31343585 DOI: 10.1097/hcr.0000000000000441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE The 6-min walk test (6MWT) is broadly used to evaluate the functional ability of patients with heart failure (HF). The purpose of this study was to evaluate the accuracy and reliability of the wearable cardioverter defibrillator (WCD)-guided 6MWT performed at home by patients with HF versus in-clinic testing. METHODS Patients (n = 197) with HF and a low ejection fraction prescribed a WCD were randomized to 2 groups. Group 1 completed an in-clinic clinician-guided 6MWT while wearing the WCD; results were recorded by the clinician. Group 2 completed a WCD-guided 6MWT, also performed in the clinic; results were recorded by the WCD accelerometer. Both groups performed weekly unsupervised WCD-guided 6MWTs at home, with results recorded by the WCD. RESULTS The initial in-clinic 6MWT showed no significant group difference in distance walked (group 1 = 306 m; group 2 = 297 m). For patients in group 2 who completed at least one 6MWT at home, there was a 15-step decrease between the in-clinic WCD-guided 6MWT and the first at-home 6MWT, 558 and 543 median steps (P = .001), respectively. Among patients with at least 8 weekly home WCD-guided 6MWTs (n = 70), there was no significant difference in the number of steps walked during the 6MWT from week to week. CONCLUSIONS Results of the in-clinic 6MWT are similar between clinician-guided and WCD-guided patients across objective distances. Distances walked with a WCD-guided walk test were consistent whether conducted in the clinic or at home and were reliable over time.
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Salvi D, Poffley E, Tarassenko L, Orchard E. App-Based Versus Standard Six-Minute Walk Test in Pulmonary Hypertension: Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e22748. [PMID: 34096876 PMCID: PMC8218218 DOI: 10.2196/22748] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary vasculature that can lead to heart failure and premature death. Assessment of patients with PAH includes performing a 6-minute walk test (6MWT) in clinics. We developed a smartphone app to compute the walked distance (6MWD) indoors, by counting U-turns, and outdoors, by using satellite positioning. Objective The goal of the research was to assess (1) accuracy of the indoor 6MWTs in clinical settings, (2) validity and test-retest reliability of outdoor 6MWTs in the community, (3) compliance, usability, and acceptance of the app, and (4) feasibility of pulse oximetry during 6MWTs. Methods We tested the app on 30 PAH patients over 6 months. Patients were asked to perform 3 conventional 6MWTs in clinic while using the app in the indoor mode and one or more app-based 6MWTs in outdoor mode in the community per month. Results Bland-Altman analysis of 70 pairs of conventional versus app-based indoor 6MWDs suggests that the app is sometimes inaccurate (14.6 m mean difference, lower and upper limit of agreement: –133.35 m to 162.55 m). The comparison of 69 pairs of conventional 6MWDs and community-based outdoor 6MWDs within 7 days shows that community tests are strongly related to those performed in clinic (correlation 0.89), but the interpretation of the distance should consider that differences above the clinically significant threshold are not uncommon. Analysis of 89 pairs of outdoor tests performed by the same patient within 7 days shows that community-based tests are repeatable (intraclass correlation 0.91, standard error of measurement 36.97 m, mean coefficient of variation 12.45%). Questionnaires and semistructured interviews indicate that the app is usable and well accepted, but motivation to use it could be affected if the data are not used for clinical decision, which may explain low compliance in 52% of our cohort. Analysis of pulse oximetry data indicates that conventional pulse oximeters are unreliable if used during a walk. Conclusions App-based outdoor 6MWTs in community settings are valid, repeatable, and well accepted by patients. More studies would be needed to assess the benefits of using the app in clinical practice. Trial Registration ClinicalTrials.gov NCT04633538; https://clinicaltrials.gov/ct2/show/NCT04633538
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Affiliation(s)
- Dario Salvi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Emma Poffley
- Department of Cardiology, Oxford University National Health Service Foundation Trust, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Orchard
- Department of Cardiology, Oxford University National Health Service Foundation Trust, Oxford, United Kingdom
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Clifford SP, Ramirez J, Akca O, Ghafghazi S, Huang J. Perioperative Cardiac Research Considerations During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Cardiothorac Vasc Anesth 2021; 35:1573-1577. [PMID: 33618962 PMCID: PMC7863767 DOI: 10.1053/j.jvca.2021.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Julio Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Ozan Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Comprehensive Stroke Clinical Research Program (CSCRP), University of Louisville, Louisville, KY
| | - Shahab Ghafghazi
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY.
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Moon SJE, Dabbs AD, Hergenroeder AL, Vendetti ML, Jones KB, Willey BM, Morrell MR, Imes CC. Considerations for assessing physical function and physical activity in clinical trials during the COVID-19 pandemic. Contemp Clin Trials 2021; 105:106407. [PMID: 33887443 PMCID: PMC8055496 DOI: 10.1016/j.cct.2021.106407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 01/12/2023]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has changed the conduct of clinical trials. For studies with physical function and physical activity outcomes that require in-person participation, thoughtful approaches in transitioning to the remote research environment are critical. Here, we share our experiences in transitioning from in-person to remote assessments of physical function and activity during the pandemic and highlight key considerations for success. Details on the development of the remote assessment protocol, integration of a two-way video platform, and implementation of remote assessments are addressed. In particular, procedural challenges and considerations in transitioning and conducting remote assessments will be discussed in terms of efforts to maintain participant safety, maximize study efficiency, and sustain trial integrity. Plans for triangulation and analysis are also discussed. Although the role of telehealth platforms and research activities in remote settings are still growing, our experiences suggest that adopting remote assessment strategies are useful and convenient in assessing study outcomes during, and possibly even beyond, the current pandemic. Trial register and number: ClinicalTrials.gov [NCT03728257].
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Affiliation(s)
- Seol Ju E Moon
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.
| | | | - Andrea L Hergenroeder
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Melissa L Vendetti
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kristen B Jones
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bryan M Willey
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew R Morrell
- Pulmonary Transplant Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Imes
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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Bakogiannis C, Tsarouchas A, Mouselimis D, Lazaridis C, Theofillogianakos EK, Billis A, Tzikas S, Fragakis N, Bamidis PD, Papadopoulos CE, Vassilikos VP. A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study. JMIR Mhealth Uhealth 2021; 9:e24271. [PMID: 33847599 PMCID: PMC8080140 DOI: 10.2196/24271] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/05/2020] [Accepted: 03/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.
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Affiliation(s)
- Constantinos Bakogiannis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Billis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Rens N, Gandhi N, Mak J, Paul J, Bent D, Liu S, Savage D, Nielsen-Bowles H, Triggs D, Ata G, Talgo J, Gutierrez S, Aalami O. Activity data from wearables as an indicator of functional capacity in patients with cardiovascular disease. PLoS One 2021; 16:e0247834. [PMID: 33760846 PMCID: PMC7990307 DOI: 10.1371/journal.pone.0247834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Smartphone and wearable-based activity data provide an opportunity to remotely monitor functional capacity in patients. In this study, we assessed the ability of a home-based 6-minute walk test (6MWT) as well as passively collected activity data to supplement or even replace the in-clinic 6MWTs in patients with cardiovascular disease. Methods We enrolled 110 participants who were scheduled for vascular or cardiac procedures. Each participant was supplied with an iPhone and an Apple Watch running the VascTrac research app and was followed for 6 months. Supervised 6MWTs were performed during clinic visits at scheduled intervals. Weekly at-home 6MWTs were performed via the VascTrac app. The app passively collected activity data such as daily step counts. Logistic regression with forward feature selection was used to assess at-home 6MWT and passive data as predictors for “frailty” as measured by the gold-standard supervised 6MWT. Frailty was defined as walking <300m on an in-clinic 6MWT. Results Under a supervised in-clinic setting, the smartphone and Apple Watch with the VascTrac app were able to accurately assess ‘frailty’ with sensitivity of 90% and specificity of 85%. Outside the clinic in an unsupervised setting, the home-based 6MWT is 83% sensitive and 60% specific in assessing “frailty.” Passive data collected at home were nearly as accurate at predicting frailty on a clinic-based 6MWT as was a home-based 6MWT, with area under curve (AUC) of 0.643 and 0.704, respectively. Conclusions In this longitudinal observational study, passive activity data acquired by an iPhone and Apple Watch were an accurate predictor of in-clinic 6MWT performance. This finding suggests that frailty and functional capacity could be monitored and evaluated remotely in patients with cardiovascular disease, enabling safer and higher resolution monitoring of patients.
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Affiliation(s)
- Neil Rens
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
- Graduate School of Business, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Neil Gandhi
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
- Graduate School of Business, Stanford University, Stanford, California, United States of America
| | - Jonathan Mak
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Jeddeo Paul
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
- Graduate School of Business, Stanford University, Stanford, California, United States of America
| | - Drew Bent
- Graduate School of Business, Stanford University, Stanford, California, United States of America
| | - Stephanie Liu
- Graduate School of Business, Stanford University, Stanford, California, United States of America
| | - Dasha Savage
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Helle Nielsen-Bowles
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Doran Triggs
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Ghausia Ata
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Julia Talgo
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Santiago Gutierrez
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
| | - Oliver Aalami
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California, United States of America
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Varnfield M, Mahoney A. Appraisal of digital home-based 6-Minute Walk Test for use in remote healthcare delivery. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:75-76. [PMID: 36711181 PMCID: PMC9707972 DOI: 10.1093/ehjdh/ztab021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Marlien Varnfield
- Australian e-Health Research Centre, CSIRO, Royal Brisbane and Women’s Hospital, Herston 4029, Australia
| | - Alison Mahoney
- Physiotherapy Department, The Prince Charles Hospital, Metro North Health, Chermside 4032, Australia
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Wesley Milks M, Sahay S, Benza RL, Farber HW. Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review. J Heart Lung Transplant 2021; 40:172-182. [PMID: 33414063 PMCID: PMC7749286 DOI: 10.1016/j.healun.2020.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
Patients affected by pulmonary arterial hypertension (PAH) benefit from intensive, continuous clinical monitoring to guide escalation of treatments that carry the potential to improve survival and quality of life. During the coronavirus disease 2019 pandemic, the need for physical distancing has fueled the expeditious expansion of various telehealth modalities, which may apply in a unique manner to individuals with PAH. Performance of objective risk assessments in patients with PAH remotely via telemedical visits and other telehealth mechanisms is unprecedented and not yet rigorously validated. The uniquely high risk for rapid deterioration in patients with PAH demands a high degree of sensitivity to detect changes in functional assessments. In this review, several telehealth modalities for potential utilization in risk assessment and treatment titration in patients with PAH are explored, yet additional study is needed for their validation with the pre-pandemic care paradigm.
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Affiliation(s)
- Michael Wesley Milks
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sandeep Sahay
- Houston Methodist Lung Center, Division of Pulmonary, Critical care & Sleep Medicine, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medicine College, Institute of Academic Medicine, Houston Methodist Hospital, Houston, Texas.
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Harrison W Farber
- Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
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Mak J, Rens N, Savage D, Nielsen-Bowles H, Triggs D, Talgo J, Gandhi N, Gutierrez S, Gutierrez S, Aalami O. Reliability and repeatability of a smartphone-based 6-min walk test as a patient-centred outcome measure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:77-87. [PMID: 36711173 PMCID: PMC9707915 DOI: 10.1093/ehjdh/ztab018] [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: 10/12/2020] [Revised: 12/28/2020] [Accepted: 02/03/2021] [Indexed: 02/01/2023]
Abstract
Aims The 6-min-walk test (6MWT) is a validated proxy for frailty and a predictor of clinical outcomes, yet is not widely used due to implementation challenges. This comparative effectiveness study assesses the reliability and repeatability of a home-based 6MWT compared to in-clinic 6MWTs in patients with cardiovascular disease. Methods and results One hundred and ten (110) patients scheduled for cardiac or vascular surgery were enrolled during a study period from June 2018 to December 2019 at the Palo Alto VA Hospital. Subjects were provided with an Apple iPhone 7 and Apple Watch Series 3 loaded with the VascTrac research study application and performed a supervised in-clinic 6MWT during enrolment, at 2 weeks, 1, 3, and 6 months post-operatively. Subjects also received notifications to perform at-home smartphone-based 6MWTs once a week for a duration of 6 months. Test-retest reliability of in-clinic measurements and at-home measurements was assessed with an industry standard Cronbach's alpha reliability test. Test-retest reliability for in-clinic ground truth 6MWT steps vs. in-clinic iPhone 6MWT steps was 0·99, showing high reliability between the two tested measurements. When comparing for in-clinic ground truth 6MWT steps vs. neighbouring at-home iPhone 6MWT steps, reliability was 0·74. Conclusion Running the test-reliability test on both measurements shows that an iPhone 6MWT test is reliable compared to an in-clinic ground truth measurement in patients with cardiovascular disease.
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Affiliation(s)
- Jonathan Mak
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | - Neil Rens
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | - Dasha Savage
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | - Helle Nielsen-Bowles
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | - Doran Triggs
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | - Julia Talgo
- University of California, Berkeley, Berkeley, CA, USA
| | - Neil Gandhi
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | | | - Santiago Gutierrez
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA
| | - Oliver Aalami
- Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Bldg., M121, Stanford, CA, USA,Division of Vascular Surgery, Palo Alto VA Health Care System, Palo Alto, CA, USA,Corresponding author.
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Fischer F, Kleen S. Possibilities, Problems, and Perspectives of Data Collection by Mobile Apps in Longitudinal Epidemiological Studies: Scoping Review. J Med Internet Res 2021; 23:e17691. [PMID: 33480850 PMCID: PMC7864774 DOI: 10.2196/17691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background The broad availability of smartphones and the number of health apps in app stores have risen in recent years. Health apps have benefits for individuals (eg, the ability to monitor one’s health) as well as for researchers (eg, the ability to collect data in population-based, clinical, and observational studies). Although the number of health apps on the global app market is huge and the associated potential seems to be great, app-based questionnaires for collecting patient-related data have not played an important role in epidemiological studies so far. Objective This study aims to provide an overview of studies that have collected patient data using an app-based approach, with a particular focus on longitudinal studies. This literature review describes the current extent to which smartphones have been used for collecting (patient) data for research purposes, and the potential benefits and challenges associated with this approach. Methods We conducted a scoping review of studies that used data collection via apps. PubMed was used to identify studies describing the use of smartphone app questionnaires for collecting data over time. Overall, 17 articles were included in the summary. Results Based on the results of this scoping review, there are only a few studies that integrate smartphone apps into data-collection approaches. Studies dealing with the collection of health-related data via smartphone apps have mainly been developed with regard to psychosomatic, neurodegenerative, respiratory, and cardiovascular diseases, as well as malign neoplasm. Among the identified studies, the duration of data collection ranged from 4 weeks to 12 months, and the participants’ mean ages ranged from 7 to 69 years.
Potential can be seen for real-time information transfer, fast data synchronization (which saves time and increases effectivity), and the possibility of tracking responses longitudinally. Furthermore, smartphone-based data-collection techniques might prevent biases, such as reminder bias or mistakes occurring during manual data transfers. In chronic diseases, real-time communication with physicians and early detection of symptoms enables rapid modifications in disease management. Conclusions The results indicate that using mobile technologies can help to overcome challenges linked with data collection in epidemiological research. However, further feasibility studies need to be conducted in the near future to test the applicability and acceptance of these mobile apps for epidemiological research in various subpopulations.
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Affiliation(s)
- Florian Fischer
- Institut of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany.,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Sina Kleen
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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Muntaner-Mas A, Martinez-Nicolas A, Quesada A, Cadenas-Sanchez C, Ortega FB. Smartphone App (2kmFIT-App) for Measuring Cardiorespiratory Fitness: Validity and Reliability Study. JMIR Mhealth Uhealth 2021; 9:e14864. [PMID: 33416503 PMCID: PMC7822719 DOI: 10.2196/14864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/02/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is strong evidence suggesting that higher levels of cardiorespiratory fitness (CRF) are associated with a healthier metabolic profile, and that CRF can serve as a powerful predictor of morbidity and mortality. In this context, a smartphone app based on the 2-km walk test (UKK test) would provide the possibility to assess CRF remotely in individuals geographically distributed around a country or continent, and even between continents, with minimal equipment and low costs. OBJECTIVE The overall aim of this study was to evaluate the validity and reliability of 2kmFIT-App developed for Android and iOS mobile operating systems to estimate maximum oxygen consumption (VO2max) as an indicator of CRF. The specific aims of the study were to determine the validity of 2kmFIT-App to track distance and calculate heart rate (HR). METHODS Twenty participants were included for field-testing validation and reliability analysis. The participants completed the UKK test twice using 2kmFIT-App. Distance and HR were measured with the app as well as with accurate methods, and VO2max was estimated using the UKK test equation. RESULTS The validity results showed the following mean differences (app minus criterion): distance (-70.40, SD 51.47 meters), time (-0.59, SD 0.45 minutes), HR (-16.75, SD 9.96 beats/minute), and VO2max (3.59, SD 2.01 ml/kg/min). There was moderate validity found for HR (intraclass correlation coefficient [ICC] 0.731, 95% CI -0.211 to 0.942) and good validity found for VO2max (ICC 0.878, 95% CI -0.125 to 0.972). The reliability results showed the following mean differences (retest minus test): app distance (25.99, SD 43.21 meters), app time (-0.15, SD 0.94 seconds), pace (-0.18, SD 0.33 min/km), app HR (-4.5, 13.44 beats/minute), and app VO2max (0.92, SD 3.04 ml/kg/min). There was good reliability for app HR (ICC 0.897, 95% CI 0.742-0.959) and excellent validity for app VO2max (ICC 0.932, 95% CI 0.830-0.973). All of these findings were observed when using the app with an Android operating system, whereas validity was poor when the app was used with iOS. CONCLUSIONS This study shows that 2kmFIT-App is a new, scientifically valid and reliable tool able to objectively and remotely estimate CRF, HR, and distance with an Android but not iOS mobile operating system. However, certain limitations such as the time required by 2kmFIT-App to calculate HR or the temperature environment should be considered when using the app.
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Affiliation(s)
- Adria Muntaner-Mas
- Department of Physical Education and Sports, Faculty of Education, University of Balearic Islands, Palma, Spain
- PROmoting FITness and Health Through Physical Activity Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Antonio Martinez-Nicolas
- Chronobiology Research Group, Department of Physiology, Faculty of Biology, University of Murcia, Murcia, Spain
- Ciber Fragilidad y Envejecimiento Saludable, Madrid, Spain
| | - Alberto Quesada
- PROmoting FITness and Health Through Physical Activity Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Cristina Cadenas-Sanchez
- PROmoting FITness and Health Through Physical Activity Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Francisco B Ortega
- PROmoting FITness and Health Through Physical Activity Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
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Budnevsky AV, Kravchenko AY, Tokmachev RE, Chernik TA, Tokmachev EV, Letnikova YB. Diagnostic, prognostic and therapeutic potential of 6-minute walk test in patients with heart failure. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The six-minute walk test (6MWT) is a well-known exercise test used in medical practice to assess the functional status of patients with various chronic cardiovascular and respiratory diseases. The results of modern research describe new potential of 6MWT, which allow a more accurate interpretation and predict the course of diseases. Heart failure (HF) is the outcome of many structural and functional heart disorders. To improve the prognosis of patients with HF, early diagnosis, appropriate therapy and effective control of the disease course are important components. This review describes the diagnostic, prognostic and therapeutic potential of 6MWT in patients with HF.
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Matsumoto K, Xiao Y, Homma S, Thompson JLP, Buchsbaum R, Ito K, Anker SD, Qian M, Di Tullio MR. Prognostic impact of 6 min walk test distance in patients with systolic heart failure: insights from the WARCEF trial. ESC Heart Fail 2020; 8:819-828. [PMID: 33377631 PMCID: PMC8006715 DOI: 10.1002/ehf2.13068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS This study aimed to investigate the impact of baseline 6 min walk test distance (6MWTD) on time to major cardiovascular (CV) events in heart failure with reduced ejection fraction (HFrEF) and its impact in clinically relevant subgroups. METHODS AND RESULTS In the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial, 6MWTD at baseline was available in 2102 HFrEF patients. Median follow-up was 3.4 years. All-cause death and heart failure hospitalization (HFH) exhibited a significant non-linear relationship with 6MWTD (P = 0.023 and 0.032, respectively), whereas a significant association between 6MWTD and CV death was shown in a linear model [hazard ratio (HR) per 10 m increase, 0.989; P = 0.011]. In linear splines with the best cut-off point at 200 m, the positive effect of a longer 6MWTD on all-cause death and HFH was only observed for 6MWTD > 200 m (HR per 10 m increase, 0.987; P = 0.0036 and 0.986; P = 0.0022, respectively). The associations between 6MWTD and CV outcomes were consistent across clinical subgroups; for age, a significant relationship between 6MWTD and HFH was observed in patients ≥60 years (HR per 10 m increase, 0.98; P < 0.001), but not in patients <60 years (HR per 10 m increase, 1.00; P = 0.98; P = 0.02 for the interaction). CONCLUSIONS In HFrEF, 6MWTD is independently associated with all-cause death, CV death, and HFH. 6MWTD of 200 m is the best cut-off point for predicting these adverse events. The prognostic impact of 6MWTD for HFH was only observed in older patients.
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Affiliation(s)
- Kenji Matsumoto
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - Yi Xiao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - John L P Thompson
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kazato Ito
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marco R Di Tullio
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
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Lansky A, Shah T, Wijns W, Stefanini GG, Farb A, Kaplan A, Xu B, Pietras C, Velazquez E, Serruys PW, Mahfoud F, Baumbach A. Immediate and long-term impact of the COVID-19 pandemic on cardiovascular clinical trials: considerations for study conduct and endpoint determination. EUROINTERVENTION 2020; 16:787-793. [PMID: 33215993 DOI: 10.4244/eijv16i10a147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Habib GMM, Rabinovich R, Divgi K, Ahmed S, Saha SK, Singh S, Uddin A, Uzzaman MN, Pinnock H. Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings. NPJ Prim Care Respir Med 2020; 30:52. [PMID: 33214560 PMCID: PMC7677536 DOI: 10.1038/s41533-020-00210-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.
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Affiliation(s)
- G M Monsur Habib
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Roberto Rabinovich
- ELEGI/Colt Laboratory, Centre for Inflammation Research, QMRI, The University of Edinburgh and Respiratory Department, Royal Infirmary Edinburgh, Edinburgh, UK
| | | | - Salahuddin Ahmed
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
- Johns Hopkins University-Bangladesh, Projahnmo, Dhaka, Bangladesh
| | | | - Sally Singh
- Pulmonary and Cardiac Rehabilitation, Department of Respiratory Medicine (Acute Division), University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Aftab Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Nazim Uzzaman
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.
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Psotka MA, Abraham WT, Fiuzat M, Filippatos G, Lindenfeld J, Ahmad T, Bhatt AS, Carson PE, Cleland JGF, Felker GM, Januzzi JL, Kitzman DW, Leifer ES, Lewis EF, McMurray JJV, Mentz RJ, Solomon SD, Stockbridge N, Teerlink JR, Vaduganathan M, Vardeny O, Whellan DJ, Wittes J, Anker SD, O'Connor CM. Conduct of Clinical Trials in the Era of COVID-19: JACC Scientific Expert Panel. J Am Coll Cardiol 2020; 76:2368-2378. [PMID: 33183511 PMCID: PMC7836888 DOI: 10.1016/j.jacc.2020.09.544] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/12/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has profoundly changed clinical care and research, including the conduct of clinical trials, and the clinical research ecosystem will need to adapt to this transformed environment. The Heart Failure Academic Research Consortium is a partnership between the Heart Failure Collaboratory and the Academic Research Consortium, composed of academic investigators from the United States and Europe, patients, the U.S. Food and Drug Administration, the National Institutes of Health, and industry members. A series of meetings were convened to address the challenges caused by the COVID-19 pandemic, review options for maintaining or altering best practices, and establish key recommendations for the conduct and analysis of clinical trials for cardiovascular disease and heart failure. This paper summarizes the discussions and expert consensus recommendations.
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Affiliation(s)
- Mitchell A Psotka
- Inova Heart and Vascular Institute, Falls Church, Virginia. https://twitter.com/mpsotka
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
| | - Mona Fiuzat
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina. https://twitter.com/mfiuzat
| | - Gerasimos Filippatos
- University of Cyprus Medical School, Shakolas Educational Center for Clinical Medicine, Nicosia, Cyprus
| | - JoAnn Lindenfeld
- Heart Failure and Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ankeet S Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter E Carson
- Department of Cardiology, Washington Veterans Affairs Medical Center, Washington, DC
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - G Michael Felker
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, Massachusetts
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Eric S Leifer
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, California
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Robert J Mentz
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, California. https://twitter.com/jteerlinkmd
| | | | - Orly Vardeny
- Pharmacy Practice Division, Minneapolis VA Center for Care Delivery and Outcomes Research and University of Minnesota, Minneapolis, Minnesota
| | - David J Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin-Brandenburg Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christopher M O'Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia; Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina. https://twitter.com/coconnormd
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Rubin DS, Dalton A, Tank A, Berkowitz M, Arnolds DE, Liao C, Gerlach RM. Development and Pilot Study of an iOS Smartphone Application for Perioperative Functional Capacity Assessment. Anesth Analg 2020; 131:830-839. [PMID: 31567326 DOI: 10.1213/ane.0000000000004440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Functional capacity assessment plays a core role in the preoperative evaluation. The Duke Activity Status Index (DASI) and the 6-minute walk test (6MWT) are 2 methods that have demonstrated the ability to evaluate functional capacity and predict perioperative outcomes. Smartphones offer a novel method to facilitate functional capacity assessment as they can easily administer a survey and accelerometers can track patient activity during a 6MWT. We developed a smartphone application to administer a 6MWT and DASI survey and performed a pilot study to evaluate the accuracy of a smartphone-based functional capacity tool in our Anesthesia and Perioperative Medicine Clinic. METHODS Using the Apple ResearchKit software platform, we developed an application that administers a DASI survey and 6MWT on an iOS smartphone. The DASI was presented to the patient 1 question on the screen at a time and the application calculated the DASI score and estimated peak oxygen uptake (VO2). The 6MWT used the CMPedometer class from Apple's core motion facility to retrieve accelerometer data collected from the device's motion coprocessor to estimate steps walked. Smartphone estimated steps were compared to a research-grade pedometer using the intraclass correlation coefficient (ICC). Distance walked was directly measured during the 6MWT and we performed a multivariable linear regression with biometric variables to create a distance estimation algorithm to estimate distance walked from the number of steps recorded by the application. RESULTS Seventy-eight patients were enrolled in the study and completed the protocol. Steps measured by the smartphone application as compared to the pedometer demonstrated moderate agreement with an ICC (95% CI) of 0.87 (0.79-0.92; P = .0001). The variables in the distance estimation algorithm included (β coefficient [slope], 95% CI) steps walked (0.43, 0.29-0.57; P < .001), stride length (0.38, 0.22-0.53; P < .001), age in years (-1.90, -3.06 to -0.75; P = .002), and body mass index (-2.59, -5.13 to -0.06; P = .045). The overall model fit was R = 0.72, which indicates a moderate level of goodness of fit and explains 72% of the variation of distance walked during a 6MWT. CONCLUSIONS Our pilot study demonstrated that a smartphone-based functional capacity assessment is feasible using the DASI and 6MWT. The DASI was easily completed by patients and the application clearly presented the results of the DASI to providers. Our application measured steps walked during a 6MWT moderately well in a preoperative patient population; however, future studies are needed to improve the smartphone application's step-counting accuracy and distance estimation algorithm.
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Affiliation(s)
| | | | - Allyson Tank
- Pritzker School of Medicine, the University of Chicago, Chicago, Illinois
| | | | | | - Chuanhong Liao
- Department of Public Health Sciences, the University of Chicago, Chicago, Illinois
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Yan X, Rau PLP, Zhong R. Leveraging Walking Performance to Understand Work Fatigue Among Young Adults: Mixed-Methods Study. Interact J Med Res 2020; 9:e16376. [PMID: 33185557 PMCID: PMC7695524 DOI: 10.2196/16376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/30/2020] [Accepted: 06/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Work fatigue negatively impacts personal health in the long term. Prior research has indicated the possibility of leveraging both walking parameters and perceptual measures to assess a person’s fatigue status. However, an effective and ubiquitous approach to assessing work fatigue in young adults remains unexplored. Objective The goals of this paper were to (1) explore how walking rhythms and multiple streams of data, including reaction time, self-reports, and an activity diary, reflect work-induced fatigue in the lab setting; (2) identify the relationship between objective performance and subjective perception in indicating fatigue status and fatigability; and (3) propose a mobile-based assessment for work-induced fatigue that uses multiple measurements. Methods We conducted a 2-day in-lab study to measure participants’ fatigue status using multiple measurements, including the stair climb test (SCT), the 6-minute walk test (6MWT), and the reaction time test. Both the SCT and the 6MWT were conducted at different points in time and under 2 conditions (measurement time, including prior to and after work, and pace, including normal and fast). Participants reported their fatigue perception through questionnaires completed before conducting walking tests and in an activity diary recorded over a week. Walking performance data were collected by a smartphone with a built-in 3-axis accelerometer. To examine the effect of fatigability on walking performance, we first clustered participants into 2 groups based on their reported mental fatigue level in the entry surveys and then compared their walking performance using a generalized linear model (GLM). The reaction time was examined using a 2-way repeated-measures GLM. We conducted semistructured interviews to understand participants’ fatigue perception after each day’s walking tests. Results All participants (N=26; mean age 24.68 years) were divided into 2 groups—the fatigue-sensitive group (11/26, 42%) and the fatigue-nonsensitive group (15/26, 58%)—based on their mental subscores from 3 entry surveys: Fatigue Scale-14, Three-Dimensional Work Fatigue Inventory, and Fatigue Self-Assessment Scale (FSAS). The fatigue-sensitive group reported a significantly higher FSAS score in the before-work setting (t50=–3.361; P=.001). The fatigue-sensitive group covered fewer steps than the fatigue-nonsensitive group (β1=–0.099; SE 0.019; t1=–5.323; P<.001) and had a higher step-to-step time variability in the 6MWT (β1=9.61 × 10–4; t1=2.329; P=.02). No strong correlation between subjective and objective measurements was observed in the study. Conclusions Walking parameters, including step counts and step-to-step time variability, and some selected scales (eg, FSAS) were found to reflect participants’ work-induced fatigue. Overall, our work suggests the opportunity of employing mobile-based walking measurements to indicate work fatigue among young adults.
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Affiliation(s)
- Xinghui Yan
- Department of Industrial Engineering, Tsinghua University, Beijing, China.,School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Runting Zhong
- Department of Industrial Engineering, Tsinghua University, Beijing, China.,School of Business, Jiangnan University, Wuxi, China
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Benincasa G, de Candia P, Costa D, Faenza M, Mansueto G, Ambrosio G, Napoli C. Network Medicine Approach in Prevention and Personalized Treatment of Dyslipidemias. Lipids 2020; 56:259-268. [PMID: 33118184 DOI: 10.1002/lipd.12290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022]
Abstract
Dyslipidemias can affect molecular networks underlying the metabolic homeostasis and vascular function leading to atherogenesis at early stages of development. Since disease-related proteins often interact with each other in functional modules, many advanced network-oriented algorithms were applied to patient-derived big data to identify the complex gene-environment interactions underlying the early pathophysiology of dyslipidemias and atherosclerosis. Both the proprotein convertase subtilisin/kexin type 7 (PCSK7) and collagen type 1 alpha 1 chain (COL1A1) genes arose from the application of TFfit and WGCNA algorithms, respectively, as potential useful therapeutic targets in prevention of dyslipidemias. Moreover, the Seed Connector algorithm (SCA) algorithm suggested a putative role of the neuropilin-1 (NRP1) protein as drug target, whereas a regression network analysis reported that niacin may provide benefits in mixed dyslipidemias. Dyslipidemias are highly heterogeneous at the clinical level; thus, it would be helpful to overcome traditional evidence-based paradigm toward a personalized risk assessment and therapy. Network Medicine uses omics data, artificial intelligence (AI), imaging tools, and clinical information to design personalized therapy of dyslipidemias and atherosclerosis. Recently, a novel non-invasive AI-derived biomarker, named Fat Attenuation Index (FAI™) has been established to early detect clinical signs of atherosclerosis. Moreover, an integrated AI-radiomics approach can detect fibrosis and microvascular remodeling improving the customized risk assessment. Here, we offer a network-based roadmap ranging from novel molecular pathways to digital therapeutics which can improve personalized therapy of dyslipidemias.
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Affiliation(s)
- Giuditta Benincasa
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Pz. Miraglia, 2, Naples, 80138, Italy
| | | | - Dario Costa
- UOC Division of Immunohematology, Transfusion Medicine and Transplant Immunology, Department of Internal Medicine and Specialistics, University of Campania "Luigi Vanvitelli", Pz. Miraglia, 2, Naples, 80138, Italy
| | - Mario Faenza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, University of Campania "Luigi Vanvitelli", Pz. Miraglia, 2, Naples, 80138, Italy
| | - Gelsomina Mansueto
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Pz. Miraglia, 2, Naples, 80138, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Via S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Pz. Miraglia, 2, Naples, 80138, Italy.,Clinical Department of Internal Medicine and Specialistics, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Pz. Miraglia, 2, Naples, 80138, Italy
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Rubin DS, Rich Severin, Arena R, Bond S. Leveraging technology to move more and sit less. Prog Cardiovasc Dis 2020; 64:55-63. [PMID: 33129794 DOI: 10.1016/j.pcad.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
One of the major changes in the updated physical activity (PA) guidelines is the recommendation for adults to simply move more and sit less throughout the day. This recommendation comes during a time of proliferation and advancement of personal health technologies that allow adults greater access to interventions to increase PA. Wearable activity monitors provide direct feedback of activity levels allowing users to reach PA targets throughout the day. Gamification of these and other devices can engage users and sustain their motivation to increase PA, along with the formation of social networks through social media platforms. This review will discuss and present an overview of current technologies that can be leveraged to increase PA in adults. Specific attention will be paid to wearable activity monitors, gamification and social network platforms that can help adults increase and sustain their PA levels to improve their overall health.
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Affiliation(s)
- Daniel S Rubin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Rich Severin
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Samantha Bond
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Biomedical & Health Information Science, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
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