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Carrozzo AE, Zimmermann G, Bathke AC, Neunhaeuserer D, Niebauer J, Kulnik ST. Two-Arm Crossover Randomized Controlled Trial Versus Meta-Analysis of N-of-1 Studies: Comparison of Statistical Efficiency in Determining an Intervention Effect. Biom J 2025; 67:e70045. [PMID: 40071868 PMCID: PMC11898578 DOI: 10.1002/bimj.70045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/30/2025] [Accepted: 02/10/2025] [Indexed: 03/15/2025]
Abstract
N-of-1 trials are currently receiving broader attention in healthcare research when assessing the effectiveness of interventions. In contrast to the most commonly applied two-arm randomized controlled trial (RCT), in an N-of-1 design, the individual acts as their own control condition in the sense of a multiple crossover trial. N-of-1 trials can lead to a higher quality of patient by examining the effectiveness of an intervention at an individual level. Moreover, when a series of N-of-1 trials are properly aggregated, it becomes possible to detect an intervention effect at a population level. This work investigates whether a meta-analysis of summary data of a series of N-of-1 trials allows us to detect a statistically significant intervention effect with fewer participants than in a traditional, prospectively powered two-arm RCT and crossover design when evaluating a digital health intervention in cardiovascular care. After introducing these different analysis approaches, we compared the empirical properties in a simulation study both under the null hypothesis and with respect to power with different between-subject heterogeneity settings and in the presence of a carry-over effect. We further investigate the performance of a sequential aggregation procedure. In terms of simulated power, the threshold of 80% was achieved earlier for the aggregating procedure, requiring fewer participants.
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Affiliation(s)
- Anna Eleonora Carrozzo
- Ludwig Boltzmann Institute for Digital Health and PreventionSalzburgAustria
- Faculty of Digital and Analytical SciencesParis‐Lodron University SalzburgSalzburgAustria
- Salzburg Research Forschungsgesellschaft m.b.HSalzburgAustria
| | - Georg Zimmermann
- Intelligent Data Analytics (IDA) Lab SalzburgDepartment of Artificial Intelligence and Human Interface (AIHI)Faculty of Digital and Analytical SciencesParis‐Lodron University SalzburgSalzburgAustria
- Team Biostatistics and Big Medical DataIDA Lab SalzburgParacelsus Medical UniversitySalzburgAustria
- Research Programme Biomedical Data ScienceParacelsus Medical UniversitySalzburgAustria
| | - Arne C. Bathke
- Intelligent Data Analytics (IDA) Lab SalzburgDepartment of Artificial Intelligence and Human Interface (AIHI)Faculty of Digital and Analytical SciencesParis‐Lodron University SalzburgSalzburgAustria
| | - Daniel Neunhaeuserer
- Sport and Exercise Medicine DivisionDepartment of MedicineUniversity of PadovaPaduaItaly
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and PreventionSalzburgAustria
- Institute for Molecular Sports and Rehabilitation, Paracelsus Medical UniversitySalzburgAustria
- University Institute of Sports Medicine, Prevention, Paracelsus Medical UniversitySalzburgAustria
| | - Stefan T. Kulnik
- Ludwig Boltzmann Institute for Digital Health and PreventionSalzburgAustria
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Pong C, Tseng RMWW, Tham YC, Lum E. Current Implementation of Digital Health in Chronic Disease Management: Scoping Review. J Med Internet Res 2024; 26:e53576. [PMID: 39666972 PMCID: PMC11671791 DOI: 10.2196/53576] [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: 10/11/2023] [Revised: 03/26/2024] [Accepted: 10/28/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated. OBJECTIVE This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors. METHODS We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data. RESULTS A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were "obtain and use patient or consumer feedback" (196/252, 77.8%); "audit and provide feedback" (106/252, 42.1%); and piloting before implementation or "stage implementation scale-up" (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs. CONCLUSIONS This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them.
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Affiliation(s)
- Candelyn Pong
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Rachel Marjorie Wei Wen Tseng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elaine Lum
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth, Singapore, Singapore
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Harbi AS, Soh KL, Yubbu PB, Soh KG. Digital health intervention in patients undergoing cardiac rehabilitation: systematic review and meta-analysis. F1000Res 2024; 13:596. [PMID: 38984016 PMCID: PMC11231633 DOI: 10.12688/f1000research.152315.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background Cardiovascular disease (CVD) continues to be the foremost mortality internationally. Cardiac rehabilitation has proven as an effective program in reducing CVD burden. Participation in cardiac rehabilitation programs is very low. Digital health intervention emerged as an alternative method to deliver Cardiac rehabilitation. This review aimed to investigate the impact of digital health intervention on the outcomes of interest. Methods the following databases: PubMed, CINAHL, Scopus, and Cochrane Library have been searched to retrieve randomized controlled trials that examine the impact of digital health intervention on blood pressure, body mass index, lipid profile, blood glucose, Six-Minute Walk Test, and peak oxygen consumption. filters were set to include studies published in English between 2000-2023. Results Nineteen studies were included in this review. Six-Minute Walk Test (MD = 16.70; 95% CI: 6.00 to 27.39, p = 0.000) and maximal oxygen consumption (SMD = 0.27; 95% CI: 0.08 to 0.45, p = 0.004) significantly improved following digital health intervention, after employing the sensitivity analysis significant improvement was observed in systolic (MD = -2.54; 95% CI: -4.98 to -0.11, p = 0.04) and diastolic blood pressure (SMD = -2.0182; 95% CI: -3.9436 to -0.0928, p = 0.04) favoring experimental groups. Subgroup analysis revealed significant improvement in quality of life after three months of follow-up (SMD = 0.18; 95% CI: 0.05 to 0.31, p = 0.00), no significant differences have been observed in body mass index, lipid profile, and blood glucose. Conclusion The findings emphasize the significant impact of digital vs CBCR or usual care on physical capacity, blood pressure, and quality of life. Despite the non-statistically significant differences in body mass index and lipid profile, the comparable effect between the two methods suggests the superiority of digital over CBCR or usual care due to its convenient nature, accessibility, and cost-effectiveness.
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Affiliation(s)
- Ali Suleiman Harbi
- Department of Nursing, Faculty of Medicine & Health Sciences,, University Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Kim Lam Soh
- Department of Nursing, Faculty of Medicine & Health Sciences,, University Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Putri Binti Yubbu
- Department of Paediatrics, Faculty of Medicine & Health Sciences,, University Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Kim Geok Soh
- Department of Sport Studies, Faculty of Educational Studies, University Putra Malaysia, Serdang, Selangor, 43400, Malaysia
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Claes J, Kuznetsova T, Cauwenberghs N, Cornelissen V. The changing landscape of cardiac rehabilitation and the power of personalized therapy. Front Cardiovasc Med 2024; 11:1393217. [PMID: 38699581 PMCID: PMC11063310 DOI: 10.3389/fcvm.2024.1393217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Jomme Claes
- Group Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nicholas Cauwenberghs
- Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Group Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Pieles G, Papadakis M, Budts W. Exercise, prescription and training in ACHD. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023; 13:100467. [PMID: 39712234 PMCID: PMC11657731 DOI: 10.1016/j.ijcchd.2023.100467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 12/24/2024] Open
Abstract
The number of adult patients with congenital heart disease (CHD) is steadily increasing and exceeds nowadays the number of children with CHD. This is due to significant advances in therapeutic possibilities that became available over the last four decades. As such, this aging population survives the CHD complications and is exposed to the traditional cardiovascular risk factors for atherosclerotic disease such as high blood pressure, elevated cholesterol levels, long-standing exposure to smoking, overweight and obesity, and a sedentary lifestyle. Consequently, it becomes important to put more emphasis on all these risk factors. A preventive strategy is central, and early encouragement of physical activity is part of this approach. A minimum of physical activity has a beneficial effect both physically and mentally. With this overview, we mainly want to emphasize the importance of preventive measures. We would like to emphasize that all individuals should receive an exercise prescription which adheres to the minimum recommendations by WHO/NICE and this advice should form the baseline. Moreover, we intend to show that physical activity can be done safely in patients with CHD and that recreational and competitive sports are feasible in many circumstances.
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Affiliation(s)
- Guido Pieles
- Aspetar Orthopaedic and Sports Medicine Hospital Doha, Qatar
- Institute of Sport, Exercise and Health, University College London, United Kingdom
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St. George's, University of London, and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
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Ye X, Sun M, Yu S, Yang J, Liu Z, Lv H, Wu B, He J, Wang X, Huang L. Smartwatch-Based Maximum Oxygen Consumption Measurement for Predicting Acute Mountain Sickness: Diagnostic Accuracy Evaluation Study. JMIR Mhealth Uhealth 2023; 11:e43340. [PMID: 37410528 PMCID: PMC10360014 DOI: 10.2196/43340] [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: 10/09/2022] [Revised: 12/11/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Cardiorespiratory fitness plays an important role in coping with hypoxic stress at high altitudes. However, the association of cardiorespiratory fitness with the development of acute mountain sickness (AMS) has not yet been evaluated. Wearable technology devices provide a feasible assessment of cardiorespiratory fitness, which is quantifiable as maximum oxygen consumption (VO2max) and may contribute to AMS prediction. OBJECTIVE We aimed to determine the validity of VO2max estimated by the smartwatch test (SWT), which can be self-administered, in order to overcome the limitations of clinical VO2max measurements. We also aimed to evaluate the performance of a VO2max-SWT-based model in predicting susceptibility to AMS. METHODS Both SWT and cardiopulmonary exercise test (CPET) were performed for VO2max measurements in 46 healthy participants at low altitude (300 m) and in 41 of them at high altitude (3900 m). The characteristics of the red blood cells and hemoglobin levels in all the participants were analyzed by routine blood examination before the exercise tests. The Bland-Altman method was used for bias and precision assessment. Multivariate logistic regression was performed to analyze the correlation between AMS and the candidate variables. A receiver operating characteristic curve was used to evaluate the efficacy of VO2max in predicting AMS. RESULTS VO2max decreased after acute high altitude exposure, as measured by CPET (25.20 [SD 6.46] vs 30.17 [SD 5.01] at low altitude; P<.001) and SWT (26.17 [SD 6.71] vs 31.28 [SD 5.17] at low altitude; P<.001). Both at low and high altitudes, VO2max was slightly overestimated by SWT but had considerable accuracy as the mean absolute percentage error (<7%) and mean absolute error (<2 mL·kg-1·min-1), with a relatively small bias compared with VO2max-CPET. Twenty of the 46 participants developed AMS at 3900 m, and their VO2max was significantly lower than that of those without AMS (CPET: 27.80 [SD 4.55] vs 32.00 [SD 4.64], respectively; P=.004; SWT: 28.00 [IQR 25.25-32.00] vs 32.00 [IQR 30.00-37.00], respectively; P=.001). VO2max-CPET, VO2max-SWT, and red blood cell distribution width-coefficient of variation (RDW-CV) were found to be independent predictors of AMS. To increase the prediction accuracy, we used combination models. The combination of VO2max-SWT and RDW-CV showed the largest area under the curve for all parameters and models, which increased the area under the curve from 0.785 for VO2max-SWT alone to 0.839. CONCLUSIONS Our study demonstrates that the smartwatch device can be a feasible approach for estimating VO2max. In both low and high altitudes, VO2max-SWT showed a systematic bias toward a calibration point, slightly overestimating the proper VO2max when investigated in healthy participants. The SWT-based VO2max at low altitude is an effective indicator of AMS and helps to better identify susceptible individuals following acute high-altitude exposure, particularly by combining the RDW-CV at low altitude. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200059900; https://www.chictr.org.cn/showproj.html?proj=170253.
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Affiliation(s)
- Xiaowei Ye
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Mengjia Sun
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shiyong Yu
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhen Liu
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Boji Wu
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jingyu He
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xuhong Wang
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Bourke A, Niranjan V, O’Connor R, Woods C. Barriers to and motives for engagement in an exercise-based cardiac rehabilitation programme in Ireland: a qualitative study. BMC PRIMARY CARE 2022; 23:28. [PMID: 35148675 PMCID: PMC8832858 DOI: 10.1186/s12875-022-01637-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022]
Abstract
Background Insufficient physical activity (PA) is a leading risk factor for premature death worldwide. Ireland’s public healthcare system, the Health Service Executive (HSE), has supported the development of the National Exercise Referral Framework (NERF) to tackle low levels of PA amongst those with non-communicable diseases (NCDs). ‘NERF centres’ are medically supervised PA programmes across Ireland that have established referral pathways with local hospitals and general practitioners. ULMedX is one such NERF centre offering exercise-based cardiac rehabilitation (EBCR) with the aim of intervention development to reduce early drop-out and maximise adherence for optimal health benefits. Aim The purpose of this research was to identify the major factors influencing participants’ adherence and early drop-out at ULMedX. Exploring areas for future development were also prioritised. Design & setting Qualitative interviews were conducted with long-term attenders and people who have dropped out (PWDO) from ULMedX. Methods Guided by the Theory of Planned Behaviour the 1–1 semi-structured interviews were performed, transcribed, and evaluated through thematic analysis. Results Analysis was performed on 14 participants (50% female; mean age 67.3 years), comprising long-term attenders (n = 7; 13-month duration, 64% of classes) and PWDO (n = 7; 2.8-month duration, 22% of classes). Three major factors affecting adherence and drop-out were identified: social support, perceived outcomes from participation and practical barriers to attendance. Areas for future development included the provision of evening and advanced classes, psychological support, more exercise variety, more educational seminars and new members start as their own group. Conclusion The findings suggest participants at ULMedX are more likely to have had a better experience and commit to the programme if they believed involvement would benefit their physical and mental health, increase their exercise motivation by engendering a positive attitude to exercise, and that the ability to attend was within their control. Future interventions at ULMedX should have their structures centred around these motives for engagement. ULMedX should also test the participant recommendations to overcome the common barriers to adherence.
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Vilasi A, Panuccio VA, Morante S, Villa A, Versace MC, Mezzatesta S, Mercuri S, Inguanta R, Aiello G, Cutrupi D, Puglisi R, Capria S, Li Vigni M, Tripepi G, Torino C. Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36766. [PMID: 38935948 PMCID: PMC11135230 DOI: 10.2196/36766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. OBJECTIVE With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. METHODS The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. RESULTS The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. CONCLUSIONS Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.
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Affiliation(s)
- Antonio Vilasi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | | | | | - Sabrina Mezzatesta
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | - Giuseppe Aiello
- Department of Engineering, University of Palermo, Palermo, Italy
| | - Demetrio Cutrupi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Salvatore Capria
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Giovanni Tripepi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
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Lew LA, Williams JS, Stone JC, Au AKW, Pyke KE, MacDonald MJ. Examination of Sex-Specific Participant Inclusion in Exercise Physiology Endothelial Function Research: A Systematic Review. Front Sports Act Living 2022; 4:860356. [PMID: 35399599 PMCID: PMC8990239 DOI: 10.3389/fspor.2022.860356] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background To combat historical underrepresentation of female participants in research, guidelines have been established to motivate equal participation by both sexes. However, the pervasiveness of female exclusion has not been examined in vascular exercise physiology research. The purpose of this study was to systematically quantify the sex-specific prevalence of human participants and identify the rationales for sex-specific inclusion/exclusion in research examining the impact of exercise on vascular endothelial function. Methods A systematic search was conducted examining exercise/physical activity and vascular endothelial function, assessed via flow mediated dilation. Studies were categorized by sex: male-only, female-only, or mixed sex, including examination of the sample size of males and females. Analysis was performed examining sex-inclusion criteria in study design and reporting and rationale for inclusion/exclusion of participants on the basis of sex. Changes in proportion of female participants included in studies were examined over time in 5 year cohorts. Results A total of 514 studies were identified, spanning 26 years (1996–2021). Of the total participants, 64% were male and 36% were female, and a male bias was identified (32% male-only vs. 12% female-only studies). Proportions of female participants in studies remained relatively constant in the last 20 years. Male-only studies were less likely to report sex in the title compared to female-only studies (27 vs. 78%, p < 0.001), report sex in the abstract (72 vs. 98%, p < 0.001) and justify exclusion on the basis of sex (15 vs. 55%, p < 0.001). Further, male-only studies were more likely to be conducted in healthy populations compared to female-only studies (p = 0.002). Qualitative analysis of justifications identified four themes: sex-specific rationale or gap in the literature, exclusion of females based on the hormonal cycle or sex-differences, maintaining congruence with the male norm, and challenges with recruitment, retention and resources. Conclusions This systematic review provides the first analysis of sex-based inclusion/exclusion and rationale for sex-based decisions in human vascular exercise physiology research. These findings contribute to identifying the impact of research guidelines regarding inclusion of males and females and the perceived barriers to designing studies with equal sex participation, in an effort to increase female representation in vascular exercise physiology research. Systematic Review Registration: CRD42022300388.
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Affiliation(s)
- Lindsay A. Lew
- Cardiovascular Stress Response Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Jennifer S. Williams
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Jenna C. Stone
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Alicia K. W. Au
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Kyra E. Pyke
- Cardiovascular Stress Response Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Maureen J. MacDonald
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
- *Correspondence: Maureen J. MacDonald
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Omovvat Z, Elahi N, Sayadi N, Ghanbari S. The Persian validation of the Coronary Artery Disease Education Questionnaire Short Version for education of patients undergoing cardiac rehabilitation. ARYA ATHEROSCLEROSIS 2022; 18:1-7. [PMID: 36819837 PMCID: PMC9931616 DOI: 10.48305/arya.v18i0.2183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/15/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of cardiovascular death worldwide. Therefore, assessing knowledge in patients with CAD needs a specific tool. This study aims to carry out the Persian validation of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV) for education of patients undergoing cardiac rehabilitation (CR). METHODS This study was a cross-sectional study. First, the original version of the CADE-Q SV was translated from English into Farsi using the standard approach. The face validity and content validity were measured using quantitative and qualitative approaches. The confirmatory factor analysis (CFA) was done to examine the construct validity. The reliability of the questionnaire was investigated through test-retest reliability and by calculating Cronbach's alpha coefficient. SPSS software was used to analyze the data, and the R package lavaan, to approve the CFA. RESULTS The result of quantitative face validity showed that the minimum score was 4.42. The minimum scores for quantitative content validity were 0.83 for content validity index (CVI) and 0.66 for content validity ratio (CVR); therefore, all the items were approved. According to the results of the CFA, the comparative fit index (CFI) was reported to be 0.969, indicating a good fit for the items. The Cronbach's alpha coefficient for the whole instrument was 0.679, and the test-retest correlation was measured to be > 0.4, after a 2-week interval. CONCLUSION In total, it can be concluded that the CADE-Q SV has good psychometric properties and proper reliability. It can be utilized in medical and CR centers.
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Affiliation(s)
- Zahra Omovvat
- Department of Nursing and Midwifery, School of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Elahi
- Associate Professor, Department of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Sayadi
- Assistant Professor, Department of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,Address for correspondence: Neda Sayadi; Assistant Professor, Department of Nursing and Midwifery, Nursing Care Research Centre in
Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;
| | - Saeed Ghanbari
- Assistant Professor, Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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11
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Kruse C, Heinemann K. Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review. J Med Internet Res 2022; 24:e31752. [PMID: 34854815 PMCID: PMC8729874 DOI: 10.2196/31752] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. OBJECTIVE The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. METHODS The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. RESULTS Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. CONCLUSIONS The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted.
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Affiliation(s)
- Clemens Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX, United States
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12
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Pogosova NV, Badtieva VA, Ovchinnikova AI, Sokolova OY. [New treatments and technologies in cardiac rehabilitation programs]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:50-57. [PMID: 35700376 DOI: 10.17116/kurort20229903150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article presents a review of literature data reflecting the relevance and modern views on the effectiveness and expediency of using various options for rehabilitation programs for cardiovascular diseases. The issues of the history of the development of cardiac rehabilitation both abroad and in Russia are consecrated. The article also presents alternative models for conducting cardiac rehabilitation, in particular, using remote and telemedicine technologies. The widespread use of smartphones and high-speed Internet access contributed to the further introduction and use of telemedicine technologies in cardiac rehabilitation. The article discusses the possibilities of telerehabilitation of cardiological patients and shows its comparable effectiveness with traditional cardiac rehabilitation.
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Affiliation(s)
- N V Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - V A Badtieva
- Moscow Scientific-Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - A I Ovchinnikova
- Moscow Scientific-Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - O Yu Sokolova
- National Medical Research Center of Cardiology, Moscow, Russia
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13
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Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021; 11:CD001800. [PMID: 34741536 PMCID: PMC8571912 DOI: 10.1002/14651858.cd001800.pub4] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
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Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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14
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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15
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Ding EY, Erskine N, Stut W, McManus DD, Peterson A, Wang Z, Escobar Valle J, Albuquerque D, Alonso A, Botkin NF, Pack QR, McManus DD. MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study. JMIR Hum Factors 2021; 8:e18130. [PMID: 34255660 PMCID: PMC8299347 DOI: 10.2196/18130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/17/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. OBJECTIVE In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch-informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. METHODS We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. RESULTS Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). CONCLUSIONS This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.
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Affiliation(s)
- Eric Y Ding
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nathaniel Erskine
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Wim Stut
- Philips Research, Eindhoven, Netherlands
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Amy Peterson
- University of Massachusetts Memorial Marlborough Hospital, Marlborough, MA, United States
| | - Ziyue Wang
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Daniella Albuquerque
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Alvaro Alonso
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Naomi F Botkin
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Quinn R Pack
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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16
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Kwon S, Wan N, Burns RD, Brusseau TA, Kim Y, Kumar S, Ertin E, Wetter DW, Lam CY, Wen M, Byun W. The Validity of MotionSense HRV in Estimating Sedentary Behavior and Physical Activity under Free-Living and Simulated Activity Settings. SENSORS 2021; 21:s21041411. [PMID: 33670507 PMCID: PMC7922785 DOI: 10.3390/s21041411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
MotionSense HRV is a wrist-worn accelerometery-based sensor that is paired with a smartphone and is thus capable of measuring the intensity, duration, and frequency of physical activity (PA). However, little information is available on the validity of the MotionSense HRV. Therefore, the purpose of this study was to assess the concurrent validity of the MotionSense HRV in estimating sedentary behavior (SED) and PA. A total of 20 healthy adults (age: 32.5 ± 15.1 years) wore the MotionSense HRV and ActiGraph GT9X accelerometer (GT9X) on their non-dominant wrist for seven consecutive days during free-living conditions. Raw acceleration data from the devices were summarized into average time (min/day) spent in SED and moderate-to-vigorous PA (MVPA). Additionally, using the Cosemed K5 indirect calorimetry system (K5) as a criterion measure, the validity of the MotionSense HRV was examined in simulated free-living conditions. Pearson correlations, mean absolute percent errors (MAPE), Bland–Altman (BA) plots, and equivalence tests were used to examine the validity of the MotionSense HRV against criterion measures. The correlations between the MotionSense HRV and GT9X were high and the MAPE were low for both the SED (r = 0.99, MAPE = 2.4%) and MVPA (r = 0.97, MAPE = 9.1%) estimates under free-living conditions. BA plots illustrated that there was no systematic bias between the MotionSense HRV and criterion measures. The estimates of SED and MVPA from the MotionSense HRV were significantly equivalent to those from the GT9X; the equivalence zones were set at 16.5% for SED and 29% for MVPA. The estimates of SED and PA from the MotionSense HRV were less comparable when compared with those from the K5. The MotionSense HRV yielded comparable estimates for SED and PA when compared with the GT9X accelerometer under free-living conditions. We confirmed the promising application of the MotionSense HRV for monitoring PA patterns for practical and research purposes.
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Affiliation(s)
- Sunku Kwon
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA; (S.K.); (R.D.B.); (T.A.B.)
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, UT 84112, USA;
| | - Ryan D. Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA; (S.K.); (R.D.B.); (T.A.B.)
| | - Timothy A. Brusseau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA; (S.K.); (R.D.B.); (T.A.B.)
| | - Youngwon Kim
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong;
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, UK
| | - Santosh Kumar
- Department of Computer Science, University of Memphis, Memphis, TN 38152, USA;
| | - Emre Ertin
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43210, USA;
| | - David W. Wetter
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84132, USA; (D.W.W.); (C.Y.L.)
| | - Cho Y. Lam
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84132, USA; (D.W.W.); (C.Y.L.)
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Wonwoo Byun
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA; (S.K.); (R.D.B.); (T.A.B.)
- Correspondence: ; Tel.: +1-801-585-1119
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17
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Tighe SA, Ball K, Kensing F, Kayser L, Rawstorn JC, Maddison R. Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions. J Med Internet Res 2020; 22:e16774. [PMID: 33112239 PMCID: PMC7657720 DOI: 10.2196/16774] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. OBJECTIVE This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. METHODS A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. CONCLUSIONS Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
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Affiliation(s)
- Sarah A Tighe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Finn Kensing
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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18
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O’Shea O, Woods C, McDermott L, Buys R, Cornelis N, Claes J, Cornelissen V, Gallagher A, Newton H, Moyna N, McCaffrey N, Susta D, McDermott C, McCormack C, Budts W, Moran K. A qualitative exploration of cardiovascular disease patients' views and experiences with an eHealth cardiac rehabilitation intervention: The PATHway Project. PLoS One 2020; 15:e0235274. [PMID: 32628688 PMCID: PMC7337342 DOI: 10.1371/journal.pone.0235274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of this study is to explore participants' views and experiences of an eHealth phase 3 cardiac rehabilitation (CR) intervention: Physical Activity Towards Health (PATHway). Sixty participants took part in the PATHway intervention. Debriefs were conducted after the six-month intervention. All interviews were audio recorded and transcribed verbatim. Transcripts were analysed with Braun and Clarke's thematic analysis. Forty-four (71%) debriefs were conducted (n = 34 male, mean (SD) age 61 (10) years). Five key themes were identified: (1) Feedback on the components of the PATHway system, (2) Motivation, (3) Barriers to using PATHway, (4) Enablers to using PATHway, and (5) Post programme reflection. There were a number of subthemes within each theme, for example motivation explores participants motivation to take part in PATHway and participants motivation to sustain engagement with PATHway throughout the intervention period. Participant engagement with the components of the PATHway system was variable. Future research should focus on optimising participant familiarisation with eHealth systems and employ an iterative approach to development and evaluation.
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Affiliation(s)
- Orlagh O’Shea
- School of Physiotherapy, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | | | - Roselien Buys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nils Cornelis
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Anne Gallagher
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall Moyna
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | | | - Davide Susta
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Clare McDermott
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Ciara McCormack
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Werner Budts
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Kieran Moran
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
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