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French MA, Balasubramanian A, Hansel NN, Penttinen SK, Wise R, Raghavan P, Wegener ST, Roemmich RT, Celnik PA. Impact of automated data flow and reminders on adherence and resource utilization for remotely monitoring physical activity in individuals with stroke or chronic obstructive pulmonary disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.15.24305852. [PMID: 38699312 PMCID: PMC11064997 DOI: 10.1101/2024.04.15.24305852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
As rehabilitation advances into the era of digital health, remote monitoring of physical activity via wearable devices has the potential to change how we provide care. However, uncertainties about patient adherence and the significant resource requirements needed create challenges to adoption of remote monitoring into clinical care. Here we aim to determine the impact of a novel digital application to overcome these barriers. The Rehabilitation Remote Monitoring Application (RRMA) automatically extracts data about physical activity collected via a Fitbit device, screens the data for adherence, and contacts the participant if adherence is low. We compare adherence and estimate the resources required (i.e., time and financial) to perform remote monitoring of physical activity with and without the RRMA in two patient groups. Seventy-three individuals with stroke or chronic obstructive pulmonary disease completed 28 days of monitoring physical activity with the RRMA, while 62 individuals completed 28 days with the data flow processes being completed manually. Adherence (i.e., the average percentage of the day that the device was worn) was similar between groups (p=0.85). However, the RRMA saved an estimated 123.8 minutes or $50.24 per participant month when compared to manual processes. These results demonstrate that automated technologies like the RRMA can maintain patient adherence to remote monitoring of physical activity while reducing the time and financial resources needed. Applications like the RRMA can facilitate the adoption of remote monitoring in rehabilitation by reducing barriers related to adherence and resource requirements.
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Affiliation(s)
- Margaret A French
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, United States of America
| | - Aparna Balasubramanian
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nadia N Hansel
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sharon K Penttinen
- inHealth Precision Medicine Program, Technology Innovation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robert Wise
- inHealth Precision Medicine Program, Technology Innovation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ryan T Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
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Yocum D, Elashoff B, Verta P, Armock G, Yergler J. Patient reported outcomes do not correlate to functional knee recovery and range of motion in total knee arthroplasty. J Orthop 2023; 43:36-40. [PMID: 37564705 PMCID: PMC10409997 DOI: 10.1016/j.jor.2023.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Background Many total knee arthroplasty (TKA) patients exhibit continued pain and limited function following surgery. Determining TKA outcomes is typically reliant on post-operative evaluations and completing patient-reported outcomes (PROMs). Due to low compliance rates, it is essential to identify new strategies for monitoring patients. The purpose of this analysis was to assess the correlations between gait kinematics, PROMs, and knee range of motion (ROM). Methods 130 patients (75 female) received Persona IQ TKA (Zimmer Biomet, Warsaw, IN, USA) which includes a stem extension with embedded accelerometer and gyroscope. PROM scores were compared at baseline and 6 weeks post-TKA using a paired t-test. Gait kinematics were recorded daily via the Persona IQ stem extension. Pearson's correlation coefficients were derived between PROMs and average gait kinematics. Results Knee Injury and Osteoarthritis Outcome Score (KOOS Jr.) and Veterans RAND 12 (VR-12) physical scores improved following surgery (p ≤ 0.001, p = 0.003, respectively). Weak statistically significant correlations were found between PROMS and gait kinematics. Conclusion Weak correlations between PROMs and gait kinematics indicate patient perception of improvement and objectively measured functional status may not be interchangeable. Further, compliance with Persona IQ data reached 95.4-97.7% (depending on the parameter) at 6 weeks following surgery, a 20% higher compliance rate over PROMs. Daily functional measurements provide insight into the patient's progression and may be useful in detecting poor outcomes.
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Affiliation(s)
- Derek Yocum
- South Bend Orthopaedics, 53880 Carmichael Dr., South Bend, IN, 46635, USA
| | | | - Patrick Verta
- Canary Medical, 2710 Loker Ave W, Carlsbad, CA, 92010, USA
| | - Gary Armock
- South Bend Orthopaedics, 53880 Carmichael Dr., South Bend, IN, 46635, USA
| | - Jeffrey Yergler
- South Bend Orthopaedics, 53880 Carmichael Dr., South Bend, IN, 46635, USA
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French MA, Keatley E, Li J, Balasubramanian A, Hansel NN, Wise R, Searson P, Singh A, Raghavan P, Wegener S, Roemmich RT, Celnik P. The feasibility of remotely monitoring physical, cognitive, and psychosocial function in individuals with stroke or chronic obstructive pulmonary disease. Digit Health 2023; 9:20552076231176160. [PMID: 37214659 PMCID: PMC10192672 DOI: 10.1177/20552076231176160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Clinical implementation of remote monitoring of human function requires an understanding of its feasibility. We evaluated adherence and the resources required to monitor physical, cognitive, and psychosocial function in individuals with either chronic obstructive pulmonary disease or stroke during a three-month period. Methods Seventy-three individuals agreed to wear a Fitbit to monitor physical function and to complete monthly online assessments of cognitive and psychosocial function. During a three-month period, we measured adherence to monitoring (1) physical function using average daily wear time, and (2) cognition and psychosocial function using the percentage of assessments completed. We measured the resources needed to promote adherence as (1) the number of participants requiring at least one reminder to synchronize their Fitbit, and (2) the number of reminders needed for each completed cognitive and psychosocial assessment. Results After accounting for withdrawals, the average daily wear time was 77.5 ± 19.9% of the day and did not differ significantly between months 1, 2, and 3 (p = 0.30). To achieve this level of adherence, 64.9% of participants required at least one reminder to synchronize their device. Participants completed 61.0% of the cognitive and psychosocial assessments; the portion of assessments completed each month didnot significantly differ (p = 0.44). Participants required 1.13 ± 0.57 reminders for each completed assessment. Results did not differ by disease diagnosis. Conclusions Remote monitoring of human function in individuals with either chronic obstructive pulmonary disease or stroke is feasible as demonstrated by high adherence. However, the number of reminders required indicates that careful consideration must be given to the resources available to obtain high adherence.
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Affiliation(s)
- Margaret A French
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Eva Keatley
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Junyao Li
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care
Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care
Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Wise
- Division of Pulmonary and Critical Care
Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Searson
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
- Department of Materials Science and
Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Anil Singh
- Department of Pulmonary and Critical
Care Medicine, Allegheny Health Network, Pittsburg, PA, USA
| | - Preeti Raghavan
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Stephen Wegener
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Ryan T Roemmich
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
- Kennedy Krieger Institute, Center for Movement Studies, Baltimore, MD, USA
| | - Pablo Celnik
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
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Constantinescu D, Pavlis W, Rizzo M, Vanden Berge D, Barnhill S, Hernandez VH. The role of commercially available smartphone apps and wearable devices in monitoring patients after total knee arthroplasty: a systematic review. EFORT Open Rev 2022; 7:481-490. [PMID: 35900191 PMCID: PMC9297050 DOI: 10.1530/eor-21-0115] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Commercially available smartphone apps and wearable devices have proven valuable in a variety of clinical settings, yet their utility in measuring physical activity and monitoring patient status following total knee arthroplasty (TKA) remains unclear. Methods A systematic review was performed to assess the evidence supporting the use of smartphone apps and wearable devices to assist rehabilitation interventions following TKA. A search was conducted in the PubMed, Cochrane, Medline, and Web of Science databases in September 2021. Results One hundred and seventy-six studies were retrieved, of which 15 met inclusion criteria, including 6 randomized control trials. Four of these studies utilized smartphone apps, seven utilized wearable devices, and four utilized a combination of both. A total of 1607 TKA patients participated in the included studies. For primary outcomes, three reported on device accuracy, three on recovery prediction, two on functional recovery, two on physical activity promotion, two on patient compliance, two on pain control, and one on healthcare utilization. Conclusion Commercially available smartphone apps and wearable devices were shown to capably monitor physical activity and improve patient engagement following TKA, making them potentially viable adjuncts or replacements to traditional rehabilitation programs. Components of interventions such as step goals, app-based patient engagement platforms, and patient-specific benchmarks for recovery may improve effectiveness. However, future research should focus on the economics of implementation, long-term outcomes, and optimization of compliance and accuracy when using these devices.
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Affiliation(s)
| | - William Pavlis
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Rizzo
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
| | | | - Spencer Barnhill
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
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Johnson AM, Baker KS, Haviland MJ, Syrjala KL, Abbey-Lambertz M, Chow EJ, Mendoza JA. A Pilot Randomized Controlled Trial of a Fitbit- and Facebook-Based Physical Activity Intervention for Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2021; 11:379-388. [PMID: 34677081 PMCID: PMC9419976 DOI: 10.1089/jayao.2021.0056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Most young adult cancer survivors (YACS) do not meet physical activity (PA) guidelines. Although PA can improve health and quality of life (QOL), few randomized controlled trials (RCTs) of PA interventions for YACS exist. We conducted a pilot RCT to test feasibility of a PA intervention among YACS. Methods: We recruited 18-39-year-olds (≥1 and <5 years postcancer therapy) from Seattle Cancer Care Alliance. The 12-week intervention involved a wrist-worn PA-tracking device (Fitbit), a peer-based Facebook support group, step count goal setting, and a self-selected support "buddy." Controls received Fitbit only. Baseline assessments occurred before randomization; follow-up assessments occurred during intervention weeks 10-12. Feasibility criteria are listed below. Exploratory outcomes included PA, sedentary time (ST), QOL measures (e.g., fatigue), and self-determination theory (SDT) construct measures. Results: All feasibility criteria were met: We recruited 50 YACS, intervention participants wore the Fitbit on the majority of intervention days (82.9%), ≥75% of participants completed questionnaires at baseline (100%) and follow-up (93.9%). Exploratory analyses, adjusted for wave, accelerometer wear time, race, and income, showed significant group differences for change in ST (-52.4 vs. 2.5 minutes/day; p = 0.002) but no change in moderate-to-vigorous intensity PA (0.0 vs. -0.2 minutes/day; p = 0.40), comparing intervention participants to controls. The intervention (vs. control) group had a greater increase in fatigue interference (p = 0.03). No other significant differences in SDT or QOL measures were found. Conclusion: This Fitbit and Facebook-based PA intervention was feasible to YACS, with promising effects on reducing ST, and warrants a fully powered RCT. Clinical Trial Registration no.: NCT03233581.
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Affiliation(s)
- Ashleigh M Johnson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - K Scott Baker
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Mark Abbey-Lambertz
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Jason A Mendoza
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
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