Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting

A Behavioral Lifestyle Intervention to Improve Frailty in Overweight or Obese Older Adults with Type 2 Diabetes: A Feasibility Study

BACKGROUND

Older adults with Type 2 diabetes (T2D) are more likely to be frail, which increases the risk for disability and mortality.

OBJECTIVES

To determine the feasibility of a behavioral lifestyle intervention, enhanced with mobile health technology for self-monitoring of diet and activity, to improve frailty in overweight/obese older adults (≥65 years) diagnosed with T2D.

DESIGN, SETTING, AND PARTICIPANTS

Single arm, 6-month study of a behavioral lifestyle intervention in 20 overweight/obese (BMI>25) older adults (≥ 65 years) with self-reported T2D diagnosis who owned a smartphone. A Fitbit tracker was provided to all participants for self-monitoring of diet and physical activity. Our primary outcome of feasibility was measured by session attendance, adherence to Fitbit usage to self-monitor diet and physical activity, and study retention. Secondary outcomes included the preliminary efficacy of the intervention on frailty, physical function, quality of life, and T2D-related outcomes.

RESULTS

Eighteen participants completed the study. The mean age was 71.5 (SD ± 5.3) years, 56% were female, and half were Hispanic. At baseline, 13 (72%) were pre-frail, 4 (22%) were frail, and 1 (6%) were non-frail. At follow-up, frailty scores improved significantly from 1.61 ± 1.15 to 0.94 ± 0.94 (p=0.01) and bodyweight improved from 205.66 ± 45.52 lbs. to 198.33 ± 43.6 lbs. (p=<0.001).

CONCLUSION

This study provides evidence for the feasibility of a behavioral lifestyle intervention in overweight/obese older adults with T2D and preliminary results support its potential efficacy in improving frailty score.

A Wearable Walking Gait Speed-Sensing Device using Frequency Bifurcations of Multi-Resonator Inductive Link

This paper describes a wearable inductive sensing system to monitor (i.e., sense and estimate) walking gait speed. This proposed design relies on the multi-resonance inductive link to quantify the angle of the human legs for calculating the speed of walking. The walking gait speed can be used to estimate the frailty in elderly patients with cancer. We have designed, optimized, and implemented a multi-resonator sensor unit to precisely measure the angle between human legs during walking. The couplings between resonators change by lateral displacements due to walking, and a reading coil senses the frequency bifurcations, corresponding to the changes in angle between legs. The proposed design is optimized using ANSYS HFSS and implemented using copper foil. The Specific Absorption Rate, SAR, in the human body is calculated 0.035 W/kg using the developed HFSS model. The operating frequency range of the proposed sensor is from 25 MHz to 46 MHz, and it can measure angles up to 90° (-45° to +45°). The measured resolution for estimating the angle shows the capability of the sensor for calculating the walking speed with a resolution of less than 0.1 m/s.

Digital Health Interventions among People Living with Frailty: A Scoping Review

OBJECTIVES

Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population.

DESIGN

Scoping review with PRISMA guidelines based on Population, Concept, and Context.

SETTING AND PARTICIPANTS

We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science).

MEASURES

We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design.

RESULTS

We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies.

CONCLUSIONS AND IMPLICATIONS

There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.

How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.

Systematic review of telemedicine in spine surgery

OBJECTIVE

The use of telemedicine (TM) has long been available, but recent restrictions to hospitals due to the coronavirus disease 2019 (COVID-19) pandemic have accelerated the global implementation of TM. However, evidence on the effectiveness of this technology for the care of spine surgery patients is limited. In this systematic review the authors aimed to examine the current utilization of TM for spine surgery.

METHODS

Using PubMed, Scopus, and the Cochrane Library, the authors performed a systematic review of the literature focused on the themes of telemedicine and spine surgery. Included in the search were randomized controlled trials, cohort studies, and case-controlled studies. Two independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies.

RESULTS

Out of 1463 references from the initial search results, 12 studies met the inclusion criteria. The majority of TM interventions focused on improving perioperative patient communication and patient education by using mobile phone apps, online surveys, or online materials for consent. The studies reported the feasibility of the use of TM for perioperative care and positive user experiences from the patients.

CONCLUSIONS

The current increase in TM adoption due to the COVID-19 crisis presents an opportunity to further develop and validate this technology. Early evidence in the literature supports the use of TM as an adjunct to traditional in-person clinical encounters for certain perioperative tasks such as supplemental patient education and postoperative surveys.

Clinicians' User Experience of Telemedicine in Neurosurgery During COVID-19

BACKGROUND

Restricted access to hospitals due to the 2019 novel coronavirus disease (COVID-19) pandemic has significantly altered practice patterns for elective neurosurgical care. Particularly, telemedicine has become the primary modality of patient visits for nonemergent conditions. This study aimed to characterize user experiences of neurosurgeons and advanced practice providers focusing on perceived utility and barriers of telemedicine in management of elective neurosurgical patients during COVID-19.

METHODS

An online survey was sent to clinicians involved in neurosurgical care using telemedicine with questions focusing on frequency of utilization, duration of patient encounters, benefits of telemedicine, and barriers to current forms of remote patient visits. Survey responses were stratified by clinical position (neurosurgeon vs. advanced practice provider) and subspecialty focus (cranial vs. spinal neurosurgery).

RESULTS

The survey was completed by 14 of 17 eligible clinicians. Respondents included 10 neurosurgeons and 4 APPs with 57% specializing in cranial neurosurgery and 43% specializing in spinal neurosurgery. During the COVID-19 period, 78% of respondents used teleconference/video conference visits multiple times in a week, and 86% planned to continue using telemedicine after the pandemic. The most common barrier for telemedicine was the inability to perform a neurological examination, while the most common perceived benefit was increased convenience for patients.

CONCLUSIONS

During the COVID-19 period, telemedicine was heavily relied on to ensure the continuation of perioperative care for patients with elective neurosurgical pathologies. While clinicians identified numerous barriers for current telemedicine platforms, the use of telemedicine will likely continue, as it has provided unique benefits for patients, clinicians, and hospitals.

A Tablet-Based Assessment of Rhythmic Ability

The exponential rise in use of mobile consumer electronics has presented a great potential for research to be conducted remotely, with participants numbering several orders of magnitude greater than a typical research paradigm. Here, we attempt to demonstrate the validity and reliability of using a consumer game-engine to create software presented on a mobile tablet to assess sensorimotor synchronization, a proxy of rhythmic ability. Our goal was to ascertain whether previously observed research results can be replicated, rather than assess whether a mobile tablet achieves comparable performance to a desktop computer. To achieve this, younger (aged 18–35 years) and older (aged 60–80 years) adult musicians and non-musicians were recruited to play a custom-designed sensorimotor synchronization assessment on a mobile tablet in a controlled laboratory environment. To assess reliability, participants performed the assessment twice, separated by a week, and an intra-class correlation coefficient (ICC) was calculated. Results supported the validity of this approach to assessing rhythmic abilities by replicating previously observed results. Specifically, musicians performed better than non-musicians, and younger adults performed better than older adults. Participants also performed best when the tempo was in the range of previously-identified preferred tempos, when the stimuli included both audio and visual information, and when synchronizing on-beat compared to off-beat or continuation (self-paced) synchronization. Additionally, high ICC values (>0.75) suggested excellent test–retest reliability. Together, these results support the notion that consumer electronics running software built with a game engine may serve as a valuable resource for remote, mobile-based data collection of rhythmic abilities.

Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care

Background

Mobile and wearable technology presents exciting opportunities for monitoring behavior using widely available sensor data. This could support clinical research and practice aimed at improving quality of life among the growing number of people with dementia. However, it requires suitable tools for measuring behavior in a natural real-life setting that can be easily implemented by others.

Objective

The objectives of this study were to develop and test a set of algorithms for measuring mobility and activity and to describe a technical setup for collecting the sensor data that these algorithms require using off-the-shelf devices.

Methods

A mobility measurement module was developed to extract travel trajectories and home location from raw GPS (global positioning system) data and to use this information to calculate a set of spatial, temporal, and count-based mobility metrics. Activity measurement comprises activity bout extraction from recognized activity data and daily step counts. Location, activity, and step count data were collected using smartwatches and mobile phones, relying on open-source resources as far as possible for accessing data from device sensors. The behavioral monitoring solution was evaluated among 5 healthy subjects who simultaneously logged their movements for 1 week.

Results

The evaluation showed that the behavioral monitoring solution successfully measures travel trajectories and mobility metrics from location data and extracts multimodal activity bouts during travel between locations. While step count could be used to indicate overall daily activity level, a concern was raised regarding device validity for step count measurement, which was substantially higher from the smartwatches than the mobile phones.

Conclusions

This study contributes to clinical research and practice by providing a comprehensive behavioral monitoring solution for use in a real-life setting that can be replicated for a range of applications where knowledge about individual mobility and activity is relevant.

Extended, continuous measures of functional status in community dwelling persons with Alzheimer's and related dementia: Infrastructure, performance, tradeoffs, preliminary data, and promise

BACKGROUND

The past decades have seen phenomenal growth in the availability of inexpensive and powerful personal computing devices. Efforts to leverage these devices to improve health care outcomes promise to remake many aspects of healthcare delivery, but remain in their infancy.

NEW METHOD

We describe the development of a mobile health platform designed for daily measures of functional status in ambulatory, community dwelling subjects, including those who have Alzheimer's disease or related neurodegenerative disorders. Using Smartwatches and Smartphones we measure subject overall activity and outdoor location (to derive their lifespace). These clinically-relevant measures allow us to track a subject's functional status in their natural environment over prolonged periods of time without repeated visits to healthcare providers. Functional status metrics are integrated with medical information and caregiver reports, which are used by a caregiving team to guide referrals for physician/APRN/NP care. COMPARISON: with Existing Methods We describe the design tradeoffs involved in all aspects of our current system architecture, focusing on decisions with significant impact on system cost, performance, scalability, and user-adherence.

RESULTS

We provide real-world data from current subject enrollees demonstrating system accuracy and reliability.

CONCLUSIONS

We document real-world feasibility in a group of men and women with dementia that Smartwatches/Smartphones can provide long-term, relevant clinical data regarding individual functional status. We describe the underlying considerations of this system so that interested organizations can adapt and scale our approach to their needs. Finally, we provide a potential agenda to guide development of future systems.