1
|
Zhao F, Balthazaar S, Hiremath SV, Nightingale TE, Panza GS. Enhancing Spinal Cord Injury Care: Using Wearable Technologies for Physical Activity, Sleep, and Cardiovascular Health. Arch Phys Med Rehabil 2024; 105:1997-2007. [PMID: 38972475 DOI: 10.1016/j.apmr.2024.06.014] [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: 02/16/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
Wearable devices have the potential to advance health care by enabling real-time monitoring of biobehavioral data and facilitating the management of an individual's health conditions. Individuals living with spinal cord injury (SCI) have impaired motor function, which results in deconditioning and worsening cardiovascular health outcomes. Wearable devices may promote physical activity and allow the monitoring of secondary complications associated with SCI, potentially improving motor function, sleep, and cardiovascular health. However, several challenges remain to optimize the application of wearable technologies within this population. One is striking a balance between research-grade and consumer-grade devices in terms of cost, accessibility, and validity. Additionally, limited literature supports the validity and use of wearable technology in monitoring cardio-autonomic and sleep outcomes for individuals with SCI. Future directions include conducting performance evaluations of wearable devices to precisely capture the additional variation in movement and physiological parameters seen in those with SCI. Moreover, efforts to make the devices small, lightweight, and inexpensive for consumer ease of use may affect those with severe motor impairments. Overcoming these challenges holds the potential for wearable devices to help individuals living with SCI receive timely feedback to manage their health conditions and help clinicians gather comprehensive patient health information to aid in diagnosis and treatment.
Collapse
Affiliation(s)
- Fei Zhao
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI
| | - Shane Balthazaar
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada; Department of Cardiology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | - Gino S Panza
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI.
| |
Collapse
|
2
|
Russell MK, Horton JF, Clermont CA, Demarty JM, Transfiguracion LC, Worobets BR, Pineda ME, Santaniemi N, Stergiou P, Asmussen MJ, Day TA. Validation of Polar Elixir™ Pulse Oximeter against Arterial Blood Gases during Stepwise Steady-State Inspired Hypoxia. Med Sci Sports Exerc 2024; 56:1585-1594. [PMID: 38635406 DOI: 10.1249/mss.0000000000003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of peripheral oxygen saturation (SpO 2 ) measurements from Polar Elixir™ pulse oximetry technology compared with arterial oxygen saturation (SaO 2 ) measurements during acute stepwise steady-state inspired hypoxia at rest. A post hoc objective was to determine if SpO 2 measurements could be improved by recalibrating the Polar Elixir™ algorithm with SaO 2 values from a random subset of participants. METHODS The International Organization for Standardization (ISO) protocol (ISO 80601-2-61:2017) for evaluating the SpO 2 accuracy of pulse oximeter equipment was followed whereby five plateaus of SaO 2 between 70% and 100% were achieved using stepwise reductions in inspired O 2 during supine rest. Blood samples drawn through a radial arterial catheter from 25 participants were first used to compare SaO 2 with SpO 2 measurements from Polar Elixir™. Then the Polar Elixir™ algorithm was recalibrated using SaO 2 data from 13 random participants, and SpO 2 estimates were recalculated for the other 12 participants. For SaO 2 values between 70% and 100%, root mean square error, intraclass correlation coefficients (ICC), Pearson correlations, and Bland-Altman plots were used to assess the accuracy, agreement, and strength of relationship between SaO 2 values and SpO 2 values from Polar Elixir™. RESULTS The initial root mean square error for Polar Elixir™ was 4.13%. After recalibrating the algorithm, the RMSE was improved to 2.67%. The ICC revealed excellent levels of agreement between SaO 2 and Polar Elixir™ SpO 2 values both before (ICC(1,3) = 0.837, df = 574, P < 0.001) and after (ICC(1,3) = 0.942, df = 287, P < 0.001) recalibration. CONCLUSIONS Relative to ISO standards, Polar Elixir™ yielded accurate SpO 2 measurements during stepwise inspired hypoxia at rest when compared with SaO 2 values, which were improved by recalibrating the algorithm using a subset of the SaO 2 data.
Collapse
Affiliation(s)
- Monica K Russell
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | - John F Horton
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | | | | | - Breann R Worobets
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | - Mark E Pineda
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | - Pro Stergiou
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | | |
Collapse
|
3
|
Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Tarvainen MP, Väliaho ES, Rantula OA, Naukkarinen NS, Hartikainen JEK, Martikainen TJ, Halonen J. Novel Technologies in the Detection of Atrial Fibrillation: Review of Literature and Comparison of Different Novel Technologies for Screening of Atrial Fibrillation. Cardiol Rev 2024; 32:440-447. [PMID: 36946975 PMCID: PMC11296284 DOI: 10.1097/crd.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Atrial fibrillation (AF) is globally the most common arrhythmia associated with significant morbidity and mortality. It impairs the quality of the patient's life, imposing a remarkable burden on public health, and the healthcare budget. The detection of AF is important in the decision to initiate anticoagulation therapy to prevent thromboembolic events. Nonetheless, AF detection is still a major clinical challenge as AF is often paroxysmal and asymptomatic. AF screening recommendations include opportunistic or systematic screening in patients ≥65 years of age or in those individuals with other characteristics pointing to an increased risk of stroke. The popularities of well-being and taking personal responsibility for one's own health are reflected in the continuous development and growth of mobile health technologies. These novel mobile health technologies could provide a cost-effective solution for AF screening and an additional opportunity to detect AF, particularly its paroxysmal and asymptomatic forms.
Collapse
Affiliation(s)
- Onni E. Santala
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A. Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P. Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Eemu-Samuli Väliaho
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli A. Rantula
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S. Naukkarinen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E. K. Hartikainen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Jari Halonen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
4
|
Quigley KS, Gianaros PJ, Norman GJ, Jennings JR, Berntson GG, de Geus EJC. Publication guidelines for human heart rate and heart rate variability studies in psychophysiology-Part 1: Physiological underpinnings and foundations of measurement. Psychophysiology 2024; 61:e14604. [PMID: 38873876 DOI: 10.1111/psyp.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 06/15/2024]
Abstract
This Committee Report provides methodological, interpretive, and reporting guidance for researchers who use measures of heart rate (HR) and heart rate variability (HRV) in psychophysiological research. We provide brief summaries of best practices in measuring HR and HRV via electrocardiographic and photoplethysmographic signals in laboratory, field (ambulatory), and brain-imaging contexts to address research questions incorporating measures of HR and HRV. The Report emphasizes evidence for the strengths and weaknesses of different recording and derivation methods for measures of HR and HRV. Along with this guidance, the Report reviews what is known about the origin of the heartbeat and its neural control, including factors that produce and influence HRV metrics. The Report concludes with checklists to guide authors in study design and analysis considerations, as well as guidance on the reporting of key methodological details and characteristics of the samples under study. It is expected that rigorous and transparent recording and reporting of HR and HRV measures will strengthen inferences across the many applications of these metrics in psychophysiology. The prior Committee Reports on HR and HRV are several decades old. Since their appearance, technologies for human cardiac and vascular monitoring in laboratory and daily life (i.e., ambulatory) contexts have greatly expanded. This Committee Report was prepared for the Society for Psychophysiological Research to provide updated methodological and interpretive guidance, as well as to summarize best practices for reporting HR and HRV studies in humans.
Collapse
Affiliation(s)
- Karen S Quigley
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Greg J Norman
- Department of Psychology, The University of Chicago, Chicago, Illinois, USA
| | - J Richard Jennings
- Department of Psychiatry & Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gary G Berntson
- Department of Psychology & Psychiatry, The Ohio State University, Columbus, Ohio, USA
| | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Ćosić K, Popović S, Wiederhold BK. Enhancing Aviation Safety through AI-Driven Mental Health Management for Pilots and Air Traffic Controllers. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024; 27:588-598. [PMID: 38916063 DOI: 10.1089/cyber.2023.0737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
This article provides an overview of the mental health challenges faced by pilots and air traffic controllers (ATCs), whose stressful professional lives may negatively impact global flight safety and security. The adverse effects of mental health disorders on their flight performance pose a particular safety risk, especially in sudden unexpected startle situations. Therefore, the early detection, prediction and prevention of mental health deterioration in pilots and ATCs, particularly among those at high risk, are crucial to minimize potential air crash incidents caused by human factors. Recent research in artificial intelligence (AI) demonstrates the potential of machine and deep learning, edge and cloud computing, virtual reality and wearable multimodal physiological sensors for monitoring and predicting mental health disorders. Longitudinal monitoring and analysis of pilots' and ATCs physiological, cognitive and behavioral states could help predict individuals at risk of undisclosed or emerging mental health disorders. Utilizing AI tools and methodologies to identify and select these individuals for preventive mental health training and interventions could be a promising and effective approach to preventing potential air crash accidents attributed to human factors and related mental health problems. Based on these insights, the article advocates for the design of a multidisciplinary mental healthcare ecosystem in modern aviation using AI tools and technologies, to foster more efficient and effective mental health management, thereby enhancing flight safety and security standards. This proposed ecosystem requires the collaboration of multidisciplinary experts, including psychologists, neuroscientists, physiologists, psychiatrists, etc. to address these challenges in modern aviation.
Collapse
Affiliation(s)
- Krešimir Ćosić
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Siniša Popović
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | | |
Collapse
|
6
|
Brignol A, Paas A, Sotelo-Castro L, St-Onge D, Beltrame G, Coffey EBJ. Overcoming boundaries: Interdisciplinary challenges and opportunities in cognitive neuroscience. Neuropsychologia 2024; 200:108903. [PMID: 38750788 DOI: 10.1016/j.neuropsychologia.2024.108903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/13/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Cognitive neuroscience has considerable untapped potential to translate our understanding of brain function into applications that maintain, restore, or enhance human cognition. Complex, real-world phenomena encountered in daily life, professional contexts, and in the arts, can also be a rich source of information for better understanding cognition, which in turn can lead to advances in knowledge and health outcomes. Interdisciplinary work is needed for these bi-directional benefits to be realized. Our cognitive neuroscience team has been collaborating on several interdisciplinary projects: hardware and software development for brain stimulation, measuring human operator state in safety-critical robotics environments, and exploring emotional regulation in actors who perform traumatic narratives. Our approach is to study research questions of mutual interest in the contexts of domain-specific applications, using (and sometimes improving) the experimental tools and techniques of cognitive neuroscience. These interdisciplinary attempts are described as case studies in the present work to illustrate non-trivial challenges that come from working across traditional disciplinary boundaries. We reflect on how obstacles to interdisciplinary work can be overcome, with the goals of enriching our understanding of human cognition and amplifying the positive effects cognitive neuroscientists have on society and innovation.
Collapse
Affiliation(s)
- Arnaud Brignol
- Department of Psychology, Concordia University, Montreal, QC, Canada; Department of Computer and Software Engineering, Polytechnique Montreal, Montreal, QC, Canada.
| | - Anita Paas
- Department of Psychology, Concordia University, Montreal, QC, Canada; Department of Mechanical Engineering, Ecole de Technologie Supérieure (ETS), Montreal, QC, Canada
| | | | - David St-Onge
- Department of Mechanical Engineering, Ecole de Technologie Supérieure (ETS), Montreal, QC, Canada
| | - Giovanni Beltrame
- Department of Computer and Software Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Emily B J Coffey
- Department of Psychology, Concordia University, Montreal, QC, Canada
| |
Collapse
|
7
|
Essop H, Kekana R, Smuts H. Co-designing of a prototype mobile application for fetal radiation dose monitoring among pregnant radiographers using a design thinking approach. Health Informatics J 2024; 30:14604582241284960. [PMID: 39348214 DOI: 10.1177/14604582241284960] [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] [Indexed: 10/02/2024]
Abstract
This study aimed to develop a prototype mobile application to enhance fetal dosimetry among pregnant radiographers in #### through a design thinking approach. Eleven participants were recruited to engage in a participatory design workshop, which encompassed five stages: Empathise, Ideate, Define, Prototype and Test. The participants were divided into two teams. Qualitative datasets from the workshop included field notes and FIGMA screens. The data were analysed through thematic analysis, from which three major themes emerged: (1) Unsafe working environments for pregnant radiographers, (2) The need for enhanced fetal radiation dose monitoring by pregnant radiographers as an occupational health and safety requirement, and (3) Co-designing of the prototype mobile application, PregiDose. The participants contributed towards a prototype mobile application which addressed challenges experienced in the real-life setting. Hence, the prototype can be used as an effective framework by which to guide the development of the final artefact.
Collapse
Affiliation(s)
- Hafsa Essop
- Department of Radiography, Faculty of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
| | - Ramadimetja Kekana
- Department of Radiography, Faculty of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
| | - Hanlie Smuts
- Department of Informatics, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
8
|
Sato W. Advancements in Sensors and Analyses for Emotion Sensing. SENSORS (BASEL, SWITZERLAND) 2024; 24:4166. [PMID: 39000945 PMCID: PMC11244073 DOI: 10.3390/s24134166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
Exploring the objective signals associated with subjective emotional states has practical significance [...].
Collapse
Affiliation(s)
- Wataru Sato
- Psychological Process Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto 619-0288, Japan
| |
Collapse
|
9
|
de Looff PC, Noordzij ML, Nijman HLI, Goedhard L, Bogaerts S, Didden R. Putting the usability of wearable technology in forensic psychiatry to the test: a randomized crossover trial. Front Psychiatry 2024; 15:1330993. [PMID: 38947186 PMCID: PMC11212012 DOI: 10.3389/fpsyt.2024.1330993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/02/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Forensic psychiatric patients receive treatment to address their violent and aggressive behavior with the aim of facilitating their safe reintegration into society. On average, these treatments are effective, but the magnitude of effect sizes tends to be small, even when considering more recent advancements in digital mental health innovations. Recent research indicates that wearable technology has positive effects on the physical and mental health of the general population, and may thus also be of use in forensic psychiatry, both for patients and staff members. Several applications and use cases of wearable technology hold promise, particularly for patients with mild intellectual disability or borderline intellectual functioning, as these devices are thought to be user-friendly and provide continuous daily feedback. Method In the current randomized crossover trial, we addressed several limitations from previous research and compared the (continuous) usability and acceptance of four selected wearable devices. Each device was worn for one week by staff members and patients, amounting to a total of four weeks. Two of the devices were general purpose fitness trackers, while the other two devices used custom made applications designed for bio-cueing and for providing insights into physiological reactivity to daily stressors and events. Results Our findings indicated significant differences in usability, acceptance and continuous use between devices. The highest usability scores were obtained for the two fitness trackers (Fitbit and Garmin) compared to the two devices employing custom made applications (Sense-IT and E4 dashboard). The results showed similar outcomes for patients and staff members. Discussion None of the devices obtained usability scores that would justify recommendation for future use considering international standards; a finding that raises concerns about the adaptation and uptake of wearable technology in the context of forensic psychiatry. We suggest that improvements in gamification and motivational aspects of wearable technology might be helpful to tackle several challenges related to wearable technology.
Collapse
Affiliation(s)
- Peter C. de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Science and Treatment Innovation, Fivoor, Rotterdam, Netherlands
- National Expercentre Intellectual Disabilities and Severe Behavioral Problems, De Borg, Bilthoven, Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Matthijs L. Noordzij
- Department of Psychology, Health and Technology, Twente University, Enschede, Netherlands
| | - Henk L. I. Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Science and Treatment Innovation, Fivoor, Rotterdam, Netherlands
| | | | - Stefan Bogaerts
- Science and Treatment Innovation, Fivoor, Rotterdam, Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Trajectum, Specialized and Forensic Care, Zwolle, Netherlands
| |
Collapse
|
10
|
Keogh A, Argent R, Doherty C, Duignan C, Fennelly O, Purcell C, Johnston W, Caulfield B. Breaking down the Digital Fortress: The Unseen Challenges in Healthcare Technology-Lessons Learned from 10 Years of Research. SENSORS (BASEL, SWITZERLAND) 2024; 24:3780. [PMID: 38931564 PMCID: PMC11207951 DOI: 10.3390/s24123780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Healthcare is undergoing a fundamental shift in which digital health tools are becoming ubiquitous, with the promise of improved outcomes, reduced costs, and greater efficiency. Healthcare professionals, patients, and the wider public are faced with a paradox of choice regarding technologies across multiple domains. Research is continuing to look for methods and tools to further revolutionise all aspects of health from prediction, diagnosis, treatment, and monitoring. However, despite its promise, the reality of implementing digital health tools in practice, and the scalability of innovations, remains stunted. Digital health is approaching a crossroads where we need to shift our focus away from simply looking at developing new innovations to seriously considering how we overcome the barriers that currently limit its impact. This paper summarises over 10 years of digital health experiences from a group of researchers with backgrounds in physical therapy-in order to highlight and discuss some of these key lessons-in the areas of validity, patient and public involvement, privacy, reimbursement, and interoperability. Practical learnings from this collective experience across patient cohorts are leveraged to propose a list of recommendations to enable researchers to bridge the gap between the development and implementation of digital health tools.
Collapse
Affiliation(s)
- Alison Keogh
- Clinical Medicine, School of Medicine, Trinity College Dublin, Tallaght University Hospital, D24 TP66 Dublin, Ireland;
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
| | - Rob Argent
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine & Health Sciences, D02 YN77 Dublin, Ireland
| | - Cailbhe Doherty
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Ciara Duignan
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
| | - Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
| | - Ciaran Purcell
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
- School of Allied Health, University of Limerick, V94 T9PX Limerick, Ireland
| | - William Johnston
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, D04 V1W8 Dublin, Ireland; (R.A.); (C.D.); (O.F.); (C.P.); (W.J.); (B.C.)
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| |
Collapse
|
11
|
Düking P, Ruf L, Altmann S, Thron M, Kunz P, Sperlich B. Assessment of Maximum Oxygen Uptake in Elite Youth Soccer Players: A Comparative Analysis of Smartwatch Technology, Yoyo Intermittent Recovery Test 2, and Respiratory Gas Analysis. J Sports Sci Med 2024; 23:351-357. [PMID: 38841641 PMCID: PMC11149075 DOI: 10.52082/jssm.2024.351] [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: 01/10/2024] [Accepted: 04/19/2024] [Indexed: 06/07/2024]
Abstract
The maximum oxygen uptake (VO2max) is a critical factor for endurance performance in soccer. Novel wearable technology may allow frequent assessment of V̇O2max during non-fatiguing warm-up runs of soccer players with minimal interference to soccer practice. The aim of this study was to assess the validity of VO2max provided by a consumer grade smartwatch (Garmin Forerunner 245, Garmin, Olathe, USA, Software:13.00) and the YoYo Intermittent Recovery Run 2 (YYIR2) by comparing it with respiratory gas analysis. 24 trained male youth soccer players performed different tests to assess VO2max: i) a treadmill test employing respiratory gas analysis, ii) YYIR2 and iii) during a non-fatiguing warm-up run of 10 min wearing a smartwatch as recommended by the device-manufacturer on 3 different days within 2 weeks. As the device-manufacturer indicates that validity of smartwatch-derived VO2max may differ with an increase in runs, 16 players performed a second run with the smartwatch to test this claim. The main evidence revealed that the smartwatch showed an ICC of 0.37 [95% CI: -0.25; 0.71] a mean absolute percentage error (MAPE) of 5.58% after one run, as well as an ICC of 0.54 [95% CI: -0.3; 8.4] and a MAPE of 1.06% after the second run with the smartwatch. The YYIR2 showed an ICC of 0.17 [95% CI: -5.7; 0.6]; and MAPE of 4.2%. When using the smartwatch for VO2max assessment in a non-fatiguing run as a warm-up, as suggested by the device manufacturer before soccer practice, the MAPE diminishes after two runs. Therefore, for more accurate VO2max assessment with the smartwatch, we recommend to perform at least two runs to reduce the MAPE and enhance the validity of the findings.
Collapse
Affiliation(s)
- Peter Düking
- Department of Sports Science and Movement Pedagogy, Technische Universität Braunschweig, Braunschweig, Germany
| | - Ludwig Ruf
- TSG ResearchLab gGmbH, Zuzenhausen, Germany
| | - Stefan Altmann
- TSG ResearchLab gGmbH, Zuzenhausen, Germany
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Maximiliane Thron
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Philipp Kunz
- Integrative and Experimental Exercise Science, Department of Sport Science, University of Würzburg, Würzburg, Germany
| | - Billy Sperlich
- Integrative and Experimental Exercise Science, Department of Sport Science, University of Würzburg, Würzburg, Germany
| |
Collapse
|
12
|
Richardson KM, Schembre SM, da Silva V, Blew RM, Behrens N, Roe DJ, Marvasti FF, Hingle M. Adding a Brief Continuous Glucose Monitoring Intervention to the National Diabetes Prevention Program: A Multimethod Feasibility Study. J Diabetes Res 2024; 2024:7687694. [PMID: 38919262 PMCID: PMC11199067 DOI: 10.1155/2024/7687694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 06/27/2024] Open
Abstract
The National Diabetes Prevention Program (DPP) promotes lifestyle changes to prevent diabetes. However, only one-third of DPP participants achieve weight loss goals, and changes in diet are limited. Continuous glucose monitoring (CGM) has shown potential to raise awareness about the effects of diet and activity on glucose among people with diabetes, yet the feasibility of including CGM in behavioral interventions for people with prediabetes has not been explored. This study assessed the feasibility of adding a brief CGM intervention to the Arizona Cooperative Extension National DPP. Extension DPP participants were invited to participate in a single CGM-based education session and subsequent 10-day CGM wear period, during which participants reflected on diet and physical activity behaviors occurring prior to and after hyperglycemic events. Following the intervention, participants completed a CGM acceptability survey and participated in a focus group reflecting on facilitators and barriers to CGM use and its utility as a behavior change tool. A priori feasibility benchmarks included opt-in participation rates ≥ 50%, education session attendance ≥ 80%, acceptability scores ≥ 80%, and greater advantages than disadvantages of CGM emerging from focus groups, as analyzed using the Key Point Summary (KPS) method. Thirty-five DPP members were invited to participate; 27 (77%) consented, and 24 of 27 (89%) attended the brief CGM education session. Median survey scores indicated high acceptability of CGM (median = 5, range = 1-5), with nearly all (n = 23/24, 96%) participants believing that CGM should be offered as part of the DPP. In focus groups, participants described how CGM helped them make behavior changes to improve their glucose (e.g., reduced portion sizes, increased activity around eating events, and meditation). In conclusion, adding a single CGM-based education session and 10-day CGM wear to the DPP was feasible and acceptable. Future research will establish the efficacy of adding CGM to the DPP on participant health outcomes and behaviors.
Collapse
Affiliation(s)
- Kelli M. Richardson
- School of Nutritional Sciences and Wellness, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, Arizona, USA
| | - Susan M. Schembre
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Vanessa da Silva
- School of Nutritional Sciences and Wellness, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, Arizona, USA
| | - Robert M. Blew
- School of Nutritional Sciences and Wellness, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, Arizona, USA
| | - Nick Behrens
- Department of Ecology and Evolutionary Biology, College of Science, University of Arizona, Tucson, Arizona, USA
| | - Denise J. Roe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Farshad Fani Marvasti
- Department of Family, Community and Preventive Medicine, College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Melanie Hingle
- School of Nutritional Sciences and Wellness, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, Arizona, USA
| |
Collapse
|
13
|
Crowe C, Barton J, O'Flynn B, Tedesco S. Association between wrist-worn free-living accelerometry and hand grip strength in middle-aged and older adults. Aging Clin Exp Res 2024; 36:108. [PMID: 38717552 PMCID: PMC11078825 DOI: 10.1007/s40520-024-02757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Wrist-worn activity monitors have seen widespread adoption in recent times, particularly in young and sport-oriented cohorts, while their usage among older adults has remained relatively low. The main limitations are in regards to the lack of medical insights that current mainstream activity trackers can provide to older subjects. One of the most important research areas under investigation currently is the possibility of extrapolating clinical information from these wearable devices. METHODS The research question of this study is understanding whether accelerometry data collected for 7-days in free-living environments using a consumer-based wristband device, in conjunction with data-driven machine learning algorithms, is able to predict hand grip strength and possible conditions categorized by hand grip strength in a general population consisting of middle-aged and older adults. RESULTS The results of the regression analysis reveal that the performance of the developed models is notably superior to a simple mean-predicting dummy regressor. While the improvement in absolute terms may appear modest, the mean absolute error (6.32 kg for males and 4.53 kg for females) falls within the range considered sufficiently accurate for grip strength estimation. The classification models, instead, excel in categorizing individuals as frail/pre-frail, or healthy, depending on the T-score levels applied for frailty/pre-frailty definition. While cut-off values for frailty vary, the results suggest that the models can moderately detect characteristics associated with frailty (AUC-ROC: 0.70 for males, and 0.76 for females) and viably detect characteristics associated with frailty/pre-frailty (AUC-ROC: 0.86 for males, and 0.87 for females). CONCLUSIONS The results of this study can enable the adoption of wearable devices as an efficient tool for clinical assessment in older adults with multimorbidities, improving and advancing integrated care, diagnosis and early screening of a number of widespread diseases.
Collapse
Affiliation(s)
- Colum Crowe
- Tyndall National Institute, University College Cork, Lee Maltings, Prospect Row, Cork, T12R5CP, Ireland
| | - John Barton
- Tyndall National Institute, University College Cork, Lee Maltings, Prospect Row, Cork, T12R5CP, Ireland
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Lee Maltings, Prospect Row, Cork, T12R5CP, Ireland
| | - Salvatore Tedesco
- Tyndall National Institute, University College Cork, Lee Maltings, Prospect Row, Cork, T12R5CP, Ireland.
| |
Collapse
|
14
|
Ibrahim AH, Beaumont CT, Strohacker K. Implementing Meta-Session Autoregulation Strategies for Exercise - A Scoping Review. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:382-404. [PMID: 38665139 PMCID: PMC11042849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Meta-session autoregulation, a person-adaptive form of exercise prescription that adjusts training variables according to daily fluctuations in performance considering an individual's daily fitness, fatigue, and readiness-to-exercise is commonly used in sports-related training and may be beneficial for non-athlete populations to promote exercise adherence. To guide refinement of meta-session autoregulation, it is crucial to examine the existing literature and synthesize how these procedures have been practically implemented. Following PRIMSA guidelines a scoping review of two databases was conducted from August 2021 to September 2021 to identify and summarize the selected measures of readiness-to-exercise and decision-making processes used to match workload to participants in meta-session autoregulatory strategies, while also evaluating the methodological quality of existing study designs using a validated checklist. Eleven studies reported utilizing a form of meta-session autoregulation for exercise. Primary findings include: (i) readiness-to-exercise measures have been divided into either objective or subjective measures, (ii) measures of subjective readiness measures lacked evidence of validity, and (iii) fidelity to autoregulatory strategies was not reported. Results of the risk of bias assessment indicated that 45% of the studies had a poor-quality score. Existing implementations of meta-session autoregulation are not directly translatable for use in health promotion and disease prevention settings. Considerable refinement research is required to optimize this person-adaptive strategy prior to estimating effects related to exercise adherence and/or health and fitness outcomes. Based on the methodological deficits uncovered, researchers implementing autoregulation strategies would benefit reviewing existing models and frameworks created to guide behavioral intervention development.
Collapse
Affiliation(s)
- Adam H Ibrahim
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Cory T Beaumont
- College of Education and Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Kelley Strohacker
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
15
|
McElwain NL, Fisher MC, Nebeker C, Bodway JM, Islam B, Hasegawa-Johnson M. Evaluating Users' Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach. JMIR Hum Factors 2024; 11:e49316. [PMID: 38329785 PMCID: PMC10884896 DOI: 10.2196/49316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Wearable devices permit the continuous, unobtrusive collection of data from children in their natural environments and can transform our understanding of child development. Although the use of wearable devices has begun to emerge in research involving children, few studies have considered families' experiences and perspectives of participating in research of this kind. OBJECTIVE Through a mixed methods approach, we assessed parents' and children's experiences of using a new wearable device in the home environment. The wearable device was designed specifically for use with infants and young children, and it integrates audio, electrocardiogram, and motion sensors. METHODS In study 1, semistructured phone interviews were conducted with 42 parents of children aged 1 month to 9.5 years who completed 2 day-long recordings using the device, which the children wore on a specially designed shirt. In study 2, a total of 110 parents of children aged 2 months to 5.5 years responded to a questionnaire assessing their experience of completing 3 day-long device recordings in the home. Guided by the Digital Health Checklist, we assessed parental responses from both studies in relation to the following three key domains: (1) access and usability, (2) privacy, and (3) risks and benefits. RESULTS In study 1, most parents viewed the device as easy to use and safe and remote visits as convenient. Parents' views on privacy related to the audio recordings were more varied. The use of machine learning algorithms (vs human annotators) in the analysis of the audio data, the ability to stop recordings at any time, and the view that the recordings reflected ordinary family life were some reasons cited by parents who expressed minimal, if any, privacy concerns. Varied risks and benefits were also reported, including perceived child comfort or discomfort, the need to adjust routines to accommodate the study, the understanding gained from the study procedures, and the parent's and child's enjoyment of study participation. In study 2, parents' ratings on 5 close-ended items yielded a similar pattern of findings. Compared with a "neutral" rating, parents were significantly more likely to agree that (1) device instructions were helpful and clear (t109=-45.98; P<.001), (2) they felt comfortable putting the device on their child (t109=-22.22; P<.001), and (3) they felt their child was safe while wearing the device (t109=-34.48; P<.001). They were also less likely to worry about the audio recordings gathered by the device (t108=6.14; P<.001), whereas parents' rating of the burden of the study procedures did not differ significantly from a "neutral" rating (t109=-0.16; P=.87). CONCLUSIONS On the basis of parents' feedback, several concrete changes can be implemented to improve this new wearable platform and, ultimately, parents' and children's experiences of using child wearable devices in the home setting.
Collapse
Affiliation(s)
- Nancy L McElwain
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Beckman Institute for Advanced Science & Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Meghan C Fisher
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Camille Nebeker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Jordan M Bodway
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Bashima Islam
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Mark Hasegawa-Johnson
- Beckman Institute for Advanced Science & Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
| |
Collapse
|
16
|
Brown SA, Beavers C, Bauer B, Cheng RK, Berman G, Marshall CH, Guha A, Jain P, Steward A, DeCara JM, Olaye IM, Hansen K, Logan J, Bergom C, Glide-Hurst C, Loh I, Gambril JA, MacLeod J, Maddula R, McGranaghan PJ, Batra A, Campbell C, Hamid A, Gunturkun F, Davis R, Jefferies J, Fradley M, Albert K, Blaes A, Choudhuri I, Ghosh AK, Ryan TD, Ezeoke O, Leedy DJ, Williams W, Roman S, Lehmann L, Sarkar A, Sadler D, Polter E, Ruddy KJ, Bansal N, Yang E, Patel B, Cho D, Bailey A, Addison D, Rao V, Levenson JE, Itchhaporia D, Watson K, Gulati M, Williams K, Lloyd-Jones D, Michos E, Gralow J, Martinez H. Advancing the care of individuals with cancer through innovation & technology: Proceedings from the cardiology oncology innovation summit 2020 and 2021. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 38:100354. [PMID: 38510746 PMCID: PMC10945974 DOI: 10.1016/j.ahjo.2023.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 03/22/2024]
Abstract
As cancer therapies increase in effectiveness and patients' life expectancies improve, balancing oncologic efficacy while reducing acute and long-term cardiovascular toxicities has become of paramount importance. To address this pressing need, the Cardiology Oncology Innovation Network (COIN) was formed to bring together domain experts with the overarching goal of collaboratively investigating, applying, and educating widely on various forms of innovation to improve the quality of life and cardiovascular healthcare of patients undergoing and surviving cancer therapies. The COIN mission pillars of innovation, collaboration, and education have been implemented with cross-collaboration among academic institutions, private and public establishments, and industry and technology companies. In this report, we summarize proceedings from the first two annual COIN summits (inaugural in 2020 and subsequent in 2021) including educational sessions on technological innovations for establishing best practices and aligning resources. Herein, we highlight emerging areas for innovation and defining unmet needs to further improve the outcome for cancer patients and survivors of all ages. Additionally, we provide actionable suggestions for advancing innovation, collaboration, and education in cardio-oncology in the digital era.
Collapse
Affiliation(s)
- Sherry-Ann Brown
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Craig Beavers
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Brenton Bauer
- COR Healthcare Associates, Torrance Memorial Medical Center, Torrance, CA, USA
| | - Richard K. Cheng
- Cardio-Oncology Program, Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Catherine H. Marshall
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Prantesh Jain
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Jeanne M. DeCara
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Iredia M. Olaye
- Division of Clinical Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Jim Logan
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, USA
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Irving Loh
- Ventura Heart Institute, Thousand Oaks, CA, USA
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Alan Gambril
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | | | - Peter J. McGranaghan
- Department of Cardiothoracic Surgery, German Heart Center, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Akshee Batra
- Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Courtney Campbell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Fatma Gunturkun
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Davis
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John Jefferies
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
- St. Jude Children's Research Hospital, Memphis, TN, USA
- The Heart Institute at Le Bonheur Children's Hospital, University of Tennessee Health and Science Center, Memphis, TN, USA
| | - Michael Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Albert
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Denver, CO, USA
| | - Anne Blaes
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Indrajit Choudhuri
- Department of Electrophysiology, Froedtert South Hospital, Milwaukee, WI, USA
| | - Arjun K. Ghosh
- Cardio-Oncology Service, Barts Heart Centre and University College London Hospital, London, UK
| | - Thomas D. Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine; Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ogochukwu Ezeoke
- Department of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Douglas J. Leedy
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Sebastian Roman
- Department of Internal Medicine III: Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lorenz Lehmann
- Department of Internal Medicine III: Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Abdullah Sarkar
- Department of Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Diego Sadler
- Department of Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Elizabeth Polter
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Neha Bansal
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Yang
- Cardio-Oncology Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - David Cho
- Division of Cardiovascular Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alison Bailey
- Center for Heart, Lung, and Vascular Health at Parkridge, HCA Healthcare, Chattanooga, TN, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Vijay Rao
- Indiana Heart Physicians, Franciscan Health, Indianapolis, IN, USA
| | - Joshua E. Levenson
- Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dipti Itchhaporia
- Cardiology, University of California Irvine, Hoag Hospital Newport Beach, Newport Beach, CA, USA
| | - Karol Watson
- Division of Cardiovascular Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Kim Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erin Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Hugo Martinez
- St. Jude Children's Research Hospital, Memphis, TN, USA
- The Heart Institute at Le Bonheur Children's Hospital, University of Tennessee Health and Science Center, Memphis, TN, USA
| |
Collapse
|
17
|
Islam B, McElwain NL, Li J, Davila MI, Hu Y, Hu K, Bodway JM, Dhekne A, Roy Choudhury R, Hasegawa-Johnson M. Preliminary Technical Validation of LittleBeats™: A Multimodal Sensing Platform to Capture Cardiac Physiology, Motion, and Vocalizations. SENSORS (BASEL, SWITZERLAND) 2024; 24:901. [PMID: 38339617 PMCID: PMC10857055 DOI: 10.3390/s24030901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
Across five studies, we present the preliminary technical validation of an infant-wearable platform, LittleBeats™, that integrates electrocardiogram (ECG), inertial measurement unit (IMU), and audio sensors. Each sensor modality is validated against data from gold-standard equipment using established algorithms and laboratory tasks. Interbeat interval (IBI) data obtained from the LittleBeats™ ECG sensor indicate acceptable mean absolute percent error rates for both adults (Study 1, N = 16) and infants (Study 2, N = 5) across low- and high-challenge sessions and expected patterns of change in respiratory sinus arrythmia (RSA). For automated activity recognition (upright vs. walk vs. glide vs. squat) using accelerometer data from the LittleBeats™ IMU (Study 3, N = 12 adults), performance was good to excellent, with smartphone (industry standard) data outperforming LittleBeats™ by less than 4 percentage points. Speech emotion recognition (Study 4, N = 8 adults) applied to LittleBeats™ versus smartphone audio data indicated a comparable performance, with no significant difference in error rates. On an automatic speech recognition task (Study 5, N = 12 adults), the best performing algorithm yielded relatively low word error rates, although LittleBeats™ (4.16%) versus smartphone (2.73%) error rates were somewhat higher. Together, these validation studies indicate that LittleBeats™ sensors yield a data quality that is largely comparable to those obtained from gold-standard devices and established protocols used in prior research.
Collapse
Affiliation(s)
- Bashima Islam
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Nancy L. McElwain
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (Y.H.); (K.H.); (J.M.B.)
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Jialu Li
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (J.L.); (R.R.C.)
| | - Maria I. Davila
- Research Triangle Institute, Research Triangle Park, NC 27709, USA;
| | - Yannan Hu
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (Y.H.); (K.H.); (J.M.B.)
| | - Kexin Hu
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (Y.H.); (K.H.); (J.M.B.)
| | - Jordan M. Bodway
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (Y.H.); (K.H.); (J.M.B.)
| | - Ashutosh Dhekne
- School of Computer Science, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Romit Roy Choudhury
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (J.L.); (R.R.C.)
| | - Mark Hasegawa-Johnson
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (J.L.); (R.R.C.)
| |
Collapse
|
18
|
Kainec KA, Caccavaro J, Barnes M, Hoff C, Berlin A, Spencer RMC. Evaluating Accuracy in Five Commercial Sleep-Tracking Devices Compared to Research-Grade Actigraphy and Polysomnography. SENSORS (BASEL, SWITZERLAND) 2024; 24:635. [PMID: 38276327 PMCID: PMC10820351 DOI: 10.3390/s24020635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
The development of consumer sleep-tracking technologies has outpaced the scientific evaluation of their accuracy. In this study, five consumer sleep-tracking devices, research-grade actigraphy, and polysomnography were used simultaneously to monitor the overnight sleep of fifty-three young adults in the lab for one night. Biases and limits of agreement were assessed to determine how sleep stage estimates for each device and research-grade actigraphy differed from polysomnography-derived measures. Every device, except the Garmin Vivosmart, was able to estimate total sleep time comparably to research-grade actigraphy. All devices overestimated nights with shorter wake times and underestimated nights with longer wake times. For light sleep, absolute bias was low for the Fitbit Inspire and Fitbit Versa. The Withings Mat and Garmin Vivosmart overestimated shorter light sleep and underestimated longer light sleep. The Oura Ring underestimated light sleep of any duration. For deep sleep, bias was low for the Withings Mat and Garmin Vivosmart while other devices overestimated shorter and underestimated longer times. For REM sleep, bias was low for all devices. Taken together, these results suggest that proportional bias patterns in consumer sleep-tracking technologies are prevalent and could have important implications for their overall accuracy.
Collapse
Affiliation(s)
- Kyle A. Kainec
- Neuroscience & Behavior Program, French Hall, University of Massachusetts Amherst, 230 Stockbridge Road, Amherst, MA 01003, USA;
- Institute for Applied Life Sciences, Life Science Laboratories, University of Massachusetts Amherst, 240 Thatcher Road, Amherst, MA 01003, USA; (M.B.); (C.H.)
| | - Jamie Caccavaro
- Department of Psychological and Brain Sciences, Tobin Hall, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Morgan Barnes
- Institute for Applied Life Sciences, Life Science Laboratories, University of Massachusetts Amherst, 240 Thatcher Road, Amherst, MA 01003, USA; (M.B.); (C.H.)
- Department of Psychological and Brain Sciences, Tobin Hall, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Chloe Hoff
- Institute for Applied Life Sciences, Life Science Laboratories, University of Massachusetts Amherst, 240 Thatcher Road, Amherst, MA 01003, USA; (M.B.); (C.H.)
- Department of Psychological and Brain Sciences, Tobin Hall, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Annika Berlin
- Institute for Applied Life Sciences, Life Science Laboratories, University of Massachusetts Amherst, 240 Thatcher Road, Amherst, MA 01003, USA; (M.B.); (C.H.)
- Department of Psychological and Brain Sciences, Tobin Hall, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Rebecca M. C. Spencer
- Neuroscience & Behavior Program, French Hall, University of Massachusetts Amherst, 230 Stockbridge Road, Amherst, MA 01003, USA;
- Institute for Applied Life Sciences, Life Science Laboratories, University of Massachusetts Amherst, 240 Thatcher Road, Amherst, MA 01003, USA; (M.B.); (C.H.)
- Department of Psychological and Brain Sciences, Tobin Hall, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| |
Collapse
|
19
|
Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
Collapse
Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
20
|
Fedor S, Lewis R, Pedrelli P, Mischoulon D, Curtiss J, Picard RW. Wearable Technology in Clinical Practice for Depressive Disorder. N Engl J Med 2023; 389:2457-2466. [PMID: 38157501 DOI: 10.1056/nejmra2215898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Szymon Fedor
- From the MIT Media Lab, Massachusetts Institute of Technology, Cambridge (S.F., R.L., R.W.P.), and the Depression Clinical and Research Program, Massachusetts General Hospital (P.P., D.M., J.C.), and the Applied Psychology Department, Northeastern University (J.C.), Boston - all in Massachusetts
| | - Robert Lewis
- From the MIT Media Lab, Massachusetts Institute of Technology, Cambridge (S.F., R.L., R.W.P.), and the Depression Clinical and Research Program, Massachusetts General Hospital (P.P., D.M., J.C.), and the Applied Psychology Department, Northeastern University (J.C.), Boston - all in Massachusetts
| | - Paola Pedrelli
- From the MIT Media Lab, Massachusetts Institute of Technology, Cambridge (S.F., R.L., R.W.P.), and the Depression Clinical and Research Program, Massachusetts General Hospital (P.P., D.M., J.C.), and the Applied Psychology Department, Northeastern University (J.C.), Boston - all in Massachusetts
| | - David Mischoulon
- From the MIT Media Lab, Massachusetts Institute of Technology, Cambridge (S.F., R.L., R.W.P.), and the Depression Clinical and Research Program, Massachusetts General Hospital (P.P., D.M., J.C.), and the Applied Psychology Department, Northeastern University (J.C.), Boston - all in Massachusetts
| | - Joshua Curtiss
- From the MIT Media Lab, Massachusetts Institute of Technology, Cambridge (S.F., R.L., R.W.P.), and the Depression Clinical and Research Program, Massachusetts General Hospital (P.P., D.M., J.C.), and the Applied Psychology Department, Northeastern University (J.C.), Boston - all in Massachusetts
| | - Rosalind W Picard
- From the MIT Media Lab, Massachusetts Institute of Technology, Cambridge (S.F., R.L., R.W.P.), and the Depression Clinical and Research Program, Massachusetts General Hospital (P.P., D.M., J.C.), and the Applied Psychology Department, Northeastern University (J.C.), Boston - all in Massachusetts
| |
Collapse
|
21
|
Szabo DA, Neagu N, Teodorescu S, Apostu M, Predescu C, Pârvu C, Veres C. The Role and Importance of Using Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches. SENSORS (BASEL, SWITZERLAND) 2023; 23:8950. [PMID: 37960649 PMCID: PMC10648494 DOI: 10.3390/s23218950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Due to the growth of sensor technology, more affordable integrated circuits, and connectivity technologies, the usage of wearable equipment and sensing devices for monitoring physical activities, whether for wellness, sports monitoring, or medical rehabilitation, has exploded. The current literature review was performed between October 2022 and February 2023 using PubMed, Web of Science, and Scopus in accordance with P.R.I.S.M.A. criteria. The screening phase resulted in the exclusion of 69 articles that did not fit the themes developed in all subchapters of the study, 41 articles that dealt exclusively with rehabilitation and orthopaedics, 28 articles whose abstracts were not visible, and 10 articles that dealt exclusively with other sensor-based devices and not medical ones; the inclusion phase resulted in the inclusion of 111 articles. Patients who utilise sensor-based devices have several advantages due to rehabilitating a missing component, which marks the accomplishment of a fundamental goal within the rehabilitation program. As technology moves faster and faster forward, the field of medical rehabilitation has to adapt to the time we live in by using technology and intelligent devices. This means changing every part of rehabilitation and finding the most valuable and helpful gadgets that can be used to regain lost functions, keep people healthy, or prevent diseases.
Collapse
Affiliation(s)
- Dan Alexandru Szabo
- Department of Human Movement Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Department ME1, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Nicolae Neagu
- Department of Human Movement Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Silvia Teodorescu
- Department of Doctoral Studies, National University of Physical Education and Sports, 060057 Bucharest, Romania;
| | - Mihaela Apostu
- Department of Special Motor and Rehabilitation Medicine, National University of Physical Education and Sports, 060057 Bucharest, Romania; (M.A.); (C.P.)
| | - Corina Predescu
- Department of Special Motor and Rehabilitation Medicine, National University of Physical Education and Sports, 060057 Bucharest, Romania; (M.A.); (C.P.)
| | - Carmen Pârvu
- Faculty of Physical Education and Sports, “Dunărea de Jos” University, 63-65 Gării Street, 337347 Galati, Romania;
| | - Cristina Veres
- Department of Industrial Engineering and Management, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
| |
Collapse
|
22
|
Omcirk D, Vetrovsky T, Padecky J, Malecek J, Tufano JJ. Validity of Commercially Available Punch Trackers. J Strength Cond Res 2023; 37:2273-2281. [PMID: 37192502 PMCID: PMC10599804 DOI: 10.1519/jsc.0000000000004535] [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] [Indexed: 05/18/2023]
Abstract
ABSTRACT Omcirk, D, Vetrovsky, T, Padecky, J, Malecek, J, and Tufano, JJ. Validity of commercially available punch trackers. J Strength Cond Res 37(11): 2273-2281, 2023-This study determined how well data from commercially available punch trackers (Corner, Hykso, and StrikeTec) related to gold-standard velocity and force measures during full-contact punches. In a quasi-randomized order, 20 male subjects performed 6 individual rear straight punches, rear hooks, and rear uppercuts against a wall-mounted force plate. Punch tracker variables were compared with the peak force of the force plate and to the peak (QPV) and mean velocity (QMV) assessed through Qualisys 3-dimensional tracking. For each punch tracker variable, Pearson's correlation coefficient, mean absolute percentage error (MAPE), and mean percentage error (MPE) were calculated. There were no strong correlations between punch tracker data and gold-standard force and velocity data. However, Hykso "velocity" was moderately correlated with QMV ( r = 0.68, MAPE 0.64, MPE 0.63) and QPV ( r = 0.61, MAPE 0.21, MPE -0.06). Corner Power G was moderately correlated with QMV ( r = 0.59, MAPE 0.65, MPE 0.58) and QPV ( r = 0.58, MAPE 0.27, MPE -0.09), but Corner "velocity" was not. StrikeTec "velocity" was moderately correlated with QMV ( r = 0.56, MAPE 1.49, MPE 1.49) and QPV ( r = 0.55, MAPE 0.46, MPE 0.43). Therefore, none of the devices fared particularly well for all of their data output, and if not willing to accept any room for error, none of these devices should be used. Nevertheless, these devices and their proprietary algorithms may be updated in the future, which would warrant further investigation.
Collapse
Affiliation(s)
- Dan Omcirk
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jan Padecky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jan Malecek
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - James J. Tufano
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| |
Collapse
|
23
|
Joshi J, Wang K, Cho Y. PhysioKit: An Open-Source, Low-Cost Physiological Computing Toolkit for Single- and Multi-User Studies. SENSORS (BASEL, SWITZERLAND) 2023; 23:8244. [PMID: 37837074 PMCID: PMC10575364 DOI: 10.3390/s23198244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
The proliferation of physiological sensors opens new opportunities to explore interactions, conduct experiments and evaluate the user experience with continuous monitoring of bodily functions. Commercial devices, however, can be costly or limit access to raw waveform data, while low-cost sensors are efforts-intensive to setup. To address these challenges, we introduce PhysioKit, an open-source, low-cost physiological computing toolkit. PhysioKit provides a one-stop pipeline consisting of (i) a sensing and data acquisition layer that can be configured in a modular manner per research needs, and (ii) a software application layer that enables data acquisition, real-time visualization and machine learning (ML)-enabled signal quality assessment. This also supports basic visual biofeedback configurations and synchronized acquisition for co-located or remote multi-user settings. In a validation study with 16 participants, PhysioKit shows strong agreement with research-grade sensors on measuring heart rate and heart rate variability metrics data. Furthermore, we report usability survey results from 10 small-project teams (44 individual members in total) who used PhysioKit for 4-6 weeks, providing insights into its use cases and research benefits. Lastly, we discuss the extensibility and potential impact of the toolkit on the research community.
Collapse
|
24
|
Lins LFTDS, do Nascimento EGC, da Silva Júnior JA, de Medeiros Fernandes TAA, de Andrade MF, de Mesquita Andrade C. Accuracy of wearable electronic device compared to manual and automatic methods of blood pressure determination. Med Biol Eng Comput 2023; 61:2627-2636. [PMID: 37405672 DOI: 10.1007/s11517-023-02869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023]
Abstract
Blood pressure (BP) is the main biomarker for monitoring patients, as its lack of control above values considered normal is a modifiable risk factor for target organ damage. The aim of this study is to evaluate the accuracy of the wearable electronic device photoplethysmography technology (PPG) Samsung Galaxy Watch 4 in determining BP in young patients compared to manual and automatic methods of BP determination. This is a quantitative and cross-sectional study, following validation protocols for wearable devices and BP measurement. It was carried out with twenty healthy young adults, in which BP was measured using four instruments, namely, standard sphygmomanometer device (manual), automatic arm oscillometric device (reference), wrist oscillometric device, and Smartwatch PPG. Eighty systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings were observed. SBP means manual 118 ± 2.20,arm 113 ± 2.54, wrist 118 ± 2.51, and PPG (smartwatch) 113 ± 2.58. Among means, arm and PPG difference is 0.15, arm and wrist 4.95, arm and manual 4.45 wrist with PPG. The mean DBP manual 76.7 ± 1.84, arm 73.6 ± 1.92, wrist 79.3 ± 1.87, and PPG 72.2 ± 1.38. Among means, the difference between the arm and PPG is 1.4 and arm and hand 3.5 mmHg. The correlation shows PPG with manual, arm, and wrist. There was a strong SBP correlation and a moderate DBP correlation between the methods tested, evidencing the accuracy of the PPG smartwatch in relation to the reference method.
Collapse
Affiliation(s)
| | - Ellany Gurgel Cosme do Nascimento
- Faculdade de Ciências da Saúde, Universidade Do Estado Do Rio Grande Do Norte, Atirador Miguel Antonio da Silva St, Mossoró, RN, 59607-360, Brazil
| | - José Antonio da Silva Júnior
- Faculdade de Ciências da Saúde, Universidade Do Estado Do Rio Grande Do Norte, Atirador Miguel Antonio da Silva St, Mossoró, RN, 59607-360, Brazil.
| | | | | | - Cléber de Mesquita Andrade
- Faculdade de Ciências da Saúde, Universidade Do Estado Do Rio Grande Do Norte, Atirador Miguel Antonio da Silva St, Mossoró, RN, 59607-360, Brazil
| |
Collapse
|
25
|
Richardson KM, Jospe MR, Saleh AA, Clarke TN, Bedoya AR, Behrens N, Marano K, Cigan L, Liao Y, Scott ER, Guo JS, Aguinaga A, Schembre SM. Use of Biological Feedback as a Health Behavior Change Technique in Adults: Scoping Review. J Med Internet Res 2023; 25:e44359. [PMID: 37747766 PMCID: PMC10562972 DOI: 10.2196/44359] [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: 11/16/2022] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Recent advancements in personal biosensing technology support the shift from standardized to personalized health interventions, whereby biological data are used to motivate health behavior change. However, the implementation of interventions using biological feedback as a behavior change technique has not been comprehensively explored. OBJECTIVE The purpose of this review was to (1) map the domains of research where biological feedback has been used as a behavior change technique and (2) describe how it is implemented in behavior change interventions for adults. METHODS A comprehensive systematic search strategy was used to query 5 electronic databases (Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global) in June 2021. Eligible studies were primary analyses of randomized controlled trials (RCTs) in adults that incorporated biological feedback as a behavior change technique. DistillerSR was used to manage the literature search and review. RESULTS After removing 49,500 duplicates, 50,287 articles were screened and 767 articles were included. The earliest RCT was published in 1972 with a notable increase in publications after 2000. Biological feedback was most used in RCTs aimed at preventing or managing diabetes (n=233, 30.4%), cardiovascular disease (n=175, 22.8%), and obesity (n=115, 15%). Feedback was often given on multiple biomarkers and targeted multiple health behaviors. The most common biomarkers used were anthropometric measures (n=297, 38.7%), blood pressure (n=238, 31%), and glucose (n=227, 29.6%). The most targeted behaviors were diet (n=472, 61.5%), physical activity (n=417, 54.4%), and smoking reduction (n=154, 20.1%). The frequency and type of communication by which biological feedback was provided varied by the method of biomarker measurement. Of the 493 (64.3%) studies where participants self-measured their biomarker, 476 (96.6%) received feedback multiple times over the intervention and 468 (94.9%) received feedback through a biosensing device. CONCLUSIONS Biological feedback is increasingly being used to motivate behavior change, particularly where relevant biomarkers can be readily assessed. Yet, the methods by which biological feedback is operationalized in intervention research varied, and its effectiveness remains unclear. This scoping review serves as the foundation for developing a guiding framework for effectively implementing biological feedback as a behavior change technique. TRIAL REGISTRATION Open Science Framework Registries; https://doi.org/10.17605/OSF.IO/YP5WAd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32579.
Collapse
Affiliation(s)
- Kelli M Richardson
- School of Nutritional Sciences and Wellness, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Michelle R Jospe
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Ahlam A Saleh
- Arizona Health Sciences Library, University of Arizona, Tucson, AZ, United States
| | - Thanatcha Nadia Clarke
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Arianna R Bedoya
- Department of Internal Medicine, College of Medicine - Phoenix, University of Arizona, Tucson, AZ, United States
| | - Nick Behrens
- Department of Ecology and Evolutionary Biology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Kari Marano
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Lacey Cigan
- School of Nutritional Sciences and Wellness, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Yue Liao
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Eric R Scott
- Communications & Cyber Technologies, Arizona Experiment Station, University of Arizona, Tucson, AZ, United States
| | - Jessica S Guo
- Communications & Cyber Technologies, Arizona Experiment Station, University of Arizona, Tucson, AZ, United States
| | - April Aguinaga
- Arizona Health Sciences Library, University of Arizona, Tucson, AZ, United States
| | - Susan M Schembre
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| |
Collapse
|
26
|
Canali S, De Marchi B, Aliverti A. Wearable Technologies and Stress: Toward an Ethically Grounded Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6737. [PMID: 37754597 PMCID: PMC10530607 DOI: 10.3390/ijerph20186737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
The widespread use of digital technologies that can be worn on our bodies-wearables-is presented as a turning point for various areas of biomedical research and healthcare, such as stress. The ability to constantly measure these parameters, the perceived quality of measurement, and their individual and personal level frame wearable technology as a possibly crucial step in the direction of a more accurate and objective definition and measurement of stress for clinical, research, and personal purposes. In this paper, we discuss the hypothesis that the use of wearables for stress is also beneficial from an ethical viewpoint. We start by situating wearables in the context of existing methods and limitations of stress research. On this basis, we discuss the ethics of wearables for stress by applying ethical principles from bioethics (beneficence, non-maleficence, autonomy, justice), which allows us to identify ethical benefits as well as challenges in this context. As a result, we develop a more balanced view of the ethics of wearables for stress, which we use to present recommendations and indications with a focus on certification, accessibility, and inclusion. This article is, thus, a contribution towards ethically grounded wearable and digital health technology for stress.
Collapse
|
27
|
van Dijk W, Huizink AC, Oosterman M, Lemmers-Jansen ILJ, de Vente W. Validation of Photoplethysmography Using a Mobile Phone Application for the Assessment of Heart Rate Variability in the Context of Heart Rate Variability-Biofeedback. Psychosom Med 2023; 85:568-576. [PMID: 37678565 DOI: 10.1097/psy.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Heart rate variability-biofeedback (HRV-BF) is an effective intervention to reduce stress and anxiety and requires accurate measures of real-time HRV. HRV can be measured through photoplethysmography (PPG) using the camera of a mobile phone. No studies have directly compared HRV-BF supported through PPG against classical electrocardiogram (ECG). The current study aimed to validate PPG HRV measurements during HRV-BF against ECG. METHODS Fifty-seven healthy participants (70% women) with a mean (standard deviation) age of 26.70 (9.86) years received HRV-BF in the laboratory. Participants filled out questionnaires and performed five times a 5-minute diaphragmatic breathing exercise at different paces (range, ~6.5 to ~4.5 breaths/min). Four HRV indices obtained through PPG, using the Happitech software development kit, and ECG, using the validated NeXus apparatus, were calculated and compared: RMSSD, pNN50, LFpower, and HFpower. Resonance frequency (i.e., optimal breathing pace) was also compared between methods. RESULTS All intraclass correlation coefficient values of the five different breathing paces were "near perfect" (>0.90) for all HRV indices: lnRMSSD, lnpNN50, lnLFpower, and lnHFpower. All Bland-Altman analyses (with just three incidental exceptions) showed good interchangeability of PPG- and ECG-derived HRV indices. No systematic evidence for proportional bias was found for any of the HRV indices. In addition, correspondence in resonance frequency detection was good with 76.6% agreement between PPG and ECG. CONCLUSIONS PPG is a potentially reliable and valid method for the assessment of HRV. PPG is a promising replacement of ECG assessment to measure resonance frequency during HRV-BF.
Collapse
Affiliation(s)
- Willeke van Dijk
- From the Departments of Clinical, Neuro and Developmental Psychology (van Dijk, Huizink, Lemmers-Jansen) and Clinical Child and Family Studies (Oosterman), Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam; Institute for Brain and Behavior Amsterdam (IBBA), Amsterdam, the Netherlands; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom (Lemmers-Jansen); and Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands (de Vente)
| | | | | | | | | |
Collapse
|
28
|
Alhejaili R, Alomainy A. The Use of Wearable Technology in Providing Assistive Solutions for Mental Well-Being. SENSORS (BASEL, SWITZERLAND) 2023; 23:7378. [PMID: 37687834 PMCID: PMC10490605 DOI: 10.3390/s23177378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023]
Abstract
The main goal of this manuscript is to provide an extensive literature review and analysis of certain biomarkers, which are frequently used to identify stress, anxiety, and other emotions, leading to potential solutions for the monitoring of mental wellness using wearable technologies. It is possible to see the impacts of several biomarkers in detecting stress levels and their effectiveness with an investigation into the literature on this subject. Biofeedback training has demonstrated some psychological effects, such as a reduction in anxiety and self-control enhancement. This survey demonstrates backed up by evidence that wearable devices are assistive in providing health and mental wellness solutions. Because physical activity tracing would reduce the stress stressors, which affect the subject's body, therefore, it would also affect the mental activity and would lead to a reduction in cognitive mental load.
Collapse
Affiliation(s)
- Reham Alhejaili
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK
- Department of Computer Science and Artificial Intelligence, College of Computer Science and Engineering, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Akram Alomainy
- Antennas and Electromagnetics Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK;
| |
Collapse
|
29
|
Jerath R, Syam M, Ahmed S. The Future of Stress Management: Integration of Smartwatches and HRV Technology. SENSORS (BASEL, SWITZERLAND) 2023; 23:7314. [PMID: 37687769 PMCID: PMC10490434 DOI: 10.3390/s23177314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023]
Abstract
In the modern world, stress has become a pervasive concern that affects individuals' physical and mental well-being. To address this issue, many wearable devices have emerged as potential tools for stress detection and management by measuring heart rate, heart rate variability (HRV), and various metrics related to it. This literature review aims to provide a comprehensive analysis of existing research on HRV tracking and biofeedback using smartwatches pairing with reliable 3rd party mobile apps like Elite HRV, Welltory, and HRV4Training specifically designed for stress detection and management. We apply various algorithms and methodologies employed for HRV analysis and stress detection including time-domain, frequency-domain, and non-linear analysis techniques. Prominent smartwatches, such as Apple Watch, Garmin, Fitbit, Polar, and Samsung Galaxy Watch, are evaluated based on their HRV measurement accuracy, data quality, sensor technology, and integration with stress management features. We describe the efficacy of smartwatches in providing real-time stress feedback, personalized stress management interventions, and promoting overall well-being. To assist researchers, doctors, and developers with using smartwatch technology to address stress and promote holistic well-being, we discuss the data's advantages and limitations, future developments, and the significance of user-centered design and personalized interventions.
Collapse
|
30
|
Galli V, Sailapu SK, Cuthbert TJ, Ahmadizadeh C, Hannigan BC, Menon C. Passive and Wireless All-Textile Wearable Sensor System. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2206665. [PMID: 37208801 PMCID: PMC10401120 DOI: 10.1002/advs.202206665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/05/2023] [Indexed: 05/21/2023]
Abstract
Mobile health technology and activity tracking with wearable sensors enable continuous unobtrusive monitoring of movement and biophysical parameters. Advancements in clothing-based wearable devices have employed textiles as transmission lines, communication hubs, and various sensing modalities; this area of research is moving towards complete integration of circuitry into textile components. A current limitation for motion tracking is the need for communication protocols demanding physical connection of textile with rigid devices, or vector network analyzers (VNA) with limited portability and lower sampling rates. Inductor-capacitor (LC) circuits are ideal candidates as textile sensors can be easily implemented with textile components and allow wireless communication. In this paper, the authors report a smart garment that can sense movement and wirelessly transmit data in real time. The garment features a passive LC sensor circuit constructed of electrified textile elements that sense strain and communicate through inductive coupling. A portable, lightweight reader (fReader) is developed for achieving a faster sampling rate than a downsized VNA to track body movement, and for wirelessly reading sensor information suitable for deployment with a smartphone. The smart garment-fReader system monitors human movement in real-time and exemplifies the potential of textile-based electronics moving forward.
Collapse
Affiliation(s)
- Valeria Galli
- Biomedical and Mobile Health Technology (BMHT) GroupDepartment of Health Sciences and TechnologyETH ZürichLengghalde 5Zürich8008Switzerland
| | - Sunil Kumar Sailapu
- Biomedical and Mobile Health Technology (BMHT) GroupDepartment of Health Sciences and TechnologyETH ZürichLengghalde 5Zürich8008Switzerland
| | - Tyler J. Cuthbert
- Biomedical and Mobile Health Technology (BMHT) GroupDepartment of Health Sciences and TechnologyETH ZürichLengghalde 5Zürich8008Switzerland
| | - Chakaveh Ahmadizadeh
- Biomedical and Mobile Health Technology (BMHT) GroupDepartment of Health Sciences and TechnologyETH ZürichLengghalde 5Zürich8008Switzerland
| | - Brett C. Hannigan
- Biomedical and Mobile Health Technology (BMHT) GroupDepartment of Health Sciences and TechnologyETH ZürichLengghalde 5Zürich8008Switzerland
| | - Carlo Menon
- Biomedical and Mobile Health Technology (BMHT) GroupDepartment of Health Sciences and TechnologyETH ZürichLengghalde 5Zürich8008Switzerland
| |
Collapse
|
31
|
Boolani A, Yager C, Reid J, Lackman J, Smith ML. Correlates of depressive mood among graduate-level allied health students: An exploratory study examining trait energy and fatigue. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1685-1695. [PMID: 34379564 DOI: 10.1080/07448481.2021.1960843] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/28/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
Objective: The objective of this study was to identify factors associated with the occurrence and severity of depressive mood states among graduate-level allied health students. Participants: Students (N = 77) completed this study. Methods: Participants completed a series of self-reported surveys measuring moods, lifestyle behaviors, trait mental and physical energy and fatigue, and objective assessments of Trail-Making Test Part-B, and muscle oxygen consumption. Multiple backwards linear regression models were fitted to identify factors associated with depressive mood states. Results: When accounting for all subjects, increased severity of depressive mood states was associated with worse sleep quality (SQ), increased sitting time (ST), and trait physical fatigue (TPF). When examining subjects reporting depressive mood states, increased severity of depressive mood states was associated with worse SQ, increased ST, decreased mental workload on non-school days, and trait physical energy (TPE). Conclusion: Adjustments in lifestyle factors such as sleep, mental workload, and ST, may ameliorate depressive mood states.
Collapse
Affiliation(s)
- Ali Boolani
- Department of Physical Therapy, Clarkson University, Potsdam, New York, USA
| | - Chelsea Yager
- Department of Neurology, St. Joseph's Hospital, Syracuse, New York, USA
| | - Jeri Reid
- Department of Neurology, St. Joseph's Hospital, Syracuse, New York, USA
| | - Jeremy Lackman
- Department of Health and Physical Education, Monmouth University, West Long Branch, New Jersey, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, USA
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
32
|
Giurgiu M, Ketelhut S, Kubica C, Nissen R, Doster AK, Thron M, Timm I, Giurgiu V, Nigg CR, Woll A, Ebner-Priemer UW, Bussmann JBJ. Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions. Int J Behav Nutr Phys Act 2023; 20:68. [PMID: 37291598 DOI: 10.1186/s12966-023-01473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Wearable technology is used by consumers and researchers worldwide for continuous activity monitoring in daily life. Results of high-quality laboratory-based validation studies enable us to make a guided decision on which study to rely on and which device to use. However, reviews in adults that focus on the quality of existing laboratory studies are missing. METHODS We conducted a systematic review of wearable validation studies with adults. Eligibility criteria were: (i) study under laboratory conditions with humans (age ≥ 18 years); (ii) validated device outcome must belong to one dimension of the 24-hour physical behavior construct (i.e., intensity, posture/activity type, and biological state); (iii) study protocol must include a criterion measure; (iv) study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in five electronic databases as well as back- and forward citation searches. The risk of bias was assessed based on the QUADAS-2 tool with eight signaling questions. RESULTS Out of 13,285 unique search results, 545 published articles between 1994 and 2022 were included. Most studies (73.8% (N = 420)) validated an intensity measure outcome such as energy expenditure; only 14% (N = 80) and 12.2% (N = 70) of studies validated biological state or posture/activity type outcomes, respectively. Most protocols validated wearables in healthy adults between 18 and 65 years. Most wearables were only validated once. Further, we identified six wearables (i.e., ActiGraph GT3X+, ActiGraph GT9X, Apple Watch 2, Axivity AX3, Fitbit Charge 2, Fitbit, and GENEActiv) that had been used to validate outcomes from all three dimensions, but none of them were consistently ranked with moderate to high validity. Risk of bias assessment resulted in 4.4% (N = 24) of all studies being classified as "low risk", while 16.5% (N = 90) were classified as "some concerns" and 79.1% (N = 431) as "high risk". CONCLUSION Laboratory validation studies of wearables assessing physical behaviour in adults are characterized by low methodological quality, large variability in design, and a focus on intensity. Future research should more strongly aim at all components of the 24-hour physical behaviour construct, and strive for standardized protocols embedded in a validation framework.
Collapse
Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
| | - Sascha Ketelhut
- Health Science Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Claudia Kubica
- Health Science Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Rebecca Nissen
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Ann-Kathrin Doster
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Maximiliane Thron
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Valeria Giurgiu
- Baden-Wuerttemberg Cooperative State University (DHBW), Karlsruhe, Germany
| | - Claudio R Nigg
- Sport Pedagogy Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Ulrich W Ebner-Priemer
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Johannes B J Bussmann
- Erasmus MC, Department of Rehabilitation medicine, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
33
|
Naranjo-Saucedo AB, Escobar-Rodriguez GA, Tabernero C, Cuadrado E, Parra-Calderon CL, Arenas A. Mobile Health Requirements for the Occupational Health Assessment of Health Care Professionals: Delphi Study. JMIR Form Res 2023; 7:e40327. [PMID: 37256659 PMCID: PMC10267780 DOI: 10.2196/40327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND In recent years, owing to the COVID-19 pandemic, awareness of the high level of stress among health care professionals has increased, and research in this area has intensified. Hospital staff members have historically been known to work in an environment involving high emotional demands, time pressure, and workload. Furthermore, the pandemic has increased the strain experienced by health care professionals owing to the high number of people they need to manage and, on many occasions, the limited available resources with which they must carry out their functions. These psychosocial risks are not always well dealt with by the organization or the professionals themselves. Therefore, it is necessary to have tools to assess these psychosocial risks and to optimize the management of this demand from health care professionals. Digital health, and more specifically, mobile health (mHealth), is presented as a health care modality that can contribute greatly to respond to these unmet needs. OBJECTIVE We aimed to analyze whether mHealth tools can provide value for the study and management of psychosocial risks in health care professionals, and assess the requirements of these tools. METHODS A Delphi study was carried out to determine the opinions of experts on the relevance of using mHealth tools to evaluate physiological indicators and psychosocial factors in order to assess occupational health, and specifically, stress and burnout, in health care professionals. The study included 58 experts with knowledge and experience in occupational risk prevention, psychosocial work, and health-related technology, as well as health professionals from private and public sectors. RESULTS Our data suggested that there is still controversy about the roles that organizations play in occupational risk prevention in general and psychosocial risks in particular. An adequate assessment of the stress levels and psychosocial factors can help improve employees' well-being. Moreover, making occupational health evaluations available to the team would positively affect employees by increasing their feelings of being taken into account by the organization. This assessment can be improved with mHealth tools that identify and quickly highlight the difficulties or problems that occur among staff and work teams. However, to achieve good adherence and participation in occupational health and safety evaluations, experts consider that it is essential to ensure the privacy of professionals and to develop feelings of being supported by their supervisors. CONCLUSIONS For years, mHealth has been used mainly to propose intervention programs to improve occupational health. Our research highlights the usefulness of these tools for evaluating psychosocial risks in a preliminary and essential phase of approaches to improve the health and well-being of professionals in health care settings. The most urgent requirements these tools must meet are those aimed at protecting the confidentiality and privacy of measurements.
Collapse
Affiliation(s)
- Ana Belen Naranjo-Saucedo
- Institute of Biomedicine of Seville/Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas/University of Seville, Sevilla, Spain
| | - German Antonio Escobar-Rodriguez
- Institute of Biomedicine of Seville/Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas/University of Seville, Sevilla, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Department of Social Psychology and Anthropology, Instituto de Neurociencias de Castilla y León, Campus of the University of Salamanca-Miguel de Unamuno, Salamanca, Spain
| | - Esther Cuadrado
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Faculty of Educational Sciences and Psychology, University of Córdoba, Córdoba, Spain
| | - Carlos Luis Parra-Calderon
- Institute of Biomedicine of Seville/Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas/University of Seville, Sevilla, Spain
| | - Alicia Arenas
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Department of Social Psychology, University of Seville, Seville, Spain
| |
Collapse
|
34
|
López-Larraz E, Escolano C, Robledo-Menéndez A, Morlas L, Alda A, Minguez J. A garment that measures brain activity: proof of concept of an EEG sensor layer fully implemented with smart textiles. Front Hum Neurosci 2023; 17:1135153. [PMID: 37305362 PMCID: PMC10250743 DOI: 10.3389/fnhum.2023.1135153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
This paper presents the first garment capable of measuring brain activity with accuracy comparable to that of state-of-the art dry electroencephalogram (EEG) systems. The main innovation is an EEG sensor layer (i.e., the electrodes, the signal transmission, and the cap support) made entirely of threads, fabrics, and smart textiles, eliminating the need for metal or plastic materials. The garment is connected to a mobile EEG amplifier to complete the measurement system. As a first proof of concept, the new EEG system (Garment-EEG) was characterized with respect to a state-of-the-art Ag/AgCl dry-EEG system (Dry-EEG) over the forehead area of healthy participants in terms of: (1) skin-electrode impedance; (2) EEG activity; (3) artifacts; and (4) user ergonomics and comfort. The results show that the Garment-EEG system provides comparable recordings to Dry-EEG, but it is more susceptible to artifacts under adverse recording conditions due to poorer contact impedances. The textile-based sensor layer offers superior ergonomics and comfort compared to its metal-based counterpart. We provide the datasets recorded with Garment-EEG and Dry-EEG systems, making available the first open-access dataset of an EEG sensor layer built exclusively with textile materials. Achieving user acceptance is an obstacle in the field of neurotechnology. The introduction of EEG systems encapsulated in wearables has the potential to democratize neurotechnology and non-invasive brain-computer interfaces, as they are naturally accepted by people in their daily lives. Furthermore, supporting the EEG implementation in the textile industry may result in lower cost and less-polluting manufacturing processes compared to metal and plastic industries.
Collapse
|
35
|
Daniel N, Sybilski K, Kaczmarek W, Siemiaszko D, Małachowski J. Relationship between EMG and fNIRS during Dynamic Movements. SENSORS (BASEL, SWITZERLAND) 2023; 23:5004. [PMID: 37299730 PMCID: PMC10255104 DOI: 10.3390/s23115004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
In the scientific literature focused on surface electromyography (sEMG) and functional near-infrared spectroscopy (fNIRS), which have been described together and separately many times, presenting different possible applications, researchers have explored a diverse range of topics related to these advanced physiological measurement techniques. However, the analysis of the two signals and their interrelationships continues to be a focus of study in both static and dynamic movements. The main purpose of this study was to determine the relationship between signals during dynamic movements. To carry out the analysis described, the authors of this research paper chose two sports exercise protocols: the Astrand-Rhyming Step Test and the Astrand Treadmill Test. In this study, oxygen consumption and muscle activity were recorded from the gastrocnemius muscle of the left leg of five female participants. This study found positive correlations between EMG and fNIRS signals in all participants: 0.343-0.788 (median-Pearson) and 0.192-0.832 (median-Spearman). On the treadmill, the signal correlations between the participants with the most active and least active lifestyle achieved the following medians: 0.788 (Pearson)/0.832 (Spearman) and 0.470 (Pearson)/0.406 (Spearman), respectively. The shapes of the changes in the EMG and fNIRS signals during exercise suggest a mutual relationship during dynamic movements. Furthermore, during the treadmill test, a higher correlation was observed between the EMG and NIRS signals in participants with a more active lifestyle. Due to the sample size, the results should be interpreted with caution.
Collapse
Affiliation(s)
- Natalia Daniel
- Faculty of Mechatronics, Armament and Aviation, Institute of Rocket Technology and Mechatronics, Military University of Technology, 2 gen. S. Kaliskiego Street, 00-908 Warsaw, Poland
| | - Kamil Sybilski
- Faculty of Mechanical Engineering, Institute of Mechanics & Computational Engineering, Military University of Technology, 2 gen. S. Kaliskiego Street, 00-908 Warsaw, Poland
| | - Wojciech Kaczmarek
- Faculty of Mechatronics, Armament and Aviation, Institute of Rocket Technology and Mechatronics, Military University of Technology, 2 gen. S. Kaliskiego Street, 00-908 Warsaw, Poland
| | - Dariusz Siemiaszko
- Department of Functional Materials and Hydrogen Technology, Military University of Technology, 2 gen. S. Kaliskiego Street, 00-908 Warsaw, Poland
| | - Jerzy Małachowski
- Faculty of Mechanical Engineering, Institute of Mechanics & Computational Engineering, Military University of Technology, 2 gen. S. Kaliskiego Street, 00-908 Warsaw, Poland
| |
Collapse
|
36
|
Newman SJ. Early-life physical performance predicts the aging and death of elite athletes. SCIENCE ADVANCES 2023; 9:eadf1294. [PMID: 37205754 DOI: 10.1126/sciadv.adf1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/14/2023] [Indexed: 05/21/2023]
Abstract
Athleticism and the mortality rates begin a lifelong trajectory of decline during early adulthood. Because of the substantial follow-up time required, however, observing any longitudinal link between early-life physical declines and late-life mortality and aging remains largely inaccessible. Here, we use longitudinal data on elite athletes to reveal how early-life athletic performance predicts late-life mortality and aging in healthy male populations. Using data on over 10,000 baseball and basketball players, we calculate age at peak athleticism and rates of decline in athletic performance to predict late-life mortality patterns. Predictive capacity of these variables persists for decades after retirement, displays large effect sizes, and is independent of birth month, cohort, body mass index, and height. Furthermore, a nonparametric cohort-matching approach suggests that these mortality rate differences are associated with differential aging rates, not just extrinsic mortality. These results highlight the capacity of athletic data to predict late-life mortality, even across periods of substantial social and medical change.
Collapse
Affiliation(s)
- Saul Justin Newman
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
- The Research School of Biology, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
37
|
Rohaj A, Bulaj G. Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health. Healthcare (Basel) 2023; 11:1469. [PMID: 37239755 PMCID: PMC10218553 DOI: 10.3390/healthcare11101469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Digital therapeutics (DTx, software as a medical device) provide personalized treatments for chronic diseases and expand precision medicine beyond pharmacogenomics-based pharmacotherapies. In this perspective article, we describe how DTx for chronic low back pain (CLBP) can be integrated with pharmaceutical drugs (e.g., NSAIDs, opioids), physical therapy (PT), cognitive behavioral therapy (CBT), and patient empowerment. An example of an FDA-authorized DTx for CLBP is RelieVRx, a prescription virtual reality (VR) app that reduces pain severity as an adjunct treatment for moderate to severe low back pain. RelieVRx is an immersive VR system that delivers at-home pain management modalities, including relaxation, self-awareness, pain distraction, guided breathing, and patient education. The mechanism of action of DTx is aligned with recommendations from the American College of Physicians to use non-pharmacological modalities as the first-line therapy for CLBP. Herein, we discuss how DTx can provide multimodal therapy options integrating conventional treatments with exposome-responsive, just-in-time adaptive interventions (JITAI). Given the flexibility of software-based therapies to accommodate diverse digital content, we also suggest that music-induced analgesia can increase the clinical effectiveness of digital interventions for chronic pain. DTx offers opportunities to simultaneously address the chronic pain crisis and opioid epidemic while supporting patients and healthcare providers to improve therapy outcomes.
Collapse
Affiliation(s)
- Aarushi Rohaj
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| |
Collapse
|
38
|
Vos G, Trinh K, Sarnyai Z, Rahimi Azghadi M. Generalizable machine learning for stress monitoring from wearable devices: A systematic literature review. Int J Med Inform 2023; 173:105026. [PMID: 36893657 DOI: 10.1016/j.ijmedinf.2023.105026] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Wearable sensors have shown promise as a non-intrusive method for collecting biomarkers that may correlate with levels of elevated stress. Stressors cause a variety of biological responses, and these physiological reactions can be measured using biomarkers including Heart Rate Variability (HRV), Electrodermal Activity (EDA) and Heart Rate (HR) that represent the stress response from the Hypothalamic-Pituitary-Adrenal (HPA) axis, the Autonomic Nervous System (ANS), and the immune system. While Cortisol response magnitude remains the gold standard indicator for stress assessment [1], recent advances in wearable technologies have resulted in the availability of a number of consumer devices capable of recording HRV, EDA and HR sensor biomarkers, amongst other signals. At the same time, researchers have been applying machine learning techniques to the recorded biomarkers in order to build models that may be able to predict elevated levels of stress. OBJECTIVE The aim of this review is to provide an overview of machine learning techniques utilized in prior research with a specific focus on model generalization when using these public datasets as training data. We also shed light on the challenges and opportunities that machine learning-enabled stress monitoring and detection face. METHODS This study reviewed published works contributing and/or using public datasets designed for detecting stress and their associated machine learning methods. The electronic databases of Google Scholar, Crossref, DOAJ and PubMed were searched for relevant articles and a total of 33 articles were identified and included in the final analysis. The reviewed works were synthesized into three categories of publicly available stress datasets, machine learning techniques applied using those, and future research directions. For the machine learning studies reviewed, we provide an analysis of their approach to results validation and model generalization. The quality assessment of the included studies was conducted in accordance with the IJMEDI checklist [2]. RESULTS A number of public datasets were identified that are labeled for stress detection. These datasets were most commonly produced from sensor biomarker data recorded using the Empatica E4 device, a well-studied, medical-grade wrist-worn wearable that provides sensor biomarkers most notable to correlate with elevated levels of stress. Most of the reviewed datasets contain less than twenty-four hours of data, and the varied experimental conditions and labeling methodologies potentially limit their ability to generalize for unseen data. In addition, we discuss that previous works show shortcomings in areas such as their labeling protocols, lack of statistical power, validity of stress biomarkers, and model generalization ability. CONCLUSION Health tracking and monitoring using wearable devices is growing in popularity, while the generalization of existing machine learning models still requires further study, and research in this area will continue to provide improvements as newer and more substantial datasets become available.
Collapse
Affiliation(s)
- Gideon Vos
- College of Science and Engineering, James Cook University, James Cook Dr, Townsville, 4811, QLD, Australia
| | - Kelly Trinh
- College of Science and Engineering, James Cook University, James Cook Dr, Townsville, 4811, QLD, Australia
| | - Zoltan Sarnyai
- College of Public Health, Medical, and Vet Sciences, James Cook University, James Cook Dr, Townsville, 4811, QLD, Australia
| | - Mostafa Rahimi Azghadi
- College of Science and Engineering, James Cook University, James Cook Dr, Townsville, 4811, QLD, Australia.
| |
Collapse
|
39
|
Sato S, Hiratsuka T, Hasegawa K, Watanabe K, Obara Y, Kariya N, Shinba T, Matsui T. Screening for Major Depressive Disorder Using a Wearable Ultra-Short-Term HRV Monitor and Signal Quality Indices. SENSORS (BASEL, SWITZERLAND) 2023; 23:3867. [PMID: 37112208 PMCID: PMC10143236 DOI: 10.3390/s23083867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
To encourage potential major depressive disorder (MDD) patients to attend diagnostic sessions, we developed a novel MDD screening system based on sleep-induced autonomic nervous responses. The proposed method only requires a wristwatch device to be worn for 24 h. We evaluated heart rate variability (HRV) via wrist photoplethysmography (PPG). However, previous studies have indicated that HRV measurements obtained using wearable devices are susceptible to motion artifacts. We propose a novel method to improve screening accuracy by removing unreliable HRV data (identified on the basis of signal quality indices (SQIs) obtained by PPG sensors). The proposed algorithm enables real-time calculation of signal quality indices in the frequency domain (SQI-FD). A clinical study conducted at Maynds Tower Mental Clinic enrolled 40 MDD patients (mean age, 37.5 ± 8.8 years) diagnosed on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and 29 healthy volunteers (mean age, 31.9 ± 13.0 years). Acceleration data were used to identify sleep states, and a linear classification model was trained and tested using HRV and pulse rate data. Ten-fold cross-validation showed a sensitivity of 87.3% (80.3% without SQI-FD data) and specificity of 84.0% (73.3% without SQI-FD data). Thus, SQI-FD drastically improved sensitivity and specificity.
Collapse
Affiliation(s)
- Shohei Sato
- Department of Electrical Engineering and Computer Science, Faculty of Systems Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan
| | - Takuma Hiratsuka
- Department of Electrical Engineering and Computer Science, Faculty of Systems Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan
| | - Kenya Hasegawa
- Department of Electrical Engineering and Computer Science, Faculty of Systems Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan
| | - Keisuke Watanabe
- Department of Electrical Engineering and Computer Science, Faculty of Systems Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan
| | - Yusuke Obara
- Maynds Tower Mental Clinic, Tokyo 151-0053, Japan
| | | | - Toshikazu Shinba
- Department of Psychiatry, Shizuoka Saiseikai General Hospital, Shizuoka 422-8527, Japan
- Research Division, Saiseikai Research Institute of Health Care and Welfare, Tokyo 108-0073, Japan
| | - Takemi Matsui
- Department of Electrical Engineering and Computer Science, Graduate School of System Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan
| |
Collapse
|
40
|
Smith M, Withnall R, Anastasova S, Gil-Rosa B, Blackadder-Coward J, Taylor N. Developing a multimodal biosensor for remote physiological monitoring. BMJ Mil Health 2023; 169:170-175. [PMID: 33542142 PMCID: PMC10176328 DOI: 10.1136/bmjmilitary-2020-001629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Several UK military expeditions have successfully used physiological sensors to monitor participant's physiological responses to challenging environmental conditions. This article describes the development and trial of a multimodal wearable biosensor that was used during the first all-female unassisted ski crossing of the Antarctic land mass. The project successfully transmitted remote real-time physiological data back to the UK. The ergonomic and technical lessons identified have informed recommendations for future wearable devices. METHOD The biosensor devices were designed to be continuously worn against the skin and capture: HR, ECG, body surface temperature, bioimpedance, perspiration pH, sodium, lactate and glucose. The data were transmitted from the devices to an android smartphone using near-field technology. A custom-built App running on an android smartphone managed the secure transmission of the data to a UK research centre, using a commercially available satellite transceiver. RESULTS Real-time physiological data, captured by the multimodal device, was successfully transmitted back to a UK research control centre on 6 occasions. Postexpedition feedback from the participants has contributed to the ergonomic and technical refinement of the next generation of devices. CONCLUSION The future success of wearable technologies lies in establishing clinical confidence in the quality of the measured data and the accurate interpretation of those data in the context of the individual, the environment and activity being undertaken. In the near future, wearable physiological monitoring could improve point-of-care diagnostic accuracy and inform critical medical and command decisions.
Collapse
Affiliation(s)
- Michael Smith
- Academic Department of Military General Practice, RCI, Birmingham, UK
| | - R Withnall
- Defence Postgraduate Medical Deanery, Lichfield, Staffordshire, UK
| | - S Anastasova
- The Hamlyn Centre, Imperial College London, London, UK
| | - B Gil-Rosa
- The Hamlyn Centre, Imperial College London, London, UK
| | | | - N Taylor
- Academic Department of Military General Practice, RCI, Birmingham, UK
| |
Collapse
|
41
|
Mellodge P, Saavedra S, Tran Poit L, Pratt KA, Goodworth AD. Quantifying States and Transitions of Emerging Postural Control for Children Not Yet Able to Sit Independently. SENSORS (BASEL, SWITZERLAND) 2023; 23:3309. [PMID: 36992020 PMCID: PMC10054170 DOI: 10.3390/s23063309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
Objective, quantitative postural data is limited for individuals who are non-ambulatory, especially for those who have not yet developed trunk control for sitting. There are no gold standard measurements to monitor the emergence of upright trunk control. Quantification of intermediate levels of postural control is critically needed to improve research and intervention for these individuals. Accelerometers and video were used to record postural alignment and stability for eight children with severe cerebral palsy aged 2 to 13 years, under two conditions, seated on a bench with only pelvic support and with additional thoracic support. This study developed an algorithm to classify vertical alignment and states of upright control; Stable, Wobble, Collapse, Rise and Fall from accelerometer data. Next, a Markov chain model was created to calculate a normative score for postural state and transition for each participant with each level of support. This tool allowed quantification of behaviors previously not captured in adult-based postural sway measures. Histogram and video recordings were used to confirm the output of the algorithm. Together, this tool revealed that providing external support allowed all participants: (1) to increase their time spent in the Stable state, and (2) to reduce the frequency of transitions between states. Furthermore, all participants except one showed improved state and transition scores when given external support.
Collapse
Affiliation(s)
- Patricia Mellodge
- Department of Electrical and Computer Engineering, College of Engineering, Technology, and Architecture, University of Hartford, West Hartford, CT 06117, USA
| | - Sandra Saavedra
- Physical Therapy Program, College of Health Sciences, Western University of Health Sciences-Oregon, Lebanon, OR 97355, USA;
| | | | - Kristamarie A. Pratt
- Department of Rehabilitation Sciences, College of Education, Nursing and Health Professions, University of Hartford, West Hartford, CT 06117, USA;
| | - Adam D. Goodworth
- Department of Kinesiology, Westmont College, Santa Barbara, CA 93108, USA;
| |
Collapse
|
42
|
Panigutti C, Beretta A, Fadda D, Giannotti F, Pedreschi D, Perotti A, Rinzivillo S. Co-design of human-centered, explainable AI for clinical decision support. ACM T INTERACT INTEL 2023. [DOI: 10.1145/3587271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
eXplainable AI (XAI) involves two intertwined but separate challenges: the development of techniques to extract explanations from black-box AI models, and the way such explanations are presented to users, i.e., the explanation user interface. Despite its importance, the second aspect has received limited attention so far in the literature. Effective AI explanation interfaces are fundamental for allowing human decision-makers to take advantage and oversee high-risk AI systems effectively. Following an iterative design approach, we present the first cycle of prototyping-testing-redesigning of an explainable AI technique, and its explanation user interface for clinical Decision Support Systems (DSS). We first present an XAI technique that meets the technical requirements of the healthcare domain: sequential, ontology-linked patient data, and multi-label classification tasks. We demonstrate its applicability to explain a clinical DSS, and we design a first prototype of an explanation user interface. Next, we test such a prototype with healthcare providers and collect their feedback, with a two-fold outcome: first, we obtain evidence that explanations increase users’ trust in the XAI system, and second, we obtain useful insights on the perceived deficiencies of their interaction with the system, so that we can re-design a better, more human-centered explanation interface.
Collapse
Affiliation(s)
- Cecilia Panigutti
- Università di Pisa, Italy and European Commission, Joint Research Centre (JRC), Italy
| | | | | | | | | | | | | |
Collapse
|
43
|
Son C, Hegde S, Markert C, Zahed K, Sasangohar F. Use of a Mobile Biofeedback Application to Provide Health Coaching for Stress Self-Management: Findings from a Pilot Quasi-Experiment. JMIR Form Res 2023; 7:e41018. [PMID: 36952560 PMCID: PMC10131670 DOI: 10.2196/41018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Mental health is an increasing concern among vulnerable populations, including college students and veterans. OBJECTIVE The purpose of this study was to determine if mobile Health (mHealth) technology combined with health coaching can better enable user to self-manage their mental health. METHODS This study evaluated a mobile Biofeedback app that provided health coaching on stress self-management for college student veterans' mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives using the Biofeedback app and smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at two-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile Biofeedback app. RESULTS Deep breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants' heart rate during the 6-minute time period immediately after conducting the breathing exercises [Spearman's rank correlation coefficient of -0.61 (P<.001 and S=9,816,176)]. There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicate that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. CONCLUSIONS Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app. CLINICALTRIAL
Collapse
Affiliation(s)
- Changwon Son
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
- Texas Tech University, Lubbock, US
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
- Clemson University, Clemson, US
| | - Carl Markert
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
| | - Karim Zahed
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, US
| |
Collapse
|
44
|
Sousa AC, Ferrinho SN, Travassos B. The Use of Wearable Technologies in the Assessment of Physical Activity in Preschool- and School-Age Youth: Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3402. [PMID: 36834100 PMCID: PMC9966103 DOI: 10.3390/ijerph20043402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
In recent years, physical activity assessment has increasingly relied on wearable monitors to provide measures for surveillance, intervention, and epidemiological research. This present systematic review aimed to examine the current research about the utilization of wearable technology in the evaluation in physical activities of preschool- and school-age children. A database search (Web of Science, PubMed and Scopus) for original research articles was performed. A total of twenty-one articles met the inclusion criteria, and the Cochrane risk of bias tool was used. Wearable technology can actually be a very important instrument/tool to detect the movements and monitor the physical activity of children and adolescents. The results revealed that there are a few studies on the influence of these technologies on physical activity in schools, and most of them are descriptive. In line with previous research, the wearable devices can be used as a motivational tool to improve PA behaviors and in the evaluation of PA interventions. However, the different reliability levels of the different devices used in the studies can compromise the analysis and understanding of the results.
Collapse
Affiliation(s)
- António C. Sousa
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5001-801 Vila Real, Portugal
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Susana N. Ferrinho
- Department of Letters, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Bruno Travassos
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5001-801 Vila Real, Portugal
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal
| |
Collapse
|
45
|
Martín-Escudero P, Cabanas AM, Dotor-Castilla ML, Galindo-Canales M, Miguel-Tobal F, Fernández-Pérez C, Fuentes-Ferrer M, Giannetti R. Are Activity Wrist-Worn Devices Accurate for Determining Heart Rate during Intense Exercise? Bioengineering (Basel) 2023; 10:254. [PMID: 36829748 PMCID: PMC9952291 DOI: 10.3390/bioengineering10020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
The market for wrist-worn devices is growing at previously unheard-of speeds. A consequence of their fast commercialization is a lack of adequate studies testing their accuracy on varied populations and pursuits. To provide an understanding of wearable sensors for sports medicine, the present study examined heart rate (HR) measurements of four popular wrist-worn devices, the (Fitbit Charge (FB), Apple Watch (AW), Tomtom runner Cardio (TT), and Samsung G2 (G2)), and compared them with gold standard measurements derived by continuous electrocardiogram examination (ECG). Eight athletes participated in a comparative study undergoing maximal stress testing on a cycle ergometer or a treadmill. We analyzed 1,286 simultaneous HR data pairs between the tested devices and the ECG. The four devices were reasonably accurate at the lowest activity level. However, at higher levels of exercise intensity the FB and G2 tended to underestimate HR values during intense physical effort, while the TT and AW devices were fairly reliable. Our results suggest that HR estimations should be considered cautiously at specific intensities. Indeed, an effective intervention is required to register accurate HR readings at high-intensity levels (above 150 bpm). It is important to consider that even though none of these devices are certified or sold as medical or safety devices, researchers must nonetheless evaluate wrist-worn wearable technology in order to fully understand how HR affects psychological and physical health, especially under conditions of more intense exercise.
Collapse
Affiliation(s)
- Pilar Martín-Escudero
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ana María Cabanas
- Departamento de Física, FACI, Universidad de Tarapacá, Arica 1010069, Chile
| | | | - Mercedes Galindo-Canales
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Francisco Miguel-Tobal
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Cristina Fernández-Pérez
- Servicio de Medicina Preventiva Complejo Hospitalario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago, 15706 Santiago de Compostela, Spain
| | - Manuel Fuentes-Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - Romano Giannetti
- IIT, Institute of Technology Research, Universidad Pontificia Comillas, 28015 Madrid, Spain
| |
Collapse
|
46
|
Prasad S, Arunachalam S, Boillat T, Ghoneima A, Gandedkar N, Diar-Bakirly S. Wearable Orofacial Technology and Orthodontics. Dent J (Basel) 2023; 11:24. [PMID: 36661561 PMCID: PMC9858298 DOI: 10.3390/dj11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.
Collapse
Affiliation(s)
- Sabarinath Prasad
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Sivakumar Arunachalam
- Orthodontics and Dentofacial Orthopedics, School of Dentistry, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Thomas Boillat
- Design Lab, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Ahmed Ghoneima
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Narayan Gandedkar
- Discipline of Orthodontics & Paediatric Dentistry, School of Dentistry, University of Sydney, Sydney, NSW 2006, Australia
| | - Samira Diar-Bakirly
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| |
Collapse
|
47
|
Tiller NB, Sullivan JP, Ekkekakis P. Baseless Claims and Pseudoscience in Health and Wellness: A Call to Action for the Sports, Exercise, and Nutrition-Science Community. Sports Med 2023; 53:1-5. [PMID: 35687251 DOI: 10.1007/s40279-022-01702-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 01/12/2023]
Abstract
The global health and wellness industry has an estimated value of US$4 trillion. Profits derive from heath club memberships, exercise classes, diets, supplements, alternative 'therapies', and thousands of other products and services that are purported to improve health, recovery, and/or sports performance. The industry has expanded at an alarming rate, far outstripping the capacity of federal bodies to regulate the market and protect consumer interests. As a result, many products are sold on baseless or exaggerated claims, feigned scientific legitimacy, and questionable evidence of safety and efficacy. This article is a consciousness raiser. Herein, the implications of the mismatch between extraordinary health and performance claims and the unextraordinary scientific evidence are discussed. Specifically, we explore how pseudoscience and so-called 'quick fix' interventions undermine initiatives aimed at evoking long-term behavior change, impede the ongoing pursuit of sports performance, and lead to serious downstream consequences for clinical practice. Moreover, pseudoscience in health and wellness, if left unchecked and unchallenged, may have profound implications for the reputation of exercise science as a discipline. This is a call to action to unify exercise scientists around the world to more proactively challenge baseless claims and pseudoscience in the commercial health and wellness industry. Furthermore, we must shoulder the burden of ensuring that the next generation of exercise scientists are sufficiently skilled to distinguish science from pseudoscience, and information from mis- and disinformation. Better population health, sports performance, and the very reputation of the discipline may depend on it.
Collapse
Affiliation(s)
- Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA.
| | - John P Sullivan
- Department of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | | |
Collapse
|
48
|
Marquard JL, Howard J, LeBlanc R. Using Novel Data Visualization Methods to Understand Mobile Health Usability: Exemplar From a Technology-Enabled Sleep Self-monitoring Intervention. Comput Inform Nurs 2023; 41:1-5. [PMID: 36634231 PMCID: PMC9851666 DOI: 10.1097/cin.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Jordan Howard
- College of Engineering, University of Massachusetts Amherst, Amherst, MA
| | - Raeann LeBlanc
- College of Nursing, University of Massachusetts Amherst, Amherst, MA
| |
Collapse
|
49
|
Mason R, Pearson LT, Barry G, Young F, Lennon O, Godfrey A, Stuart S. Wearables for Running Gait Analysis: A Systematic Review. Sports Med 2023; 53:241-268. [PMID: 36242762 PMCID: PMC9807497 DOI: 10.1007/s40279-022-01760-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Running gait assessment has traditionally been performed using subjective observation or expensive laboratory-based objective technologies, such as three-dimensional motion capture or force plates. However, recent developments in wearable devices allow for continuous monitoring and analysis of running mechanics in any environment. Objective measurement of running gait is an important (clinical) tool for injury assessment and provides measures that can be used to enhance performance. OBJECTIVES We aimed to systematically review the available literature investigating how wearable technology is being used for running gait analysis in adults. METHODS A systematic search of the literature was conducted in the following scientific databases: PubMed, Scopus, Web of Science and SPORTDiscus. Information was extracted from each included article regarding the type of study, participants, protocol, wearable device(s), main outcomes/measures, analysis and key findings. RESULTS A total of 131 articles were reviewed: 56 investigated the validity of wearable technology, 22 examined the reliability and 77 focused on applied use. Most studies used inertial measurement units (n = 62) [i.e. a combination of accelerometers, gyroscopes and magnetometers in a single unit] or solely accelerometers (n = 40), with one using gyroscopes alone and 31 using pressure sensors. On average, studies used one wearable device to examine running gait. Wearable locations were distributed among the shank, shoe and waist. The mean number of participants was 26 (± 27), with an average age of 28.3 (± 7.0) years. Most studies took place indoors (n = 93), using a treadmill (n = 62), with the main aims seeking to identify running gait outcomes or investigate the effects of injury, fatigue, intrinsic factors (e.g. age, sex, morphology) or footwear on running gait outcomes. Generally, wearables were found to be valid and reliable tools for assessing running gait compared to reference standards. CONCLUSIONS This comprehensive review highlighted that most studies that have examined running gait using wearable sensors have done so with young adult recreational runners, using one inertial measurement unit sensor, with participants running on a treadmill and reporting outcomes of ground contact time, stride length, stride frequency and tibial acceleration. Future studies are required to obtain consensus regarding terminology, protocols for testing validity and the reliability of devices and suitability of gait outcomes. CLINICAL TRIAL REGISTRATION CRD42021235527.
Collapse
Affiliation(s)
- Rachel Mason
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Liam T Pearson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Gillian Barry
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Fraser Young
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK.
| |
Collapse
|
50
|
Bures M, Neumannova K, Blazek P, Klima M, Schvach H, Nema J, Kopecky M, Dygryn J, Koblizek V. A Sensor Network Utilizing Consumer Wearables for Telerehabilitation of Post-Acute COVID-19 Patients. IEEE INTERNET OF THINGS JOURNAL 2022; 9:23795-23809. [PMID: 36514319 PMCID: PMC9728539 DOI: 10.1109/jiot.2022.3188914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/27/2022] [Accepted: 06/30/2022] [Indexed: 06/17/2023]
Abstract
A considerable number of patients with COVID-19 suffer from respiratory problems in the post-acute phase of the disease (the second-third month after disease onset). Individual telerehabilitation and telecoaching are viable, effective options for treating these patients. To treat patients individually, medical staff must have detailed knowledge of their physical activity and condition. A sensor network that utilizes medical-grade devices can be created to collect these data, but the price and availability of these devices might limit such a network's scalability to larger groups of patients. Hence, the use of low-cost commercial fitness wearables is an option worth exploring. This article presents the concept and technical infrastructure of such a telerehabilitation program that started in April 2021 in the Czech Republic. A pilot controlled study with 14 patients with COVID-19 indicated the program's potential to improve patients' physical activity, (85.7% of patients in telerehabilitation versus 41.9% educational group) and exercise tolerance (71.4% of patients in telerehabilitation versus 42.8% of the educational group). Regarding the accuracy of collected data, the used commercial wristband was compared with the medical-grade device in a separate test. Evaluating [Formula: see text]-scores of the intensity of participants' physical activity in this test, the difference in data is not statistically significant at level [Formula: see text]. Hence, the used infrastructure can be considered sufficiently accurate for the telerehabilitation program examined in this study. The technical and medical aspects of the problem are discussed, as well as the technical details of the solution and the lessons learned, regarding using this approach to treat COVID-19 patients in the post-acute phase.
Collapse
Affiliation(s)
- Miroslav Bures
- Department of Computer ScienceFaculty of Electrical EngineeringCzech Technical University in Prague121 35PragueCzechia
| | - Katerina Neumannova
- Department of PhysiotherapyFaculty of Physical CulturePalacký University Olomouc771 47OlomoucCzechia
| | - Pavel Blazek
- Military Medical Management DepartmentFaculty of Military Health SciencesUniversity of Defence500 01Hradec KraloveCzechia
| | - Matej Klima
- Department of Computer ScienceFaculty of Electrical EngineeringCzech Technical University in Prague121 35PragueCzechia
| | - Hynek Schvach
- Military Medical Management DepartmentFaculty of Military Health SciencesUniversity of Defence500 01Hradec KraloveCzechia
| | - Jiri Nema
- Military Medical Management DepartmentFaculty of Military Health SciencesUniversity of Defence500 01Hradec KraloveCzechia
| | - Michal Kopecky
- Faculty of Medicine in Hradec KraloveCharles University110 00PragueCzechia
| | - Jan Dygryn
- Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc771 47OlomoucCzechia
| | - Vladimir Koblizek
- Department of PneumologyUniversity Hospital Hradec Kralove500 05Hradec KraloveCzechia
| |
Collapse
|