A novel personalized approach to cardiovascular prevention: The VIVOPTIM programme

BACKGROUND

Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable.

AIMS

The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors.

METHODS

Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring.

RESULTS

Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2hours/week, P=0.619).

CONCLUSION

As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France.

[VIVOPTIM: Feedback of an e-Health experimental program of primary prevention of cardiovascular risk on 30 to 70 years old volunteers]

Today by the e-health and the telemedicine, many people are more and more interested by the improvement of disease knowledge on cardiovascular diseases and associated risk factors, personalized self management support follow-up and e-Health monitoring. MGEN is a not-for-profit complementary health insurance gave itself the ways to use the new digital tools in health. MGEN developed an original and personalized program VIVOPTIM for the primary prevention of the cardiovascular risks for their members. The VIVOPTIM Pilot program is based upon digital services and was experimented by November 2015 to December, 2017 with 8000 members of the MGEN, from 30 to 70 years old and resident in two French areas (Occitanie and Bourgogne Franche-Comté). The assessment of the experiment VIVOPTIM e -health program was positive for the personalized cardiovascular support and for their health. Therefore, the MGEN generalized the VIVOPTIM program of cardiovascular prevention, to the whole France on July 11th, 2018.

Step-to-step reproducibility and asymmetry to study gait auto-optimization in healthy and cerebral palsied subjects

OBJECTIVE

The purpose of our study was to compare plantar pressure asymmetry and step-to-step reproducibility in both able-bodied persons and two groups of hemiplegics. The relevance of the research was to determine the efficiency of asymmetry and reproducibility as indexes for diagnosis and rehabilitation processes.

MATERIAL AND METHOD

This study comprised 31 healthy young subjects and 20 young subjects suffering from cerebral palsy hemiplegia assigned to two groups of 10 subjects according to the severity of their musculoskeletal disorders. The peaks of plantar pressure and the time to peak pressure were recorded with an in-shoe measurement system. The intra-individual coefficient of variability was calculated to indicate the consistency of plantar pressure during walking and to define gait stability. The effect size was computed to quantify the asymmetry and measurements were conducted at eight footprint locations.

RESULTS

Results indicated few differences in step-to-step reproducibility between the healthy group and the less spastic group while the most affected group showed a more asymmetrical and unstable gait.

CONCLUSION

From the concept of self-optimisation and depending on the neuromotor disorders the organism could make priorities based on pain, mobility, stability or energy expenditure to develop the best gait auto-optimisation.

Measurement of plantar pressure distribution in hemiplegic children: changes to adaptative gait patterns in accordance with deficiency

OBJECTIVE

A comparison of plantar pressure distribution in hemiplegic children with a healthy control group was performed to illustrate the link between the changing dynamics during the stance phase and the degree of deficiency.

DESIGN

Twenty three healthy control subjects and two groups of six hemiplegic children with minor and major spasticity were tested.

BACKGROUND

In previous studies, it was shown that the musculoskeletal dysfunction due to spasticity disturbed the hemiplegic gait pattern, for example reduced walking speed and step length. However, plantar pressure measurements which would help to understand the pathological gait mechanisms have not been studied.

METHODS

The stance phase parameters measured included spatio-temporal data and the relative impulse measurements during consecutive gait cycles. The relative impulses under eight plantar areas were determined with an in-shoe plantar pressure measurement device.

RESULTS

Each group had a specific plantar pressure distribution profile that varied with the degree of deficiency. The most significant differences were found beneath the midfoot, the first metatarsal head and the hallux.

CONCLUSION

The neuromuscular disorders and foot deformities due to the cerebral lesion modified the contact of the foot with the ground, and led to specific plantar pressure distribution profiles. The equinovarus, with clawed-toe deformity due to greater spasticity, seemed to be an important factor in disturbances of the terminal stance phase. However, the spastic hemiplegic subjects seemed to adopt a gait pattern required for optimal stability.

RELEVANCE

From previous work, comparable data were available only for the hemiparetic adult patients. In-shoe pressure data from spastic hemiplegic children can provide detailed information specific to each region of contact for the support of diagnosis, a clinical decision or the prescription of appropriate footwear, braces or othoses. Both peak pressure and local impulse have proven to be valuable for the understanding of foot function, lower extremity dysfunctions and walking strategies.

[Asymmetries in dynamic plantar pressure distribution measurement in able-bodied gait: application to the study of the gait asymmetries in children with hemiplegic cerebral palsy]

OBJECTIVES

The aim of this study was to analyse, firstly, the plantar pressure distribution in healthy subjects in order to validate or invalidate the previous studies results on the asymmetrical profile of the stance phase. The studies of asymmetries was based on the identification of a propulsive foot and a loading foot from a concept introduced by Viel. Secondly, the approach was applied to the study of gait asymmetries in two children with hemiplegic cerebral plasy.

MATERIAL AND METHOD

Thirty healthy control subjects and two hemiplegic children (H1 and H2) performed a walking test at self selected speed. The recordings of dynamic parameters were realized thanks to an in-shoe plantar pressure analysis system (Parotec, by Paromed Medizintechnik, GMBH, Germany). The pressure peaks were determined from the recording of pressures under eight footprint locations. A program calculated the sum of forces under the heel and determined the loading foot. By defect, the second foot is the propulsive foot.

RESULTS

The asymmetrical profile of the human normal stance phase was validated. Under the heel, the pressure peaks lower by 28 % were noticed beneath the loading foot compared to the propulsive foot. Inversely, under the metatarsal heads and the hallux, the pressure peaks were greater by 32 % beneath the propulsive foot. For the two hemiplegic children, the plantar pressure profile equally highlighted significant differences between the unaffected and affected feet. The pressure peaks under the affected heel were respectively lower by 21 % and 97 % for H1 and H2. The loading function was found and associated to the affected limb. The propulsive function was not systematically found under the unaffected foot.

DISCUSSION

The analysis of plantar pressure measurements during able-bodied gait showed differences between the two lower limbs. These dynamic asymmetries are the results of a natural functional organization of the supports differentiating a loading foot and a propulsive foot and corroborating the concept proposed by Viel. The hemiplegic gait also presented dynamic asymmetries partially agreement with a personalized functional logic of loading and propulsion. However, the asymmetrical profile can also result a gait self-optimization strategy compensating biomechanical, anatomical and physiological disorders linked to the cerebral deficiency.

[Spasticity and dynamic plantar pressure distribution measurements in hemiplegic spastic children]

OBJECTIVE

The aim of this study was to analyse the plantar pressure distribution in nine hemiplegic spastic children to illustrate the dynamic alteration during stance phase linked spasticity grade.

MATERIAL AND METHODS

The graduation of the lower limbs muscle tone related to the Aschworth spasticity scale enabled us to identify two groups of hemiplegics subjects. The groups Asch 1 and Asch 3 have respectively presented a low and a strong spasticity. The peak pressures during consecutive gait cycles were determined under the feet of 30 healthy subjects and two cerebral palsy groups using a wearable footprint analysis system.

RESULTS

A statistical study showed a similarity between the two disabled groups. Peak pressures under the midfoot were significantly higher compared to the control group. While the plantar pressure distribution profile was specific for each group under all other anatomical structures. The significant alterations were observed under the forefoot and hallux.

DISCUSSION-CONCLUSION

Spasticity modifies the foot contact to ground and leads to a specific plantar pressure distribution profile linked to the spasticity grade. The equinovarus with clawed toes deformity due to higher spasticity seems to be an important factor in terminal stance phase perturbations. However spastic hemiplegic subjects seem to adopt a gait pattern in agreement with stability optimization criteria.