Sensor technology more than a support

SMART (self- monitoring analysis and reporting technology) and sensor based technology applications in trauma and orthopaedic surgery

Background

Innovations in implant designs and computer technology have led to the development of smart implants and prostheses in the field of orthopedics and trauma. Sensor-guided devices enable close monitoring of physical, chemical and biological environment around the implants, which has been purported to meliorate the intra-operative precision and post-operative surveillance of patients.

Objective

We evaluate the current applications of sensor-based technology in the management of patients with a spectrum of musculoskeletal conditions.

Material and methods

A thorough search of literature was performed on May 1, 2023, using the 5 databases (Embase, PubMed, Google Scholar, Cochrane Library and Web of Science) in order to identify suitable studies published between 2000 and 2023. All the studies which reported on SMART implants and Sensor based technology in the diverse sub-specialties of orthopedics like trauma, arthroplasty, spine surgery, infections, arthroscopy or sports medicine and paediatric orthopedics were considered. The keywords used for the search included 'Sensor technology', 'SMART implant' and "Orthopedics".

Results

Thirty articles were considered for this narrative review. A generation of SMART implants has been developed due to advancements in the microchip technology. Sensor based technology has been utilised in various subspecialties of arthroplasty (in assessing ligament balancing intra-operatively; or prosthetic loosening and gait analysis during follow-up), trauma surgery (as SMART instruments intra-operatively; or in the assessment of bone healing, distraction osteogenesis and functional recovery during follow-up), spine surgery (identification and protection of neural elements from iatrogenic injuries intra-operatively; and assessment of fusion across the instrumented levels during follow-up), paediatric orthopedics (compliance assessment for foot abduction orthosis in congenital talipes equinovarus), infection (monitoring of infection and biofilm formation), rehabilitation (gait analysis) and sports medicine (rotational stability and ligament compliance in patients with ligament injuries or reconstruction).

Conclusion

SMART implants and Sensor based technology have applications in the surgical planning, intra-operative performance, post-operative monitoring and patient surveillance diverse subspecialties of orthopedics and trauma. Future research in newer designs, cost-effective SMART implants and refinement of Sensor based technology will enhance Patient Related Outcome Measures (PROMs).

Technologies in Home-Based Digital Rehabilitation: Scoping Review

BACKGROUND

Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR.

OBJECTIVE

In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR.

METHODS

The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR.

RESULTS

A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies.

CONCLUSIONS

Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.

The impact of wearable continuous vital sign monitoring on deterioration detection and clinical outcomes in hospitalised patients: a systematic review and meta-analysis

BACKGROUND

Timely recognition of the deteriorating inpatient remains challenging. Wearable monitoring systems (WMS) may augment current monitoring practices. However, there are many barriers to implementation in the hospital environment, and evidence describing the clinical impact of WMS on deterioration detection and patient outcome remains unclear.

OBJECTIVE

To assess the impact of vital-sign monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using WMS, in comparison with standard care.

METHODS

A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL, Health Technology Assessment databases and grey literature. Studies comparing the use of WMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information.

RESULTS

Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the WMS, when compared with standard care, was not associated with significant reductions in intensive care transfers (risk ratio, RR 0.87; 95% confidence interval, CI 0.66-1.15), rapid response or cardiac arrest team activation (RR 0.84; 95% CI 0.69-1.01), total (RR 0.77; 95% CI 0.44-1.32) and major (RR 0.55; 95% CI 0.24-1.30) complications prevalence. There was also no statistically significant association with reduced mortality (RR 0.48; 95% CI 0.18-1.29) and hospital length of stay (mean difference, MD - 0.09; 95% CI - 0.43 to 0.44).

CONCLUSION

This systematic review indicates that there is no current evidence that implementation of WMS impacts early deterioration detection and associated clinical outcomes, as differing design/quality of available studies and diversity of outcome measures make it difficult to reach a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alarms and promote rapid clinical action in response to deterioration. PROSPERO Registration number: CRD42020188633 .

Short-Term Wearable Sensors for In-Hospital Medical and Surgical Patients: Mixed Methods Analysis of Patient Perspectives

BACKGROUND

Continuous vital sign monitoring using wearable sensors may enable early detection of patient deterioration and sepsis.

OBJECTIVE

This study aimed to explore patient experiences with wearable sensor technology and carry out continuous monitoring through questionnaire and interview studies in an acute hospital setting.

METHODS

Patients were recruited for a wearable sensor study and were asked to complete a 9-item questionnaire. Patients responses were evaluated using a Likert scale and with continuous variables. A subgroup of surgical patients wearing a Sensium Vital Sign Sensor was invited to participate in semistructured interviews. The Sensium wearable sensor measures the vital signs: heart rate, respiratory rate, and temperature. All interview data were subjected to thematic analysis.

RESULTS

Out of a total of 500 patients, 453 (90.6%) completed the questionnaire. Furthermore, 427 (85.4%) patients agreed that the wearable sensor was comfortable, 429 (85.8%) patients agreed to wear the patch again when in hospital, and 398 (79.6%) patients agreed to wear the patch at home. Overall, 12 surgical patients consented to the interviews. Five main themes of interest to patients emerged from the interviews: (1) centralized monitoring, (2) enhanced feelings of patient safety, (3) impact on nursing staff, (4) comfort and usability, and (5) future use and views on technology.

CONCLUSIONS

Overall, the feedback from patients using wearable monitoring sensors was strongly positive with relatively few concerns raised. Patients felt that the wearable sensors would improve their sense of safety, relieve pressure on health care staff, and serve as a favorable aspect of future health care technology.

Refined Composite Multi-Scale Reverse Weighted Permutation Entropy and Its Applications in Ship-Radiated Noise

Ship-radiated noise is one of the important signal types under the complex ocean background, which can well reflect physical properties of ships. As one of the valid measures to characterize the complexity of ship-radiated noise, permutation entropy (PE) has the advantages of high efficiency and simple calculation. However, PE has the problems of missing amplitude information and single scale. To address the two drawbacks, refined composite multi-scale reverse weighted PE (RCMRWPE), as a novel measurement technology of describing the signal complexity, is put forward based on refined composite multi-scale processing (RCMP) and reverse weighted PE (RWPE). RCMP is an improved method of coarse-graining, which not only solves the problem of single scale, but also improves the stability of traditional coarse-graining; RWPE has been proposed more recently, and has better inter-class separability and robustness performance to noise than PE, weighted PE (WPE), and reverse PE (RPE). Additionally, a feature extraction scheme of ship-radiated noise is proposed based on RCMRWPE, furthermore, RCMRWPE is combined with discriminant analysis classifier (DAC) to form a new classification method. After that, a large number of comparative experiments of feature extraction schemes and classification methods with two artificial random signals and six ship-radiated noise are carried out, which show that the proposed feature extraction scheme has better performance in distinguishing ability and stability than the other three similar feature extraction schemes based on multi-scale PE (MPE), multi-scale WPE (MWPE), and multi-scale RPE (MRPE), and the proposed classification method also has the highest recognition rate.

Smart home and communication technology for people with disability: a scoping review

PURPOSE

The links between disability, activity limitation and participation restriction are well established. Recent and continued advancement of technology, particularly smart home and communication technologies, presents new ways in which some of the limitations and restrictions experienced by people with disabilities can be overcome. The aim of this scoping review was to explore the impact of smart home and communication technology on the outcomes of people with disabilities and complex needs.

METHOD

This review involved systematic searching of four databases, hand searches and data extraction. Eligibility criteria included [1] participant outcomes of [2] technology used within the home [3] among adults with a disability and complex needs.

RESULTS

Of the 2400 studies identified, 21 met our inclusion criteria. Studies were characterized by significant diversity in relation to disability and type of technology. Overall, technology appeared to improve independence, participation and quality of life among people with a disability and complex needs. Despite this, ethical considerations were raised given the vulnerability of this population, including potential risks through social participation and privacy concerns of using monitoring technology.

CONCLUSIONS

Smart home and communication technology can improve outcomes for people living with disabilities and complex needs. However, a number of factors impact the successful implementation of technology, including personalization, flexibility and ongoing support to the person with a disability and their close others. Future research should utilize high-quality study designs and established measures of important outcomes for this group.IMPLICATIONS FOR REHABILITATIONThere is a broad range of smart home and communication technology devices and systems available that may support the independence and participation of people with disabilities and complex needs; however, high-quality evidence documenting the impact of technology is lacking.Soft-technology supports, including assessment, training and evaluation of technology implementation, may play just as important a role in shaping outcomes as the technology itself.Systematic research is required to ensure there is quality evidence to inform investment in both technologies, and the soft-technology supports that promote its successful use.

Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature

Background: Assistive technologies (AT) have been used to improve the daily living conditions of people living with dementia (PWD). Research supports the positive impact of the use of AT such as decreased burden on caregivers and behavioral support for people with dementia. Four reviews in the last six years have analyzed AT and PWD, but none have incorporated the dimension of medical outcomes. Objectives: The purpose of this review is to identify the facilitators, barriers, and medical outcomes commensurate with the use of AT with PWD. Method: This review queried The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, and PubMed databases for peer-reviewed publications in the last five years for facilitators, barriers, and medical outcomes commensurate with the use of AT with PWD. The study is reported and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Kruse Protocol for conducting a systematic review. Results: 48 studies were analyzed. Fourteen types of AT, 17 facilitators, 17 barriers, and 16 medical outcomes were identified in the literature. The two most frequently mentioned ATs were cognitive stimulators (9/48, 19%) and social robots (5/48, 10%). The two most frequently mentioned facilitators were caregivers want AT (8/68, 12%) and enables increased independence (7/68, 10%). The top two barriers were cost (8/75, 11%) and PWD reject AT (8/75, 11%). The top medical outcomes were improved cognitive abilities (6/69, 9%), increased activities of daily living (ADLs), and increased autonomy (each at 5/69, 7%): Zero negative outcomes were reported. Conclusion: The systematic review revealed the positive relations that occur when PWD and their caregivers use AT. Although many reservations surrounding the use of AT exist, a majority of the literature shows a positive effect of its use. Research supports a strong support for AT by caregivers due to many positive medical outcomes, but also a reticence to adopt by PWD. If ATs for PWD are a way to reduce stress on caregivers, barriers of cost and complexity need to be addressed through health policy or grants.

Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review

Background

The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia.

Methods

The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5^th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3^rd of May 2019.

Results

A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted.

Conclusions

Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation.

Systematic Review Registration

PROSPERO, identifier CRD42019134313.

Reverse Dispersion Entropy: A New Complexity Measure for Sensor Signal

Permutation entropy (PE), as one of the powerful complexity measures for analyzing time series, has advantages of easy implementation and high efficiency. In order to improve the performance of PE, some improved PE methods have been proposed through introducing amplitude information and distance information in recent years. Weighted-permutation entropy (W-PE) weight each arrangement pattern by using variance information, which has good robustness and stability in the case of high noise level and can extract complexity information from data with spike feature or abrupt amplitude change. Dispersion entropy (DE) introduces amplitude information by using the normal cumulative distribution function (NCDF); it not only can detect the change of simultaneous frequency and amplitude, but also is superior to the PE method in distinguishing different data sets. Reverse permutation entropy (RPE) is defined as the distance to white noise in the opposite trend with PE and W-PE, which has high stability for time series with varying lengths. To further improve the performance of PE, we propose a new complexity measure for analyzing time series, and term it as reverse dispersion entropy (RDE). RDE takes PE as its theoretical basis and combines the advantages of DE and RPE by introducing amplitude information and distance information. Simulation experiments were carried out on simulated and sensor signals, including mutation signal detection under different parameters, noise robustness testing, stability testing under different signal-to-noise ratios (SNRs), and distinguishing real data for different kinds of ships and faults. The experimental results show, compared with PE, W-PE, RPE, and DE, that RDE has better performance in detecting abrupt signal and noise robustness testing, and has better stability for simulated and sensor signal. Moreover, it also shows higher distinguishing ability than the other four kinds of PE for sensor signals.

Perspectives of Stakeholders on Technology Use in the Care of Community-Living Older Adults with Dementia: A Systematic Literature Review

Although technology has the potential to promote aging in place, the use of technology remains scarce among community-living older adults with dementia. A reason might be that many stakeholders are involved who all have a different perspective on technology use (i.e., needs, wishes, attitudes, possibilities, and difficulties). We systematically searched the literature in order to provide an overview of perspectives of different stakeholders on technology use among community-living older adults with dementia. After selection, 46 studies were included. We mainly found perspectives of informal caregivers and, to a lesser extent, of persons with dementia and formal caregivers. Perspectives of suppliers of technology were not present. Shared perspectives among persons with dementia and informal and formal caregivers were, among other things, ease of use, stability and flexibility of technology, importance of privacy, and confidentiality. We also found that among older persons, fun and pleasure, in addition to enhancing freedom and independence, facilitates technology use. Informal caregivers' peace of mind and relief of burden also appeared to be important in using technologies. Formal caregivers value the potential of technologies to improve monitoring and communication. Insight in shared, and conflicting perspectives of stakeholders are essential to enhance the use of technology.