Home health monitoring around the time of surgery: qualitative study of patients' experiences before and after joint replacement

Digital Endpoints for Assessing Instrumental Activities of Daily Living in Mild Cognitive Impairment: Systematic Review

BACKGROUND

Subtle impairments in instrumental activities of daily living (IADLs) can be a key predictor of disease progression and are considered central to functional independence. Mild cognitive impairment (MCI) is a syndrome associated with significant changes in cognitive function and mild impairment in complex functional abilities. The early detection of functional decline through the identification of IADL impairments can aid early intervention strategies. Digital health technology is an objective method of capturing IADL-related behaviors. However, it is unclear how these IADL-related behaviors have been digitally assessed in the literature and what differences can be observed between MCI and normal aging.

OBJECTIVE

This review aimed to identify the digital methods and metrics used to assess IADL-related behaviors in people with MCI and report any statistically significant differences in digital endpoints between MCI and normal aging and how these digital endpoints change over time.

METHODS

A total of 16,099 articles were identified from 8 databases (CINAHL, Embase, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and Scopus), out of which 15 were included in this review. The included studies must have used continuous remote digital measures to assess IADL-related behaviors in adults characterized as having MCI by clinical diagnosis or assessment. This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Ambient technology was the most commonly used digital method to assess IADL-related behaviors in the included studies (14/15, 93%), with passive infrared motion sensors (5/15, 33%) and contact sensors (5/15, 33%) being the most prevalent types of methods. Digital technologies were used to assess IADL-related behaviors across 5 domains: activities outside of the home, everyday technology use, household and personal management, medication management, and orientation. Other recognized domains-culturally specific tasks and socialization and communication-were not assessed. Of the 79 metrics recorded among 11 types of technologies, 65 (82%) were used only once. There were inconsistent findings around differences in digital IADL endpoints across the cognitive spectrum, with limited longitudinal assessment of how they changed over time.

CONCLUSIONS

Despite the broad range of metrics and methods used to digitally assess IADL-related behaviors in people with MCI, several IADLs relevant to functional decline were not studied. Measuring multiple IADL-related digital endpoints could offer more value than the measurement of discrete IADL outcomes alone to observe functional decline. Key recommendations include the development of suitable core metrics relevant to IADL-related behaviors that are based on clinically meaningful outcomes to aid the standardization and further validation of digital technologies against existing IADL measures. Increased longitudinal monitoring is necessary to capture changes in digital IADL endpoints over time in people with MCI.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022326861; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=326861.

Toward Enhanced Clinical Decision Support for Patients Undergoing a Hip or Knee Replacement: Focus Group and Interview Study With Surgeons

BACKGROUND

The current assessment of recovery after total hip or knee replacement is largely based on the measurement of health outcomes through self-report and clinical observations at follow-up appointments in clinical settings. Home activity-based monitoring may improve assessment of recovery by enabling the collection of more holistic information on a continuous basis.

OBJECTIVE

This study aimed to introduce orthopedic surgeons to time-series analyses of patient activity data generated from a platform of sensors deployed in the homes of patients who have undergone primary total hip or knee replacement and understand the potential role of these data in postoperative clinical decision-making.

METHODS

Orthopedic surgeons and registrars were recruited through a combination of convenience and snowball sampling. Inclusion criteria were a minimum required experience in total joint replacement surgery specific to the hip or knee or familiarity with postoperative recovery assessment. Exclusion criteria included a lack of specific experience in the field. Of the 9 approached participants, 6 (67%) orthopedic surgeons and 3 (33%) registrars took part in either 1 of 3 focus groups or 1 of 2 interviews. Data were collected using an action-based approach in which stimulus materials (mock data visualizations) provided imaginative and creative interactions with the data. The data were analyzed using a thematic analysis approach.

RESULTS

Each data visualization was presented sequentially followed by a discussion of key illustrative commentary from participants, ending with a summary of key themes emerging across the focus group and interview data set.

CONCLUSIONS

The limitations of the evidence are as follows. The data presented are from 1 English hospital. However, all data reflect the views of surgeons following standard national approaches and training. Although convenience sampling was used, participants' background, skills, and experience were considered heterogeneous. Passively collected home monitoring data offered a real opportunity to more objectively characterize patients' recovery from surgery. However, orthopedic surgeons highlighted the considerable difficulty in navigating large amounts of complex data within short medical consultations with patients. Orthopedic surgeons thought that a proposed dashboard presenting information and decision support alerts would fit best with existing clinical workflows. From this, the following guidelines for system design were developed: minimize the risk of misinterpreting data, express a level of confidence in the data, support clinicians in developing relevant skills as time-series data are often unfamiliar, and consider the impact of patient engagement with data in the future.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2018-021862.

Quality of Life and Adherence to Healthcare Services During the COVID-19 Pandemic: A Cross-Sectional Analysis

Purpose

To determine the relationship of various domains of quality of life (QoL) with healthcare adherence during the COVID-19 pandemic in Saudi Arabia.

Methods

The study sample comprised 795 participants among which 203 had a current diagnosis of any major NCDs, including cardiovascular diseases, diabetes mellitus, asthma, chronic pulmonary diseases, and chronic psychiatric illnesses and a control group of 592 participants who had no NCD. Participants completed an online survey questionnaire which obtained data on socio-demographic variables, types of NCDs, and healthcare adherence during the year 2020, the period during which Saudi Arabia underwent the first two waves of the COVID-19 pandemic. World Health Organization Quality of Life (WHOQOL-BREF) assessed the QoL in four domains physical, psychological, social and environmental and used standard scores in the analysis. GraphPad Prism 5 and SPSS 25V were employed for the statistical analysis. Bar graphs and frequency distribution tables present descriptive data. Bivariate and multivariate logistic regression analyses were computed to determine the significance of the relationship between QoL and healthcare adherence.

Results

Almost equal proportions of participants with NCDs (n=109/203; 54%) and without NCDs (n=327/592; 55%) demonstrated nonadherence to their regular healthcare during the COVID-19 pandemic (χ2=0.14; p=0.71). Patients with NCDs experienced lower quality of life in the psychological, social and environmental domains of QoL (p<0.05). Results from the multivariate regression analysis showed that female gender (AOR=1.52; p<0.05) psychological QoL (AOR=1.99; p<0.05), social QoL (AOR=1.98; p<0.05) and environmental QoL (AOR=1.95; p<0.05) significantly relate with adherence to healthcare.

Conclusion

Psychological, social and environmental may influence healthcare adherence among patients with NCDs during pandemics and should be focused on while devising future healthcare policy and interventions.

Internet-of-Things (IoT) in healthcare and social services – experiences of a sensor system for notifications of deviant behaviours in the home from the users’ perspective

Studies on use of IT in residential care are limited; thus, there is a need for investigations to understand both older people’s and nursing staff’s perspectives on experiences of new technology. ‘Smart homes’ provide home automation solutions, making life easier for those residing there. The aim was to explore, from the users’ perspective, experiences of a sensor system installed in the home. The sensors are meant to provide notifications of deviations in behaviours or routines by the resident, requiring healthcare staff or relatives to do a supervisory visit. The sensor notification system made the users feel secure by being monitored, having control over the situation, and allowing them to become more independent in their daily lives; furthermore, they emphasised the importance of having well-functioning systems. Further development of the technology and use, in co-creation with the users, is needed. Careful preparation in installing/starting the system and repeated information about its aim are needed.

Acceptability of an In-Home Multimodal Sensor Platform in Parkinson’s Disease: A Qualitative Study (Preprint)

Background

Parkinson disease (PD) symptoms are complex, gradually progressive, and fluctuate hour by hour. Home-based technological sensors are being investigated to measure symptoms and track disease progression. A smart home sensor platform, with cameras and wearable devices, could be a useful tool to use to get a fuller picture of what someone’s symptoms are like. High-resolution video can capture the ground truth of symptoms and activities. There is a paucity of information about the acceptability of such sensors in PD.

Objective

The primary objective of our study was to explore the acceptability of living with a multimodal sensor platform in a naturalistic setting in PD. Two subobjectives are to identify any suggested limitations and to explore the sensors’ impact on participant behaviors.

Methods

A qualitative study was conducted with an inductive approach using semistructured interviews with a cohort of PD and control participants who lived freely for several days in a home-like environment while continuously being sensed.

Results

This study of 24 participants (12 with PD) found that it is broadly acceptable to use multimodal sensors including wrist-worn wearables, cameras, and other ambient sensors passively in free-living in PD. The sensor that was found to be the least acceptable was the wearable device. Suggested limitations on the platform for home deployment included camera-free time and space. Behavior changes were noted by the study participants, which may have related to being passively sensed. Recording high-resolution video in the home setting for limited periods of time was felt to be acceptable to all participants.

Conclusions

The results broaden the knowledge of what types of sensors are acceptable for use in research in PD and what potential limitations on these sensors should be considered in future work. The participants’ reported behavior change in this study should inform future similar research design to take this factor into account. Collaborative research study design, involving people living with PD at every stage, is important to ensure that the technology is acceptable and that the data outcomes produced are ecologically valid and accurate.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-041303

Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

Background

Physical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6 weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns.

Methods

Thirty-one orthogeriatric fracture patients [pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF)] were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24 h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up.

Results

During postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively [FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005)] and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6 weeks, but did not reach the initial level.

Conclusions

Gait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the “fast track” concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice.

Level of evidence

Prospective cohort study, 2.

Developments in the human machine interface technologies and their applications: a review

Human-machine interface (HMI) techniques use bioelectrical signals to gain real-time synchronised communication between the human body and machine functioning. HMI technology not only provides a real-time control access but also has the ability to control multiple functions at a single instance of time with modest human inputs and increased efficiency. The HMI technologies yield advanced control access on numerous applications such as health monitoring, medical diagnostics, development of prosthetic and assistive devices, automotive and aerospace industry, robotic controls and many more fields. In this paper, various physiological signals, their acquisition and processing techniques along with their respective applications in different HMI technologies have been discussed.

Development of a Telemedicine Neurological Examination for Spine Surgery: A Pilot Trial

STUDY DESIGN

This was a prospective cohort study.

OBJECTIVE

The objective of this study was to design and test a novel spine neurological examination adapted for telemedicine.

SUMMARY OF BACKGROUND DATA

Telemedicine is a rapidly evolving technology associated with numerous potential benefits for health care, especially in the modern era of value-based care. To date, no studies have assessed whether.

METHODS

Twenty-one healthy controls and 20 patients with cervical or lumbar spinal disease (D) were prospectively enrolled. Each patient underwent a telemedicine neurological examination as well as a traditional in-person neurological examination administered by a fellowship trained spine surgeon and a physiatrist. Both the telemedicine and in-person tests consisted of motor, sensory, and special test components. Scores were compared via univariate analysis and secondary qualitative outcomes, including responses from a satisfaction survey, were obtained upon completion of the trial.

RESULTS

Of the 20 patients in the D group, 9 patients had cervical disease and 11 patients had lumbar disease. Comparing healthy control with the D group, there were no significant differences with respect to all motor scores, most sensory scores, and all special tests. There was a high rate of satisfaction among the cohort with 92.7% of participants feeling "very satisfied" with the overall experience.

CONCLUSIONS

This study presents the development of a viable neurological spine examination adapted for telemedicine. The findings in this study suggest that patients have comparable motor, sensory, and special test scores with telemedicine as with a traditional in-person examination administered by an experienced clinician, as well as reporting a high rate of satisfaction among participants. To our knowledge, this is the first telemedicine neurological examination for spine surgery. Further studies are warranted to validate these findings.