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Oakes DB, Baker MJ, McLeod C, Nattabi B, Blyth CC. Patient-reported outcome measures for paediatric acute lower respiratory infection studies. Eur Respir Rev 2023; 32:32/167/220229. [PMID: 36889787 PMCID: PMC10032589 DOI: 10.1183/16000617.0229-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are recommended for capturing meaningful outcomes in clinical trials. The use of PROMs for children with acute lower respiratory infections (ALRIs) has not been systematically reported. We aimed to identify and characterise patient-reported outcomes and PROMs used in paediatric ALRI studies and summarise their measurement properties. METHODS Medline, Embase and Cochrane were searched (until April 2022). Studies that reported on patient-reported outcome (or measure) use or development and included subjects aged <18 years with ALRIs were included. Study, population and patient-reported outcome (or measure) characteristics were extracted. RESULTS Of 2793 articles identified, 18 met inclusion criteria, including 12 PROMs. Two disease-specific PROMs were used in settings in which they had been validated. The Canadian Acute Respiratory Illness and Flu Scale was the most frequently used disease-specific PROM (five studies). The EuroQol-Five Dimensions-Youth system was the most frequently used generic PROM (two studies). There was considerable heterogeneity in validation methods. The outcome measures identified in this review lack validation for young children and none involve sufficient content validity for use with First Nations children. CONCLUSIONS There is an urgent need for PROM development that considers the populations in which the burden of ALRI predominates.
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Affiliation(s)
- Daniel B Oakes
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Megan J Baker
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Charlie McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
| | - Barbara Nattabi
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Australia
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Rafl J, Bachman TE, Rafl-Huttova V, Walzel S, Rozanek M. Commercial smartwatch with pulse oximeter detects short-time hypoxemia as well as standard medical-grade device: Validation study. Digit Health 2022; 8:20552076221132127. [PMID: 36249475 PMCID: PMC9554125 DOI: 10.1177/20552076221132127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We investigated how a commercially available smartwatch that measures peripheral blood oxygen saturation (SpO2) can detect hypoxemia compared to a medical-grade pulse oximeter. METHODS We recruited 24 healthy participants. Each participant wore a smartwatch (Apple Watch Series 6) on the left wrist and a pulse oximeter sensor (Masimo Radical-7) on the left middle finger. The participants breathed via a breathing circuit with a three-way non-rebreathing valve in three phases. First, in the 2-minute initial stabilization phase, the participants inhaled the ambient air. Then in the 5-minute desaturation phase, the participants breathed the oxygen-reduced gas mixture (12% O2), which temporarily reduced their blood oxygen saturation. In the final stabilization phase, the participants inhaled the ambient air again until SpO2 returned to normal values. Measurements of SpO2 were taken from the smartwatch and the pulse oximeter simultaneously in 30-s intervals. RESULTS There were 642 individual pairs of SpO2 measurements. The bias in SpO2 between the smartwatch and the oximeter was 0.0% for all the data points. The bias for SpO2 less than 90% was 1.2%. The differences in individual measurements between the smartwatch and oximeter within 6% SpO2 can be expected for SpO2 readings 90%-100% and up to 8% for SpO2 readings less than 90%. CONCLUSIONS Apple Watch Series 6 can reliably detect states of reduced blood oxygen saturation with SpO2 below 90% when compared to a medical-grade pulse oximeter. The technology used in this smartwatch is sufficiently advanced for the indicative measurement of SpO2 outside the clinic. TRIAL REGISTRATION ClinicalTrials.gov NCT04780724.
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Affiliation(s)
- Jakub Rafl
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic,Jakub Rafl, Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, nam. Sitna 3105, CZ-272 01 Kladno, Czech Republic.
| | - Thomas E Bachman
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Veronika Rafl-Huttova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Simon Walzel
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Martin Rozanek
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
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Dauletbaev N, Oftring ZS, Akik W, Michaelis-Braun L, Korel J, Lands LC, Waldmann S, Müller BS, Dreher M, Rohde G, Vogelmeier CF, Kuhn S. A scoping review of mHealth monitoring of pediatric bronchial asthma before and during COVID-19 pandemic. Paediatr Respir Rev 2022; 43:67-77. [PMID: 35131174 PMCID: PMC8761580 DOI: 10.1016/j.prrv.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022]
Abstract
Mobile (m) Health technology is well-suited for Remote Patient Monitoring (RPM) in a patient's habitual environment. In recent years there have been fast-paced developments in mHealth-enabled pediatric RPM, especially during the COVID-19 pandemic, necessitating evidence synthesis. To this end, we conducted a scoping review of clinical trials that had utilized mHealth-enabled RPM of pediatric asthma. MEDLINE, Embase and Web of Science were searched from September 1, 2016 through August 31, 2021. Our scoping review identified 25 publications that utilized synchronous and asynchronous mHealth-enabled RPM in pediatric asthma, either involving mobile applications or via individual devices. The last three years has seen the development of evidence-based, multidisciplinary, and participatory mHealth interventions. The quality of the studies has been improving, such that 40% of included study reports were randomized controlled trials. In conclusion, there exists high-quality evidence on mHealth-enabled RPM in pediatric asthma, warranting future systematic reviews and/or meta-analyses of the benefits of such RPM.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany; Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Centre, Montreal, QC, Canada; al-Farabi Kazakh National University, Almaty, Kazakhstan.
| | - Zoe S. Oftring
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Wided Akik
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Lukas Michaelis-Braun
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Julia Korel
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Larry C. Lands
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada,The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Susanne Waldmann
- Central Medical Library, Philipps University of Marburg, Marburg, Germany
| | - Beate S. Müller
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Gernot Rohde
- Medical Clinic 1, Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus F. Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
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Machine learning-based optimization of pre-symptomatic COVID-19 detection through smartwatch. Sci Rep 2022; 12:7886. [PMID: 35550526 PMCID: PMC9097889 DOI: 10.1038/s41598-022-11329-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Patients with weak or no symptoms accelerate the spread of COVID-19 through various mutations and require more aggressive and active means of validating the COVID-19 infection. More than 30% of patients are reported as asymptomatic infection after the delta mutation spread in Korea. It means that there is a need for a means to more actively and accurately validate the infection of the epidemic via pre-symptomatic detection, besides confirming the infection via the symptoms. Mishara et al. (Nat Biomed Eng 4, 1208–1220, 2020) reported that physiological data collected from smartwatches could be an indicator to suspect COVID-19 infection. It shows that it is possible to identify an abnormal state suspected of COVID-19 by applying an anomaly detection method for the smartwatch’s physiological data and identifying the subject’s abnormal state to be observed. This paper proposes to apply the One Class-Support Vector Machine (OC-SVM) for pre-symptomatic COVID-19 detection. We show that OC-SVM can provide better performance than the Mahalanobis distance-based method used by Mishara et al. (Nat Biomed Eng 4, 1208–1220, 2020) in three aspects: earlier (23.5–40% earlier) and more detection (13.2–19.1% relative better) and fewer false positives. As a result, we could conclude that OC-SVM using Resting Heart Rate (RHR) with 350 and 300 moving average size is the most recommended technique for COVID-19 pre-symptomatic detection based on physiological data from the smartwatch.
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Kruizinga MD, Essers E, Stuurman FE, Yavuz Y, de Kam ML, Zhuparris A, Janssens HM, Groothuis I, Sprij AJ, Nuijsink M, Cohen AF, Driessen GJA. Clinical validation of digital biomarkers for pediatric patients with asthma and cystic fibrosis - Potential for clinical trials and clinical care. Eur Respir J 2021; 59:13993003.00208-2021. [PMID: 34887326 DOI: 10.1183/13993003.00208-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/10/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Digital biomarkers are a promising novel method to capture clinical data in a home-setting. However, clinical validation prior to implementation is of vital importance. The aim of this study was to clinically validate physical activity, heart rate, sleep and FEV1 as digital biomarkers measured by a smartwatch and portable spirometer in children with asthma and cystic fibrosis (CF). METHODS This was a prospective cohort study including 60 children with asthma and 30 children with CF (age 6-16). Participants wore a smartwatch, performed daily spirometry at home and completed a daily symptom questionnaire for 28-days. Physical activity, heart rate, sleep and FEV1 were considered candidate digital endpoints. Data from 128 healthy children was used for comparison. Reported outcomes were compliance, difference between patients and controls, correlation with disease-activity and potential to detect clinical events. Analysis was performed with linear mixed effect models. RESULTS Median compliance was 88%. On average, patients exhibited lower physical activity and FEV1 compared to healthy children, whereas the heart rate of children with asthma was higher compared to healthy children. Days with a higher symptom score were associated with lower physical activity for children with uncontrolled asthma and CF. Furthermore, FEV1 was lower and (nocturnal) heart rate was higher for both patient groups on days with more symptoms. Candidate biomarkers and showed a distinct pattern before- and after a pulmonary exacerbation. CONCLUSION Portable spirometer- and smartwatch-derived digital biomarkers show promise as candidate endpoints for use in clinical trials or clinical care in pediatric lung disease.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, the Netherlands .,Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Esmée Essers
- Centre for Human Drug Research, Leiden, the Netherlands.,Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Yalçin Yavuz
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | | | - Hettie M Janssens
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Iris Groothuis
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Gertjan J A Driessen
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands.,Department of pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
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