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Haukeland-Parker S, Jervan Ø, Ghanima W, Spruit MA, Holst R, Tavoly M, Gleditsch J, Johannessen HH. Physical activity following pulmonary embolism and clinical correlates in selected patients: a cross-sectional study. Res Pract Thromb Haemost 2024; 8:102366. [PMID: 38562511 PMCID: PMC10982567 DOI: 10.1016/j.rpth.2024.102366] [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: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
Background There is limited knowledge regarding physical activity and clinical correlates among people who have suffered a pulmonary embolism (PE). Objectives To assess physical activity levels after PE and potential clinical correlates. Methods One hundred forty-five individuals free of major comorbidities were recruited at a mean of 23 months (range, 6-72) after PE diagnosis. Physical activity was assessed by steps/day on the Sensewear monitor for 7 consecutive days, exercise capacity with the incremental shuttle walk test, and cardiac function with left ventricular ejection fraction (LVEF). The association between physical activity and other variables was analyzed by a mixed-effects model. Results Participants achieved a mean of 6494 (SD, 3294; range, 1147-18.486) steps/day. The mixed-effects model showed that physical activity was significantly associated with exercise capacity (β-coefficient, 0.04; 95% CI, 0.03-0.05) and LVEF (β-coefficient, -0.81; 95% CI, -1.42 to -0.21). The analysis further showed that men became less physically active with increasing age (β-coefficient, -0.14; 95% CI, -0.24 to -0.04), whereas no change with age could be detected for women. Conclusion In selected post-PE patients, physical activity seems to be associated with exercise capacity and LVEF but not with quality of life, dyspnea, or characteristics of the initial PE. Men appear to become less physically active with increasing age.
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Affiliation(s)
- Stacey Haukeland-Parker
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Jervan
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Waleed Ghanima
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research, Emergency Medicine and Hematooncology, Østfold Hospital Trust, Grålum, Norway
- Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martijn A. Spruit
- Department of Research and Development, CIRO+, Horn, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - René Holst
- Department of Research, Emergency Medicine and Hematooncology, Østfold Hospital Trust, Grålum, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Mazdak Tavoly
- Department of Research, Emergency Medicine and Hematooncology, Østfold Hospital Trust, Grålum, Norway
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jostein Gleditsch
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
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Fuhr DP, Brotto AR, Rowe BH, Bhutani M, Rosychuk RJ, Stickland MK. Examining changes in vascular function, arterial stiffness and systemic inflammation during hospitalization and recovery from an acute exacerbation of chronic obstructive pulmonary disease. Sci Rep 2023; 13:12245. [PMID: 37507427 PMCID: PMC10382488 DOI: 10.1038/s41598-023-39001-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
An acute exacerbation of COPD (AECOPD) is associated with increased risk of cardiovascular (CV) events. The elevated risk during an AECOPD may be related to changes in vascular function, arterial stiffness, and systemic inflammation; the time course of these measures and their corresponding recovery are poorly understood. Further, physical activity is reduced during an AECOPD, and physical activity may influence the cardiovascular responses to an AECOPD. The purpose of the study was to examine the acute impact of an AECOPD requiring hospitalization on vascular function, arterial stiffness, and systemic inflammation and examine whether physical activity modulates these variables during recovery. Patients hospitalized for an AECOPD were prospectively recruited and compared to control patients with stable COPD. Vascular function, arterial stiffness, and systemic inflammation (CRP, IL-6) were measured at hospital admission, hospital discharge and within 14 days of discharge. Physical activity was electronically tracked daily while in hospital and for 7 days following discharge using a Fitbit. One hundred and twenty-one patients with an AECOPD requiring hospitalization and 33 control patients with stable COPD were enrolled in the study. Vascular function was significantly lower, and systemic inflammation higher at hospital admission in patients with an AECOPD compared to stable COPD. Significant improvements in vascular function and inflammation were observed within 14 days of hospital discharge; however, vascular function remained lower than stable COPD. Physical activity was low at admission and increased following discharge; however, physical activity was unrelated to measures of vascular function or inflammation at any time point. An AECOPD requiring hospitalization is associated with impaired vascular function that persists during recovery. These findings provide a mechanistic link to help explain the enduring increase in CV risk and mortality following a severe AECOPD event.Clinical trial registration: ClinicalTrials.gov #NCT01949727; Registered: 09/20/2013.
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Affiliation(s)
- Desi P Fuhr
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3-135 Clinical Sciences Building, Edmonton, AB, T6G 2J3, Canada
| | - Andrew R Brotto
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3-135 Clinical Sciences Building, Edmonton, AB, T6G 2J3, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3-135 Clinical Sciences Building, Edmonton, AB, T6G 2J3, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3-135 Clinical Sciences Building, Edmonton, AB, T6G 2J3, Canada.
- G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada.
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Pol M, Qadeer A, van Hartingsveldt M, Choukou MA. Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study. JMIR Rehabil Assist Technol 2023; 10:e44498. [PMID: 37463040 PMCID: PMC10394599 DOI: 10.2196/44498] [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: 11/21/2022] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identified as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. OBJECTIVE The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. METHODS We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. RESULTS The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. CONCLUSIONS Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals.
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Affiliation(s)
- Margriet Pol
- Amsterdam University of Applied Sciences, Research Group Occupational Therapy - Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam, Netherlands
- Amsterdam University Medical center, location Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Amarzish Qadeer
- Bimedical Engineering graduate program, University of Manitoba, Winnipeg, MB, Canada
| | - Margo van Hartingsveldt
- Amsterdam University of Applied Sciences, Research Group Occupational Therapy - Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam, Netherlands
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
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Rozenberg D, Shore J, Camacho Perez E, Nourouzpour S, Ibrahim Masthan M, Santa Mina D, Campos JL, Huszti E, Green R, Khan MH, Lau A, Gold D, Stanbrook MB, Reid WD. Feasibility of a Home-Based Cognitive-Physical Exercise Program in Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Feasibility and Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48666. [PMID: 37436794 PMCID: PMC10372770 DOI: 10.2196/48666] [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: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive condition associated with physical and cognitive impairments contributing to difficulty in performing activities of daily living (ADLs) that require dual tasking (eg, walking and talking). Despite evidence showing that cognitive decline occurs among patients with COPD and may contribute to functional limitations and decreased health-related quality of life (HRQL), pulmonary rehabilitation continues to focus mainly on physical training (ie, aerobic and strength exercises). An integrated cognitive and physical training program compared to physical training alone may be more effective in increasing dual-tasking ability among people living with COPD, leading to greater improvements in performance of ADLs and HRQL. OBJECTIVE The aims of this study are to evaluate the feasibility of an 8-week randomized controlled trial of home-based, cognitive-physical training versus physical training for patients with moderate to severe COPD and derive preliminary estimates of cognitive-physical training intervention efficacy on measures of physical and cognitive function, dual task performance, ADLs, and HRQL. METHODS A total of 24 participants with moderate to severe COPD will be recruited and randomized into cognitive-physical training or physical training. All participants will be prescribed an individualized home physical exercise program comprising 5 days of moderate-intensity aerobic exercise (30-50 minutes/session) and 2 days of whole-body strength training per week. The cognitive-physical training group will also perform cognitive training for approximately 60 minutes, 5 days per week via the BrainHQ platform (Posit Science Corporation). Participants will meet once weekly with an exercise professional (via videoconference) who will provide support by reviewing the progression of their training and addressing any queries. Feasibility will be assessed through the recruitment rate, program adherence, satisfaction, attrition, and safety. The intervention efficacy regarding dual task performance, physical function, ADLs, and HRQL will be evaluated at baseline and at 4 and 8 weeks. Descriptive statistics will be used to summarize intervention feasibility. Paired 2-tailed t tests and 2-tailed t tests will be used to compare the changes in the outcome measures over the 8-week study period within and between the 2 randomized groups, respectively. RESULTS Enrollment started in January 2022. It is estimated that the enrollment period will be 24 months long, with data collection to be completed by December 2023. CONCLUSIONS A supervised home-based cognitive-physical training program may be an accessible intervention to improve dual-tasking ability in people living with COPD. Evaluating the feasibility and effect estimates is a critical first step to inform future clinical trials evaluating this approach and its effects on physical and cognitive function, ADL performance, and HRQL. TRIAL REGISTRATION ClinicalTrials.gov NCT05140226; https://clinicaltrials.gov/ct2/show/NCT05140226. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48666.
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Affiliation(s)
- Dmitry Rozenberg
- Respirology and Lung Transplantation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Josh Shore
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | | | - Sahar Nourouzpour
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Jennifer L Campos
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Robin Green
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, ON, Canada
| | | | - Ambrose Lau
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | - David Gold
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Matthew B Stanbrook
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | - W Darlene Reid
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Watson PK, Eitivipart AC, Davis GM, Arora M, Middleton JW, De Oliveira CQ. Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 67:102408. [PMID: 37665869 DOI: 10.1016/j.psychsport.2023.102408] [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: 09/12/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES This review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious. METHODS The protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool. RESULTS The search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31-0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96-38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46-1.16), which were individualised (d = 0.62, 95% CI = 0.34-0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34-0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques. CONCLUSIONS Interventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques.
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Affiliation(s)
- Paul K Watson
- Sydney School of Health Sciences, Faulty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Aitthanatt C Eitivipart
- Accessibility and Assistive Technology Research Team, Assistive Technology and Medical Devices Research Centre, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Glen M Davis
- Sydney School of Health Sciences, Faulty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Translational Research Collective, The University of Sydney, Sydney, NSW, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Translational Research Collective, The University of Sydney, Sydney, NSW, Australia
| | - Camila Quel De Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, NSW, Australia
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Michaelchuk W, Colella TJF, Goldstein RS, Brooks D. Wearable device for sedentary behavior change in chronic obstructive pulmonary disease is feasible and acceptable. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023. [DOI: 10.1080/24745332.2023.2177213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Wade Michaelchuk
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Respiratory Medicine, Toronto, Ontario, Canada
| | - Tracey JF Colella
- Kite-Toronto Rehabilitation, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Roger S. Goldstein
- West Park Healthcare Centre, Respiratory Medicine, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- West Park Healthcare Centre, Respiratory Medicine, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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7
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Valkenet K, Bor P, Reijneveld E, Veenhof C, Dronkers J. Physical activity monitoring during hospital stay: a validation study. Disabil Rehabil 2023; 45:449-454. [PMID: 35175168 DOI: 10.1080/09638288.2022.2034995] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The primary aim of this study was to investigate the concurrent validity of the PAM AM400 accelerometer for measuring physical activity in usual care in hospitalized patients by comparing it with the ActiGraph wGT3X-BT accelerometer. MATERIALS AND METHODS This was a prospective single centre observational study performed at the University Medical Centre Utrecht in The Netherlands. Patients admitted to different clinical wards were included. Intraclass Correlation Coefficients (ICCs) were computed using a two-way mixed model with random subjects. Additionally, Bland-Altman plots were made to visualize the level of agreement of the PAM with the ActiGraph. To test for proportional bias, a regression analysis was performed. RESULTS In total 17 patients from different clinical wards were included in the analyses. The level of agreement between the PAM and ActiGraph was found strong with an ICC of 0.955. The Bland-Altman analyses showed a mean difference of 1.12 min between the two accelerometers and no proportional bias (p = 0.511). CONCLUSIONS The PAM is a suitable movement sensor to validly measure the active minutes of hospitalized patients. Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.IMPLICATIONS FOR REHABILITATIONPhysical inactivity is common during hospital admission and the main cause of loss of muscle mass and physical fitness.The PAM AM400 is a suitable movement sensor to validly measure the active minutes of hospitalized patients.Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.
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Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Elja Reijneveld
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Jaap Dronkers
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
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Geelen SJG, Giele BM, Veenhof C, Nollet F, Engelbert RHH, van der Schaaf M. Physical dependence and urinary catheters both strongly relate to physical inactivity in adults during hospital stay: a cross-sectional, observational study. Disabil Rehabil 2022; 44:6684-6691. [PMID: 34528861 DOI: 10.1080/09638288.2021.1970257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine which factors are associated with physical inactivity in hospitalized adults of all ages. METHODS A cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations. RESULTS Patients were physically active for median(IQR) 26 (13-52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05). CONCLUSIONS Independence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline.Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay.Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline.
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences and Sports, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Qureshi SM, Bookey-Bassett S, Purdy N, Greig MA, Kelly H, Neumann WP. Modelling the impacts of COVID-19 on nurse workload and quality of care using process simulation. PLoS One 2022; 17:e0275890. [PMID: 36228015 PMCID: PMC9560613 DOI: 10.1371/journal.pone.0275890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Higher acuity levels in COVID-19 patients and increased infection prevention and control routines have increased the work demands on nurses. To understand and quantify these changes, discrete event simulation (DES) was used to quantify the effects of varying the number of COVID-19 patient assignments on nurse workload and quality of care. Model testing was based on the usual nurse-patient ratio of 1:5 while varying the number of COVID-19 positive patients from 0 to 5. The model was validated by comparing outcomes to a step counter field study test with eight nurses. The DES model showed that nurse workload increased, and the quality of care deteriorated as nurses were assigned more COVID-19 positive patients. With five COVID-19 positive patients, the most demanding condition, the simulant-nurse donned and doffed personal protective equipment (PPE) 106 times a shift, totaling 6.1 hours. Direct care time was reduced to 3.4 hours (-64% change from baseline pre-pandemic case). In addition, nurses walked 10.5km (+46% increase from base pre-pandemic conditions) per shift while 75 care tasks (+242%), on average, were in the task queue. This contributed to 143 missed care tasks (+353% increase from base pre-pandemic conditions), equivalent to 9.6 hours (+311%) of missed care time and care task waiting time increased to 1.2 hours (+70%), in comparison to baseline (pre-pandemic) conditions. This process simulation approach may be used as potential decision support tools in the design and management of hospitals in-patient care settings, including pandemic planning scenarios.
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Affiliation(s)
- Sadeem Munawar Qureshi
- Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
- * E-mail:
| | - Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | - Nancy Purdy
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | - Michael A. Greig
- Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | | | - W. Patrick Neumann
- Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
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Brons A, Braam K, Broekema A, Timmerman A, Millenaar K, Engelbert R, Kröse B, Visser B. Translating Promoting Factors and Behavior Change Principles Into a Blended and Technology-Supported Intervention to Stimulate Physical Activity in Children With Asthma (Foxfit): Design Study. JMIR Form Res 2022; 6:e34121. [PMID: 35877162 PMCID: PMC9361148 DOI: 10.2196/34121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Children with asthma can decrease the impact of their disease by improving their physical activity (PA). However, health care providers lack interventions for children with asthma that effectively increase their PA levels and achieve behavior change. A technology-supported approach can positively influence PA and physical functioning in children. Objective The aims of this study were to develop a technology-supported intervention that facilitates health care providers in promoting PA for children (aged 8 to 12 years) with asthma and to systematically describe this developmental process. Methods Intervention mapping (IM) was applied to develop a blended and technology-supported intervention in cocreation with children with asthma, their parents, and health care providers. In accordance with the IM framework, the following steps were performed: conduct a needs assessment; define the intervention outcome, performance objectives, and change objectives; select theory-based intervention methods and strategies; create components of the intervention and conduct pilot tests; create an implementation plan; and create an evaluation plan. Results We developed the blended intervention Foxfit that consists of an app with a PA monitor for children (aged 8 to 12 years) with asthma and a web-based dashboard for their health care provider. The intervention focuses on PA in everyday life to improve social participation. Foxfit contains components based on behavior change principles and gamification, including goal setting, rewards, action planning, monitoring, shaping knowledge, a gamified story, personal coaching and feedback, and a tailored approach. An evaluation plan was created to assess the intervention’s usability and feasibility for both children and health care providers. Conclusions The IM framework was very useful for systematically developing a technology-supported intervention and for describing the translational process from scientific evidence, the needs and wishes of future users, and behavior change principles into this intervention. This has led to the technology-supported intervention Foxfit that facilitates health care providers in promoting PA in children with asthma. The structured description of the development process and functional components shows the way behavior change techniques are incorporated in the intervention. Trial Registration International Clinical Trial Registry Platform NTR6658; https://tinyurl.com/3rxejksf
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Affiliation(s)
- Annette Brons
- Digital Life Center, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Katja Braam
- Centre of Expertise Urban Vitality, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Aline Broekema
- Centre of Expertise Urban Vitality, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
| | | | - Karel Millenaar
- Play and Civid Media, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
| | - Raoul Engelbert
- Centre of Expertise Urban Vitality, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ben Kröse
- Digital Life Center, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Computer Science, University of Amsterdam, Amsterdam, Netherlands
| | - Bart Visser
- Centre of Expertise Urban Vitality, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
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11
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Sano N, Taniguchi T, Nakazono H. Influence of upper limb activity on the step count and accuracy of sleep time of a wristband-type physical activity tracker. PLoS One 2022; 17:e0271155. [PMID: 35802885 PMCID: PMC9270058 DOI: 10.1371/journal.pone.0271155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background A wristband-type consumer physical activity tracker (PAT) is commonly used in rehabilitation to assess an individual’s physical activity. However, under the free-living setting, the wristband-type PAT tends to overestimate step counts when compared with the research-standard criterion. Also, daily rhythm characteristics, such as sleep time, are difficult to monitor accurately based solely on self-reporting. Purpose To identify the conditions measured as step counts by a wristband-type consumer PAT when using the upper limbs in daily living, and the measurement accuracy of the sleeping time estimated from the wristband-type PAT. Methods Forty participants (20 females, mean age 32.65 ± 9.52 years) were enrolled in two experiments in this study. In Experiment 1, we measured the influence of upper limbs activity (movement speed and distance) on step counts of wristband-type and waist holder-type PAT in two upper limb tasks. In Experiment 2, we verified the measurement accuracy of two sleep times by wristband-type PAT using a self-reported survey for 3 days. Results The results of Experiment 1 revealed that the step counts using wristband-type PAT were influenced by upper limbs activity depending on movement distance (F (1, 19) = 31.705, p < 0.001) but not speed (F (1, 19) = 2.669, p < 0.117). Whereas, there was no relationship between step counts and upper limb activity in waist holder-type PAT. The results of Experiment 2 showed that the sleep times of wristband-type and self-report had a strong correlation (coefficient value = 0.93, p < 0.001). Conclusions This PAT is useful for capturing changes in the amount of physical activity and the daily rhythm within the individual. It can be expected to be used for rehabilitation support centered on upper limb activity and daily rhythm.
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Affiliation(s)
- Nobuyuki Sano
- Department of Occupational Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Fukuoka, Japan
- * E-mail:
| | - Takanori Taniguchi
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Fukuoka, Japan
| | - Hisato Nakazono
- Department of Occupational Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Fukuoka, Japan
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12
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Block VJ, Bove R, Nourbakhsh B. The Role of Remote Monitoring in Evaluating Fatigue in Multiple Sclerosis: A Review. Front Neurol 2022; 13:878313. [PMID: 35832181 PMCID: PMC9272225 DOI: 10.3389/fneur.2022.878313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
Abstract
Fatigue is one of the most common multiple sclerosis (MS) symptoms. Despite this, monitoring and measuring fatigue (subjective lack of energy)- and fatigability (objectively measurable and quantifiable performance decline)- in people with MS have remained challenging. Traditionally, administration of self-report questionnaires during in-person visits has been used to measure fatigue. However, remote measurement and monitoring of fatigue and fatigability have become feasible in the past decade. Traditional questionnaires can be administered through the web in any setting. The ubiquitous availability of smartphones allows for momentary and frequent measurement of MS fatigue in the ecological home-setting. This approach reduces the recall bias inherent in many traditional questionnaires and demonstrates the fluctuation of fatigue that cannot be captured by standard measures. Wearable devices can assess patients' fatigability and activity levels, often influenced by the severity of subjective fatigue. Remote monitoring of fatigue, fatigability, and activity in real-world situations can facilitate quantifying symptom-severity in clinical and research settings. Combining remote measures of fatigue as well as objective fatigability in a single construct, composite score, may provide a more comprehensive outcome. The more granular data obtained through remote monitoring techniques may also help with the development of interventions aimed at improving fatigue and lowering the burden of this disabling symptom.
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Affiliation(s)
- Valerie J. Block
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Valerie J. Block
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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13
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Geelen SJ, Giele BM, Veenhof C, Nollet F, Engelbert RH, van der Schaaf M. The Better By Moving study: A multifaceted intervention to improve physical activity in adults during hospital stay. Clin Rehabil 2022; 36:1342-1368. [PMID: 35702004 PMCID: PMC9420894 DOI: 10.1177/02692155221105337] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective ‘Better By Moving’ is a multifaceted intervention developed and implemented in collaboration with patients and healthcare professionals to improve physical activity in hospitalized adults. This study aimed to understand if, how and why ‘Better By Moving’ resulted in higher levels of physical activity by evaluating both outcomes and implementation process. Design Mixed-methods study informed by the Medical Research Council guidance. Setting Tertiary hospital. Participants Adult patients admitted to surgery, haematology, infectious diseases and cardiology wards, and healthcare professionals. Measures Physical activity was evaluated before and after implementation using the Physical Activity Monitor AM400 on one random day during hospital stay between 8 am and 8 pm. Furthermore, the time spent lying on bed, length of stay and discharge destination was investigated. The implementation process was evaluated using an audit trail, surveys and interviews. Results There was no significant difference observed in physical activity (median [IQR] 23 [12–51] vs 27 [17–55] minutes, P = 0.107) and secondary outcomes before-after implementation. The intervention components’ reach was moderate and adoption was low among patients and healthcare professionals. Patients indicated they perceived more encouragement from the environment and performed exercises more frequently, and healthcare professionals signalled increased awareness and confidence among colleagues. Support (priority, resources and involvement) was perceived a key contextual factor influencing the implementation and outcomes. Conclusion Although implementing ‘Better By Moving’ did not result in significant improvements in outcomes at our centre, the process evaluation yielded important insights that may improve the effectiveness of implementing multifaceted interventions aiming to improve physical activity during hospital stay.
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Affiliation(s)
- Sven Jg Geelen
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,522567Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, Netherlands
| | - Boukje M Giele
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, 8124University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, 8119University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Frans Nollet
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Raoul Hh Engelbert
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, 10191Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,522567Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, 10191Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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14
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Robinson A, Husband A, Slight R, Slight SP. Designing Digital Health Technology to Support Patients Before and After Bariatric Surgery: Qualitative Study Exploring Patient Desires, Suggestions, and Reflections to Support Lifestyle Behavior Change. JMIR Hum Factors 2022; 9:e29782. [PMID: 35254271 PMCID: PMC8933804 DOI: 10.2196/29782] [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: 04/20/2021] [Revised: 10/05/2021] [Accepted: 11/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background A patient’s capability, motivation, and opportunity to change their lifestyle are determinants of successful outcomes following bariatric surgery. Lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been associated with greater postsurgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviors, and provide holistic patient support, to improve surgical success. Previous research focused on implementing digital technologies and measuring effectiveness in surgical cohorts. However, there is limited work concerning the desires, suggestions, and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patients’ perspectives on technology features that would support behavior changes during the pre- and postoperative periods, to potentially maintain long-term healthy lifestyles following surgery. Objective This study aims to understand how digital technologies can be used to support patient care during the perioperative journey to improve weight loss outcomes and surgical success, focusing on what patients want from digital technologies, how they want to use them, and when they would be of most benefit during their surgical journey. Methods Patients attending bariatric surgery clinics in one hospital in the North of England were invited to participate. Semistructured interviews were conducted with purposively sampled pre- and postoperative patients to discuss lifestyle changes and the use of digital technologies to complement their care. The interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the National Health Service Health Research Authority. Results A total of 20 patients were interviewed (preoperative phase: 40% (8/20); postoperative phase: 60% (12/20). A total of 4 overarching themes were developed and related to the optimization of technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs during the surgical pathway. Functionalities that delivered personalized feedback and postoperative follow-up were considered beneficial. Individualized goal setting functionality could support a generation of digitally engaged patients with bariatric conditions as working toward achievable targets was deemed an effective strategy for motivating behavior change. The creation of digital package of care checklists between patients and clinicians was a novel finding from this study. Conclusions Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made relating to the design, content, and functionality of digital interventions to best address the needs of this cohort. These findings have the potential to influence the co-design and integration of person-centered, perioperative technologies.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert Slight
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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15
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Domingos C, Costa P, Santos NC, Pêgo JM. Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal. J Med Internet Res 2022; 24:e26652. [PMID: 35080503 PMCID: PMC8829694 DOI: 10.2196/26652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/24/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. OBJECTIVE This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. METHODS Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. RESULTS A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high-perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (β=.530; P<.01) and the direct negative effect of depression on usability (β=-.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. CONCLUSIONS Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults.
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Affiliation(s)
- Célia Domingos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,iCognitus4ALL - IT Solutions, Braga, Portugal.,Clinical Academic Center - 2CA-B, Braga, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clinical Academic Center - 2CA-B, Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clinical Academic Center - 2CA-B, Braga, Portugal.,Associação Centro de Medicina P5, School of Medicine, University of Minho, Braga, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,iCognitus4ALL - IT Solutions, Braga, Portugal.,Clinical Academic Center - 2CA-B, Braga, Portugal
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16
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Haukeland-Parker S, Frisk B, Spruit MA, Stafne SN, Johannessen HH. Treatment of urinary incontinence in women with chronic obstructive pulmonary disease-a randomised controlled study. Trials 2021; 22:900. [PMID: 34895285 PMCID: PMC8665568 DOI: 10.1186/s13063-021-05816-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known regarding treatment of urinary incontinence (UI) in women with chronic obstructive pulmonary disease (COPD). The aim of the study was to explore the efficacy of pelvic floor muscle training (PFMT) or cough-suppression techniques (CST) on UI in women with COPD. METHODS A three-armed, two-centred, single-blinded, randomised controlled study was performed. Subjects were randomised to (a) PFMT for 16 weeks, (b) 2-3 educational sessions in CST, or (c) written information only. All participants completed questionnaires about UI, cough symptoms, and health status and underwent clinical examinations to evaluate the strength of the pelvic floor muscles and exercise capacity. Daily physical activity levels were measured using an activity monitor and lung function with spirometry. With a significance level of 5% and an 80% chance of detecting a significant difference between groups of 2.5 points on the ICIQ UI SF score, our sample size calculation showed that a total of 78 women, 26 in each group, was required to complete the study. RESULTS During the period 2016 to 2018, 95 women were invited to the study. A total of 42 were recruited, three were excluded and 10 (24%) dropped out during the follow-up period. Mean ICIQ-UI SF total baseline score was 9.6 (range: 1-17) and 7.0 (range: 0-16) at follow-up. Changes in subjective UI as measured with the ICIQ-UI SF questionnaire were seen in the PFMT group and control group, but not in the CST group. CONCLUSION Due to the low number of available participants and recruitment difficulties including practical issues such as travel distance, lack of interest, poor state of health, and high number of comorbidities, our results are inconclusive. However, reduced subjective UI was observed in the PFMT and control groups with a trend towards best effect in the PFMT group. Screening for UI is advisable in all women with COPD to be able to identify and treat these women to reduce symptom burden and improve quality of life. Future studies should focus on barriers to recruitment as well as randomised controlled studies with larger sample sizes. TRIAL REGISTRATION ClinicalTrials.gov NCT02614105. 25th November 2015.
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Affiliation(s)
| | - Bente Frisk
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Martijn A Spruit
- Department of Research and Development, CIRO+, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, NTNU Faculty of Medicine and Health Sciences, Trondheim, Norway.,Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway.,Faculty of Nursing, health and laboratory science, Østfold University College, Fredrikstad, Norway
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17
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Ráthonyi G, Takács V, Szilágyi R, Bácsné Bába É, Müller A, Bács Z, Harangi-Rákos M, Balogh L, Ráthonyi-Odor K. Your Physical Activity Is in Your Hand-Objective Activity Tracking Among University Students in Hungary, One of the Most Obese Countries in Europe. Front Public Health 2021; 9:661471. [PMID: 34604150 PMCID: PMC8481615 DOI: 10.3389/fpubh.2021.661471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Inadequate physical activity is currently one of the leading risk factors for mortality worldwide. University students are a high-risk group in terms of rates of obesity and lack of physical activity. In recent years, activity trackers have become increasingly popular for measuring physical activity. The aim of the present study is to examine whether university students in Hungary meet the health recommendations (10,000 steps/day) for physical activity and investigate the impact of different variables (semester-exam period, days-weekdays, days, months, sex) on the level of physical activity in free-living conditions for 3 months period. In free-living conditions, 57 healthy university students (male: 25 female: 32 mean age: 19.50 SD = 1.58) wore MiBand 1S activity tracker for 3 months. Independent sample t-tests were used to explore differences between sexes. A One-way analysis of variance (ANOVA) was used to explore differences in measures among different grouping variables and step count. A Two-way ANOVA was conducted to test for differences in the number of steps by days of the week, months, seasons and for sex differences. Tukey HSD post-hoc tests were used to examine significant differences. Students in the study achieved 10,000 steps per day on 17% of days (minimum: 0%; maximum: 76.5%; median: 11.1%). Unfortunately, 70% of the participants did not comply the 10,000 steps at least 80% of the days studied. No statistical difference were found between sexes. However, significant differences were found between BMI categories (underweight <18.50 kg/m2; normal range 18.50–24.99 kg/m2; overweight: 25.00–29.99 kg/m2 obese > 30 kg/m2, the number of steps in the overweight category was significantly lower (F = 72.073, p < 0.001). The average daily steps were significantly higher in autumn (t = 11.457, p < 0.001) than in winter. During exam period average steps/day were significantly lower than during fall semester (t = 13.696, p < 0.001). On weekdays, steps were significantly higher than on weekends (F = 14.017, p < 0.001), and even within this, the greatest physical activity can be done by the middle of the week. Our data suggest that university students may be priority groups for future physical activity interventions. Commercial activity trackers provide huge amount of data for relatively low cost therefore it has the potential to objectively analyze physical activity and plan interventions.
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Affiliation(s)
- Gergely Ráthonyi
- Institute of Applied Informatics and Logistics, University of Debrecen, Debrecen, Hungary
| | - Viktor Takács
- Institute of Applied Informatics and Logistics, University of Debrecen, Debrecen, Hungary
| | - Róbert Szilágyi
- Institute of Applied Informatics and Logistics, University of Debrecen, Debrecen, Hungary
| | - Éva Bácsné Bába
- Institute of Sport Management, University of Debrecen, Debrecen, Hungary
| | - Anetta Müller
- Institute of Sport Management, University of Debrecen, Debrecen, Hungary
| | - Zoltán Bács
- Institute of Accounting and Finance, University of Debrecen, Debrecen, Hungary
| | - Mónika Harangi-Rákos
- Institute of Rural Development, Regional Economy and Tourism Management, University of Debrecen, Debrecen, Hungary
| | - László Balogh
- Institute of Sport Science Coordination, University of Debrecen, Debrecen, Hungary
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18
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Improving Healthy Aging by Monitoring Patients' Lifestyle through a Wearable Device: Results of a Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189806. [PMID: 34574738 PMCID: PMC8469467 DOI: 10.3390/ijerph18189806] [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: 07/31/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 12/03/2022]
Abstract
Population aging is related to a huge growth in healthcare and welfare costs. Therefore, wearable devices could be strategic for minimizing years of disability in old age and monitoring patients’ lifestyles and health. The purpose of this study was to assess the feasibility of using smart devices to monitor patients’ physical activity in a primary care setting. To assess the acceptance of this novel technology from the point of view of both patients and healthcare professionals, two questionnaires (one paper-based and one ex-novo developed) were administered to 11 patients with type 2 diabetes mellitus and a non-compliant behavior towards the therapeutic indications of their general practitioner (GP). Seven participants would continue to use a wearable activity tracker to monitor their health. We observed that 75% of patients reported a device’s characteristics satisfaction level of over 80% of the total score assigned to this dimension. No differences were observed in the questionnaire’s scores between the two professionals categories (GPs and nurses). Three dimensions (equipment characteristics, subjective norm, perceived risks, perceived ease-of-use and facilitating conditions) correlated > 0.5 with the device’s acceptability level. Some weak correlations were observed between healthcare professionals’ perception and patients’ parameters, particularly between the dimensions of collaboration and web interface ease-of-use and patients’ median number of steps and hours of sleep. In conclusion, despite the limited number of subjects involved, a good acceptance level towards these non-medical devices was observed, according to both patients’ and healthcare professionals’ impressions.
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19
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Keogh A, Argent R, Anderson A, Caulfield B, Johnston W. Assessing the usability of wearable devices to measure gait and physical activity in chronic conditions: a systematic review. J Neuroeng Rehabil 2021; 18:138. [PMID: 34526053 PMCID: PMC8444467 DOI: 10.1186/s12984-021-00931-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Health Organisation's global strategy for digital health emphasises the importance of patient involvement. Understanding the usability and acceptability of wearable devices is a core component of this. However, usability assessments to date have focused predominantly on healthy adults. There is a need to understand the patient perspective of wearable devices in participants with chronic health conditions. METHODS A systematic review was conducted to identify any study design that included a usability assessment of wearable devices to measure mobility, through gait and physical activity, within five cohorts with chronic conditions (Parkinson's disease [PD], multiple sclerosis [MS], congestive heart failure, [CHF], chronic obstructive pulmonary disorder [COPD], and proximal femoral fracture [PFF]). RESULTS Thirty-seven studies were identified. Substantial heterogeneity in the quality of reporting, the methods used to assess usability, the devices used, and the aims of the studies precluded any meaningful comparisons. Questionnaires were used in the majority of studies (70.3%; n = 26) with a reliance on intervention specific measures (n = 16; 61.5%). For those who used interviews (n = 17; 45.9%), no topic guides were provided, while methods of analysis were not reported in over a third of studies (n = 6; 35.3%). CONCLUSION Usability of wearable devices is a poorly measured and reported variable in chronic health conditions. Although the heterogeneity in how these devices are implemented implies acceptance, the patient voice should not be assumed. In the absence of being able to make specific usability conclusions, the results of this review instead recommends that future research needs to: (1) Conduct usability assessments as standard, irrespective of the cohort under investigation or the type of study undertaken. (2) Adhere to basic reporting standards (e.g. COREQ) including the basic details of the study. Full copies of any questionnaires and interview guides should be supplied through supplemental files. (3) Utilise mixed methods research to gather a more comprehensive understanding of usability than either qualitative or quantitative research alone will provide. (4) Use previously validated questionnaires alongside any intervention specific measures.
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Affiliation(s)
- Alison Keogh
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. .,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
| | - Rob Argent
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | | | - Brian Caulfield
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - William Johnston
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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20
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Patel J, Lai P, Dormer D, Gullapelli R, Wu H, Jones JJ. Comparison of Ease of Use and Comfort in Fitness Trackers for Participants Impaired by Parkinson's Disease: An exploratory study. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2021; 2021:505-514. [PMID: 34457166 PMCID: PMC8378622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Parkinson's disease (PD) is an incurable, fatal neurodegenerative disease, and only available treatment is to minimize symptoms. Anecdotal evidence suggests whole body workout can help to reduce PD severity; however, it is challenging to quantify its effect on PD. The increased availability of fitness trackers can help in quantifying the effect of whole-body workout on PD. Before using any over the counter fitness tracker, we must study the ease of use of the fitness trackers in PD patients. We interviewed 32 PD patients with six over the counter fitness trackers and determined their perceptions and attitude towards the fitness trackers. Although none of the fitness trackers received perfect scores for ease of use or comfort due to the presence of tremors, two trackers performed significantly better than the others. Further study is warranted to understand the potential for fitness trackers to be used by PD patients.
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Affiliation(s)
- Jay Patel
- Department of Bio-Health Informatics, School of Informatics and Computing, Indiana University Purdue University Indianapolis
- Department of Health Services Administration and Policy, College of Public Health, Temple University
| | - Patrick Lai
- Department of Bio-Health Informatics, School of Informatics and Computing, Indiana University Purdue University Indianapolis
| | - Doug Dormer
- Department of Bio-Health Informatics, School of Informatics and Computing, Indiana University Purdue University Indianapolis
| | - Rakesh Gullapelli
- Department of Bio-Health Informatics, School of Informatics and Computing, Indiana University Purdue University Indianapolis
- Center for Outcomes Research, Houston Methodist
| | - Huanmei Wu
- Department of Bio-Health Informatics, School of Informatics and Computing, Indiana University Purdue University Indianapolis
- Department of Health Services Administration and Policy, College of Public Health, Temple University
| | - Josette J Jones
- Department of Bio-Health Informatics, School of Informatics and Computing, Indiana University Purdue University Indianapolis
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21
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Ferguson C, Hickman LD, Turkmani S, Breen P, Gargiulo G, Inglis SC. “Wearables only work on patients that wear them”: Barriers and facilitators to the adoption of wearable cardiac monitoring technologies. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:137-147. [PMID: 35265900 PMCID: PMC8890057 DOI: 10.1016/j.cvdhj.2021.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Wearable technologies are increasingly popular. Yet their use remains low by older adults, who may stand the greatest benefit of use. While there is an abundance of research examining the performance, accuracy, specificity, and sensitivity of wearable devices, many barriers remain and need to be addressed to optimize uptake in clinical practice. There is a paucity of research exploring factors that help to understand barriers and facilitators to inform acceptance, adoption, wearability, and sustainability of use. Objectives (1) To explore the perceptions and experiences of older adults and health professionals about using wearable cardiac monitoring technologies, and (2) to identify barriers and facilitators of acceptance and uptake of these devices in clinical practice. Methods A systematic review with a qualitative meta-synthesis was undertaken. Results A total of 7 original research studies were included. Four interrelated themes emerged: (1) trust, including safety, and confidence; (2) functionality and affordability; (3) risks; and (4) assurance. Conclusion There are many barriers and facilitators to the adoption of wearable devices based on experiences of older adults, health professionals, and carers. Most significant factors related to the design aspects of the devices, appropriate and timely feedback, user-friendly technology, and issues related to affordability and cost.
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Affiliation(s)
- Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District, and Western Sydney University, Sydney, Australia
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Address reprint requests and correspondence: Dr Caleb Ferguson, Senior Research Fellow, NHMRC Emerging Leadership Fellow & Heart Foundation Postdoctoral Fellow, Western Sydney Nursing & Midwifery Research Centre, Western Sydney University, & Western Sydney Local Health District, Blacktown Hospital, Marcel Crescent, Blacktown, NSW, 2148, Australia.
| | - Louise D. Hickman
- Faculty of Health, University of Technology Sydney, Sydney, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sabera Turkmani
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District, and Western Sydney University, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Paul Breen
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Gaetano Gargiulo
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, Australia
| | - Sally C. Inglis
- Faculty of Health, University of Technology Sydney, Sydney, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
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22
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Simmich J, Mandrusiak A, Smith ST, Hartley N, Russell TG. A Co-Designed Active Video Game for Physical Activity Promotion in People With Chronic Obstructive Pulmonary Disease: Pilot Trial. JMIR Serious Games 2021; 9:e23069. [PMID: 33502321 PMCID: PMC7875701 DOI: 10.2196/23069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) who are less active have lower quality of life, greater risk of exacerbations, and greater mortality than those who are more active. The effectiveness of physical activity interventions may facilitate the addition of game elements to improve engagement. The use of a co-design approach with people with COPD and clinicians as co-designers may also improve the effectiveness of the intervention. OBJECTIVE The primary aim of this study is to evaluate the feasibility of a co-designed mobile game by examining the usage of the game, subjective measures of game engagement, and adherence to wearing activity trackers. The secondary aim of this study is to estimate the effect of the game on daily steps and daily moderate-to-vigorous physical activity (MVPA). METHODS Participants with COPD who were taking part in the co-design of the active video game (n=9) acted as the experiment group, spending 3 weeks testing the game they helped to develop. Daily steps and MVPA were compared with a control group (n=9) of participants who did not co-design or test the game. RESULTS Most participants (8/9, 89%) engaged with the game after downloading it. Participants used the game to record physical activity on 58.6% (82/141) of the days the game was available. The highest scores on the Intrinsic Motivation Inventory were seen for the value and usefulness subscale, with a mean of 6.38 (SD 0.6). Adherence to wearing Fitbit was high, with participants in both groups recording steps on >80% of days. Usage of the game was positively correlated with changes in daily steps but not with MVPA. CONCLUSIONS The co-designed mobile app shows promise as an intervention and should be evaluated in a larger-scale trial in this population.
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Affiliation(s)
- Joshua Simmich
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Allison Mandrusiak
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Stuart Trevor Smith
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, Australia
| | - Nicole Hartley
- Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Trevor Glen Russell
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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23
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Haukeland-Parker S, Jervan Ø, Johannessen HH, Gleditsch J, Stavem K, Steine K, Spruit MA, Holst R, Tavoly M, Klok FA, Ghanima W. Pulmonary rehabilitation to improve physical capacity, dyspnea, and quality of life following pulmonary embolism (the PeRehab study): study protocol for a two-center randomized controlled trial. Trials 2021; 22:22. [PMID: 33407792 PMCID: PMC7789311 DOI: 10.1186/s13063-020-04940-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, a large group of patients with persistent dyspnea, poor physical capacity, and reduced health-related quality of life (HRQoL) following pulmonary embolism (PE) has been identified and clustered under the name "post pulmonary embolism syndrome" (PPS). These patients seem good candidates for pulmonary rehabilitation. The aim of the study is to explore whether a pulmonary rehabilitation program can improve physical capacity, dyspnea, and HRQoL in PPS patients. METHODS A two-center randomized controlled trial (RCT) is being performed at Østfold Hospital and Akershus University Hospital in Norway. Patients with PPS are 1:1 randomized into an intervention or a control group. The intervention consists of a supervised, outpatient rehabilitation program twice weekly (1 h) for 8 weeks provided by experienced physiotherapists. The intervention involves individually adapted exercises based on existing pulmonary rehabilitation programs (relaxation, interval, and resistance training), and an educational session including topics such as normal anatomy and physiology of the respiratory and circulatory system, information on PE/PPS, breathing strategies, and benefits of exercise/physical activity. Patients randomized to the control group receive usual care without specific instructions to exercise. Participants in the intervention and control groups will be compared based on assessments conducted at baseline, 12 weeks, and 36 weeks after inclusion using the incremental shuttle walk test (primary outcome) and endurance shuttle walk test (exercise capacity), Sensewear activity monitor (daily physical activity), the modified Medical Research Council scale, the Shortness of Breath Questionnaire (dyspnea), and EQ-5D-5L and the Pulmonary Embolism Quality of Life Questionnaire (HRQoL). Recruitment of 190 patients is currently ongoing. DISCUSSION Results from this study may provide a currently untreated group of PPS patients with an effective treatment resulting in reduced symptoms of dyspnea, improved exercise capacity, and better HRQoL following PE. TRIAL REGISTRATION Clinical Trials NCT03405480 . Registered prospectively on September 2017. Protocol version 1 (from original protocol September 2017). The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 1).
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Affiliation(s)
- Stacey Haukeland-Parker
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, PB 300, 1714, Grålum, Norway. .,Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.
| | - Øyvind Jervan
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.,Department of Internal Medicine, Østfold Hospital Trust (number 3), Grålum, Norway
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, PB 300, 1714, Grålum, Norway.,Department of Health and Welfare, Østfold University College, Fredrikstad, Norway
| | - Jostein Gleditsch
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.,Department of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Knut Stavem
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kjetil Steine
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Medical Division, Akershus University Hospital, Lørenskog, Norway
| | - Martijn A Spruit
- Department of Research and Development, CIRO+, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - René Holst
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.,Department of Internal Medicine, Østfold Hospital Trust (number 3), Grålum, Norway
| | - Mazdak Tavoly
- Department of Internal Medicine, Østfold Hospital Trust (number 3), Grålum, Norway.,Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Waleed Ghanima
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.,Departments of Research, Emergency Medicine and Hematooncology, Østfold Hospital Trust, Grålum, Norway
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24
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Clemenza K, Weiss SH, Cheslack K, Kandel DB, Kandel ER, Levine AA. Social isolation is closely linked to a marked reduction in physical activity in male mice. J Neurosci Res 2020; 99:1099-1107. [PMID: 33368537 DOI: 10.1002/jnr.24777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 11/12/2022]
Abstract
The effects of social isolation on an individual's behavior is an important field of research, especially as public health officials encourage social distancing to prevent the spread of pandemic disease. In this study we evaluate the effects of social isolation on physical activity in mice. Utilizing a pixel-based tracking system, we continuously monitored the movement of isolated mice compared with paired cage mates in the home cage environment. We demonstrate that mice that are socially isolated dramatically decrease their movement when separated from their cage mate, and especially in the dark cycle, when mice are normally most active. When isolated mice are re-paired with their original cage mate, this effect is reversed, and mice return to their prior levels of activity. These findings suggest a close link between social isolation and physical activity, and are of particular interest in the wake of coronavirus disease 2019, when many are forced into isolation. Social isolation may affect an individual's overall activity levels in humans too, which may have unintended effects on health that deserve further consideration.
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Affiliation(s)
- Kelly Clemenza
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Shira H Weiss
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Keely Cheslack
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Denise B Kandel
- Department of Psychiatry and Mailman School of Public Health, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | - Eric R Kandel
- Kavli Institute for Brain Science, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY, USA.,Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, USA.,Howard Hughes Medical Institute, Columbia University, New York, NY, USA.,Department of Neuroscience, Columbia University, New York, NY, USA.,Department of Biochemistry and Molecular Biophysics, Columbia University, New York, NY, USA.,Department of Psychiatry, Columbia University, New York, NY, USA
| | - Amir A Levine
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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25
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Robinson A, Oksuz U, Slight R, Slight S, Husband A. Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review. JMIR Mhealth Uhealth 2020; 8:e19237. [PMID: 33258787 PMCID: PMC7738263 DOI: 10.2196/19237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. OBJECTIVE This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. METHODS A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. RESULTS A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality-based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. CONCLUSIONS These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Umay Oksuz
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert Slight
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sarah Slight
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew Husband
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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26
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An Objective Methodology for the Selection of a Device for Continuous Mobility Assessment. SENSORS 2020; 20:s20226509. [PMID: 33202608 PMCID: PMC7696193 DOI: 10.3390/s20226509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 01/11/2023]
Abstract
Continuous monitoring by wearable technology is ideal for quantifying mobility outcomes in “real-world” conditions. Concurrent factors such as validity, usability, and acceptability of such technology need to be accounted for when choosing a monitoring device. This study proposes a bespoke methodology focused on defining a decision matrix to allow for effective decision making. A weighting system based on responses (n = 69) from a purpose-built questionnaire circulated within the IMI Mobilise-D consortium and its external collaborators was established, accounting for respondents’ background and level of expertise in using wearables in clinical practice. Four domains (concurrent validity, CV; human factors, HF; wearability and usability, WU; and data capture process, CP), associated evaluation criteria, and scores were established through literature research and group discussions. While the CV was perceived as the most relevant domain (37%), the others were also considered highly relevant (WU: 30%, HF: 17%, CP: 16%). Respondents (~90%) preferred a hidden fixation and identified the lower back as an ideal sensor location for mobility outcomes. Overall, this study provides a novel, holistic, objective, as well as a standardized approach accounting for complementary aspects that should be considered by professionals and researchers when selecting a solution for continuous mobility monitoring.
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27
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Geelen SJG, Giele BM, Nollet F, Engelbert RHH, van der Schaaf M. Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study. JMIR Res Protoc 2020; 9:e19000. [PMID: 33185561 PMCID: PMC7695526 DOI: 10.2196/19000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID) DERR1-10.2196/19000
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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28
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Assawasaksakul N, Sirichana W, Joosri W, Kulaputana O, Eksakulkla S, Ketanun C, Kittiskulnam P, Chantadisai M, Takkavatakarn K, Susantitaphong P, Praditpornsilpa K, Eiam-Ong S, Tiranathanagul K. Effects of intradialytic cycling exercise on daily physical activity, physical fitness, body composition, and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-controlled trial. Int Urol Nephrol 2020; 53:359-371. [PMID: 33128722 DOI: 10.1007/s11255-020-02677-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The mortality of dialysis patients treated with high-volume online hemodiafiltration (OL-HDF) is better than hemodialysis, but is still higher than healthy population. Low daily physical activity increases cardiovascular mortality. Addition of intradialytic exercise (IDX) program might improve physical activity and health status in OL-HDF patients. This pilot open-labeled randomized-controlled trial was conducted to evaluate the effects of IDX on physical activity and other clinical parameters in OL-HDF patients. METHODS Twelve OL-HDF patients were randomized into control (n = 6) or IDX (n = 6) groups. The subjects in IDX group were trained to exercise using a cycle ergometer for 60 min during each OL-HDF session. Physical activity measured as daily step count using a wrist-worn triaxial accelerometer, physical fitness, or cardiorespiratory fitness assessed by VO2max and other physical performance tests, lean body mass determined by the Dual-energy X-ray absorptiometry (DXA), quality of life (QOL), and various parameters were compared between baseline and 6 months. RESULTS The baseline physical activity status was comparable. Following 6-month IDX, the physical activity was significantly improved in IDX group [+ 1048.79 (+ 741.50, + 2792.54) vs. - 362.06 (- 1626.82, - 167.47) steps/day, p = 0.01], while physical fitness and QOL were unchanged. The lean body mass parameters were preserved in the IDX group while seemed to decrease in the control group. Serum albumin was significantly increased in the IDX group (p = 0.01). The hemoglobin changes were significantly better (p = 0.01) and the erythropoietin resistance index was significantly lower in the IDX group (p = 0.03). Phosphate reduction was significantly greater in the IDX group (p = 0.04). CONCLUSIONS IDX could improve physical activity and other metabolic parameters in OL-HDF patients and these might contribute to further improvement in clinical and survival outcomes. TRIAL REGISTRATION ClinicalTrials.gov Registration: NCT03353844.
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Affiliation(s)
- Nawaporn Assawasaksakul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Worawan Sirichana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Waraporn Joosri
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Onanong Kulaputana
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sukanya Eksakulkla
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chutima Ketanun
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Maythinee Chantadisai
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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The Use of Inertial Measurement Units for the Study of Free Living Environment Activity Assessment: A Literature Review. SENSORS 2020; 20:s20195625. [PMID: 33019633 PMCID: PMC7583905 DOI: 10.3390/s20195625] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022]
Abstract
This article presents an overview of fifty-eight articles dedicated to the evaluation of physical activity in free-living conditions using wearable motion sensors. This review provides a comprehensive summary of the technical aspects linked to sensors (types, number, body positions, and technical characteristics) as well as a deep discussion on the protocols implemented in free-living conditions (environment, duration, instructions, activities, and annotation). Finally, it presents a description and a comparison of the main algorithms and processing tools used for assessing physical activity from raw signals.
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Kim B, McKay SM, Lee J. Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study. J Med Internet Res 2020; 22:e19732. [PMID: 32880582 PMCID: PMC7499164 DOI: 10.2196/19732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/04/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0% to 59.1%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. Objective The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. Methods From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. Results A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). Conclusions We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services.
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Affiliation(s)
- Ben Kim
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Sandra M McKay
- VHA Home Healthcare, Toronto, ON, Canada.,School of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Joon Lee
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Ng K, Kokko S, Tammelin T, Kallio J, Belton S, O'Brien W, Murphy M, Powell C, Woods C. Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study. J Med Internet Res 2020; 22:e18509. [PMID: 32667894 PMCID: PMC7492981 DOI: 10.2196/18509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background Physical activity trackers (PATs) such as apps and wearable devices (eg, sports watches, heart rate monitors) are increasingly being used by young adolescents. Despite the potential of PATs to help monitor and improve moderate-to-vigorous physical activity (MVPA) behaviors, there is a lack of research that confirms an association between PAT ownership or use and physical activity behaviors at the population level. Objective The purpose of this study was to examine the ownership and use of PATs in youth and their associations with physical activity behaviors, including daily MVPA, sports club membership, and active travel, in 2 nationally representative samples of young adolescent males and females in Finland and Ireland. Methods Comparable data were gathered in the 2018 Finnish School-aged Physical Activity (F-SPA 2018, n=3311) and the 2018 Irish Children’s Sport Participation and Physical Activity (CSPPA 2018, n=4797) studies. A cluster analysis was performed to obtain the patterns of PAT ownership and usage by adolescents (age, 11-15 years). Four similar clusters were identified across Finnish and Irish adolescents: (1) no PATs, (2) PAT owners, (3) app users, and (4) wearable device users. Adjusted binary logistic regression analyses were used to evaluate how PAT clusters were associated with physical activity behaviors, including daily MVPA, membership of sports clubs, and active travel, after stratification by gender. Results The proportion of app ownership among Finnish adolescents (2038/3311, 61.6%) was almost double that of their Irish counterparts (1738/4797, 36.2%). Despite these differences, the clustering patterns of PATs were similar between the 2 countries. App users were more likely to take part in daily MVPA (males, odds ratio [OR] 1.27, 95% CI 1.04-1.55; females, OR 1.49, 95% CI 1.20-1.85) and be members of sports clubs (males, OR 1.37, 95% CI 1.15-1.62; females, OR 1.25, 95% CI 1.07-1.50) compared to the no PATs cluster, after adjusting for country, age, family affluence, and disabilities. These associations, after the same adjustments, were even stronger for wearable device users to participate in daily MVPA (males, OR 1.83, 95% CI 1.49-2.23; females, OR 2.25, 95% CI 1.80-2.82) and be members of sports clubs (males, OR 1.88, 95% CI 1.55-2.88; females, OR 2.07, 95% CI 1.71-2.52). Significant associations were observed between male users of wearable devices and taking part in active travel behavior (OR 1.39, 95% CI 1.04-1.86). Conclusions Although Finnish adolescents report more ownership of PATs than Irish adolescents, the patterns of use and ownership remain similar among the cohorts. The findings of our study show that physical activity behaviors were positively associated with wearable device users and app users. These findings were similar between males and females. Given the cross-sectional nature of this data, the relationship between using apps or wearable devices and enhancing physical activity behaviors requires further investigation.
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Affiliation(s)
- Kwok Ng
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sami Kokko
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland
| | - Tuija Tammelin
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Jouni Kallio
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Sarahjane Belton
- School of Health and Human Performance, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Wesley O'Brien
- School of Education, University College Cork, Cork, Ireland
| | - Marie Murphy
- School of Sport, Ulster University, Belfast, United Kingdom
| | - Cormac Powell
- Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Performance Department, Swim Ireland, Irish Sport HQ, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Alghamdi AS, Alghamdi KA, Jenkins RO, Alghamdi MN, Haris PI. Impact of Ramadan on Physical Activity and Sleeping Patterns in Individuals with Type 2 Diabetes: The First Study Using Fitbit Device. Diabetes Ther 2020; 11:1331-1346. [PMID: 32367477 PMCID: PMC7261298 DOI: 10.1007/s13300-020-00825-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The impact of Ramadan fasting, a type of intermittent fasting, on the management of diabetes has not been well investigated. Physical activity, sleep duration, and time of sleep are susceptible to alterations during Ramadan due to the changes in the times and numbers of meals. This study compared physical activity and sleep patterns of individuals with type 2 diabetes mellitus (T2DM) during and after Ramadan using the international physical activity questionnaire (IPAQ) and a Fitbit Flex 2 accelerometer. METHODS Saudi individuals (n = 36) with T2DM completed a self-reported questionnaire and wore a Fitbit device for seven consecutive days during and after Ramadan. Fitbit generated weekly step counts, activity intensities, sedentary time, and sleep durations and times. IPAQ was used to estimate the physical activity and sitting time of participants in each period. Sleep patterns were assessed in each period by a self-reported questionnaire. RESULTS Both Fitbit and IPAQ indicated a high prevalence of low physical activity among the participants with non-significant variances between the during and after Ramadan periods. Also, a significant short daily total sleeping hours and daily night-time sleeping hours was seen during the Ramadan period. The duration of night-time sleep was observed to be low in each period. CONCLUSIONS This is the first study to use a Fitbit device to monitor individuals with T2DM who chose to fast during Ramadan. The study shows a high prevalence of low physical activity among Saudi individuals with T2DM in each period, and short sleep durations in the during Ramadan period compared to after Ramadan period. A high prevalence of short night-time sleep duration and excessive daytime sleeping was observed in both periods and significantly in the during Ramadan period. A larger study is needed in the future covering before, during, and after Ramadan to evaluate the impact of lifestyle changes related to Ramadan fasting on type 2 diabetes.
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Affiliation(s)
- Abdullah S Alghamdi
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK.
- General Directorate of Medical Services of the Interior Ministry, Riyadh, Saudi Arabia.
| | | | - Richard O Jenkins
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | | | - Parvez I Haris
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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Fore R, Hart JE, Choirat C, Thompson JW, Lynch K, Laden F, Chavarro JE, James P. Embedding Mobile Health Technology into the Nurses' Health Study 3 to Study Behavioral Risk Factors for Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:736-743. [PMID: 32098894 DOI: 10.1158/1055-9965.epi-19-1386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Physical activity and sleep are behavioral risk factors for cancer that may be influenced by environmental exposures, including built and natural environments. However, many studies in this area are limited by residence-based exposure assessment and/or self-reported, time-aggregated measures of behavior. METHODS The Nurses' Health Study 3 (NHS3) Mobile Health Substudy is a pilot study of 500 participants in the prospective NHS3 cohort who use a smartphone application and a Fitbit for seven-day periods, four times over a year, to measure minute-level location, physical activity, heart rate, and sleep. RESULTS We have collected data on 435 participants, comprising over 6 million participant-minutes of heart rate, step, sleep, and location. Over 90% of participants had five days of ≥600 minutes of Fitbit wear-time in their first sampling week, and this percentage dropped to 70% for weeks 2 to 4. Over 819 sampling weeks, we observed an average of 7,581 minutes of heart rate and step data [interquartile range (IQR): 6,651-9,645] per participant-week, and >2 million minutes of sleep in over 5,700 sleep bouts. We have recorded location data for 5,237 unique participant-days, averaging 104 location observations per participant-day (IQR: 103-107). CONCLUSIONS This study describes a protocol to incorporate mobile health technology into a nationwide prospective cohort to measure high-resolution objective data on environment and behavior. IMPACT This project could provide translational insights into interventions for urban planning to optimize opportunities for physical activity and healthy sleep patterns to reduce cancer risk.See all articles in this CEBP Focus section, "Modernizing Population Science."
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Affiliation(s)
- Ruby Fore
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jennifer W Thompson
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Kathleen Lynch
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Peter James
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. .,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Lin WY, Verma VK, Lee MY, Lin HC, Lai CS. Prediction of 30-Day Readmission for COPD Patients Using Accelerometer-Based Activity Monitoring. SENSORS 2019; 20:s20010217. [PMID: 31905995 PMCID: PMC6982816 DOI: 10.3390/s20010217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) claimed 3.0 million lives in 2016 and ranked 3rd among the top 10 global causes of death. Moreover, once diagnosed and discharged from the hospital, the 30-day readmission risk in COPD patients is found to be the highest among all chronic diseases. The existing diagnosis methods, such as Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019, Body-mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index, modified Medical Research Council (mMRC), COPD assessment test (CAT), 6-minute walking distance, which are adopted currently by physicians cannot predict the potential readmission of COPD patients, especially within the 30 days after discharge from the hospital. In this paper, a statistical model was proposed to predict the readmission risk of COPD patients within 30-days by monitoring their physical activity (PA) in daily living with accelerometer-based wrist-worn wearable devices. This proposed model was based on our previously reported PA models for activity index (AI) and regularity index (RI) and it introduced a new parameter, quality of activity (QoA), which incorporates previously proposed parameters, such as AI and RI, with other activity-based indices to predict the readmission risk. Data were collected from continuous PA monitoring of 16 COPD patients after hospital discharge as test subjects and readmission prediction criteria were proposed, with a 63% sensitivity and a 37.78% positive prediction rate. Compared to other clinical assessment, diagnosis, and prevention methods, the proposed model showed significant improvement in predicting the 30-day readmission risk.
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Affiliation(s)
- Wen-Yen Lin
- Department of Electrical Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan;
- Correspondence: ; Tel.: +886-3-2118-800 (ext. 3675)
| | - Vijay Kumar Verma
- Department of Electrical Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
| | - Ming-Yih Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan;
- Graduate Institute of Biomedical Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan;
| | - Chao-Sung Lai
- Department of Electronic Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan 33305, Taiwan
- Department of Materials Engineering, Ming Chi University of Technology, New Taipei 24301, Taiwan
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Gore S, Blackwood J, Guyette M, Alsalaheen B. Validity and Reliability of Accelerometers in Patients With COPD: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2019; 38:147-158. [PMID: 29120966 DOI: 10.1097/hcr.0000000000000284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Reduced physical activity is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Accelerometers have greatly improved quantification of physical activity by providing information on step counts, body positions, energy expenditure, and magnitude of force. The purpose of this systematic review was to compare the validity and reliability of accelerometers used in patients with COPD. METHODS An electronic database search of MEDLINE and CINAHL was performed. Study quality was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology checklist while methodological quality was assessed using the modified Quality Appraisal Tool for Reliability Studies. RESULTS The search yielded 5392 studies; 25 met inclusion criteria. The SenseWear Pro armband reported high criterion validity under controlled conditions (r = 0.75-0.93) and high reliability (ICC = 0.84-0.86) for step counts. The DynaPort MiniMod demonstrated highest concurrent validity for step count using both video and manual methods. DISCUSSION Validity of the SenseWear Pro armband varied between studies especially in free-living conditions, slower walking speeds, and with addition of weights during gait. A high degree of variability was found in the outcomes used and statistical analyses performed between studies, indicating a need for further studies to measure reliability and validity of accelerometers in COPD. CONCLUSION The SenseWear Pro armband is the most commonly used accelerometer in COPD, but measurement properties are limited by gait speed variability and assistive device use. DynaPort MiniMod and Stepwatch accelerometers demonstrated high validity in patients with COPD but lack reliability data.
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Affiliation(s)
- Shweta Gore
- Department of Physical Therapy, University of Michigan-Flint, Flint
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Abstract
Activity trackers are relatively inexpensive, easily available, and widely used by consumers. There has been increased interest in healthcare practice and research to use activity tracker data. Continuous collection of health variables including step count, heart rate, and calorimetry provides researchers and clinicians data to monitor patients after an intervention and/or encourage physical activity. The purpose of this article is to review the current use of activity trackers in orthopaedics and discuss potential applications in clinical research.
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Self-monitoring to increase physical activity in patients with cardiovascular disease: a systematic review and meta-analysis. Aging Clin Exp Res 2019; 31:163-173. [PMID: 29714027 DOI: 10.1007/s40520-018-0960-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS It is important to encourage physical activity in patients with cardiovascular disease (CVD), and self-monitoring is considered to contribute to increased physical activity. However, the effects of self-monitoring on CVD patients remain to be established. In this study, we examined the influence of self-monitoring on physical activity of patients with CVD via a systematic review and meta-analysis. METHODS Screening of randomized controlled trials only was undertaken twice on PubMed (date of appraisal: August 29, 2017). The inclusion criteria included outpatients with CVD, interventions for them, daily step counts as physical activity included in the outcome, and self-monitoring included in the intervention. Assessments of the risk of bias and meta-analysis in relation to the mean change of daily step counts were conducted to verify the effects of self-monitoring. RESULTS From 205 studies retrieved on PubMed, six studies were included, with the oldest study published in 2005. Participants included 693 patients of whom 541 patients completed each study program. Their mean age was 60.8 years, and the ratio of men was 79.6%. From these 6 studies, a meta-analysis was conducted with 269 patients of 4 studies including only RCTs with step counts in the intervention group and the control group, and self-monitoring significantly increased physical activity (95% confidence interval, 1916-3090 steps per day, p < 0.05). The average intervention period was about 5 months. Moreover, four studies involved intervention via the internet, and five studies confirmed the use of self-monitoring combined with other behavior change techniques. CONCLUSION The results suggest that self-monitoring of physical activity by patients with CVD has a significantly positive effect on their improvement. Moreover, the trend toward self-monitoring combined with setting counseling and activity goals, and increased intervention via the internet, may lead to the future development and spread of self-monitoring for CVD patients.
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Daligadu J, Pollock CL, Carlaw K, Chin M, Haynes A, Thevaraajah Kopal T, Tahsinul A, Walters K, Colella TJF. Validation of the Fitbit Flex in an Acute Post-Cardiac Surgery Patient Population. Physiother Can 2018; 70:314-320. [PMID: 30745716 DOI: 10.3138/ptc.2017-34] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study examined the validity of the Fitbit Flex activity monitor for step count and distance walked among post-cardiac surgery patients. Method: Participants (n=20) from a major urban cardiac surgery centre were recruited 1-2 days before hospital discharge. The Fitbit Flex step count and distance walked outputs and video recording of each participant performing the 6-minute walk test were collected. Fitbit Flex output was compared with criterion measures of manual step count obtained from the video recording and manual measurement of distance walked. Statistical analysis compared the output and criterion measures using paired sample t-tests, Pearson correlation coefficients, Lin's concordance correlations, and Bland-Altman plots. Sub-analysis compared slower walking (<0.8 m/s; n=11) and faster walking (≥0.8 m/s; n=8) group speeds (1 participant was excluded from analysis). Results: Steps counted and distance walked were significantly different between the Fitbit Flex outputs and criterion measures (p<0.05). The Fitbit Flex steps counted and distance walked showed moderate association with manual measure steps counted (r=0.67) and distance walked (r=0.45). Lin's concordance coefficients revealed a lack of agreement between the Fitbit Flex and the criterion measurement of both steps counted (concordance correlation coefficient [CCC]=0.43) and distance walked (CCC=0.36). The percentage of relative error was -18.6 (SD 22.7) for steps counted and 25.4 (SD 45.8) for distance walked. Conclusions: The Fitbit Flex activity monitor was not a valid measure of step count and distance walked in this sample of post-cardiac surgery patients. The lack of agreement between outputs and criterion measures suggests the Fitbit Flex alone would not be an acceptable clinical outcome measure for monitoring walking progression in the early postoperative period.
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Affiliation(s)
| | - Courtney L Pollock
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver
| | | | | | | | | | - Anam Tahsinul
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver
| | - Kaili Walters
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto
| | - Tracey J F Colella
- Rehabilitation Sciences Institute.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.,Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute
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O'Neill B, O'Shea O, McDonough S, McGarvey L, Bradbury I, Arden M, Troosters T, Cosgrove D, McManus T, McDonnell T, Bradley J. Clinician-Facilitated Physical Activity Intervention Versus Pulmonary Rehabilitation for Improving Physical Activity in COPD: A Feasibility Study. COPD 2018; 15:254-264. [PMID: 30183414 DOI: 10.1080/15412555.2018.1486396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pulmonary rehabilitation (PR) may not suit all individuals with chronic obstructive pulmonary disease (COPD) and may not result in increased physical activity. Higher levels of physical activity are associated with reduced mortality and morbidity. The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention (PAI) versus PR in improving physical activity in patients with COPD referred to PR. In this randomised controlled mixed methods feasibility study, all patients referred to PR who were eligible and willing were assessed at baseline and then randomised to the PAI or to PR. The assessments were repeated post-intervention and at 3-month follow-up. The main outcome was step count measured by Actigraph. Semi-structured interviews were conducted post-intervention. The N = 50 patients; mean (SD) age, 64.1(8.6) years, 24M were recruited and randomised; N = 23 (PAI) and n = 26 (PR): one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria. Key feasibility criteria were met; recruitment was 11%, dropouts in PAI were 26% (n = 6) and 50% (n = 13/26) PR. Participants in both groups experienced a range of health benefits from their respective programmes. The PAI appears to be effective in increasing step counts in people with COPD: mean change (standard deviation) [confidence interval] for the PAI group was 972.0(3230.3)[-1080.3 to 3024.4], n = 12 and 4.3(662.7)[-440.9 to 449.5], n = 11 for the PR group. The PAI met all domains of fidelity. This study provides key information to inform a future-randomised controlled trial in physical activity.
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Affiliation(s)
- Brenda O'Neill
- a Centre for Health and Rehabilitation Technologies , Ulster University , Newtownabbey , UK
| | - Orlagh O'Shea
- a Centre for Health and Rehabilitation Technologies , Ulster University , Newtownabbey , UK
| | - Suzanne McDonough
- b Centre for Health and Rehabilitation Technologies , Ulster University and UKCRC Centre of Excellence for Public Health , Northern Ireland , UK
| | - Lorcan McGarvey
- c Centre for Experimental Medicine, School of Medicine , Dentistry & Biomedical Sciences, Queens University Belfast , Belfast , UK
| | - Ian Bradbury
- a Centre for Health and Rehabilitation Technologies , Ulster University , Newtownabbey , UK
| | - Madelynne Arden
- d Department of Psychology, Sociology & Politics , Sheffield Hallam University, Heart of the Campus , Collegiate Crescent , Sheffield , UK
| | - Thierry Troosters
- e Faculty of Kinesiology and Rehabilitation Sciences , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Denise Cosgrove
- f Northern Ireland Clinical Research Network (Respiratory Health) , Belfast Health and Social Care Trust , Belfast , UK
| | - Terence McManus
- g Department of Respiratory Medicine , Western Health and Social Care Trust , Enniskillen , Northern Ireland , UK
| | - Tim McDonnell
- h Department of Respiratory Medicine , St. Vincent's University Hospital , Dublin , Ireland
| | - Judy Bradley
- i Centre for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences , Queens University Belfast , Belfast , UK
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Feehan LM, Geldman J, Sayre EC, Park C, Ezzat AM, Yoo JY, Hamilton CB, Li LC. Accuracy of Fitbit Devices: Systematic Review and Narrative Syntheses of Quantitative Data. JMIR Mhealth Uhealth 2018; 6:e10527. [PMID: 30093371 PMCID: PMC6107736 DOI: 10.2196/10527] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/05/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background Although designed as a consumer product to help motivate individuals to be physically active, Fitbit activity trackers are becoming increasingly popular as measurement tools in physical activity and health promotion research and are also commonly used to inform health care decisions. Objective The objective of this review was to systematically evaluate and report measurement accuracy for Fitbit activity trackers in controlled and free-living settings. Methods We conducted electronic searches using PubMed, EMBASE, CINAHL, and SPORTDiscus databases with a supplementary Google Scholar search. We considered original research published in English comparing Fitbit versus a reference- or research-standard criterion in healthy adults and those living with any health condition or disability. We assessed risk of bias using a modification of the Consensus-Based Standards for the Selection of Health Status Measurement Instruments. We explored measurement accuracy for steps, energy expenditure, sleep, time in activity, and distance using group percentage differences as the common rubric for error comparisons. We conducted descriptive analyses for frequency of accuracy comparisons within a ±3% error in controlled and ±10% error in free-living settings and assessed for potential bias of over- or underestimation. We secondarily explored how variations in body placement, ambulation speed, or type of activity influenced accuracy. Results We included 67 studies. Consistent evidence indicated that Fitbit devices were likely to meet acceptable accuracy for step count approximately half the time, with a tendency to underestimate steps in controlled testing and overestimate steps in free-living settings. Findings also suggested a greater tendency to provide accurate measures for steps during normal or self-paced walking with torso placement, during jogging with wrist placement, and during slow or very slow walking with ankle placement in adults with no mobility limitations. Consistent evidence indicated that Fitbit devices were unlikely to provide accurate measures for energy expenditure in any testing condition. Evidence from a few studies also suggested that, compared with research-grade accelerometers, Fitbit devices may provide similar measures for time in bed and time sleeping, while likely markedly overestimating time spent in higher-intensity activities and underestimating distance during faster-paced ambulation. However, further accuracy studies are warranted. Our point estimations for mean or median percentage error gave equal weighting to all accuracy comparisons, possibly misrepresenting the true point estimate for measurement bias for some of the testing conditions we examined. Conclusions Other than for measures of steps in adults with no limitations in mobility, discretion should be used when considering the use of Fitbit devices as an outcome measurement tool in research or to inform health care decisions, as there are seemingly a limited number of situations where the device is likely to provide accurate measurement.
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Affiliation(s)
- Lynne M Feehan
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | | | | | - Chance Park
- Arthritis Research Canada, Richmond, BC, Canada
| | - Allison M Ezzat
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Clayon B Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
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Wearable activity monitors to assess performance status and predict clinical outcomes in advanced cancer patients. NPJ Digit Med 2018; 1:27. [PMID: 31304309 PMCID: PMC6550281 DOI: 10.1038/s41746-018-0032-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/12/2022] Open
Abstract
An objective evaluation of patient performance status (PS) is difficult because patients spend the majority of their time outside of the clinic, self-report to providers, and undergo dynamic changes throughout their treatment experience. Real-time, objective activity data may allow for a more accurate assessment of PS and physical function, while reducing the subjectivity and bias associated with current assessments. Consenting patients with advanced cancer wore a wearble activity monitor for three consecutive visits in a prospective, single-cohort clinical trial. Provider-assessed PS (ECOG/Karnofsky) and NIH PROMIS® patient-reported outcomes (PROs) were assessed at each visit. Associations between wearable activity monitor metrics (steps, distance, stairs) and PS, clinical outcomes (adverse events, hospitalizations, survival), and PROs were assessed using correlation statistics and in multivariable logistic regression models. Thirty-seven patients were evaluated (54% male, median 62 years). Patients averaged 3700 steps, 1.7 miles, and 3 flights of stairs per day. Highest correlations were observed between average daily steps and ECOG-PS and KPS (r = 0.63 and r = 0.69, respectively p < 0.01). Each 1000 steps/day increase was associated with reduced odds for adverse events (OR: 0.34, 95% CI 0.13, 0.94), hospitalizations (OR: 0.21 95% CI 0.56, 0.79), and hazard for death (HR: 0.48 95% CI 0.28–0.83). Significant correlations were also observed between activity metrics and PROs. Our trial demonstrates the feasibility of using wearable activity monitors to assess PS in advanced cancer patients and suggests their potential use to predict clinical and patient-reported outcomes. These findings should be validated in larger, randomized trials. Wearable activity monitors provide an objective and continuous measure of general wellbeing and physical function among patients with advanced cancer. Gillian Gresham from Cedars-Sinai Medical Center in Los Angeles, California, USA, and colleagues enlisted 37 patients with metastatic or inoperable cancer to wear wristbands that wireless measure heart rate and activity patterns over the span of 2 weeks. At weekly clinic visits, the patients also filled in health questionnaires and their healthcare providers made independent evaluations. The researchers found a reasonably high correlation between the clinician-assessed performance status and the average daily step total calculated by the wristband. More steps also translated into lower odds of serious complications, hospitalizations or death. The study shows the feasibility of using wearable technology to track the ability of patients with advanced cancer to perform certain activities of daily living.
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Weatherall J, Paprocki Y, Meyer TM, Kudel I, Witt EA. Sleep Tracking and Exercise in Patients With Type 2 Diabetes Mellitus (Step-D): Pilot Study to Determine Correlations Between Fitbit Data and Patient-Reported Outcomes. JMIR Mhealth Uhealth 2018; 6:e131. [PMID: 29871856 PMCID: PMC6008516 DOI: 10.2196/mhealth.8122] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/12/2017] [Accepted: 03/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background Few studies assessing the correlation between patient-reported outcomes and patient-generated health data from wearable devices exist. Objective The aim of this study was to determine the direction and magnitude of associations between patient-generated health data (from the Fitbit Charge HR) and patient-reported outcomes for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Methods This was a pilot study conducted with adults diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at 3 time points: day 1, day 7, and day 14. Patient-generated health data included minutes asleep and number of steps taken. Questionnaires assessed the number of days of exercise and nights of sleep problems per week. Means and SDs were calculated for all data, and Pearson correlations were used to examine associations between patient-reported outcomes and patient-generated health data. All respondents provided informed consent before participating. Results The participants were predominantly middle-aged (mean 54.3, SD 13.3 years), white (80/86, 93%), and female (50/86, 58%). Use of oral T2DM medication correlated with the number of mean steps taken (r=.35, P=.001), whereas being unaware of the glycated hemoglobin level correlated with the number of minutes asleep (r=−.24, P=.04). On the basis of the Fitbit data, participants walked an average of 4955 steps and slept 6.7 hours per day. They self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between the number of days exercised and steps walked was strong (r=.60, P<.001), whereas the association between the number of troubled sleep nights and minutes asleep was weaker (r=.28, P=.02). Conclusions Fitbit and patient-reported data were positively associated for physical activity as well as sleep, with the former more strongly correlated than the latter. As extensive patient monitoring can guide clinical decisions regarding T2DM therapy, passive, objective data collection through wearables could potentially enhance patient care, resulting in better patient-reported outcomes.
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Affiliation(s)
| | | | | | - Ian Kudel
- Kantar Health, New York City, NY, United States
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Ummels D, Beekman E, Theunissen K, Braun S, Beurskens AJ. Counting Steps in Activities of Daily Living in People With a Chronic Disease Using Nine Commercially Available Fitness Trackers: Cross-Sectional Validity Study. JMIR Mhealth Uhealth 2018; 6:e70. [PMID: 29610110 PMCID: PMC5902695 DOI: 10.2196/mhealth.8524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/22/2017] [Accepted: 01/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Measuring physical activity with commercially available activity trackers is gaining popularity. People with a chronic disease can especially benefit from knowledge about their physical activity pattern in everyday life since sufficient physical activity can contribute to wellbeing and quality of life. However, no validity data are available for this population during activities of daily living. Objective The aim of this study was to investigate the validity of 9 commercially available activity trackers for measuring step count during activities of daily living in people with a chronic disease receiving physiotherapy. Methods The selected activity trackers were Accupedo (Corusen LLC), Activ8 (Remedy Distribution Ltd), Digi-Walker CW-700 (Yamax), Fitbit Flex (Fitbit inc), Lumoback (Lumo Bodytech), Moves (ProtoGeo Oy), Fitbit One (Fitbit inc), UP24 (Jawbone), and Walking Style X (Omron Healthcare Europe BV). In total, 130 persons with chronic diseases performed standardized activity protocols based on activities of daily living that were recorded on video camera and analyzed for step count (gold standard). The validity of the trackers’ step count was assessed by correlation coefficients, t tests, scatterplots, and Bland-Altman plots. Results The correlations between the number of steps counted by the activity trackers and the gold standard were low (range: –.02 to .33). For all activity trackers except for Fitbit One, a significant systematic difference with the gold standard was found for step count. Plots showed a wide range in scores for all activity trackers; Activ8 showed an average overestimation and the other 8 trackers showed underestimations. Conclusions This study showed that the validity of 9 commercially available activity trackers is low measuring steps while individuals with chronic diseases receiving physiotherapy engage in activities of daily living.
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Affiliation(s)
- Darcy Ummels
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands.,ParaMedisch Centrum Zuid, Sittard, Netherlands.,Care and Public Health Research Institute School for Public Health and Primary Care, Department of Family Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Emmylou Beekman
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands.,ParaMedisch Centrum Zuid, Sittard, Netherlands.,Care and Public Health Research Institute School for Public Health and Primary Care, Department of Family Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Kyra Theunissen
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands
| | - Susy Braun
- Research Centre for Nutrition, Lifestyle and Exercise, Zuyd University of Applied Sciences, Heerlen, Netherlands.,Care and Public Health Research Institute School for Public Health and Primary Care, Department of Health Services Research, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Anna J Beurskens
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands.,Care and Public Health Research Institute School for Public Health and Primary Care, Department of Family Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
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Kressler J, Koeplin-Day J, Muendle B, Rosby B, Santo E, Domingo A. Accuracy and precision of consumer-level activity monitors for stroke detection during wheelchair propulsion and arm ergometry. PLoS One 2018; 13:e0191556. [PMID: 29444105 PMCID: PMC5812573 DOI: 10.1371/journal.pone.0191556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/07/2018] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to evaluate whether consumer-level activity trackers can estimate wheelchair strokes and arm ergometer revolutions. Thirty able-bodied participants wore three consumer-level activity trackers (Garmin VivoFit, FitBit Flex, and Jawbone UP24) on the wrist. Participants propelled a wheelchair at fixed frequencies (30, 45 and 60 strokes per minute (spm)) three minutes each and at pre-determined varied frequencies, (30-80 spm) for two minutes. Participants also freely wheeled through an obstacle course. 10 other participants performed arm-ergometry at 40, 60 and 80 revolutions per minute (rpm), for three minutes each. Mean percentage error (MPE(SD)) for 30 spm were ≥46(26)% for all monitors, and declined to 3-6(2-7)% at 60 spm. For the obstacle course, MPE ranged from 12-17(7-13)% for all trackers. For arm-ergometry, MPE was at 1-96(0-37)% with the best measurement for the Fitbit at 60 and 80 rpm, and the Garmin at 80rpm, with MPE = 1(0-1)%. The consumer-level wrist-worn activity trackers we tested have higher accuracy/precision at higher movement frequencies but perform poorly at lower frequencies.
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Affiliation(s)
- Jochen Kressler
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, United States of America
| | - Joshua Koeplin-Day
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, United States of America
| | - Benedikt Muendle
- Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Brice Rosby
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, United States of America
| | - Elizabeth Santo
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, United States of America
| | - Antoinette Domingo
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, United States of America
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, United States of America
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Ehn M, Eriksson LC, Åkerberg N, Johansson AC. Activity Monitors as Support for Older Persons' Physical Activity in Daily Life: Qualitative Study of the Users' Experiences. JMIR Mhealth Uhealth 2018; 6:e34. [PMID: 29391342 PMCID: PMC5814603 DOI: 10.2196/mhealth.8345] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/08/2017] [Accepted: 12/05/2017] [Indexed: 01/14/2023] Open
Abstract
Background Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems. Objective The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective? Methods This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis. Results The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days. Conclusions Activity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA.
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Affiliation(s)
- Maria Ehn
- School of Innovation, Design and Engineering, Mälardalen University, Västerås, Sweden
| | | | - Nina Åkerberg
- Västerås Municipality Care and Welfare, Västerås Municipality, Västerås, Sweden
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Jacquemin C, Servy H, Molto A, Sellam J, Foltz V, Gandjbakhch F, Hudry C, Mitrovic S, Fautrel B, Gossec L. Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study. JMIR Mhealth Uhealth 2018; 6:e1. [PMID: 29295810 PMCID: PMC5770578 DOI: 10.2196/mhealth.7948] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/15/2017] [Accepted: 10/30/2017] [Indexed: 01/10/2023] Open
Abstract
Background Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.
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Affiliation(s)
- Charlotte Jacquemin
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | | | - Anna Molto
- Rheumatology B Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, Paris-Descartes University, Sorbonne Paris-Cité, Paris, France
| | - Jérémie Sellam
- Rheumatology Department, St-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU i2B, INSERM UMRS_938, UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Violaine Foltz
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Frédérique Gandjbakhch
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Christophe Hudry
- Rheumatology B Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Mitrovic
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Bruno Fautrel
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Laure Gossec
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
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Puri A, Kim B, Nguyen O, Stolee P, Tung J, Lee J. User Acceptance of Wrist-Worn Activity Trackers Among Community-Dwelling Older Adults: Mixed Method Study. JMIR Mhealth Uhealth 2017; 5:e173. [PMID: 29141837 PMCID: PMC5707431 DOI: 10.2196/mhealth.8211] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/06/2017] [Accepted: 09/23/2017] [Indexed: 01/15/2023] Open
Abstract
Background Wearable activity trackers are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer-grade wearable activity trackers are increasingly ubiquitous in the market, but the attitudes toward, as well as acceptance and voluntary use of, these trackers in older population are poorly understood. Objective The aim of this study was to assess acceptance and usage of wearable activity trackers in Canadian community-dwelling older adults, using the potentially influential factors as identified in literature and technology acceptance model. Methods A mixed methods design was used. A total of 20 older adults aged 55 years and older were recruited from Southwestern Ontario. Participants used 2 different wearable activity trackers (Xiaomi Mi Band and Microsoft Band) separately for each segment in the crossover design study for 21 days (ie, 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing 2 different devices. Semistructured interviews were conducted with 4 participants, and a content analysis was performed. Results Participants ranged in age from 55 years to 84 years (mean age: 64 years). The Mi Band gained higher levels of acceptance (16/20, 80%) compared with the Microsoft Band (10/20, 50%). The equipment characteristics dimension scored significantly higher for the Mi Band (P<.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (P<.05). Multivariate logistic regression with 3 covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of the following main themes: (1) smartphones as facilitators of wearable activity trackers; (2) privacy is less of a concern for wearable activity trackers, (3) value proposition: self-awareness and motivation; (4) subjective norm, social support, and sense of independence; and (5) equipment characteristics matter: display, battery, comfort, and aesthetics. Conclusions Older adults were mostly accepting of wearable activity trackers, and they had a clear understanding of its value for their lives. Wearable activity trackers were uniquely considered more personal than other types of technologies, thereby the equipment characteristics including comfort, aesthetics, and price had a significant impact on the acceptance. Results indicated that privacy was less of concern for older adults, but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of wearable activity trackers among older adults.
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Affiliation(s)
- Arjun Puri
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Ben Kim
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Olivier Nguyen
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - James Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Joon Lee
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Gresham G, Schrack J, Gresham LM, Shinde AM, Hendifar AE, Tuli R, Rimel BJ, Figlin R, Meinert CL, Piantadosi S. Wearable activity monitors in oncology trials: Current use of an emerging technology. Contemp Clin Trials 2017; 64:13-21. [PMID: 29129704 DOI: 10.1016/j.cct.2017.11.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/16/2017] [Accepted: 11/01/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Physical activity is an important outcome in oncology trials. Physical activity is commonly assessed using self-reported questionnaires, which are limited by recall and response biases. Recent advancements in wearable technology have provided oncologists with new opportunities to obtain real-time, objective physical activity data. The purpose of this review was to describe current uses of wearable activity monitors in oncology trials. METHODS We searched Pubmed, Embase, and the Cochrane Central Register of Controlled Trials for oncology trials involving wearable activity monitors published between 2005 and 2016. We extracted details on study design, types of activity monitors used, and purpose for their use. We summarized activity monitor metrics including step counts, sleep and sedentary time, and time spent in moderate-to-vigorous activity. RESULTS We identified 41 trials of which 26 (63%) involved cancer survivors (post-treatment) and 15 trials (37%) involved patients with active cancer. Most trials (65%) involved breast cancer patients. Wearable activity monitors were commonly used in exercise (54%) or behavioral (29%) trials. Cancer survivors take between 4660 and 11,000 steps/day and those undergoing treatment take 2885 to 8300steps/day. CONCLUSION Wearable activity monitors are increasingly being used to obtain objective measures of physical activity in oncology trials. There is potential for their use to expand to evaluate and predict clinical outcomes such as survival, quality of life, and treatment tolerance in future studies. Currently, there remains a lack of standardization in the types of monitors being used and how their data are being collected, analyzed, and interpreted. PRECIS Recent advancements in wearable activity monitor technology have provided oncologists with new opportunities to monitor their patients' daily activity in real-world settings. The integration of wearable activity monitors into cancer care will help increase our understanding of the associations between physical activity and the prevention and management of the disease, in addition to other important cancer outcomes.
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Affiliation(s)
- Gillian Gresham
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States; Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States.
| | - Jennifer Schrack
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States
| | | | - Arvind M Shinde
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Andrew E Hendifar
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Richard Tuli
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - B J Rimel
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Robert Figlin
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Curtis L Meinert
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States
| | - Steven Piantadosi
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
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Hermsen S, Moons J, Kerkhof P, Wiekens C, De Groot M. Determinants for Sustained Use of an Activity Tracker: Observational Study. JMIR Mhealth Uhealth 2017; 5:e164. [PMID: 29084709 PMCID: PMC5695980 DOI: 10.2196/mhealth.7311] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/06/2017] [Accepted: 07/31/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A lack of physical activity is considered to cause 6% of deaths globally. Feedback from wearables such as activity trackers has the potential to encourage daily physical activity. To date, little research is available on the natural development of adherence to activity trackers or on potential factors that predict which users manage to keep using their activity tracker during the first year (and thereby increasing the chance of healthy behavior change) and which users discontinue using their trackers after a short time. OBJECTIVE The aim of this study was to identify the determinants for sustained use in the first year after purchase. Specifically, we look at the relative importance of demographic and socioeconomic, psychological, health-related, goal-related, technological, user experience-related, and social predictors of feedback device use. Furthermore, this study tests the effect of these predictors on physical activity. METHODS A total of 711 participants from four urban areas in France received an activity tracker (Fitbit Zip) and gave permission to use their logged data. Participants filled out three Web-based questionnaires: at start, after 98 days, and after 232 days to measure the aforementioned determinants. Furthermore, for each participant, we collected activity data tracked by their Fitbit tracker for 320 days. We determined the relative importance of all included predictors by using Random Forest, a machine learning analysis technique. RESULTS The data showed a slow exponential decay in Fitbit use, with 73.9% (526/711) of participants still tracking after 100 days and 16.0% (114/711) of participants tracking after 320 days. On average, participants used the tracker for 129 days. Most important reasons to quit tracking were technical issues such as empty batteries and broken trackers or lost trackers (21.5% of all Q3 respondents, 130/601). Random Forest analysis of predictors revealed that the most influential determinants were age, user experience-related factors, mobile phone type, household type, perceived effect of the Fitbit tracker, and goal-related factors. We explore the role of those predictors that show meaningful differences in the number of days the tracker was worn. CONCLUSIONS This study offers an overview of the natural development of the use of an activity tracker, as well as the relative importance of a range of determinants from literature. Decay is exponential but slower than may be expected from existing literature. Many factors have a small contribution to sustained use. The most important determinants are technical condition, age, user experience, and goal-related factors. This finding suggests that activity tracking is potentially beneficial for a broad range of target groups, but more attention should be paid to technical and user experience-related aspects of activity trackers.
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Affiliation(s)
- Sander Hermsen
- Institute for Communication, Research Group Crossmedial Communication in the Public Domain, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Jonas Moons
- Institute for Communication, Research Group Crossmedial Communication in the Public Domain, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Peter Kerkhof
- Department of Communication Science, Vrije Universiteit, Amsterdam, Netherlands
| | - Carina Wiekens
- Centre of Expertise Energy, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Martijn De Groot
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
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50
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Verma VK. Levels of activity identification & sleep duration detection with a wrist-worn accelerometer-based device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2369-2372. [PMID: 29060374 DOI: 10.1109/embc.2017.8037332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, a model for identifying the levels of physical activity (PA) with a wrist-worn accelerometer-based device has been proposed. The levels of identified PA have been categorized into rest/sleep, sedentary, light, moderate, and vigorous activity states by analyzing the data collected from 10 normal subjects. An activity-based sleep duration detection algorithm has been proposed and implemented thereafter to further distinguish activities between short period of rest and sleep. The model and method proposed in this study could be further used to monitor subject's daily PA status and sleep quality assessment in the future for various home-based healthcare applications.
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