We think it's important to share our findings

Authors

Vavasour G, Giggins OM, Flood MW, Doyle J, Doheny E, Kelly D.

One of the problems facing an ageing population is functional decline associated with reduced levels of physical activity (PA). Traditionally researcher or clinician input is necessary to capture parameters of gait or PA. Enabling older adults to monitor their activity independently could raise their awareness of their activitiy levels, promote self-care and potentially mitigate the risks associated with ageing. The ankle is accepted as the optimum position for sensor placement to capture parameters of gait however, the waist is proposed as a more accessible body-location for older adults. This study aimed to compare step-count measurements obtained from a single inertial sensor positioned at the ankle and at the waist to that of a criterion measure of step-count, and to compare gait parameters obtained from the sensors positioned at the two different body-locations. Step-count from the waist-mounted inertial sensor was compared with that from the ankle-mounted sensor, and with a criterion measure of direct observation in healthy young and healthy older adults during a three-minute treadmill walk test. Parameters of gait obtained from the sensors at both body-locations were also compared. Results indicated there was a strong positive correlation between step-count measured by both the ankle and waist sensors and the criterion measure, and between ankle and waist sensor step-count, mean step time and mean stride time (r = .802–1.0). There was a moderate correlation between the step time variability measures at the waist and ankle (r = .405). This study demonstrates that a single sensor positioned at the waist is an appropriate method for the capture of important measures of gait and physical activity among older adults.

Authors

Moran O, Doyle J, Giggins O, McHugh L, Gould E, Smith S, Gavin S, Sojan N, Boyle G.

Background

Research indicates that the management of distress levels in those with cardiac disease is not only important for improving quality of life and functioning but also critical for condition management; adherence to treatment; and, ultimately, disease prognosis and progression. Acceptance and commitment therapy (ACT) has consistently demonstrated positive long-term outcomes across a wide array of conditions, including chronic illness. However, most empirical investigations conducted to date have also involved in-person therapy, which can be difficult to access, particularly for those dealing with the demands of chronic disease.

Objective

The objective of our research is to evaluate a digital ACT intervention for improving self-management behaviors and distress levels in those with cardiac conditions.

Methods

The digital ACT intervention will be delivered via a digital health self-management platform over 6 sessions. This will involve a randomized, multiple baseline, single case experimental design with approximately 3 to 15 adults with cardiac disease. The independent variable for each participant will be the pre-post intervention phase. The dependent variables will be a daily self-report measure of psychological flexibility as well as objective measures of condition self-management (eg, blood pressure readings) and engagement with the app (eg, completing guided mindfulness). One-to-one qualitative interviews will also be conducted to further examine participants’ experiences with using the intervention and what factors contribute to or impede successful outcomes.

Results

Participant recruitment and data collection began in October 2021, and it is projected that the study findings will be available for dissemination by spring 2022.

Conclusions

The findings will be discussed in terms of how a digital ACT intervention can best meet the needs of cardiac patients.

Authors

Doyle, J., McAleer, P., van Leeuwen, C., Smith, S., Murphy, E., Sillevis Smitt, M., Galvin, M., Jacobs, A., Tompkins, L., Sheerin, J., & Dinsmore, J.

Background

Achieving patient-centred care necessitates supporting individuals to have more involvement in the self-management of their care. Digital health technologies are widely recognised as a solution to empower more effective self-management. However, given the complexity of multiple chronic condition (multimorbidity) management, coupled with changes that occur as part of the normal ageing process, human support alongside digital self-management is often necessary for older people with multimorbidity (PwM) to sustain successful self-management.

Methods

The aim of the study was to explore the role played by a clinical, nurse-led telephone triage service in responding to alerts generated by older adults using a digital health platform, ProACT, to self-manage multiple chronic conditions over a period of 1 year. Semi-structured interviews with participants with multimorbidity were carried out across four time points during the trial, while interviews and focus groups were conducted with triage nurses at the end of the trial. Thematic analysis was conducted on the resulting transcripts.

Results

Themes found in the data include the work of triage nurses; the benefits of triage support; tensions such as anxiety due to patient monitoring; and the relationship between triage nurses and participants.

Discussion

This work contributes to an understanding of how older adults with multimorbidity and triage nurses collaborate in multiple chronic disease self-management. Findings are discussed within the context of Hudon et al.’s patient-centred care framework and indicate that patient-centred care was achieved, with both PwM and triage participants reporting positive experiences, relationships and several benefits of the triage support alongside digital self-management.

Authors

Giggins OM, Doyle J, Smith S, Vavasour G, Moran O, Gavin S, Sojan N, Boyle G.

Background

Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR.

Objective

We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre–Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program.

Methods

In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed.

Results

In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F1,14=.026; P=.87) nor effect for time (F1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study.

Conclusions

This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs.

Authors

Jonathan Turner, Ciarán Nugent, Damon Berry, Michael Wilson, Ann Marron, Julie Doyle, Dympna O Sullivan

For people with early or moderate dementia, there are benefits to them continuing to live in their own homes for as long as possible, both in improved quality of life and associated measures such as increased social contact, increased physical activity, lower use of medication, and reduced costs and burden of care. Tools to help extend the period of independent living, and to maintain quality of life in this period, are lacking. Systems exist to monitor individuals for problems, e.g. falls or wandering from the home, but there is scope for development of computerised support to help maintain activity in independent living. We aim to monitor achievement of activities, by app and by sensors, and provide recommendations on how to best maintain activities. We describe a goal model to monitor achievement and to suggest replacement activities and goals when an activity goal can no longer be achieved.

Authors

Oonagh M. Giggins, Julie Doyle, Nisanth Sojan, Orla Moran, Daniel R Crabtree, Matthew Fraser, David J Muggeridge

This study compared heart rate (HR) measurements taken from two wrist-worn devices; the Empatica E4 and the Apple Watch Series 5, to that taken from a Polar H10 chest strap. Ten healthy adult volunteers took part in a laboratory validation study and performed a treadmill exercise protocol. A single-subject validity study was also conducted to evaluate the accuracy of continuous HR measurements obtained during free-living activities. The participant wore both wrist devices, as well as the Polar H10 for 12-hours, as she continued her habitual daily activities. The key findings of the laboratory study were that the Apple Watch was accurate at assessing HR compared to the Polar H10 with Mean Absolute Percentage Error (MAPE)values < 5% during treadmill exercise. The accuracy of the E4 however was generally poor with MAPE values > 15%. Findings from the single-subject validity study indicate that the Apple Watch produces accurate measurements of HR, whereas the E4device overestimated HR, except for during the more strenuous activities undertaken where HR was underestimated.

Authors

Oonagh M Giggins, BSc, MSc, PhD; Julie Doyle, BSc, PhD; Suzanne Smith, BSocSci, MSc; Orla Moran, BA, PhD;Shane Gavin, BSc; Nisanth Sojan, PGD, BIT; Gordon Boyle, BSc, MA

Background: Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective: The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering – Cardiac Rehabilitation (ECME-CR) platform. Methods: A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semi-structured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results: Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022.Conclusions: This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform.