We think it's important to share our findings

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.

Authors

Moran, O., McHugh, L. & Larsson, A.

Acceptance and Commitment Therapy (ACT) has demonstrated promising outcomes to date with clinical populations affected by psychosis, however, there is a dearth of such investigations involving non-clinical samples despite evidence that symptoms of psychosis exist on a continuum in the general population. The present study aimed to investigate how key ACT processes relate to psychosis-like symptoms in the general population. A convenience sample of 77 adults completed self-report measures of cognitive fusion, mindfulness, experiential avoidance, and psychosis-like symptoms, and relative distress, intrusiveness and frequency. A series of correlational and hierarchical regression analyses investigated the relationship between target variables. Higher mindfulness was related to lower levels of psychosis-like symptoms as well as lower distress, intrusiveness, and frequency in relation to these experiences, as were lower levels of cognitive fusion and experiential avoidance. Higher levels of cognitive fusion and experiential avoidance, as well as lower levels mindfulness, emerged as significant predictors of higher levels of psychosis-like symptoms, and higher relative distress, intrusiveness, and frequency. Findings are discussed in relation to implications for future clinical research.

Authors

Doyle, J., Murphy, E., Gavin, S., Pascale, A., Deparis, S., Tommasi, P., Smith, S., Hannigan, C., Sillevis Smitt, M., van Leeuwen, C., Lastra, J., Galvin, M., McAleer, P., Tompkins, L., Jacobs, A., Marques, M.M., Medina, J., Boyle, G., Dinsmore, J.

Background

Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, represent a promising solution to help people monitor their conditions and lifestyle, maintain good health and reduce unscheduled clinical visits. However, most platforms tend to have a single disease focus, despite high prevalence rates of multimorbidity, or multiple chronic conditions. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement.

Objective

The objectives were to (1) design and develop a digital health platform, called ProACT, to facilitate older adults self-managing multimorbidity, with support from their care network; (2) evaluate end user engagement and experiences with the platform through a 12-month trial.

Methods

The ProACT digital health platform is presented. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts, and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement, semi-structured interviews were conducted with participants and analysed using inductive thematic analysis methods, while usability and user burden were examined using validated questionnaires.

Results

This article presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who took part, 24 withdrew before the end of the study while three passed away. The remaining 93 participants actively used the platform until the end of the trial, on average taking two or three health readings daily over the course of the trial, in Ireland and Belgium respectively. Participants reported ProACT to be usable and of low burden. Findings from interviews outline that participants experienced multiple benefits as a result of using ProACT, including improved self-management, improved health and wellbeing and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected.

Conclusions

This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multiple chronic conditions. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for this include a strong focus on user-centred design and engagement throughout the project lifecycle, resulting in a platform that met user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement.

Authors

Muggeridge, D.J., Hickson, K., Davies, A.V., Giggins, O.M., Megson, I.L., Gorely, T., Crabtree, D.R.

Background

Accurate, continuous heart rate measurements are important for health assessment, physical activity, and sporting performance, and the integration of heart rate measurements into wearable devices has extended its accessibility. Although the use of photoplethysmography technology is not new, the available data relating to the validity of measurement are limited, and the range of activities being performed is often restricted to one exercise domain and/or limited intensities.

Objective

The primary objective of this study was to assess the validity of the Polar OH1 and Fitbit Charge 3 devices for measuring heart rate during rest, light, moderate, vigorous, and sprint-type exercise.

Methods

A total of 20 healthy adults (9 female; height: mean 1.73 [SD 0.1] m; body mass: mean 71.6 [SD 11.0] kg; and age: mean 40 [SD 10] years) volunteered and provided written informed consent to participate in the study consisting of 2 trials. Trial 1 was split into 3 components: 15-minute sedentary activities, 10-minute cycling on a bicycle ergometer, and incremental exercise test to exhaustion on a motorized treadmill (18-42 minutes). Trial 2 was split into 2 components: 4 × 15-second maximal sprints on a cycle ergometer and 4 × 30- to 50-m sprints on a nonmotorized resistance treadmill. Data from the 3 devices were time-aligned, and the validity of Polar OH1 and Fitbit Charge 3 was assessed against Polar H10 (criterion device). Validity was evaluated using the Bland and Altman analysis, Pearson moment correlation coefficient, and mean absolute percentage error.

Results

Overall, there was a very good correlation between the Polar OH1 and Polar H10 devices (r=0.95), with a mean bias of −1 beats·min-1 and limits of agreement of −20 to 19 beats·min-1. The Fitbit Charge 3 device underestimated heart rate by 7 beats·min-1 compared with Polar H10, with a limit of agreement of −46 to 33 beats·min-1 and poor correlation (r=0.8). The mean absolute percentage error for both devices was deemed acceptable (<5%). Polar OH1 performed well across each phase of trial 1; however, validity was worse for trial 2 activities. Fitbit Charge 3 performed well only during rest and nonsprint-based treadmill activities.

Conclusions

Compared with our criterion device, Polar OH1 was accurate at assessing heart rate, but the accuracy of Fitbit Charge 3 was generally poor. Polar OH1 performed worse during trial 2 compared with the activities in trial 1, and the validity of the Fitbit Charge 3 device was particularly poor during our cycling exercises.

Authors

Vavasour, G., Giggins, O.M., Doyle, J., Kelly, D.

Background

Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world’s population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide.

Aim

The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults.

Method

Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS).

Results

Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty.

Conclusions

Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.

Authors

Dinsmore, J., Hannigan, C., Smith, S., Murphy, E., Kuiper, J., O’Byrne, E., Galvin, M., Jacobs, A., Sillevis Smitt, M., van Leeuwen, C., McAleer, P., Tompkins, L., Brady, A-M., McCarron, M., Doyle, J.

Background

Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practice around the provision of well-coordinated, person-centred care for persons with multimorbidity (PwMs). Present health systems across the European Union (EU) focus on supporting a single disease framework of care; the primary challenge is to create a patient centric integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale Horizon 2020 funded project, that involved the design, development and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged 65+) living with multimorbidity.

Objective

This paper describes the trial implementation protocol of a proof of concept (PoC) digital health platform (ProACT) in two EU member states (Ireland and Belgium) to support older persons with multimorbidity self-managing at home, supported by their care network.

Methods

Research was conducted across two EU member states, Ireland and Belgium. A twelve month action research trial design, divided into three evaluation cycles, lasting three months each, with a reflective re-design phase of one month after cycles 1 and 2 was conducted. Participants were 120 (n=60 in Ireland and Belgium respectively) older persons with multimorbidity (PwMs) diagnosed with two or more of the following chronic conditions: diabetes; chronic obstructive pulmonary disease (COPD); chronic heart failure (CHF); cardiovascular diseases (CVDs). With permission from the PwM, members of their care network (CN) were invited to participate in the study. PwM participants were provided with ProACT technologies (tablet/devices/sensors) to support them in self-managing their conditions. CN members also received access to an application to remotely support their PwM. Qualitative and quantitative feedback and evaluation data from PwM and CN participants was collected across 4 time-points: baseline (T1); at the end of each 3-month action research cycle (T2; T3) and in a final post-trial interview (T4). Thematic analysis was used to analyse qualitative interview data. Quantitative data were analysed via platform usage statistics (to assess engagement) and standardised questionnaires (using descriptive and inferential statistics). This study was approved by ethics committees in Ireland and Belgium.

Results

The trial implementation phase for this 44 month (2016-2019) funded study was April 2018 to June 2019. Trial outcomes are being submitted for publication in 2020.

Conclusions

ProACT aims to co-design and develop a digital intervention with PwMs and their CN, incorporating clinical guidelines with the state of the art in; human computer interaction, behavioural science, health psychology and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive integrated model of supported person-centred care.