Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review

Background Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Methods Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Results Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). Conclusion This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied

Smartphone apps for total hip replacement and total knee replacement surgery patients: a systematic review

Purpose: The aim of this study was to critically examine the content of smartphone apps produced for patients undergoing total hip replacement and total knee replacement surgery.Materials and methods: A systematic search was conducted across the five most popular smartphone app stores: iTunes; Google Play; Windows Mobile; Blackberry App World; and Nokia Ovi. Apps were identified for screening if they: targeted total hip replacement or total knee replacement patients; were free of charge; and were in English. App quality assessment was conducted independently by three reviewers using the Mobile App Rating Scale.Results: 15 apps met the inclusion criteria. On the 5-point Mobile App Rating Scale, the mean overall app quality score was 3.1. Within the Mobile App Rating Scale, the "Aesthetics" subscale had the most inconsistency across all apps, generating the highest and lowest mean scores (4.7 and 1, respectively). The "functionality" subscale had the highest mean score (3.8) among the four subscales, and the "information" subscale had the lowest mean score (2.7).Conclusion: This study highlights that despite a wide range of apps currently available to total hip replacement and total knee replacement patients, there is significant variability in their quality. Future efforts should be made to develop apps in partnership with patients, to improve the content, interactivity and relevance of apps.Implications for RehabilitationClinicians and rehabilitation professionals should consider that patients are using Smartphone apps to supplement their rehabilitation and be aware of currently available apps.Although some apps show promise, at present there is no one openly available app which is clinically recommended for rehabilitation use following total hip replacement and total knee replacement.Rehabilitation professionals tailor recovery programmes to individual patient needs following total hip replacement and total knee replacement, and future apps should also consider personal needs.We recommend that patients are involved in all stages of designing and testing future total hip replacement and total knee replacement rehabilitation apps

Smartphone apps for total hip replacement and total knee replacement surgery patients: a systematic review

Purpose: The aim of this study was to critically examine the content of smartphone apps produced for patients undergoing total hip replacement and total knee replacement surgery. Materials and methods: A systematic search was conducted across the five most popular smartphone app stores: iTunes; Google Play; Windows Mobile; Blackberry App World; and Nokia Ovi. Apps were identified for screening if they: targeted total hip replacement or total knee replacement patients; were free of charge; and were in English. App quality assessment was conducted independently by three reviewers using the Mobile App Rating Scale. Results: 15 apps met the inclusion criteria. On the 5-point Mobile App Rating Scale, the mean overall app quality score was 3.1. Within the Mobile App Rating Scale, the “Aesthetics” subscale had the most inconsistency across all apps, generating the highest and lowest mean scores (4.7 and 1, respectively). The “functionality” subscale had the highest mean score (3.8) among the four subscales, and the “information” subscale had the lowest mean score (2.7). Conclusion: This study highlights that despite a wide range of apps currently available to total hip replacement and total knee replacement patients, there is significant variability in their quality. Future efforts should be made to develop apps in partnership with patients, to improve the content, interactivity and relevance of apps

A Self-Reporting Tool to Reduce the Occurrence of Postoperative Adverse Events After Total Hip Arthroplasty

This thesis presents a research that has designed and evaluated a high-fidelity smartphone prototype, called SafeTHA. SafeTHA has been designed for patients to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A User-Centered Design approach was utilized to facilitate an optimal user experience and to emphasize the end-user. The prototype has two main functionalities. Firstly, it enables patients to self-report their current state through answering five simple questions from evidence-based practices regarding pain, anxiety, mobility, progress, and quality of recovery. Secondly, it informs the user about several aspects of rehabilitation such as pain, known risk factors, wound management, and recommended activity level. The use of mobile technology could enable timely self-reporting and collection of subjective patient data out of a hospital setting. The low-, and mid-fidelity prototypes were assessed by experts of Interaction Design, Medical Informatics, Biomedical Engineering, and healthcare professionals with respect to interaction flow, information content, and self-reporting functionalities. They found it to be practical, intuitive, sufficient and simple for users. The high-fidelity prototype was evaluated by medical experts and usability experts through the rigorous methods, System Usability Scale (SUS) and Heuristic Evaluation (HE). The results indicate that patient self-reporting could help recognize safety issues, adverse events, and empower patients postoperatively. Additional testing in a clinical setting is needed to fully demonstrate its usefulness.Masteroppgave i informasjonsvitenskapINFO390MASV-INF

Approaches to functional electrical stimulation induced cycling and application for the child with a spinal cord injury

In the hope of more compact and user-friendly approaches to FES-cycling through the incorporation of modern sensor and computing technology, two new hip-angle-based strategies (both of which utilise a limb-mounted sensor) and a “traditional” crank-angle-based strategy have been developed and incorporated into a PDA-based multi-functional FES system. Through both simulation and tricycle-based experiments, all three approaches have been shown to provide practical stimulation activation timing. The second research focus concerns the development of two FES-cycling systems which are suitable for a spinal cord injured child, and methods to facilitate the intended use of both devices. A standard child’s tricycle has been modified with appropriate instrumentation for FES-cycling and testing involving its target population was carried out at a US-based paediatric research hospital. These experiments culminated in the demonstration of FES-cycling by an untrained seven year old T4/T6 (motor complete) subject, and the evolution of the device into one which should be able to meet the specific needs of spinal cord injured children. A second system with integrated motor has also been developed. As well as offering motor assistance, this device incorporates additional instrumentation to allow investigation into exercise and training capabilities. Experiments have been undertaken to validate this equipment and it is now ready for future pilot work involving paediatric subjects. The two research foci in this thesis represent what are, in our opinion, important routes that FES-cycling should take to progress into the home environment and also allow participation of a population who have potentially the most to gain from using it

Total ankle replacement versus ankle arthrodesis for patients aged 50-85 years with end-stage ankle osteoarthritis: the TARVA RCT

BACKGROUND: We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis. METHODS: This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation. The primary outcome was the change in the Manchester-Oxford Foot Questionnaire walking/standing domain scores between the preoperative baseline and 52 weeks post surgery. RESULTS: Between March 2015 and January 2019, 303 participants were randomised using a minimisation algorithm: 152 to total ankle replacement and 151 to ankle fusion. At 52 weeks, the mean (standard deviation) Manchester-Oxford Foot Questionnaire walking/standing domain score was 31.4 (30.4) in the total ankle replacement arm (n = 136) and 36.8 (30.6) in the ankle fusion arm (n = 140); the adjusted difference in the change was -5.6 (95% confidence interval -12.5 to 1.4; p = 0.12) in the intention-to-treat analysis. By week 52, one patient in the total ankle replacement arm required revision. Rates of wound-healing issues (13.4% vs. 5.7%) and nerve injuries (4.2% vs. < 1%) were higher and the rate of thromboembolic events was lower (2.9% vs. 4.9%) in the total ankle replacement arm than in the ankle fusion arm. The bone non-union rate (based on plain radiographs) in the ankle fusion arm was 12.1%, but only 7.1% of patients had symptoms. A post hoc analysis of fixed-bearing total ankle replacement showed a statistically significant improvement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score (-11.1, 95% confidence interval -19.3 to -2.9; p = 0.008). We estimate a 69% likelihood that total ankle replacement is cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over the patient's lifetime. LIMITATIONS: This initial report contains only 52-week data, which must therefore be interpreted with caution. In addition, the pragmatic nature of the study means that there was heterogeneity between surgical implants and techniques. The trial was run across 17 NHS centres to ensure that decision-making streams reflected the standard of care in the NHS as closely as possible. CONCLUSIONS: Both total ankle replacement and ankle fusion improved patients' quality of life at 1 year, and both appear to be safe. When total ankle replacement was compared with ankle fusion overall, we were unable to show a statistically significant difference between the two arms in terms of our primary outcome measure. The total ankle replacement versus ankle arthrodesis (TARVA) trial is inconclusive in terms of superiority of total ankle replacement, as the 95% confidence interval for the adjusted treatment effect includes both a difference of zero and the minimal important difference of 12, but it can rule out the superiority of ankle fusion. A post hoc analysis comparing fixed-bearing total ankle replacement with ankle fusion showed a statistically significant improvement of total ankle replacement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score. Total ankle replacement appears to be cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over a patient's lifetime based on long-term economic modelling. FUTURE WORK: We recommend long-term follow-up of this important cohort, in particular radiological and clinical progress. We also recommend studies to explore the sensitivity of clinical scores to detect clinically important differences between arms when both have already achieved a significant improvement from baseline. TRIAL REGISTRATION: This trial is registered as ISRCTN60672307 and ClinicalTrials.gov NCT02128555. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 5. See the NIHR Journals Library website for further project information

Suggested approach for establishing a rehabilitation engineering information service for the state of California

An ever expanding body of rehabilitation engineering technology is developing in this country, but it rarely reaches the people for whom it is intended. The increasing concern of state and federal departments of rehabilitation for this technology lag was the stimulus for a series of problem-solving workshops held in California during 1977. As a result of the workshops, the recommendation emerged that the California Department of Rehabilitation take the lead in the development of a coordinated delivery system that would eventually serve the entire state and be a model for similar systems across the nation

Enabling mobile microinteractions

While much attention has been paid to the usability of desktop computers, mobile com- puters are quickly becoming the dominant platform. Because mobile computers may be used in nearly any situation--including while the user is actually in motion, or performing other tasks--interfaces designed for stationary use may be inappropriate, and alternative interfaces should be considered. In this dissertation I consider the idea of microinteractions--interactions with a device that take less than four seconds to initiate and complete. Microinteractions are desirable because they may minimize interruption; that is, they allow for a tiny burst of interaction with a device so that the user can quickly return to the task at hand. My research concentrates on methods for applying microinteractions through wrist- based interaction. I consider two modalities for this interaction: touchscreens and motion- based gestures. In the case of touchscreens, I consider the interface implications of making touchscreen watches usable with the finger, instead of the usual stylus, and investigate users' performance with a round touchscreen. For gesture-based interaction, I present a tool, MAGIC, for designing gesture-based interactive system, and detail the evaluation of the tool.Ph.D.Committee Chair: Starner, Thad; Committee Member: Abowd, Gregory; Committee Member: Isbell, Charles; Committee Member: Landay, james; Committee Member: McIntyre, Blai

Technology for monitoring everyday prosthesis use: a systematic review

BACKGROUND Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring. METHODS A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis-users during daily-living. RESULTS 60 lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm. CONCLUSIONS Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users