The Extent and Coverage of Current Knowledge of Connected Health: Systematic Mapping Study

Background: This paper examines the development of the Connected Health research landscape with a view on providing a historical perspective on existing Connected Health research. Connected Health has become a rapidly growing research field as our healthcare system is facing pressured to become more proactive and patient centred. Objective: We aimed to identify the extent and coverage of the current body of knowledge in Connected Health. With this, we want to identify which topics have drawn the attention of Connected health researchers, and if there are gaps or interdisciplinary opportunities for further research. Methods: We used a systematic mapping study that combines scientific contributions from research on medicine, business, computer science and engineering. We analyse the papers with seven classification criteria, publication source, publication year, research types, empirical types, contribution types research topic and the condition studied in the paper. Results: Altogether, our search resulted in 208 papers which were analysed by a multidisciplinary group of researchers. Our results indicate a slow start for Connected Health research but a more recent steady upswing since 2013. The majority of papers proposed healthcare solutions (37%) or evaluated Connected Health approaches (23%). Case studies (28%) and experiments (26%) were the most popular forms of scientific validation employed. Diabetes, cancer, multiple sclerosis, and heart conditions are among the most prevalent conditions studied. Conclusions: We conclude that Connected Health research seems to be an established field of research, which has been growing strongly during the last five years. There seems to be more focus on technology driven research with a strong contribution from medicine, but business aspects of Connected health are not as much studied

Investigating different approaches and analyses of psychological variables to enhance sport and exercise

This thesis addresses the acquisition of knowledge through a logical step by step process during the PhD course, highlighting five research activities with a main focus on sport and exercise psychology. The ultimate goal for research looked at exploring wearable devices and associated digital technology to deliver interventions aimed to increase exercise while measuring psychological variables such as stress. A foundation was initially set with a systematic review and meta-analysis on correlations between physical activity and key variables such as self-efficacy, self-regulation, and anxiety measured using validated questionnaires. A continued interest in exploring psychometric tools and their validation in sport drove the analysis of a motivation scales and related parameters in a cohort of Italian rugby players. With the beginning of the COVID-19 pandemic, however, community-based sports activities stopped, and the way in which exercise was performed and measured rapidly changed, as I highlighted in the report “Physical activity: Benefits and challenges during the COVID-19 pandemic”. In this unexpected scenario, government agencies as well as private entities and academic institutions applied digital technology to deliver health and wellbeing messages. The use of novel tools was beneficial while facing increased sedentarism occurring during restrictions and lock-down periods. The study performed, involving office workers and electronically delivering exercise interventions in the form of active breaks, showed improvement in wellbeing and stress reduction. Finally, the last study presented can be viewed as a marker in time, as people return to normality, exercising and performing their normal routine but with a new emphasis in keeping track of their own health and wellbeing through wearable technology, following the change in measuring physical and psychological variables consolidated during the pandemic. The results met the intended goal to successfully provide a message-based, digitally delivered intervention aimed at increasing exercise and reducing stress among university students, using wearables to measure the outcome. Moreover, the comparison of wearable-associated stress (based on physiological stimuli) with self-reported stress using a validated questionnaire (e.g., Perceived Stress Scale-10) showed a promising connection. I intend to continue in this direction to further explore benefits and limitations of digital technology in sport and exercise psychology

Evaluating the Reproducibility of Physiological Stress Detection Models

Recent advances in wearable sensor technologies have led to a variety of approaches for detecting physiological stress. Even with over a decade of research in the domain, there still exist many significant challenges, including a near-total lack of reproducibility across studies. Researchers often use some physiological sensors (custom-made or off-the-shelf), conduct a study to collect data, and build machine-learning models to detect stress. There is little effort to test the applicability of the model with similar physiological data collected from different devices, or the efficacy of the model on data collected from different studies, populations, or demographics. This paper takes the first step towards testing reproducibility and validity of methods and machine-learning models for stress detection. To this end, we analyzed data from 90 participants, from four independent controlled studies, using two different types of sensors, with different study protocols and research goals. We started by evaluating the performance of models built using data from one study and tested on data from other studies. Next, we evaluated new methods to improve the performance of stress-detection models and found that our methods led to a consistent increase in performance across all studies, irrespective of the device type, sensor type, or the type of stressor. Finally, we developed and evaluated a clustering approach to determine the stressed/not-stressed classification when applying models on data from different studies, and found that our approach performed better than selecting a threshold based on training data. This paper\u27s thorough exploration of reproducibility in a controlled environment provides a critical foundation for deeper study of such methods, and is a prerequisite for tackling reproducibility in free-living conditions

Pulse Rate Variability for the Assessment of Cardiovascular Changes

Pulse rate variability (PRV) describes the way pulse rate changes through time and is measured from pulsatile signals such as the photoplethysmogram (PPG). It has been proposed as a surrogate for heart rate variability (HRV). Nonetheless, the relationship between these variables is not entirely clear, probably due to both physiological and technical aspects involved in the extraction of PRV. Moreover, the effects of cardiovascular changes on PRV have not been elucidated. In this thesis, four studies were performed to (1) determine the best combination of some technical aspects for the extraction of PRV from PPG signals; (2) evaluate the relationship between PRV and HRV under different cardiovascular conditions; and (3) explore the effects of cardiovascular changes on PRV. First, PRV extraction gave lower errors when (1) signals were acquired for at least 120 s with a 256 Hz sampling rate and filtered with lower low cut-off frequencies and elliptic, equiripple or Parks-McClellan filter; (2) cardiac cycles were determined using the D2max algorithm and the a fiducial points; and (3) the Fast Fourier Transform was applied to obtain frequency spectra. Secondly, the relationship between HRV and PRV was found to be affected by cold exposure and changes in blood pressure, while PRV was found to be different at different body sites. Finally, PRV was affected by haemodynamic changes, such as target flow, stroke rate and blood pressure, both in an in-vitro model and in-vivo data. Additionally, PRV was found to be a potential tool for the estimation of blood pressure, with errors as low as 1:54 ± 0:17 mmHg, 1:07 ± 0:06 mmHg and 1:22 ± 0:09 mmHg for the estimation of systolic, diastolic and mean arterial pressure. Although more studies are needed to fully understand PRV and its clinical potential, PRV should not be regarded as the same as HRV, and it could be consider as a potential valuable biomarker for cardiovascular health