Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.

Assessing post-operative recovery is a significant component of perioperative care, since this assessment might facilitate detecting complications and determining an appropriate discharge date. However, recovery is difficult to assess and challenging to predict, as no universally accepted definition exists. Current solutions often contain a high level of subjectivity, measure recovery only at one moment in time, and only investigate recovery until the discharge moment. For these reasons, this research aims to create a model that predicts continuous recovery scores in perioperative care in the hospital and at home for objective decision making. This regression model utilized vital signs and activity metrics measured using wearable sensors and the XGBoost algorithm for training. The proposed model described continuous recovery profiles, obtained a high predictive performance, and provided outcomes that are interpretable due to the low number of features in the final model. Moreover, activity features, the circadian rhythm of the heart, and heart rate recovery showed the highest feature importance in the recovery model. Patients could be identified with fast and slow recovery trajectories by comparing patient-specific predicted profiles to the average fast- and slow-recovering populations. This identification may facilitate determining appropriate discharge dates, detecting complications, preventing readmission, and planning physical therapy. Hence, the model can provide an automatic and objective decision support tool.

Excessive weight gain during pregnancy increases the risk for negative effects on mother and child during pregnancy, delivery, and also postnatally. Excessive weight gain can be partially compensated by being sufficiently physically active, which can be measured using activity trackers. Modern activity trackers often use accelerometer data as well as heart rate data to estimate energy expenditure. Because pregnancy affects the metabolism and cardiac output, it is not evident that activity trackers that are calibrated to the general population can be reliably used during pregnancy. We evaluated whether an activity monitor designed for the general population is sufficiently accurate for estimating energy expenditure in pregnant women. Forty pregnant women (age: 30.8 ± 4.7 years, BMI: 25.0 ± 4.0) from all three trimesters performed a 1-h protocol including paced and self-paced exercise activities as well as household activities. We tracked reference energy expenditure using indirect calorimetry and used equivalence testing to determine whether the estimated energy expenditure from the activity monitor was within the limits of equivalence. Overall we found an averaged underestimation of 10 kcal (estimated energy expenditure was 97% of the reference measurement). The 90% CI for the cumulative total energy expenditure was 94–100%. The activities of self-paced cycling, household activities, stair-walking, and yoga had one of their equivalence boundaries outside a 80–125% range of equivalence; for exercise on a cross-trainer, for self-paced and fixed-pace walking, fixed-paced cycling, and resting, the estimations were within the limits of equivalence. We conclude that the activity monitor is sufficiently accurate for every-day use during pregnancy. The observed deviations can be accounted for and are acceptable from a statistical and an applied perspective because the positive and negative deviations that we observed cancel out to an accurate average energy expenditure over a day, and estimations during exercise are sufficiently accurate to enable coaching on physical activity. The positive and negative deviations themselves were relatively small. Therefore, the activity monitor can be used to help in preventing excessive weight gain during pregnancy by accurately tracking physical activity.

Walking speed is a strong indicator of the health status of older people and patients. Using algorithms, the walking speed can be estimated from wearable accelerometers, which enables minimally obtrusive (longitudinal) monitoring. We evaluated the performance of two algorithms, the inverted pendulum (IP) algorithm, and a novel adaptation correcting for lateral step movement, which aimed to improve accuracy during slow walking. To evaluate robustness, we gathered data from different groups (healthy adults, elderly, and elderly patients) of volunteers (n = 159) walking under various conditions (over ground, treadmill, using walking aids) at a broad range of speeds (0.11–1.93 m/s). Both of the algorithms showed good agreement with the reference values and similar root-mean-square errors (RMSEs) for walking speeds ≥0.5 m/s, which ranged from 0.09–0.16 m/s for the different positions, in line with the results from others. However, for slower walking, RMSEs were significantly better for the new method (0.06–0.09 m/s versus 0.15–0.19 m/s). Pearson correlation improved for speeds <0.5 m/s (from 0.67–0.72 to 0.73–0.82) as well as higher speeds (0.87–0.97 to 0.90–0.98) with the new method. Overall, we found that IP(-based) walking speed estimation proved to be applicable for a variety of wearing positions, conditions and speeds, indicating its potential value for health assessment applications.

UNSTRUCTURED Wearable sensor technology could have an important role for clinical research and in delivering health care. Accordingly, such technology should undergo rigorous evaluation prior to market launch, and its performance should be supported by evidence-based marketing claims. Many studies have been published attempting to validate wrist-worn photoplethysmography (PPG)-based heart rate monitoring devices, but their contrasting results question the utility of this technology. The reason why many validations did not provide conclusive evidence of the validity of wrist-worn PPG-based heart rate monitoring devices is mostly methodological. The validation strategy should consider the nature of data provided by both the investigational and reference devices. There should be uniformity in the statistical approach to the analyses employed in these validation studies. The investigators should test the technology in the population of interest and in a setting appropriate for intended use. Device industries and the scientific community require robust standards for the validation of new wearable sensor technology.