Decision Making Concepts for the Remote, Personalized Evaluation of COPD Patients’ Health Status

Colantonio, Sara; Govoni, Leonardo; Dellacà, Raffaele L.; Martinelli, Massimo; Salvetti, Ovidio; Vitacca, Michele

doi:10.3414/me13-02-0038

Cited by 14 publications

(17 citation statements)

References 29 publications

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“…We found that there were a high percentage of patients who were not interested in participating. While telemonitoring studies have not consistently reported their recruitment rate [ 18 , 19 ], our recruitment rate was lower than the rate found in the custom COPD wristband study (16% vs 57%) and our dropout rate was higher (43% vs 22%) [ 17 ]. This may have been due to privacy concerns of recording audio or the differences in recruitment settings, as one of our sources of patients was hospitalized patients who were often too sick to participate.…”

Section: Discussionmentioning

confidence: 61%

Feasibility of Using a Smartwatch to Intensively Monitor Patients With Chronic Obstructive Pulmonary Disease: Prospective Cohort Study

Wu¹,

Liaqat²,

Lara³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundAcute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated decline in lung function, diminished quality of life, and higher mortality. Proactively monitoring patients for early signs of an exacerbation and treating them early could prevent these outcomes. The emergence of affordable wearable technology allows for nearly continuous monitoring of heart rate and physical activity as well as recording of audio which can detect features such as coughing. These signals may be able to be used with predictive analytics to detect early exacerbations. Prior to full development, however, it is important to determine the feasibility of using wearable devices such as smartwatches to intensively monitor patients with COPD.ObjectiveWe conducted a feasibility study to determine if patients with COPD would wear and maintain a smartwatch consistently and whether they would reliably collect and transmit sensor data.MethodsPatients with COPD were recruited from 3 hospitals and were provided with a smartwatch that recorded audio, heart rate, and accelerations. They were asked to wear and charge it daily for 90 days. They were also asked to complete a daily symptom diary. At the end of the study period, participants were asked what would motivate them to regularly use a wearable for monitoring of their COPD.ResultsOf 28 patients enrolled, 16 participants completed the full 90 days. The average age of participants was 68.5 years, and 36% (10/28) were women. Survey, heart rate, and activity data were available for an average of 64.5, 65.1, and 60.2 days respectively. Technical issues caused heart rate and activity data to be unavailable for approximately 13 and 17 days, respectively. Feedback provided by participants indicated that they wanted to actively engage with the smartwatch and receive feedback about their activity, heart rate, and how to better manage their COPD.ConclusionsSome patients with COPD will wear and maintain smartwatches that passively monitor audio, heart rate, and physical activity, and wearables were able to reliably capture near-continuous patient data. Further work is necessary to increase acceptability and improve the patient experience.

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Section: Discussionmentioning

confidence: 61%

Feasibility of Using a Smartwatch to Intensively Monitor Patients With Chronic Obstructive Pulmonary Disease: Prospective Cohort Study

Wu¹,

Liaqat²,

Lara³

et al. 2018

JMIR Mhealth Uhealth

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“…This is going to be an important future direction and challenge in patients with COPD breathing spontaneously. 68 – 70 …”

Section: Discussionmentioning

confidence: 99%

How will telemedicine change clinical practice in chronic obstructive pulmonary disease?

Vitacca

Montini

Comini

2018

Ther Adv Respir Dis

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Within telehealth there are a number of domains relevant to pulmonary care: telemonitoring, teleassistance, telerehabilitation, teleconsultation and second opinion calls. In the last decade, several studies focusing on the effects of various telemanagement programs for patients with chronic obstructive pulmonary disease (COPD) have been published but with contradictory findings. From the literature, the best telemonitoring outcomes come from programs dedicated to aged and very sick patients, frequent exacerbators with multimorbidity and limited community support; programs using third-generation telemonitoring systems providing constant analytical and decisionmaking support (24 h/day, 7 days/week); countries where strong community links are not available; and zones where telemonitoring and rehabilitation can be delivered directly to the patient’s location. In the near future, it is expected that telemedicine will produce changes in work practices, cultural attitudes and organization, which will affect all professional figures involved in the provision of care. The key to optimizing the use of telemonitoring is to correctly identify who the ideal candidates are, at what time they need it, and for how long. The time course of disease progression varies from patient to patient; hence identifying for each patient a ‘correct window’ for initiating telemonitoring could be the correct solution.In conclusion, as clinicians, we need to identify the specific challenges we face in delivering care, and implement flexible systems that can be customized to individual patients’ requirements and adapted to our diverse healthcare contexts.

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“…The monitoring of PROs would seem to be a mutual responsibility between the professionals and patients. Indeed, the benefits of self-monitoring have already been demonstrated: patients with chronic obstructive pulmonary disease and in patients with cerebral palsy were able to detect relevant changes in their health condition [22], which reduced long-term complications [23].…”

Section: Personal Feedback Enhances Individual Grip On Spasticitymentioning

confidence: 99%

Stumbling, struggling, and shame due to spasticity: a qualitative study of adult persons with hereditary spastic paraplegia

Kerstens

Satink

Nijkrake

et al. 2019

Disability and Rehabilitation

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Purpose: Little is known concerning the impact of chronic spasticity on physical activities, social participation, and well-being, and whether patients' needs are addressed by current treatments. This study aims to investigate these lacunas in persons with a pure form of hereditary spastic paraplegia (HSP), in whom spasticity is a prominent symptom. Methods: Fourteen patients with a pure form of HSP were interviewed. These interviews were recorded, verbally transcribed, and thematically analyzed. Results: Four themes were identified which can be reflected by the phrases: (1) 'I stumble', (2) 'I struggle', (3) 'I feel ashamed', and (4) 'I need support'. Balance and gait problems led to limitations in domestic activities, employment, and recreation. 'Stumbling' also occurred due to pain, stiffness, and fatigue. Struggling was related to the continuous need for adaptation strategies, including the abandonment of some activities. Participants further reported feelings of shame, fear, and frustration. Lastly, they needed more support in daily activities than currently provided. Conclusion: Besides treating spasticity-related motor impairments, patients with HSP need practical support for optimizing their physical activities and social participation. They also seek attention for the non-motor consequences of their chronic spasticity to improve their well-being. Patient-reported outcomes might help to address these needs. ä IMPLICATIONS FOR REHABILITATION According to patients with hereditary spastic paraplegia, interventions for spasticity should not only be aimed at reducing motor impairments, but also on reducing pain and fatigue, improving nighttime rest and general well-being, and optimizing the performance of relevant personal activities. Medical, role and emotional management in patients with hereditary spastic paraplegia can be improved only when individual needs are identified and monitored over the course of the disease. Besides assessment of bodily functions and physical capacities, systematic evaluation of patientreported outcomes will help both patients and professionals to monitor the functional impact of disease progression and to evaluate the effects of interventions aimed at retarding this progression.

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Decision Making Concepts for the Remote, Personalized Evaluation of COPD Patients’ Health Status

Cited by 14 publications

References 29 publications

Feasibility of Using a Smartwatch to Intensively Monitor Patients With Chronic Obstructive Pulmonary Disease: Prospective Cohort Study

Feasibility of Using a Smartwatch to Intensively Monitor Patients With Chronic Obstructive Pulmonary Disease: Prospective Cohort Study

How will telemedicine change clinical practice in chronic obstructive pulmonary disease?

Stumbling, struggling, and shame due to spasticity: a qualitative study of adult persons with hereditary spastic paraplegia

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