Harnessing Digital Health to Objectively Assess Functional Performance in Veterans with Chronic Obstructive Pulmonary Disease

Abstract

Introduction: An early detection of impaired functional performance is critical to enhance symptom management for patients with chronic obstructive pulmonary disease (COPD). However, conventional functional measures based on walking assessments are often impractical for small clinics where the available space to administrate gait-based test is limited. This study examined the feasibility and effectiveness of an upper-extremity frailty meter (FM) in identifying digital measures of functional performance and assessing frailty in COPD patients. Methods: Forty-eight patients with COPD (age = 68.8 ± 8.5 years, body mass index [BMI] = 28.7 ± 5.8 kg/m2) and 49 controls (age = 70.0 ± 3.0 years, BMI = 28.7 ± 6.1 kg/m2) were recruited. All participants performed a 20-s repetitive elbow flexion-extension test using a wrist-worn FM sensor. Functional performance was quantified by FM metrics, including speed (slowness), range of motion (rigidity), power (weakness), flexion and extension time (slowness), as well as speed and power reduction (exhaustion). Conventional functional measures, including timed-up-and-go test, gait and balance tests, and 5 repetition sit-to-stand test, were also performed. Results: Compared to controls, COPD patients exhibited deteriorated performances in all conventional functional assessments (d = 0.64–1.26, p < 0.010) and all FM metrics (d = 0.45–1.54, p < 0.050). FM metrics had significant agreements with conventional assessment tools (|r| = 0.35–0.55, p ≤ 0.001). FM metrics efficiently identified COPD patients with pre-frailty and frailty (d = 0.82–2.12, p < 0.050). Conclusion: This study proposes the feasibility of using a 20-s repetitive elbow flexion-extension test and wrist-worn sensor-derived frailty metrics as an alternative and practical solution to evaluate functional performance in COPD patients. Its simplicity and low risk for test administration may also facilitate its application for remote patient monitoring. Furthermore, in settings where the administration of walking test is impractical, for example, when ventilator support is needed or space is limited, FM may be used as an alternative solution. Future studies are encouraged to use the FM to quantitatively monitor the progressive decline in functional performance and quantify outcomes of rehabilitation interventions.

Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review

“…Aunque exista heterogeneidad entre diferentes estudios, en general, la mayoría de ellos, tanto en el ámbito de la telemonitorización (10/19; 52 %) 3,[6][7][8][9][10][11][12][13][14]21 , de la teleeducación y autogestión (6/9; 66%) 20,23,25,[29][30][31] , telerehabilitación (12/15; 80%) 20, 32-36, 38, 40, 41, 43, 44 o uso de mHealth (8/12; 67%) [47][48][49][50][51][52][53]56 , presentó resultados positivos, incluyendo una mejor 12/ 32 calidad de vida y tolerancia al ejercicio, así como una menor frecuencia de exacerbaciones y percepción de disnea, con un alto nivel de satisfacción de los pacientes. Además, cabe destacar que ninguna de las publicaciones revisadas informó de efecto adverso alguno, lo que sugiere que la telemedicina es segura en pacientes con EPOC.…”

“…Por un lado, varios estudios reportaron efectos positivos durante su seguimiento 5 , incluyendo 7/ 32 reducción de hospitalizaciones por exacerbación de la EPOC 6 , reducción de mortalidad 7 , mejoría de la actividad física y reducción de costos 8 , mejor calidad de vida y mejor adherencia a terapias como la ventilación no invasiva en el domicilio 9,10 . Cabe destacar, además, que la telemonitorización es aceptable para los profesionales de la salud, requiere bajos costos de instalación y explotación 6 y es simple y de bajo riesgo para los pacientes 11 . En conjunto, estas observaciones indican que la telemonitorización domiciliaria puede facilitar la continuidad asistencial durante la transición del hospital al hogar y reducir las readmisiones tempranas post-hospitalización 12,13 , mejorar la supervivencia, probablemente debido a una mejor adherencia terapéutica o una mejor comprensión de la EPOC por parte de los pacientes 14 , mayor accesibilidad 15 y, potencialmente, el coste promedio por paciente 16 .…”

Telemedicine and home monitoring for COPD – a narrative review of recent literature

“…The other study examined the feasibility and effectiveness of an upper-extremity frailty meter (FM) in identifying digital measures of functional performance and assessing frailty in COPD patients [17]. The authors propose the feasibility of using a 20-s repetitive elbow flexion-extension test and wrist-worn sensor-derived frailty metrics as an alternative and practical solution to evaluate functional performance in COPD patients.…”