Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study (Preprint)

Abstract

Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient's long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than a smartphone, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate.Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards smartwatch technology for measuring patient report outcomes (PRO) as an EMA tool. Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age > 65), with uniliateral or bilateral symptomatic knee Osteoaethritis (OA). A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants' attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed and content analysis with theme characterization was performed to identify and code the major themes. Results: Twenty participants (age 65+) were recruited and consented to take part in the focus group study. The overall attitude of the participants towards the smartwatch technology was positive, and they showed interest in the direct phone call capability, availability of extra apps such as the weather apps, and sensors for tracking health and wellness such as accelerometer and heart rate sensor; with 74% of the participants showing willingness to participate in a 1-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expresses interest in using smartwatch technology for PRO assessment and availability of methods for sharing data with healthcare providers. Conclusions:All participants had overall positive views of the smartwatch technology for measuring OPROs to facilitate patient-provider communications, and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special considerations in future smartwatch PRO user interface design, especially accessibility issues, notification design, and use of intuitive assessment scales.

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“…Real-time data collection using smartwatches as ecological momentary assessment tools have been used in elderly patients with arthritis to monitor their patient-reported outcomes, pain levels, and postoperative symptoms [17]. In addition, real-time objective physical activity data obtained from WSDs is a more objective measurement than self-reported data for physical activity, which is subject to significant bias.…”