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Gastric bypass surgery leads to significant and sustained weight loss and a reduction in associated health risks in individuals with severe obesity. While reduced energy intake (EI) is the primary driver of weight loss following surgery, the underlying mechanisms accounting for this energy deficit are not well understood. The evidence base has been constrained by a lack of fit-for-purpose methodology in assessing food intake coupled with follow-up studies that are relatively short-term. This paper describes the underlying rationale and protocol for an observational, fully residential study using covert, objective methodology to evaluate changes in 24-hr food intake in patients (n = 31) at 1-month pre-surgery and 3-, 12- and 24-months post-surgery, compared to weight-stable controls (n = 32). The main study endpoints included change in EI, macronutrient intake, food preferences, and eating behaviours (speed, frequency, and duration of eating). Other physiological changes that may influence EI and weight regulation including changes in body composition, circulating appetite hormones, resting metabolic rate, total energy expenditure and gastrointestinal symptoms were also evaluated. Understanding which mechanisms contribute to a reduction in EI and weight loss post-surgery could potentially help to identify those individuals who are most likely to benefit from gastric bypass surgery as well as those that may need more targeted intervention to optimise their weight loss post-surgery. Furthermore, clarification of these mechanisms may also inform targeted approaches for non-surgical treatments of obesity.

This study focused on the development and usability evaluation of EnCare diagnostics (ECD) and the brain fit plan (BFP) in healthy older adults, cognitively impaired and physically impaired individuals. ECD is proposed as a novel solution to cognitive assessment based on colour selection. BFP is a novel solution to personalised cognitive stimulation. The study consisted of two trials designed to evaluate the usability of the apps. Trial 1 involved 11 healthy older adults and four older adults with physical impairments who undertook ECD and mini-mental state examination (MMSE) once per month for 4 months with only those with physical impairments also completing the BFP daily. Trial 2 involved eight older adults diagnosed with early stage dementia who completed MMSE and ECD once per month for 6 months. In Trial 1, 10 out of 11 participants enjoyed the trial and managed the usability of the app easily. A 75% drop out was observed in response to the BFP with issues of dexterity and lack of understanding on how to use the technology being the main reasons for lack of compliance. Four out of eight participants completed Trial 2 with most of the participants having no usability issues. This usability study demonstrated that ECD is highly acceptable in both healthy older adults and those with early stage dementia when given the shorter versions to accommodate their diagnosis. The BFP was not suited to this population of participants.

Background: Musculoskeletal injuries are common and costly. Ankle sprains are one of the most common such injuries, carrying significant risk of persistent disabling symptoms. Rehabilitation has been shown to be more effective than standard conservative approaches for musculoskeletal injuries. The use of a mobile app to present rehabilitation guidance may offer a more accessible, engaging and effective solution to ankle sprain rehabilitation. Several existing apps target the prevention and rehabilitation of ankle sprains, however evaluation details are limited. Aim: To develop a mobile phone app that provides interactive, personalised and tailored rehabilitation for people following ankle sprains. Method(s): In order to build requirements and produce content for the app (entitled ReApp 2), relevant literature was reviewed and behaviour change strategies identified from the Behaviour Change Taxonomy (BCT) developed by Michie et al (2013). A flexible and team orientated methodology called Agile was used to refine the technical specification and implemented software using feedback from technical experts (n=5) and clinicians (n=6). Technical experts consisted of participants with at least five years of experience in ICT or a related discipline. These technical experts completed the System Usability Scale (SUS) to rate the usability of the software. The SUS is a widely used usability survey, which provides a single overall score for each participant. These scores can be used to provide comparison between user groups and other software. The clinicians consisted of five physiotherapists and one sport and exercise consultant, all of whom had at least five years of experience in providing rehabilitation treatment for ankle injuries. These clinicians also completed a questionnaire and gave qualitative feedback on the clinical appropriateness of the app. Results: The identified BCTs were prioritised according to clinical importance, technical complexity and time to implement, and video and voice over content was completed. The following strategies were identified to incorporate into the app: modelling of behaviour; monitoring and receiving feedback related to individual behaviour, monitoring and receiving feedback related to the outcome of individual behaviour; and receiving reminders. ReApp 2 received a mean SUS score of 86, which is considerably above the average of 69.69 reported in Bangor et al.’s (2008) review of 2324 surveys from 206 studies. The technical experts indicated that the usability of ReApp 2 was considered to be “excellent” (SUS score over 85.58) by 60% of participants, and “good” by the remaining 40% (SUS score over 72.75). Clinicians agreed or strongly agreed that the clinical content within the app was evidence based (n=3), that the clinical content within the app was suitable for ankle rehabilitation (n=4) and that they would recommend the app to a patient presenting with ankle sprain (n=3). Conclusions: The SUS scores received from the technical evaluation in this project are considerably above average, indicating the excellent-good usability of the app. Clinicians rated the app as evidence based and 50% of clinicians would recommend the app in its current format to patients with ankle sprain.