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Exercise-induced bronchoconstriction (EIB) is a sign of uncontrolled childhood asthma and classically occurs after exercise. Recent research shows that EIB frequently starts during exercise, called breakthrough-EIB (BT-EIB). It is unknown whether this more severe type of EIB forces children to adapt their physical activity (PA) pattern in daily life. Therefore, this pilot study aims to investigate daily life PA (amount, intensity, duration, and distribution) in children with BT-EIB, 'classic' EIB, and without EIB. A Fitbit Zip activity tracker was used for one week to objectively measure daily life PA at one-minute intervals. Thirty asthmatic children participated. Children with BT-EIB were less physically active compared to children without EIB (respectively 7994 and 11,444 steps/day, p =.02). Children with BT-EIB showed less moderate-to-vigorous PA compared to the children without (respectively 117 and 170 minutes/day, p =.02). Children with EIB (both BT and classic) had significant shorter bouts of activity and a less stretched distribution of bout lengths compared to the non-EIB group (all p <.05). These results emphasize a marked association between EIB severity and PA patterns in daily life, stressing the need for a thorough clinical evaluation of exercise-induced symptoms in childhood asthma. [ABSTRACT FROM AUTHOR]

Objective: To compare self-report measures of daily activities with objective activity data to determine whether patients with chronic lower back pain report their activity levels as accurately as controls do.Design: A cross-sectional study was performed in patients and controls.Setting: The study was carried out in the daily environment of the subjects.Subjects: Thirty-two chronic lower back pain patients with symptoms more than three months and 20 healthy controls from the Netherlands, aged 18—65 years.Main measures: A tri-axial accelerometer was worn for five weekdays and the Baecke Physical Activity Questionnaire was filled in. Pearson’s correlation was calculated to get insight in the awareness of patients and controls. Comparisons of the relationship between the objective and subjective scores of each individual patient with those of the group of controls were used to allocate each patient into subgroups: overestimators, underestimators and aware patients. Physical and psychological characteristics of these groups were explored.Results: Patients showed weak correlations between the objective and subjective scores of physical activity and appear to have problems in estimating their activity levels (r = -0.27), in contrast to controls who showed strong correlations between the objective and subjective scores (r = 0.66). Comparison of the individual relationships of patients with those of controls showed that 44% of the patients were not aware of their activity level. There were relatively more underestimators (30%) than overestimators (14%). Physical characteristics between the three groups tended to be different.Conclusions: Patient self-reports about their activity level are relatively inaccurate when compared to objective measurements. [ABSTRACT FROM PUBLISHER]

Purpose. To investigate the effect of different aspects and types of augmented feedback on motor functions and motor activities of the hemiparetic arm after stroke. Method. Systematic search of the scientific literature was performed in the Pubmed and Cochrane database from 1975 to March 2009. The augmented feedback used in the intervention was classified with respect to aspects (nature, timing and frequency) and types (auditory, sensory and visual). Results. The systematic literature search resulted in 299 citations. On the basis of inclusion and exclusion criteria, 23 full-text articles were included for analysis. There are some trends in favour of providing augmented knowledge of performance feedback, augmented auditory and combined sensory and visual feedback. No consistent effects on motor relearning were observed for summary or faded, terminal or concurrent, solely visual or solely sensory augmented feedback. Conclusions. On the basis of this study, it was not possible to determine which combinations of aspects and types of augmented feedback are most essential for a beneficial effect on motor activities and motor functions of the hemiparetic arm after stroke. This was due to the combination of multiple aspects and types of augmented feedback in the included studies. This systematic review indicates that augmented feedback in general has an added value for stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose. To explore the association between perceived spasticity and psychological factors (pain sensations, coping strategies, and illness cognitions) in chronic spinal cord injured (SCI) patients. Methods. Cross-sectional study using a set of questionnaires was designed for chronic complete patients with SCI and with self-reported leg spasticity. Outcome measures were Visual Analogue Scale for average perceived leg spasticity (VAS(Spasticity)), VAS(Pain) for average perceived pain sensations in the leg, Utrecht Coping List (UCL) including its seven subscales, and Illness Cognition Questionnaire (ICQ) with its three subscales. Psychological factors with a bivariate correlation with VAS(Spasticity) of p < 0.2 were selected for regression analyses. Results. Nineteen patients with SCI (response rate 86%) participated. Bivariate correlations of p < 0.2 were found between VAS(Spasticity) and VAS(Pain), UCL(Active approach), UCL(Seeking social support), UCL(Reassuring thoughts), ICQ(Acceptation), and ICQ(Helplessness). Only UCL(Reassuring) (thoughts) (Beta -0.59, p = 0.01) and ICQ(Helplessness) (Beta 0.50, p = 0.02) were retained in the multivariate model, explaining 44% of the variance in VAS(Spasticity) (R(2)(adjusted)). Conclusions. Perceived spasticity appeared associated with psychological factors in complete patients with SCI: Those with higher levels of reassuring thoughts and lower levels of helplessness reported relatively lower levels of perceived spasticity. Large prospective cohort studies are recommended. [ABSTRACT FROM AUTHOR]

Purpose. To investigate clinometric properties of an Anglo-Dutch spasticity measurement tool (ADSMT), an objective tool providing information about both neurophysiological and biomechanical aspects of spasticity about the wrist joint in the clinical setting. Method. ADSMT measurements were performed with 12 healthy and 11 participants with post-stroke spasticity, and consisted of assessing the maximum range of passive wrist movement (pROM) and passive wrist extension at different cycle rates. Outcome measures were wrist angle, flexor and extensor activation, and resistance to movement. Intra-class Correlation Coefficients (ICCs) were calculated for inter-rater and test-retest reliability. Validity was investigated by calculating Spearman's rho between ADSMT outcome measures and the Modified Ashworth Scale (n = 12), the Action Research Arm Test (n = 6), and a validated wrist rig (n = 6). Results. Impaired participants had higher flexor activity and higher resistance to movement during passive wrist extension compared to unimpaired participants. For all outcome measures inter-rater and test-retest reliability were satisfactory to good and concurrent validity was sufficient. Conclusions. Outcome measures related to wrist flexor activity and resistance to movement during extension are promising for spasticity assessment using the ADSMT. Further knowledge on reference values and practicality is necessary for this tool to become incorporated in the clinical setting. [ABSTRACT FROM AUTHOR]

A limited number of clinical studies have examined the effect of poststroke rehabilitation with robotic devices on hemiparetic arm function. We systematically reviewed the literature to assess the effect of robot-aided therapy on stroke patients' upper-limb motor control and functional abilities. Eight clinical trials were identified and reviewed. For four of these studies, we also pooled short-term mean changes in Fugl-Meyer scores before and after robot-aided therapy. We found that robot-aided therapy of the proximal upper limb improves short-and long-term motor control of the paretic shoulder and elbow in subacute and chronic patients; however, we found no consistent influence on functional abilities. In addition, robotaided therapy appears to improve motor control more than conventional therapy. [ABSTRACT FROM AUTHOR]

Objective: Assessment of the available evidence regarding the effect of augmented feedback on motor function of the upper extremity in rehabilitation patients.Methods: A systematic literature search was performed to identify randomized controlled trials that evaluated the effect of augmented feedback on motor function. Two reviewers systematically assessed the methodological quality of the trials. The reported effects were examined to evaluate the effect of therapeutic interventions using augmented feedback and to identify a possible relationship with patient characteristics, type of intervention, or methodological quality.Results: Twenty-six randomized controlled trials were included, 9 of which reported a positive effect on arm function tests. Follow-up measurements were performed in 8 trials, 1 of which reported a positive effect. Different therapeutic interventions using augmented feedback, i.e. electromyographic biofeedback, kinetic feedback, kinematic feedback, or knowledge of results, show no difference in effectiveness.Conclusion: No firm evidence was found of effectiveness regarding the use of augmented feedback to improve motor function of the upper extremity in rehabilitation patients. Future studies should focus more on the content, form and timing of augmented feedback concerning the therapeutic intervention. It should be emphasized that motor learning effects can only be determined by re-examining the population after a follow-up period. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was twofold: (1) to investigate whether differences in activities of daily living exist between patients with chronic low back pain (CLBP) and nonsymptomatic controls; (2) to investigate the day-today variability in daily activities. Design: Physical activities were measured over a 24-hour period with an ambulant monitoring system. Setting: Measurements were carried out in the subject's own environment. Subjects: Forty-seven CLBP patients and 10 nonsymptomatic controls participated in this study. Results: On group level, CLBP patients show a lower activity pattern compared with controls, especially during the evening. This is reflected in a lower walking step frequency during the day and evening, more lying time during the day and a lower physical activity level, less standing time and more lying time during the evening. The day-to-day variability in activity pattern is high and similar for both the patient and control group. Conclusion: The lower activity level especially found during the evening might indicate that patients need all their capacity to perform the tasks imposed during the day and as a consequence have less capacity left for their leisure time, in general the evening. This suggests the existence of an imbalance between the patient's physical capacity and the imposed environmental load. The large but similar day-to-day variability in activity pattern, which does not support the clinical findings of 'bad days' in CLBP patients, suggests the need for repeated measures. [ABSTRACT FROM AUTHOR]

Electromyographic (EMG) biofeedback can be used to train motor functions at a distance, which makes therapy at home a possibility. To enable patients to train properly without the presence of a therapist, artificial feedback is considered essential. We studied the combined effect of age and timing of artificial feedback on training muscle relaxation in 32 healthy subjects (younger: 20-35 years; older: 55-70 years). All subjects improved their performance significantly (F = 6.1, P<0.001). The effect of different timing of feedback (feedback provided during or after performance) was similar in young and older adults. However, this conclusion should be interpreted with caution owing to the small sample size. It can be argued that the artificial feedback used was too complicated for older adults to interpret. When designing remotely supervised treatment programmes, one should consider carefully the way that artificial feedback is being applied as it may enable (elderly) subjects to train without the presence of a therapist. [ABSTRACT FROM AUTHOR]

Management of patients with amyotrophic lateral sclerosis (ALS) mainly consists of (psycho) social support and advice on activities of daily living. We evaluated the effects of tele-treatment in addition to the conventional method of care in four patients with ALS. A Web application was built with information about ALS and a link to the tele-treatment environment. The latter contained a chat room and a link to start personal computer (PC)-based videoconferencing with a rehabilitation physician. The effect on quality of care was evaluated by questionnaires and interviews. The interviews showed that patients were satisfied with tele-treatment and experienced a pleasant contact during teleconsultations. The rehabilitation physician experienced acceptance of tele-treatment by the patients and a decrease in the time needed for travelling. Tele-treatment was especially suitable for discussing the practical issues about ALS. On the other hand, psychosocial and emotional issues still needed to be discussed during traditional face-to-face contact. Therefore tele-treatment should only be given in addition to face-to-face contact, rather than as a replacement for it. [ABSTRACT FROM AUTHOR]

It has been hypothesized that changes in trunk muscle activity in chronic low back pain (CLBP) reflect an underlying "guarding" mechanism, which will manifest itself as increased superficial abdominal - and lumbar muscle activity. During a functional task like walking, it may be further provoked at higher walking velocities. The purpose of this cross sectional study was to investigate whether subjects with CLBP show increased co-activation of superficial abdominal - and lumbar muscles during walking on a treadmill, when compared to asymptomatic controls. Sixty-three subjects with CLBP and 33 asymptomatic controls walked on a treadmill at different velocities. Surface electromyography data of the erector spinae, rectus abdominis and obliquus abdominis externus muscles were obtained and averaged per stride. Results show that, compared to asymptomatic controls, subjects with CLBP have increased muscle activity of the erector spinae and rectus abdominis, but not of the obliquus abdominis externus. These differences in trunk muscle activity between groups do not increase with higher walking velocities. In conclusion, the observed increased trunk muscle activity in subjects with CLBP during walking supports the guarding hypothesis. [ABSTRACT FROM AUTHOR]

To identify demographics and personal motivation types that predict dropping out of eHealth interventions among older adults. We conducted an observational cohort study. Participants completed a pre-test questionnaire and got access to an eHealth intervention, called Stranded, for 4 weeks. With survival and Cox-regression analyses, demographics and types of personal motivation were identified that affect drop-out. Ninety older adults started using Stranded. 45.6% participants continued their use for 4 weeks. 32.2% dropped out in the first week and 22.2% dropped out in the second or third week. The final multivariate Cox-regression model which predicts drop-out, consisted of the variables: perceived computer skills and level of external regulation. Predicting the chance of dropping out of an eHealth intervention is possible by using level of self-perceived computer skills and level of external regulation (externally controlled rewards or punishments direct behaviour). Anticipating to these factors can improve eHealth adoption., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The impact of missing data on individual continuous glucose monitoring (CGM) data is unknown but can influence clinical decision-making for patients., Objective: We aimed to investigate the consequences of data loss on glucose metrics in individual patient recordings from continuous glucose monitors and assess its implications on clinical decision-making., Methods: The CGM data were collected from patients with type 1 and 2 diabetes using the FreeStyle Libre sensor (Abbott Diabetes Care). We selected 7-28 days of 24 hours of continuous data without any missing values from each individual patient. To mimic real-world data loss, missing data ranging from 5% to 50% were introduced into the data set. From this modified data set, clinical metrics including time below range (TBR), TBR level 2 (TBR2), and other common glucose metrics were calculated in the data sets with and that without data loss. Recordings in which glucose metrics deviated relevantly due to data loss, as determined by clinical experts, were defined as expert panel boundary error (ε EPB ). These errors were expressed as a percentage of the total number of recordings. The errors for the recordings with glucose management indicator <53 mmol/mol were investigated., Results: A total of 84 patients contributed to 798 recordings over 28 days. With 5%-50% data loss for 7-28 days recordings, the ε EPB varied from 0 out of 798 (0.0%) to 147 out of 736 (20.0%) for TBR and 0 out of 612 (0.0%) to 22 out of 408 (5.4%) recordings for TBR2. In the case of 14-day recordings, TBR and TBR2 episodes completely disappeared due to 30% data loss in 2 out of 786 (0.3%) and 32 out of 522 (6.1%) of the cases, respectively. However, the initial values of the disappeared TBR and TBR2 were relatively small (<0.1%). In the recordings with glucose management indicator <53 mmol/mol the ε EPB was 9.6% for 14 days with 30% data loss., Conclusions: With a maximum of 30% data loss in 14-day CGM recordings, there is minimal impact of missing data on the clinical interpretation of various glucose metrics., Trial Registration: ClinicalTrials.gov NCT05584293; https://clinicaltrials.gov/study/NCT05584293., (©Niala den Braber, Carlijn I R Braem, Miriam M R Vollenbroek-Hutten, Hermie J Hermens, Thomas Urgert, Utku S Yavuz, Peter H Veltink, Gozewijn D Laverman. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 31.07.2024.)

Purpose: Tailored self-management support is recommended as first-line treatment for neck and low back pain, for which mHealth applications could be promising. However, there is limited knowledge about factors influencing the engagement with such apps. The aim of this study was to assess barriers and facilitators for engaging with a self-management mHealth app among adults suffering from neck and/or low back pain., Materials and Methods: We carried out a qualitative descriptive study among adults with neck and/or low back pain. The artificial intelligence-based selfBACK app supports tailored self-management of neck and low back pain and was used for 6 weeks. After these 6 weeks, participants were interviewed by phone., Results: Thirty-two adults (17 males) with neck and/or low back pain participated (mean age = 54.9 (SD = 15.8)). Our results show that the mode of delivery and the novelty of the selfBACK app were perceived most often as a barrier to use the app. The action plans of the app and health-related factors were perceived most often as facilitating factors., Conclusions: This study provides insight into possible strategies to improve an mHealth service. Furthermore, it shows that adults with neck and/or low back pain are willing and ready to receive blended treatment.

Background: Data loss in wearable sensors is an inevitable problem that leads to misrepresentation during diabetes health monitoring. We systematically investigated missing wearable sensors data to get causal insight into the mechanisms leading to missing data., Methods: Two-week-long data from a continuous glucose monitor and a Fitbit activity tracker recording heart rate (HR) and step count in free-living patients with type 2 diabetes mellitus were used. The gap size distribution was fitted with a Planck distribution to test for missing not at random (MNAR) and a difference between distributions was tested with a Chi-squared test. Significant missing data dispersion over time was tested with the Kruskal-Wallis test and Dunn post hoc analysis., Results: Data from 77 subjects resulted in 73 cleaned glucose, 70 HR and 68 step count recordings. The glucose gap sizes followed a Planck distribution. HR and step count gap frequency differed significantly ( p < 0.001), and the missing data were therefore MNAR. In glucose, more missing data were found in the night (23:00-01:00), and in step count, more at measurement days 6 and 7 ( p < 0.001). In both cases, missing data were caused by insufficient frequency of data synchronization., Conclusions: Our novel approach of investigating missing data statistics revealed the mechanisms for missing data in Fitbit and CGM data.

Background: Perioperative telemonitoring of patients undergoing major surgery might lead to improved postoperative outcomes. The aim of this systematic review is to evaluate the effectiveness of current perioperative telemonitoring interventions on postoperative clinical, patient-reported, and financial outcome measures in patients undergoing major surgery., Methods: For this systematic review, PubMed, CINAHL, and Embase databases were searched for eligible articles published between January 1, 2009 and March 15, 2021. Studies were eligible as they described: (P) patients aged 18 years or older who underwent major abdominal surgery, (I) perioperative telemonitoring as intervention, (C) a control group receiving usual care, (O) any type of postoperative clinical, patient-reported, or financial outcome measures, and (S) an interventional study design., Results: The search identified 2958 articles of which 10 were eligible for analysis, describing nine controlled trials of 2438 patients. Perioperative telemonitoring comprised wearable biosensors ( n  = 3), websites ( n  = 3), e-mail ( n  = 1), and mobile applications ( n  = 2). Outcome measures were clinical ( n  = 8), patient-reported ( n  = 5), and financial ( n  = 2). Results show significant improvement of recovery time, stoma self-efficacy and pain in the early postoperative phase in patients receiving telemonitoring. Other outcome measures were not significantly different between the groups., Conclusion: Evidence for the effectiveness of perioperative telemonitoring in major surgery is scarce. There is a need for good quality studies with sufficient patients while ensuring that the quality and usability of the technology and the adoption in care processes are optimal., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Wireless vital signs sensors are increasingly used for remote patient monitoring, but data analysis is often challenged by missing data periods. This study explored the performance of various imputation techniques for continuous vital signs measurements. Wireless vital signs measurements (heart rate, respiratory rate, blood oxygen saturation, axillary temperature) from surgical ward patients were used for repeated random simulation of missing data periods (gaps) of 5-60 min in two-hour windows. Gaps were imputed using linear interpolation, spline interpolation, last observation- and mean carried forwards technique, and cluster-based prognosis. Imputation performance was evaluated using the mean absolute error (MAE) between original and imputed gap samples. Besides, effects on signal features (window's slope, mean) and early warning scores (EWS) were explored. Gaps were simulated in 1743 data windows, obtained from 52 patients. Although MAE ranges overlapped, median MAE was structurally lowest for linear interpolation (heart rate: 0.9-2.6 beats/min, respiratory rate: 0.8-1.8 breaths/min, temperature: 0.04-0.17 °C, oxygen saturation: 0.3-0.7% for 5-60 min gaps) but up to twice as high for other techniques. Three techniques resulted in larger ranges of signal feature bias compared to no imputation. Imputation led to EWS misclassification in 1-8% of all simulations. Imputation error ranges vary between imputation techniques and increase with gap length. Imputation may result in larger signal feature bias compared to performing no imputation, and can affect patient risk assessment as illustrated by the EWS. Accordingly, careful implementation and selection of imputation techniques is warranted., (© 2023. The Author(s).)

Background: Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown., Objective: This study aimed to explore the usability and predictive value of high-rate EWSs obtained from continuous vital sign recordings for early identification of postoperative complications and compares the performance of a sensor-based EWS alarm system with manual intermittent EWS measurements and threshold alarms applied to individual vital sign recordings (single-parameter alarms)., Methods: Continuous vital sign measurements (heart rate, respiratory rate, blood oxygen saturation, and axillary temperature) collected with wireless sensors in patients on surgical wards were used for retrospective simulation of EWSs (sensor EWSs) for different time windows (1-240 min), adopting criteria similar to EWSs based on manual vital signs measurements (nurse EWSs). Hourly sensor EWS measurements were compared between patients with (event group: 14/46, 30%) and without (control group: 32/46, 70%) postoperative complications. In addition, alarms were simulated for the sensor EWSs using a range of alarm thresholds (1-9) and compared with alarms based on nurse EWSs and single-parameter alarms. Alarm performance was evaluated using the sensitivity to predict complications within 24 hours, daily alarm rate, and false discovery rate (FDR)., Results: The hourly sensor EWSs of the event group (median 3.4, IQR 3.1-4.1) was significantly higher (P<.004) compared with the control group (median 2.8, IQR 2.4-3.2). The alarm sensitivity of the hourly sensor EWSs was the highest (80%-67%) for thresholds of 3 to 5, which was associated with alarm rates of 2 (FDR=85%) to 1.2 (FDR=83%) alarms per patient per day respectively. The sensitivity of sensor EWS-based alarms was higher than that of nurse EWS-based alarms (maximum=40%) but lower than that of single-parameter alarms (87%) for all thresholds. In contrast, the (false) alarm rates of sensor EWS-based alarms were higher than that of nurse EWS-based alarms (maximum=0.6 alarm/patient/d; FDR=80%) but lower than that of single-parameter alarms (2 alarms/patient/d; FDR=84%) for most thresholds. Alarm rates for sensor EWSs increased for shorter time windows, reaching 70 alarms per patient per day when calculated every minute., Conclusions: EWSs obtained using wireless vital sign sensors may contribute to the early recognition of postoperative complications in a ward setting, with higher alarm sensitivity compared with manual EWS measurements. Although hourly sensor EWSs provide fewer alarms compared with single-parameter alarms, high false alarm rates can be expected when calculated over shorter time spans. Further studies are recommended to optimize care escalation criteria for continuous monitoring of vital signs in a ward setting and to evaluate the effects on patient outcomes., (©Mathilde C van Rossum, Robin E M Bekhuis, Ying Wang, Johannes H Hegeman, Ellis C Folbert, Miriam M R Vollenbroek-Hutten, Cornelis J Kalkman, Ewout A Kouwenhoven, Hermie J Hermens. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 30.08.2023.)

Background: Preoperative telemonitoring of vital signs, physical activity, and well-being might be able to optimize prehabilitation of the patient's physical and mental condition prior to surgery, support setting alarms during in-hospital monitoring, and allow personalization of the postoperative recovery process., Objective: The primary aim of this study was to evaluate when and how long patients awaiting major abdominal surgery should be monitored to get reliable preoperative individual baseline values of heart rate (HR), daily step count, and patient-reported outcome measures (PROMs). The secondary aim was to describe the perioperative course of these measurements at home., Methods: In this observational single-center cohort study, patients used a wearable sensor during waking hours and reported PROMs (pain, anxiety, fatigue, nausea) on a tablet twice a day. Intraclass correlation coefficients (ICCs) were used to evaluate the reliability of mean values on 2 specific preoperative days (the first day of telemonitoring and the day before hospital admission) and randomly selected preoperative periods compared to individual reference values. Mean values of HR, step count, and PROMs per day were visualized in a boxplot from 14 days before hospital admission until 30 days after surgery., Results: A total of 16 patients were included in the data analyses. The ICCs of mean values on the first day of telemonitoring were 0.91 for HR, 0.71 for steps, and at least 0.86 for PROMs. The day before hospital admission showed reliability coefficients of 0.76 for HR, 0.71 for steps, and 0.92-0.99 for PROMs. ICC values of randomly selected measurement periods increased over the continuous period of time from 0.68 to 0.99 for HR and daily step counts. A lower bound of the 95% CI of at least 0.75 was determined after 3 days of measurements. The ICCs of randomly selected PROM measurements were 0.89-0.94. Visualization of mean values per day mainly showed variable preoperative daily step counts (median 2409, IQR 1735-4661 steps/day) and lower postoperative daily step counts (median 884, IQR 474-1605 steps/day). In addition, pain was visually reduced until 30 days after surgery at home., Conclusions: In this prospective pilot study, for patients awaiting major abdominal surgery, baseline values for HR and daily step count could be measured reliably by a wearable sensor worn for at least 3 consecutive days and PROMs during any preoperative day. No clear conclusions were drawn from the description of the perioperative course by showing mean values of HR, daily step count, and PROM values over time in the home situation., (©Marjolein E Haveman, Rianne van Melzen, Mostafa El Moumni, Richte C L Schuurmann, Hermie J Hermens, Monique Tabak, Jean-Paul P M de Vries. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 28.11.2022.)

Background: Telemonitoring during the perioperative trajectory may improve patient outcomes and self-management. The aim of this study is to assess the feasibility of and patient's experiences with telemonitoring before and after major abdominal surgery to inform future study design., Methods: Patients planned for elective major abdominal surgery wore a sensor and answered well-being questions on a tablet daily for at least 2 weeks preoperatively up to 30-days postoperatively. Feasibility was assessed by participation and completion rate, compliance per day, weekly satisfaction scores, and reasons for nonscheduled contact., Results: Twenty-three patients were included (participation rate of 54.5%) with a completion rate of 69.6%. Median compliance with the wearable sensor and well-being questions was respectively: 94.7% and 83.3% preoperatively at home; 100% and 66.7% postoperatively in-hospital; and 95.4% and 85.8% postoperatively at home. Median weekly satisfaction scores for both wearing the sensor and well-being questions were 5 (IQR, 4-5). Contact moments were related to absence of sensor data and technological issues (76.0%) or patient discomfort and insecurity (24.0%)., Conclusions: In this study, telemonitoring showed high satisfaction and compliance during the perioperative trajectory. Future trial design regarding the effectiveness of telemonitoring requires embedding in clinical practice and support for patients, relatives, and healthcare personnel.

Continuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to warn for vital sign abnormalities observed during development of an adverse event. A classical threshold-based alarm strategy used for continuous vital signs monitoring in surgical ward patients was evaluated retrospectively. Next, (combinations of) six methods to adapt alarm thresholds to personal or situational factors were simulated in the same dataset. Alarm performance was assessed using the overall alarm rate and sensitivity to detect adverse events. Using a wireless patch-based monitoring system, 3999 h of vital signs data was obtained in 39 patients. The clinically used classical alarm system produced 0.49 alarms/patient/day, and alarms were generated for 11 out of 18 observed adverse events. Each of the tested adaptive strategies either increased sensitivity to detect adverse events or reduced overall alarm rate. Combining specific strategies improved overall performance most and resulted in earlier presentation of alarms in case of adverse events. Strategies that adapt vital sign alarm thresholds to personal or situational factors may improve early detection of adverse events or reduce alarm rates as compared to classical alarm strategies. Accordingly, further investigation of the potential of adaptive alarms for continuous vital signs monitoring in ward patients is warranted., (© 2021. The Author(s).)

Background: Gamification within eHealth services can increase eHealth adoption. However, little is known about factors affecting adoption of gamified eHealth among older adults. In this study, we sought to explain the (continued) use of a gamified eHealth service among older adults (55+)., Methods: Participants used a gamified eHealth service, focusing on falls prevention, for 4 weeks and completed a post-test questionnaire based on the Technology Acceptance Model. We used Partial Least Squares Structural Equation Modeling to analyse our data., Results: Seventy-two older adults participated with a mean age of 65.1 years (SD = 7.0). Our results show that first, perceived ease of use affected use of the service (use duration: β = 0.303, R 2 = 0.130, and use frequency: β = 0.304, R 2 = 0.107). Second, perceived usefulness affected the intention to continue using the service (β = 0.754, R 2 = 0.640). Third, use of the service did not predict the intention to continue using it. Furthermore, enjoyment affected perceived usefulness (β = 0.783, R 2 = 0.563) and aesthetics affected perceived ease of use (β = 0.634, R 2 = 0.652)., Conclusions: This study refutes the expected relation between use and intention to continue use a gamified eHealth service. Additionally, we learned that using theoretical approaches focusing on technology acceptance, are not suitable for explaining (continued) use of gamified eHealth services.

Background: With the rise in human life expectancy, the prevalence of chronic disease has increased significantly. Adopting a healthy lifestyle can decrease the risk of chronic disease. Virtual coaching systems can help older adults adopt a healthy lifestyle.AimThe primary objective of this study was to assess the use, user experience and potential health effects of a conversational agent-based eHealth platform (Council of Coaches) implemented in a real-world setting among older adults., Methods: An observational cohort study was conducted with older adults aged 55 years or older in the Netherlands. Participants were enrolled for 5-9 weeks during which they had access to Council of Coaches. They completed three questionnaires: pre-test, post-test, and at follow-up. After five weeks, an interview was conducted, and participants chose whether they wanted to use the eHealth intervention for another four weeks during the facultative phase., Results: The study population consisted of 51 older adults (70.6% female) with a mean age of 65.3 years (SD = 7.4). Of these, 94.1% started interacting with Council of Coaches, and most participants interacted once per week. During the facultative phase, 21 participants were still interacting with Council of Coaches. Minimal clinical important differences in quality of life were found among the study population after interacting with Council of Coaches., Conclusion: Our results demonstrate that eHealth interventions with virtual coaching can be used among older adults. This may increase quality of life for older adults, and decrease their healthcare needs. Future research into such eHealth interventions should take into account the inclusion of sufficient personalised content and the use of a mixed methods study for assessing the eHealth intervention., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients' baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making., Objective: The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment., Methods: Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO 2 ), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA)., Results: A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO 2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (-0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of -39.0 to 28.3) bpm and 11.4 (LoA of -53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (-10.8 to 10.4 breaths/min) for RR, underestimated SpO 2 (>1%), and overestimated temperature up to 2.9 °C., Conclusions: Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring., (©Marjolein E Haveman, Mathilde C van Rossum, Roswita M E Vaseur, Claire van der Riet, Richte C L Schuurmann, Hermie J Hermens, Jean-Paul P M de Vries, Monique Tabak. Originally published in JMIR Formative Research (https://formative.jmir.org), 07.01.2022.)

Background: Wearable sensors enable continuous vital sign monitoring, although information about their performance on nursing wards is scarce. Vital signs measured by telemonitoring and nurse measurements on a surgical ward were compared to assess validity and reliability., Methods: In a prospective observational study, surgical patients wore a wearable sensor (Everion, Biovotion AG, Zürich, Switzerland) that continuously measured heart rate (HR), respiratory rate (RR), oxygen saturation (SpO 2 ), and temperature during their admittance on the ward. Validity was evaluated using repeated-measures correlation and reliability using Bland-Altman plots, mean difference, and 95% limits of agreement (LoA)., Results: Validity analyses of 19 patients (median age, 68; interquartile range, 62.5-72.5 years) showed a moderate relationship between telemonitoring and nurse measurements for HR ( r = 0.53; 95% confidence interval, 0.44-0.61) and a poor relationship for RR, SpO 2 , and temperature. Reliability analyses showed that Everion measured HR close to nurse measurements (mean difference, 1 bpm; LoA, -16.7 to 18.7 bpm). Everion overestimated RR at higher values, whereas SpO 2 and temperature were underestimated., Conclusions: A moderate relationship was determined between Everion and nurse measurements at a surgical ward in this study. Validity and reliability of telemonitoring should also be assessed with gold standard devices in future clinical trials.

Choosing the right features is important to optimize lower limb pattern recognition, such as in prosthetic control. EMG signals are noisy in nature, which makes it more challenging to extract useful information. Many features are used in the literature, which raises the question which features are most suited for use in lower limb myoelectric control. Therefore, it is important to find combinations of best performing features. One way to achieve this is by using a genetic algorithm, a meta-heuristic capable of searching vast feature spaces. The goal of this research is to demonstrate the capabilities of a genetic algorithm and come up with a feature set that has a better performance than the state-of-the-art feature set. In this study, we collected a dataset containing ten able-bodied subjects who performed various gait-related activities while measuring EMG and kinematics. The genetic algorithm selected features based on the performance on the training partition of this dataset. The selected feature sets were evaluated on the remaining test set and on the online benchmark dataset ENABL3S, against a state-of-the-art feature set. The results show that a feature set based on the selected features of a genetic algorithm outperforms the state-of-the-art set. The overall error decreased up to 0.54% and the transitional error by 2.44%, which represent a relative decrease in overall errors up to 11.6% and transitional errors up to 14.1%, although these results were not significant. This study showed that a genetic algorithm is capable of searching a large feature space and that systematic feature selection shows promising results for lower limb myoelectric control., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Schulte, Prinsen, Hermens and Buurke.)

Objective: Children with asthma who are physically active have a better quality of life, emphasizing the importance of activity monitoring and promotion in daily life. The validity of self-reported activity measurements has been questioned in pediatric populations. In this study, we aim to compare the Physical Activity Questionnaire for Children (PAQ-C) with objectively measured PA using accelerometry. Design: In this comparison study, the pooled dataset of two cross-sectional studies was used, which prospectively home-monitored PA using the alternative self-report PAQ-C questionnaire as well as with the criterion standard accelerometry (Actigraph wGT3X-BT and GT1M). Participants: Ninety children with pediatrician-diagnosed asthma participated in the study. Main Outcome Measures: Correlation coefficients were calculated to determine the relation between the PAQ-C and accelerometer data. The predictive value of the PAQ-C in differentiating between achieving and failing the recommended daily level of moderate-to-vigorous activity (MVPA) was evaluated with receiver operator characteristic (ROC) analysis. Results: The results showed weak to moderate correlations of the PAQ-C with the accelerometer data ( r = 0.29-0.47). A PAQ-C cutoff of 3.09 showed the best performance on predicting whether the recommended level of MVPA was achieved. With this cutoff, 21 of the 39 children that did achieve their daily MVPA level (53.8% sensitivity) and 33 of the 46 children that did fail their daily MVPA level (71.7% specificity) were correctly classified. A PAQ-C score of 3.5 revealed a negative predictive value of 100% for assessing physical inactivity. Conclusion: This study revealed a weak relation between the PAQ-C and PA assessed with accelerometry. However, a PAQ-C score of 3.5 or higher might be used as a low-cost and easy-to-use PA screening tool for ruling out physical inactivity in a portion of the pediatric asthma population. Clinical Trial Registration: Netherlands Trial Register: Trial NL6087., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 van der Kamp, Nieuwdorp, Thio, Tabak, Kamps, Hermens and Driessen.)

Objective: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are disorders of unknown etiology and unclear pathophysiology, with overlapping symptoms of - especially muscular -fatigue and pain. Studies have shown increased muscle fiber conduction velocity (CV) in the non-painful muscles of FM patients. We investigated whether CFS patients also show CV abnormalities., Methods: Females with CFS (n = 25), with FM (n = 22), and healthy controls (n = 21) underwent surface electromyography of the biceps brachii, loaded up to 20% of maximum strength, during short static contractions. The mean CV and motor unit potential (MUP) velocities with their statistical distribution were measured., Results: The CV changes with force differed between CFS-group and both FM-group and controls (P = 0.01). The CV of the CFS-group increased excessively with force (P < 0.001), whereas that of the controls increased only slightly and non-significantly, and that of the FM-group did not increase at all. In the CFS-group, the number of MUPs conveying very high conduction velocities increased abundantly with force and the MUPs narrowed., Conclusion: Our results suggest disturbed muscle membrane function in CFS patients, in their motor units involved in low force generation. Central neural deregulation may contribute to this disturbance., Significance: These findings help to detangle the underlying mechanisms of CFS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Pervasive health technologies can increase the effectiveness of personal health monitoring and training, but more user studies are necessary to understand the interest for these technologies, and how they should be designed and implemented. In the present study, we evaluated eWALL, a user-centered pervasive health technology consisting of a platform that monitors users' physical and cognitive behavior, providing feedback and motivation via an easy-to-use, touch-based user interface. The eWALL was placed for one month in the home of 48 subjects with a chronic condition (chronic obstructive pulmonary disease-COPD or mild cognitive impairment-MCI) or with an age-related impairment. User acceptance, platform use, and potential clinical effects were evaluated using surveys, data logs, and clinical scales. Although some features of the platform need to be improved before reaching technical maturity and making a difference in patients' lives, the real-life evaluation of eWALL has shown how some features may influence patients' intention to use this promising technology. Furthermore, this study made it clear how the free use of different health apps is modulated by the real needs of the patient and by their usefulness in the context of the patient's clinical status.

Background: Asthma is one of the most common chronic diseases in childhood. Regular follow-up of physiological parameters in the home setting, in relation to asthma symptoms, can provide complementary quantitative insights into the dynamics of the asthma status. Despite considerable interest in asthma home-monitoring in children, there is a paucity of scientific evidence, especially on multi-parameter monitoring approaches. Therefore, the aim of this study is to investigate whether asthma control can be accurately assessed in the home situation by combining parameters from respiratory physiology sensors., Methods: Sixty asthmatic and thirty non-asthmatic children were enrolled in the observational WEARCON-study. Asthma control was assessed according to GINA guidelines by the paediatrician. All children were also evaluated during a 2-week home-monitoring period with wearable devices; a physical activity tracker, a handheld spirometer, smart inhalers, and an ambulatory electrocardiography device to monitor heart and respiratory rate. Multiple logistic regression analysis was used to determine which diagnostic measures were associated with asthma control., Results: 24 of the 27 uncontrolled asthmatic children and 29 of the 32 controlled asthmatic children could be accurately identified with this model. The final model showed that a larger variation in pre-exercise lung function (OR = 1.34 95%-CI 1.07-1.68), an earlier wake-up-time (OR = 1.05 95%-CI 1.01-1.10), more reliever use (OR = 1.11 95%-CI 1.03-1.19) and a longer respiratory rate recovery time (OR = 1.12 95%-CI 1.05-1.20) were significant contributors to the probability of having uncontrolled asthma., Conclusions: Home-monitoring of physiological parameters correlates with paediatrician assessed asthma control. The constructed multivariate model identifies 88.9% of all uncontrolled asthmatic children, indicating a high potential for monitoring of asthma control. This may allow healthcare professionals to assess asthma control at home., Trial Registration: Netherlands Trail Register, NL6087 . Registered 14 February 2017.

Background: Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature., Methods: Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system., Results: In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings - particularly for levels L4-S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases., Discussion: Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas., Conclusions: We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.

This paper presents the Sensory Interactive Table (SIT): an instrumented, interactive dining table. Through the use of load cells and LEDs that are embedded in the table surface, SIT allows us to study: (1) the eating behaviors of people in a social setting, (2) the social interactions around the eating behaviors of people in a social setting, and (3) the continuous cycle of feedback through LEDs on people's eating behavior and their response to this feedback in real time, to ultimately create an effective dietary support system. This paper presents the hard- and software specifications of the system, and it shows the potential of the system to capture mass-related dimensions in real time and with high accuracy and spatial resolution.

Background: While the average human life expectancy has increased remarkably, the length of life with chronic conditions has also increased. To limit the occurrence of chronic conditions and comorbidities, it is important to adopt a healthy lifestyle. Within the European project "Council of Coaches," a personalized coaching platform was developed that supports developing and maintaining a healthy lifestyle., Objective: The primary aim of this study is to assess the user experience with and the use and potential health effects of a fully working Council of Coaches system implemented in a real-world setting among the target population, specifically older adults or adults with type 2 diabetes mellitus or chronic pain., Methods: An observational cohort study with a pretest-posttest design will be conducted. The study population will be a dynamic cohort consisting of older adults, aged ≥55 years, as well as adults aged ≥18 years with type 2 diabetes mellitus or chronic pain. Each participant will interact in a fully automated manner with Council of Coaches for 5 to 9 weeks. The primary outcomes are user experience, use of the program, and potential effects (health-related factors). Secondary outcomes include demographics, applicability of the virtual coaches, and user interaction with the virtual coaches., Results: Recruitment started in December 2019 and is conducted through mass mailing, snowball sampling, and advertisements in newspapers and social media. This study is expected to conclude in August 2020., Conclusions: The results of this study will either confirm or reject the hypothesis that a group of virtual embodied conversational coaches can keep users engaged over several weeks of interaction and contribute to positive health outcomes., Trial Registration: The Netherlands Trial Register: NL7911; https://www.trialregister.nl/trial/7911., International Registered Report Identifier (irrid): PRR1-10.2196/16641., (©Marian Z M Hurmuz, Stephanie M Jansen-Kosterink, Harm op den Akker, Hermie J Hermens. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.04.2020.)