Totally punted on this research suggesting further studies.
I'm sure that somewhere in these pieces of wearable research there is useful data.
wearable (21 posts to April 2012)
wearable arms (1 post to May 2013)
wearable computing (3 posts to August 2013)
wearable devices (34 posts to October 2015)
wearable electronic device (1 post to July 2020)
Wearable inertial measurement units (1 post to June 2019)
wearable sensors (19 posts to January 2018)
wearable shoe (1 post to December 2019)
Assessing the usability of wearable devices to measure gait and physical activity in chronic conditions: a systematic review/a>
Journal of NeuroEngineering and Rehabilitation
volume 18, Article number: 138 (2021)
Abstract
Background
The
World Health Organisation’s global strategy for digital health
emphasises the importance of patient involvement. Understanding the
usability and acceptability of wearable devices is a core component of
this. However, usability assessments to date have focused predominantly
on healthy adults. There is a need to understand the patient perspective
of wearable devices in participants with chronic health conditions.
Methods
A
systematic review was conducted to identify any study design that
included a usability assessment of wearable devices to measure mobility,
through gait and physical activity, within five cohorts with chronic
conditions (Parkinson’s disease [PD], multiple sclerosis [MS],
congestive heart failure, [CHF], chronic obstructive pulmonary disorder
[COPD], and proximal femoral fracture [PFF]).
Results
Thirty-seven
studies were identified. Substantial heterogeneity in the quality of
reporting, the methods used to assess usability, the devices used, and
the aims of the studies precluded any meaningful comparisons.
Questionnaires were used in the majority of studies (70.3%; n = 26) with
a reliance on intervention specific measures (n = 16; 61.5%). For those
who used interviews (n = 17; 45.9%), no topic guides were provided,
while methods of analysis were not reported in over a third of studies
(n = 6; 35.3%).
Conclusion
Usability
of wearable devices is a poorly measured and reported variable in
chronic health conditions. Although the heterogeneity in how these
devices are implemented implies acceptance, the patient voice should not
be assumed. In the absence of being able to make specific usability
conclusions, the results of this review instead recommends that future
research needs to: (1) Conduct usability assessments as standard,
irrespective of the cohort under investigation or the type of study
undertaken. (2) Adhere to basic reporting standards (e.g. COREQ)
including the basic details of the study. Full copies of any
questionnaires and interview guides should be supplied through
supplemental files. (3) Utilise mixed methods research to gather a more
comprehensive understanding of usability than either qualitative or
quantitative research alone will provide. (4) Use previously validated
questionnaires alongside any intervention specific measures.
Background
Healthcare
research is in the midst of a paradigm shift with a move towards more
long-term behavioural monitoring through the use of wearable devices.
This shift has been recognised by the World Health Organisation (WHO)
through its recent publication of a digital health strategy [1].
While wearable devices offer researchers access to previously
unattainable information regarding how people behave, additional factors
need to be considered when designing and implementing these devices
including patient safety, privacy, cost-effectiveness etc. Of critical
importance, is that this digital shift should be patient-centred,
evidence based, inclusive and contextualised [1].
Whether
a device is considered usable by the person who will be wearing it has
been identified as “among the most important considerations with
patient-orientated digital-based solutions” [2].
The International Organization for Standardization defines usability as
“the effectiveness, efficiency, and satisfaction with which specified
users achieve specified goals in particular environments” [3].
In this manner usability is a broad concept that can also include the
acceptability of, or satisfaction with, a device, while the WHO lists
the evaluation of the usability and feasibility of a device being the
first steps that should be undertaken when assessing any new digital
health intervention [1, 4].
It has been suggested that for wearable devices to be accepted, they
must be easy to wear, easy to use, affordable, contain relevant
functionality and be aesthetically pleasing [5,6,7,8].
Usability, by its nature, is context specific and understanding how
context may influence adoption has been highlighted as a research need
in this area [9].
The acceptability of the above will depend on the length of time the
device needs to be worn for and the characteristics of those using it,
including their health conditions. The concept of usability is therefore
almost never ending, as researchers and digital health developers need
to ensure that their selected device is fit for purpose within all
aspects of their study design. Failure to assess usability may result in
researchers implementing devices that are not worn, that are worn or
used incorrectly, and thus may negatively impact data collection and
quality and limit the impact of any intervention [1, 10, 11].
Usability
is likely to be specifically important in contexts where wearable
devices are designed to be implemented during real-world tasks or
activities. Walking (including gait and physical activity) in
particular, is a functional task that is part of most activities of
daily living and has been identified as so critical to health, that is
has been labelled a ‘vital sign’ [12, 13].
Many consumer wearable measure activity as standard, but in-depth gait
analysis, and the production of digital biomarkers linked to gait, is
becoming an important feature of current and future research as it is
recognised that understanding how people move can inform researchers and
clinicians alike of patient progress, behaviour change and intervention
effectiveness [14,15,16,17].
Thus, if walking is a key activity being measured by wearables, it is
important to understand how usable these devices are in this context. To
date, most usability studies have evaluated devices in healthy adults,
or have focused primarily on consumer and/or watch based devices [5, 18,19,20,21,22,23,24,25].
However, the needs of healthy adults are likely to be very different
than those with chronic health conditions with which many of these
devices are deployed to support. For example, issues with fine motor
control, skin sensitivity, or balance deficits may be present in
clinical cohorts and may be aggravated by the use of certain devices
depending on their size, materials and interactivity. A 2015 study
suggested that wearable devices are generally accepted by people with
chronic conditions, however this research failed to report what type of
wearables were assessed, or what chronic conditions were included in the
analysis [20]. It has been suggested that health conditions and the specific measurement needs of conditions impacts participant adherence [21].
Specifically in relation to walking, many chronic conditions are
associated with symptoms that may impact how well an individual can
walk, but the pathophysiology’s and the impact on mobility may be very
different [15],
for example cardiorespiratory conditions vs neurological. Wearable
devices need to be usable across a comprehensive trajectory of mobility
problems, thus it is worth exploring users perceptions across multiple
cohorts so as to broadly determine their usability in people with
chronic conditions. Therefore, this review focused on five clinical
cohorts, specifically respiratory problems (chronic obstructive
pulmonary disease—COPD), neurodegenerative conditions (Parkinson’s
disease—PD), neuroinflammatory problems (multiple sclerosis—MS),
osteoporosis and sarcopenia (hip fracture recovery/proximal femoral
fracture—PFF), and cardiac pathology (congestive heart failure—CHF).
Combined these cohorts are highly prevalent conditions with significant
associated disability. Specifically, COPD is the most prevalent chronic
respiratory illness globally [26], the rate of prevalence and burden for MS and PD are growing and for PD have doubled [27, 28], PFF is the fracture with the greatest direct cost to the community [29],
CHF accounts for up to 2% of healthcare expenditure, while all
conditions are associated with greater falls risk which are a
significant cause of death and disability globally [30].
Collectively these conditions represent broad array of mobility
problems with different trajectories of disability, thus allowing for a
comprehensive evaluation of mobility. Although it is likely that some
differences in usability may be noted between cohorts, it is nonetheless
worth comparing across common conditions to determine where differences
and similarities in usability exist.
To the author’s knowledge no
systematic review investigating the usability of wearable devices
specifically for mobility exists, Given the dearth of literature
examining the usability of wearable devices for the assessment of
walking in cohorts with chronic health conditions, further evaluations
of this are required to support the use and development of these devices
in the future. Therefore, this study aimed to conduct a systematic
review of the literature to explore the usability of wearable devices to
monitor gait and activity in five common patient cohorts where digital
mobility assessment may be clinically useful to monitor their symptoms
and progress.
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 138 (2021)
Abstract
Background
The World Health Organisation’s global strategy for digital health emphasises the importance of patient involvement. Understanding the usability and acceptability of wearable devices is a core component of this. However, usability assessments to date have focused predominantly on healthy adults. There is a need to understand the patient perspective of wearable devices in participants with chronic health conditions.
Methods
A systematic review was conducted to identify any study design that included a usability assessment of wearable devices to measure mobility, through gait and physical activity, within five cohorts with chronic conditions (Parkinson’s disease [PD], multiple sclerosis [MS], congestive heart failure, [CHF], chronic obstructive pulmonary disorder [COPD], and proximal femoral fracture [PFF]).
Results
Thirty-seven studies were identified. Substantial heterogeneity in the quality of reporting, the methods used to assess usability, the devices used, and the aims of the studies precluded any meaningful comparisons. Questionnaires were used in the majority of studies (70.3%; n = 26) with a reliance on intervention specific measures (n = 16; 61.5%). For those who used interviews (n = 17; 45.9%), no topic guides were provided, while methods of analysis were not reported in over a third of studies (n = 6; 35.3%).
Conclusion
Usability of wearable devices is a poorly measured and reported variable in chronic health conditions. Although the heterogeneity in how these devices are implemented implies acceptance, the patient voice should not be assumed. In the absence of being able to make specific usability conclusions, the results of this review instead recommends that future research needs to: (1) Conduct usability assessments as standard, irrespective of the cohort under investigation or the type of study undertaken. (2) Adhere to basic reporting standards (e.g. COREQ) including the basic details of the study. Full copies of any questionnaires and interview guides should be supplied through supplemental files. (3) Utilise mixed methods research to gather a more comprehensive understanding of usability than either qualitative or quantitative research alone will provide. (4) Use previously validated questionnaires alongside any intervention specific measures.
Background
Healthcare research is in the midst of a paradigm shift with a move towards more long-term behavioural monitoring through the use of wearable devices. This shift has been recognised by the World Health Organisation (WHO) through its recent publication of a digital health strategy [1]. While wearable devices offer researchers access to previously unattainable information regarding how people behave, additional factors need to be considered when designing and implementing these devices including patient safety, privacy, cost-effectiveness etc. Of critical importance, is that this digital shift should be patient-centred, evidence based, inclusive and contextualised [1].
Whether a device is considered usable by the person who will be wearing it has been identified as “among the most important considerations with patient-orientated digital-based solutions” [2]. The International Organization for Standardization defines usability as “the effectiveness, efficiency, and satisfaction with which specified users achieve specified goals in particular environments” [3]. In this manner usability is a broad concept that can also include the acceptability of, or satisfaction with, a device, while the WHO lists the evaluation of the usability and feasibility of a device being the first steps that should be undertaken when assessing any new digital health intervention [1, 4]. It has been suggested that for wearable devices to be accepted, they must be easy to wear, easy to use, affordable, contain relevant functionality and be aesthetically pleasing [5,6,7,8]. Usability, by its nature, is context specific and understanding how context may influence adoption has been highlighted as a research need in this area [9]. The acceptability of the above will depend on the length of time the device needs to be worn for and the characteristics of those using it, including their health conditions. The concept of usability is therefore almost never ending, as researchers and digital health developers need to ensure that their selected device is fit for purpose within all aspects of their study design. Failure to assess usability may result in researchers implementing devices that are not worn, that are worn or used incorrectly, and thus may negatively impact data collection and quality and limit the impact of any intervention [1, 10, 11].
Usability is likely to be specifically important in contexts where wearable devices are designed to be implemented during real-world tasks or activities. Walking (including gait and physical activity) in particular, is a functional task that is part of most activities of daily living and has been identified as so critical to health, that is has been labelled a ‘vital sign’ [12, 13]. Many consumer wearable measure activity as standard, but in-depth gait analysis, and the production of digital biomarkers linked to gait, is becoming an important feature of current and future research as it is recognised that understanding how people move can inform researchers and clinicians alike of patient progress, behaviour change and intervention effectiveness [14,15,16,17]. Thus, if walking is a key activity being measured by wearables, it is important to understand how usable these devices are in this context. To date, most usability studies have evaluated devices in healthy adults, or have focused primarily on consumer and/or watch based devices [5, 18,19,20,21,22,23,24,25]. However, the needs of healthy adults are likely to be very different than those with chronic health conditions with which many of these devices are deployed to support. For example, issues with fine motor control, skin sensitivity, or balance deficits may be present in clinical cohorts and may be aggravated by the use of certain devices depending on their size, materials and interactivity. A 2015 study suggested that wearable devices are generally accepted by people with chronic conditions, however this research failed to report what type of wearables were assessed, or what chronic conditions were included in the analysis [20]. It has been suggested that health conditions and the specific measurement needs of conditions impacts participant adherence [21]. Specifically in relation to walking, many chronic conditions are associated with symptoms that may impact how well an individual can walk, but the pathophysiology’s and the impact on mobility may be very different [15], for example cardiorespiratory conditions vs neurological. Wearable devices need to be usable across a comprehensive trajectory of mobility problems, thus it is worth exploring users perceptions across multiple cohorts so as to broadly determine their usability in people with chronic conditions. Therefore, this review focused on five clinical cohorts, specifically respiratory problems (chronic obstructive pulmonary disease—COPD), neurodegenerative conditions (Parkinson’s disease—PD), neuroinflammatory problems (multiple sclerosis—MS), osteoporosis and sarcopenia (hip fracture recovery/proximal femoral fracture—PFF), and cardiac pathology (congestive heart failure—CHF). Combined these cohorts are highly prevalent conditions with significant associated disability. Specifically, COPD is the most prevalent chronic respiratory illness globally [26], the rate of prevalence and burden for MS and PD are growing and for PD have doubled [27, 28], PFF is the fracture with the greatest direct cost to the community [29], CHF accounts for up to 2% of healthcare expenditure, while all conditions are associated with greater falls risk which are a significant cause of death and disability globally [30]. Collectively these conditions represent broad array of mobility problems with different trajectories of disability, thus allowing for a comprehensive evaluation of mobility. Although it is likely that some differences in usability may be noted between cohorts, it is nonetheless worth comparing across common conditions to determine where differences and similarities in usability exist.
To the author’s knowledge no systematic review investigating the usability of wearable devices specifically for mobility exists, Given the dearth of literature examining the usability of wearable devices for the assessment of walking in cohorts with chronic health conditions, further evaluations of this are required to support the use and development of these devices in the future. Therefore, this study aimed to conduct a systematic review of the literature to explore the usability of wearable devices to monitor gait and activity in five common patient cohorts where digital mobility assessment may be clinically useful to monitor their symptoms and progress.
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