T.M. Tönis

Daily physical activities in chronic lower back pain patients assessed with accelerometry

Background: Normalization of activities in daily living is an important goal in rehabilitation treatment of chronic lower back pain (CLBP) patients. Clinicians indicate that CLBP patients often show deconditioning but also CLBP patients who seem to be too active are seen. The objective of the present cross‐sectional study was to gain more insight into the daily activity pattern of CLBP patients compared to controls, using accelerometry.

Biosignal and context monitoring: Distributed multimedia applications of Body Area Networks in healthcare

We are investigating the use of body area networks (BANs), wearable sensors and wireless communications for measuring, processing, transmission, interpretation and display of biosignals. The goal is to provide telemonitoring and teletreatment services for patients. The remote health professional can view a multimedia display which includes graphical and numerical representation of patientspsila biosignals. Addition of feedback-control enables teletreatment services; teletreatment can be delivered to the patient via multiple modalities including tactile, text, auditory and visual. We describe the health BAN and a generic mobile health service platform and two context aware applications. The epilepsy application illustrates processing and interpretation of multi-source, multimedia BAN data. The chronic pain application illustrates multi-modal feedback and treatment, with patients able to view their own biosignals on their handheld device.

Optimal sensor placement for measuring physical activity with a 3D accelerometer

Accelerometer-based activity monitors are popular for monitoring physical activity. In this study, we investigated optimal sensor placement for increasing the quality of studies that utilize accelerometer data to assess physical activity. We performed a two-staged study, focused on sensor location and type of mounting. Ten subjects walked at various walking speeds on a treadmill, performed a deskwork protocol, and walked on level ground, while simultaneously wearing five ProMove2 sensors with a snug fit on an elastic waist belt. We found that sensor location, type of activity, and their interaction-effect affected sensor output. The most lateral positions on the waist belt were the least sensitive for interference. The effect of mounting was explored, by making two subjects repeat the experimental protocol with sensors more loosely fitted to the elastic belt. The loose fit resulted in lower sensor output, except for the deskwork protocol, where output was higher. In order to increase the reliability and to reduce the variability of sensor output, researchers should place activity sensors on the most lateral position of a participants waist belt. If the sensor hampers free movement, it may be positioned slightly more forward on the belt. Finally, sensors should be fitted tightly to the body.

Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: A case control study

OBJECTIVES Deviations in daily physical activity patterns may play an important role in the development and maintenance of fatigue in the chronic fatigue syndrome (CFS). The aim of this study is to gain insight into the objective daily physical activity pattern of patients with CFS in comparison with healthy controls. The secondary objective is studying the awareness in performing physical activities. METHODS The objective daily physical activity pattern was measured with a tri-axial accelerometer in 35 patients with CFS and in 35 age- and gender-matched healthy controls. The objective daily physical activity level and distribution of physical activities at low, medium and high intensity levels during the day were measured. Moreover, variability in performing physical activities within and between subjects was computed. Subjective ratings of self-reported daily physical activity levels were assessed at a visual analog scale. RESULTS CFS patients were significantly less physically active in the afternoon and evening, and spent fewer activities at high intensity levels and more at low intensity levels. Moreover, CFS patients showed more variability in their own physical activity pattern during the afternoon. The heterogeneity in the physical activity pattern between subjects within the CFS and control group did not differ. Finally, CFS patients were more aware about their daily physical activity level than healthy controls. CONCLUSION CFS patients showed deviations in the objectively measured daily physical activity pattern. Future research should elucidate the relation between impaired balances in daily physical activity patterns and fatigue severity in CFS.

Relationship between patterns of daily physical activity and fatigue in cancer survivors

PURPOSE This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. METHOD Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0-10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). RESULTS Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations. CONCLUSIONS This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue.

Sedentary behaviour profiling of office workers: a sensitivity analysis of sedentary cut-points

Measuring sedentary behaviour and physical activity with wearable sensors provides detailed information on activity patterns and can serve health interventions. At the basis of activity analysis stands the ability to distinguish sedentary from active time. As there is no consensus regarding the optimal cut-point for classifying sedentary behaviour, we studied the consequences of using different cut-points for this type of analysis. We conducted a battery of sitting and walking activities with 14 office workers, wearing the Promove 3D activity sensor to determine the optimal cut-point (in counts per minute (m·s−2)) for classifying sedentary behaviour. Then, 27 office workers wore the sensor for five days. We evaluated the sensitivity of five sedentary pattern measures for various sedentary cut-points and found an optimal cut-point for sedentary behaviour of 1660 × 10−3 m·s−2. Total sedentary time was not sensitive to cut-point changes within ±10% of this optimal cut-point; other sedentary pattern measures were not sensitive to changes within the ±20% interval. The results from studies analyzing sedentary patterns, using different cut-points, can be compared within these boundaries. Furthermore, commercial, hip-worn activity trackers can implement feedback and interventions on sedentary behaviour patterns, using these cut-points.

Co-creation of an ICT-supported cancer rehabilitation program for lung cancer survivors

Background: Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and Quality of Life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of ICT applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this abstract is to report on this process of co-creation of an ICT-supported cancer rehabilitation program with and for lung cancer patients and their healthcare professionals (HCP’s). Material and Methods: Requirements were established during semi-structured interviews and focus groups with LC patients (n=10) and HCP’s (n=11) and validated by means of written scenarios describing the integration of the future program in existing healthcare processes. Requirement specification was succeeded by the development of a first prototype. Usability of the prototype was then evaluated with healthy subjects (n=13), LC patients (n=7) and HCP’s (n=9) by means of semi-structured interviews and the System Usability Scale (SUS). Results: The developed rehabilitation program contains the following modules: 1) symptom self-monitoring of pain, dyspnoea, fatigue, and physical condition using on-body sensors (HR, O2 saturation, and accelerometer) in combination with a smartphone, and 2) an online physical exercise program. The results of the symptom monitoring module are visualised on a web portal integrating monitoring data with electronic patient records. Usability of the program was scored acceptable by 84% of the users (SUS median score=78). Overall, LC patients and HCP’s found the system simple and effective for daily symptom monitoring and improvement of physical fitness with a home-based exercise program, and 73% would be willing to use the system when offered to them as part of lung cancer treatment. Conclusion: With a user-centred design approach we were able to assess and evaluate the requirements of LC patients and HCP’s for the ICT-supported rehabilitation program repeatedly during the entire developmental process, resulting in a final version of the program that matches the end users’ requirements. The next step is to evaluate feasibility and clinical effect of the program as part of regular care following lung cancer surgery.