Exploring the barriers and facilitators for the use of digital health technologies for the management of COPD: a qualitative study of clinician perceptions.

BACKGROUND: Digital health technology (DHT) promises to support patients and healthcare professionals (HCPs) to optimize the management of chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence demonstrating the effectiveness of DHT for the management of COPD. One reason for this is the lack of user-involvement in the development of DHT interventions in COPD meaning their needs and preferences are rarely accounted for in the design phase. Although HCP adoption issues have been identified in relation to DHT, little is known about the challenges perceived by HCPs providing care to COPD patients. Therefore, this study aims to qualitatively explore the barriers and facilitators HCPs perceive for the use of DHT in the management of COPD. METHODS: Participants (n = 32) were recruited using snowball sampling from two university hospitals and several general practitioner clinics. A semi-structured interview was conducted with each participant. NVivo 12 software was used to complete thematic analysis on the data. RESULTS: Themes identified include: data quality; evidence-based care; resource constraints; and digital literacy presented as barriers; and facilitators include the following themes: digital health training and education; improving HCP digital literacy; and Personalized prescribing. Patient-centered approaches, such as pulmonary rehabilitation and shared decision-making were suggested as implementation strategies to ease the adoption of digital health for the management of COPD. CONCLUSION: These findings contribute new insights about the needs and preferences of HCPs working in COPD regarding DHT. The findings can be used to help mitigate user-experience issues by informing the design of person-centered implementation and adoption strategies for future digital health interventions in COPD.

Gait Biomechanics in Participants, Six Months after First-time Lateral Ankle Sprain.

No research currently exists predicating a link between the injury-affiliated sensorimotor deficits of acute ankle sprain and those of chronic ankle instability during gait. This analysis evaluates participants with a 6-month history of ankle sprain injury to affirm this link. 69 participants with a 6-month history of acute first-time lateral ankle sprain were divided into subgroups ('chronic ankle instability' and 'coper') based on their self-reported disability and compared to 20 non-injured participants during a gait task. Lower extremity kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). The 'chronic ankle instability' subgroup (who reported greater disability) displayed increased knee flexion during period 1. During period 2, this subgroup exhibited greater total displacement at their ankle joint and greater extensor dominance at their knee. That many of these features are present, both in individuals with acute ankle sprain and those with chronic ankle instability may advocate a link between acute deficits and long-term outcome. Clinicians must be aware that the sensorimotor deficits of ankle sprain may persevere beyond the acute stage of injury and be cognizant of the capacity for impairments to pervade proximally.

Single-leg drop landing movement strategies 6 months following first-time acute lateral ankle sprain injury.

No research exists predicating a link between acute ankle sprain injury-affiliated movement patterns and those of chronic ankle instability (CAI) populations. The aim of the current study was to perform a biomechanical analysis of participants, 6 months after they sustained a first-time acute lateral ankle sprain (LAS) injury to establish this link. Fifty-seven participants with a 6-month history of first-time LAS and 20 noninjured participants completed a single-leg drop landing task on both limbs. Three-dimensional kinematic (angular displacement) and sagittal plane kinetic (moment of force) data were acquired for the joints of the lower extremity, from 200 ms pre-initial contact (IC) to 200 ms post-IC. Individual joint stiffnesses and the peak magnitude of the vertical component of the ground reaction force (GRF) were also computed. LAS participants displayed increases in hip flexion and ankle inversion on their injured limb (P < 0.05); this coincided with a reduction in the net flexion-extension moment at the hip joint, with an increase in its stiffness (P < 0.05). There was no difference in the magnitude of the peak vertical GRF for either limb compared with controls. These results demonstrate that altered movement strategies persist in participants, 6 months following acute LAS, which may precipitate the onset of CAI.

Single-leg drop landing motor control strategies following acute ankle sprain injury.

No research currently exists investigating the effect of acute injury on single-limb landing strategies. The aim of the current study was to analyze the coordination strategies of participants in the acute phase of lateral ankle sprain (LAS) injury. Thirty-seven participants with acute, first-time LAS and 19 uninjured participants completed a single-leg drop landing task on both limbs. Three-dimensional kinematic (angular displacement) and sagittal plane kinetic (moment-of-force) data were acquired for the joints of the lower extremity from 200 ms pre-initial contact (IC) to 200 ms post-IC. The peak magnitude of the vertical component of the ground reaction force (GRF) was also computed. Injured participants displayed a bilateral increase in hip flexion, with altered transverse plane kinematic profiles at the knee and ankle for both limbs (P < 0.05). This coincided with a reduction in the net-supporting flexor moment of the lower extremity (P < 0.05) and magnitude of the peak vertical GRF for the injured limb (21.82 ± 2.44 N/kg vs 24.09 ± 2.77 N/kg; P = 0.013) in injured participants compared to control participants. These results demonstrate that compensatory movement strategies are utilized by participants with acute LAS to successfully reduce the impact forces of landing.

An Energetic Model of Low Frequency Isometric Neuromuscular Electrical Stimulation.

The objective of this study was to evaluate whether an adapted Hill-type model of muscle energetics could account for the relatively high energy turnover observed during low frequency isometric Neuromuscular Electrical Stimulation (NMES). A previously validated Hill-based model was adapted to estimate the energy consumption due to muscle activation, force maintenance and internal shortening of the muscle during isometric NMES. Quadriceps muscle model parameters were identified for 10 healthy subjects based on the experimentally measured torque response to isometric stimulation at 8 Hz. Model predictions of torque and energy consumption rates across the stimulation range 1-12 Hz were compared with experimental data recorded from the same subjects. The model provided estimates in close agreement with the experimental values for the group mean energy consumption rate across the frequency range tested, (R adj (2) = 0.98), although prediction of individual data points for all frequencies and all subjects was more variable, (R adj (2) = 0.70). The model suggests that approximately one-third of the energy between 4 and 6 Hz is due to shortening heat. The model provides a means of identifying optimal therapeutic stimulation patterns for sustained incremental oxygen uptake at minimum torque output for a given muscle and provides insight into the energetic components involved.

What is Connected Health and why will it change your practice?

As a society we have to re-imagine our health and social care models to meet the challenge of an ageing population with greater levels of chronic disease. The digital revolution offers us the potential to leverage technological innovations to develop proactive 'connected' health and social care models that are built around the patient's needs to facilitate efficient management of wellness and health throughout their lifespan. However, efforts to utilize technological innovations for this purpose have not been universally successful to date, indicating that technology itself is only part of the solution. To achieve a truly connected, technology enabled, health and social care model we need to overcome some key challenges; first, we need to optimize the process of sensing data from end users in the home and community such that monitoring protocols are built around the person and designed with respect to their needs to provide for accurate and reliable harvesting of target data. We then need to gather and mine large datasets from the home and community to analyse the complex relationships between home and community acquired data and health status. Only then can we begin to design, implement and evaluate new models of care that leverage technology platforms. In meeting this challenge we can leverage technology to transform the way in which we promote and manage wellness and health throughout the lifespan.

The physiological effects of low-intensity neuromuscular electrical stimulation (NMES) on short-term recovery from supra-maximal exercise bouts in male triathletes.

This study investigated the acute effects of NMES on blood lactate (BLa) and performance parameters in trained male triathletes. On three separate days, 13 trained male triathletes performed six 30 s Wingate tests (30 WanT) on a cycle ergometer. Each session consisted of performing 3 × 30 WanT (bouts 1-3) followed by a randomly assigned 30 min recovery intervention of either: (i) passive (seated), (ii) active (cycling at 30% VO(2 max)) or (iii) NMES (1 Hz/500 µs-ON:OFF 2:6 s). The 3 × 30 WanT bouts were then repeated (bouts 4-6) and compared to bouts 1-3 for peak power (PP), mean power (MP) and fatigue index (FI). BLa and heart rate (HR) were recorded at designated time points throughout. Data were analyzed using repeated measures ANOVA with Tukey's honestly significant difference post hoc test. BLa decreased significantly faster during the active recovery intervention (P < 0.001), however, there were no significant differences between interventions for PP (P = 0.217), MP (P = 0.477) and FI (P = 0.234) when the post intervention bouts (4-6) where compared to the pre intervention bouts (1-3). NMES during recovery was not more effective than active or passive recovery for improving subsequent performance. Despite BLa clearing at a significantly faster rate for the active recovery intervention, PP, MP or FI did not improve significantly compared to NMES and passive. In conclusion, NMES does not appear to be more effective than traditional methods for enhancing short-term recovery from supra-maximal exercise bouts in trained male triathletes.

Quantifying show jumping horse rider expertise using IMUs.

Horse rider ability has long been measured using horse performance, competition results and visual observation. Scientific methods of measuring rider ability on the flat are emerging such as measuring position angles and harmony of the horse-rider system. To date no research has quantified rider ability in show jumping. Kinematic analysis and motion sensors have been used in sports other than show jumping to measure the quality of motor control patterns in humans. The aim of this study was to quantify rider ability in show jumping using body-mounted IMUs. Preliminary results indicate that there are clear differences in experienced and novice riders during show jumping.

The effect of a vastus lateralis tape on muscle activity during stair climbing.

Recently taping techniques with the primary purpose of altering muscle activity have become a part of clinical physiotherapy practice. A firmly applied tape across the fibres of the vastus lateralis (VL) muscle has been proposed to decrease the VL muscle activity. The primary aim of this study was to assess the effects of an inhibitory muscle tape applied over the vastus lateralis (VL) muscle during stair climbing. Twenty five subjects without lower limb pathology were recruited. Normalised integrated EMG (IEMG) was analysed from VL, vastus medialis obliquus (VMO), biceps femoris (BF) and soleus muscles during stair climbing. The subjects were assessed during three conditions: no tape (untaped), (no tension) control tape and (tensioned tape) VL inhibitory taping application. There was a significant decrease (p<0.05) in the VL IEMG during the initial stance phase during both stair ascent and descent. The inhibition if the VL muscle occurred with both control and VL inhibitory tape applied. No significant differences (p>0.05) were noted in any of the other muscles assessed. The results demonstrated that there was a significant decrease in the IEMG of the VL both during stair ascent and descent with VL inhibitory tape and control tape applied in normal subjects.