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One goal of the project described in this paper is to create learning algorithms for machines and robots that lack a precise virtual controller for correct simulations. Using a digital twin approach, the developed mixed reality application aims for an overlay of a virtual robot model with the real world counterpart using Microsoft HoloLens 2 smart glasses. The application should help users to have an inside look into the results of the learning algorithm and therefore supervise and improve those results. The main focus of this paper is the visual representation of the digital twin on the smart glasses. One of the challenges is the level of abstraction and specific use of shaders (program code defining material attributes) to help the user differentiating between virtual and real objects. Therefore different presentation methods are described and evaluated. Study results with 48 persons show that the most abstract representation (wireframe) scores lowest, whereas a half-transparent model works best.
Background: The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk.
Objective: Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET).
Methods: A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET.
Results: Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app.
Conclusions: A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived.
Background: Peripheral arterial disease (PAD) is a common and severe disease with a highly increased cardiovascular morbidity and mortality. Through the circulatory disorder and the linked undersupply of oxygen carriers in the lower limbs, the ongoing decrease of the pain-free walking distance occurs with a significant reduction in patients’ quality of life. Studies including activity monitoring for patients with PAD are rare and digital support to increase activity via mobile health technologies is mainly targeted at patients with cardiovascular disease in general. The special requirement of patients with PAD is the need to reach a certain pain level to improve the pain-free walking distance. Unfortunately, both poor adherence and availability of institutional resources are major problems in patient-centered care.
Objective: The objective of this trackPAD pilot study is to evaluate the feasibility of a mobile phone–based self tracking app to promote physical activity and supervised exercise therapy (SET) in particular. We also aim for a subsequent patient centered adjustment of the app prototype based on the results of the app evaluation and process evaluation.
Methods: This study was designed as a closed user group trial, with assessors blinded, and parallel group study with face-to-face components for assessment with a follow-up of 3 months. Patients with symptomatic PAD (Fontaine stage IIa or IIb) and possession of a mobile phone were eligible. Eligible participants were randomly assigned into study and control group, stratified by their distance covered in the 6-min walk test, using the software TENALEA. Participants randomized to the study group received usual care and the mobile intervention (trackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received only usual care. TrackPAD records the frequency and duration of training sessions and pain level using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (6-min walk test, ankle-brachial index, and duplex ultrasound at the lower arteries) and self-reported quality of life. Usability and quality of the app was determined using the user version of the Mobile Application Rating Scale.
Results: The study enrolled 45 participants with symptomatic PAD (44% male). Of these participants, 21 (47%) were randomized to the study group and 24 (53%) were randomized to the control group. The distance walked in the 6-min walk test was comparable in both groups at baseline (study group: mean 368.1m [SD 77.6] vs control group: mean 394.6m [SD 100.6]).
Conclusions: This is the first trial to test a mobile intervention called trackPAD that was designed especially for patients with PAD. Its results will provide important insights in terms of feasibility, effectiveness, and patient preferences of an app-based mobile intervention supporting SET for the conservative treatment of PAD.
Background: Mobile health interventions are intended to support complex health care needs in chronic diseases digitally, but they are mainly targeted at general health improvement and neglect disease-specific requirements. Therefore, we designed TrackPAD, a smartphone app to support supervised exercise training in patients with peripheral arterial disease.
Objective: This pilot study aimed to evaluate changes in the 6-minute walking distance (meters) as a primary outcome measure. The secondary outcome measures included changes in physical activity and assessing the patients’ peripheral arterial disease–related quality of life.
Methods: This was a pilot two-arm, single-blinded, randomized controlled trial. Patients with symptomatic PAD (Fontaine stage IIa/b) and access to smartphones were eligible. Eligible participants were randomly assigned to the study, with the control group stratified by the distance covered in the 6-minute walking test using the TENALEA software. Participants randomized to the intervention group received usual care and the mobile intervention (TrackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received routine care only. TrackPAD records the frequency and duration of training sessions and pain levels using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (the 6-minute walk test and self-reported quality of life). The usability and quality of the app were determined using the Mobile Application Rating Scale user version.
Results: The intervention group (n=19) increased their mean 6-minute walking distance (83 meters, SD 72.2), while the control group (n=20) decreased their mean distance after 3 months of follow-up (–38.8 meters, SD 53.7; P=.01). The peripheral arterial disease–related quality of life increased significantly in terms of “symptom perception” and “limitations in physical functioning.” Users’ feedback showed increased motivation and a changed attitude toward performing supervised exercise training.
Conclusions: Besides the rating providing a valuable support tool for the user group, the mobile intervention TrackPAD was linked to a change in prognosis-relevant outcome measures combined with enhanced coping with the disease. The influence of mobile interventions on long-term prognosis must be evaluated in the future.
When it comes to improving the health of the general population, mHealth technologies with self-monitoring and intervention components hold a lot of promise. We argue, however, that due to various factors such as access, targeting, personal resources or incentives, self-monitoring applications run the risk of increasing health inequalities, thereby creating a problem of social justice. We review empirical evidence for “intervention-generated” inequalities, present arguments that self-monitoring applications are still morally acceptable, and develop approaches to avoid the promotion of health inequalities through self-monitoring applications.
Continuous monitoring of interactive exhibits in museums as part of a persuasive design approach
(2021)
Background: Cardiovascular disease is the major cause of death worldwide. Although knowledge regarding diagnosing and treating cardiovascular disease has increased dramatically, secondary prevention remains insufficiently implemented due to failure among affected individuals to adhere to guideline recommendations. This has continued to lead to high morbidity and mortality rates. Involving patients in their healthcare and facilitating their active roles in their chronic disease management is an opportunity to meet the needs of the increasing number of cardio-vascular patients. However, simple recall of advice regarding a more preventive lifestyle does not affect sustainable behavioral lifestyle changes. We investigate the effect of plaque visualization combined with low-threshold daily lifestyle tasks using the smartphone app PreventiPlaque to evaluate change in cardiovascular risk profile. Methods: and study design: This randomized, controlled clinical trial includes 240 participants with ultrasound evidence of atherosclerotic plaque in one or both carotid arteries, defined as focal thickening of the vessel wall measuring 50% more than the regular vessel wall. A criterion for participation is access to a smartphone suitable for app usage. The participants are randomly assigned to an intervention or a control group. While both groups receive the standard of care, the intervention group has additional access to the PreventiPlaque app during the 12-month follow-up. The app includes daily tasks that promote a healthier lifestyle in the areas of smoking cessation, medication adherence, physical activity, and diet. The impact of plaque visualization and app use on the change in cardiovascular risk profile is assessed by SCORE2. Feasibility and effectiveness of the PreventiPlaque app are evaluated using standardized and validated measures for patient feedback.
Hallo. Ich bin Lio.
(2022)
Von Assistenzrobotern im Pflegebereich erhofft man sich Unterstützung in vielfacher Weise: Sie sollen zur Erleichterung für das Pflegepersonal führen (z.B. durch Handreichung von Gegenständen), mehr Sicherheit bringen (z.B. indem sie Nachschauen, sobald Auffälliges registriert wird) und zu einem gesunden Altern (z.B. körperliche Aktivierung) und zu mehr Teilhabe (z.B. psychosoziale Aktivierung) beitragen. Ihre Funktionen versprechen daher einerseits Assistenz für Pflege- und Betreuungspersonal (z.B. Transport- und Serviceaufgaben) und andererseits soziale Assistenz für Senior:innen in Pflegesituationen (z.B. Unterhaltung, Aktivierung).
In dem Projekt PUR (Pflegeunterstützende Robotik) wurde der Roboter Lio der Firma F&P Robotics AG über einen Zeitraum von 22 Monaten in Wohnbereichen in zwei Pflegeeinrichtungen in Konstanz und Schaffhausen getestet und situationsangepasst weiterentwickelt. Mit Unterstützung des Personals und der Bewohner:innen vor Ort wurde Lio anhand der Kriterien Usability, User Experience, Akzeptanz sowie seinen Nutzen für die Organisation evaluiert. Neben den Befragungen der Akteur:innen in den beiden Einrichtungen erfolgte eine systematische Erfassung und Analyse von Informationen und Daten anhand von Logfiles und Dokumenten in welchen Nutzungsdauer und -häufigkeit sowie Fehlerraten erfasst wurden.
Es wurde deutlich, dass Lio sich noch hinsichtlich aller Kriterien verbessern muss um die hohen Erwartungen bezüglich einer wahrnehmbaren Entlastung des Pflegepersonals bei gleichzeitiger Aufrechterhaltung oder Verbesserung der Lebensqualität der Bewohner:innen erfüllen zu können. Als Schlüsselfunktion für eine optimierte Usability und User Experience wird die Bedienbarkeit über Sprache betrachtet. Zum einen aus Sicht der Pflege- und Betreuungskräfte die Lio z.B. in hektischen Situationen in der Nachtschicht schnell und einfach in seinem Autonomiemodus (z.B. Desinfizieren von Türen) unterbrechen müssen. Zum anderen aus Sicht der Bewohner:innen die ihn ansprechen, aber nicht verstanden werden, womit das aktivierende Potential, das in Lio steckt, nicht ausgeschöpft wird.
Eine routinemäßige Einbindung von Assistenzrobotern wie Lio in die Pflege- und Betreuungspraxis erfordert neben der Lösung von technischen Problemen (wie zuverlässige Navigation, Sprachinteraktion) auch geeignete Beteiligungsansätze der Akteuer:innen. Diese sind so zu gestalten, dass nicht nur die technikaffinen Personen abgeholt werden, sondern allen ein entsprechendes Angebot gemacht wird, den Umgang mit dem technischen System zu erproben und in der Kontrolle und Bedienung Sicherheit zu erlangen.
Die befragten Akteur:innen sehen eine Zukunft für Assistenzroboter sofern sie autonom, zuverlässig und jederzeit gut kontrollierbar funktionieren und stehen dem digitalen Transformationsprozess in der Pflege größtenteils sehr offen gegenüber.
Der Einsatz von Robotik im Pflegekontext wird kontrovers diskutiert und löst unterschiedliche Assoziationen aus. In diesem Beitrag stellen wir Ergebnisse aus einer schriftlichen Befragung bei Pflegekräften aus Deutschland vor. Es wird aufgezeigt, für welche Funktionen und Aufgaben sich Pflegekräfte den Einsatz von Roboter vorstellen können und wo gegensätzliche Einstellungen gegenüber Robotern bestehen. Ein Fallbeispiel illustriert ein mögliches Anwendungsfeld. Mit den reflexiven Fragen laden wir die:den Lesenden ein, sich selbst mit der Idee Roboter als Alltagshelfer für ältere Menschen auseinanderzusetzen.