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1.
BMC Med Res Methodol ; 23(1): 50, 2023 02 24.
Article in English | MEDLINE | ID: covidwho-2267284

ABSTRACT

BACKGROUND: Commercial activity trackers are increasingly used in research and compared with research-based accelerometers are often less intrusive, cheaper, with improved storage and battery capacity, although typically less validated. The present study aimed to determine the validity of Oura Ring step-count and energy expenditure (EE) in both laboratory and free-living. METHODS: Oura Ring EE was compared against indirect calorimetry in the laboratory, followed by a 14-day free-living study with 32 participants wearing an Oura Ring and reference monitors (three accelerometers positioned at hip, thigh, and wrist, and pedometer) to evaluate Oura EE variables and step count. RESULTS: Strong correlations were shown for Oura versus indirect calorimetry in the laboratory (r = 0.93), and versus reference monitors for all variables in free-living (r ≥ 0.76). Significant (p < 0.05) mean differences for Oura versus reference methods were found for laboratory measured sitting (- 0.12 ± 0.28 MET), standing (- 0.27 ± 0.33 MET), fast walk (- 0.82 ± 1.92 MET) and very fast run (- 3.49 ± 3.94 MET), and for free-living step-count (2124 ± 4256 steps) and EE variables (MET: - 0.34-0.26; TEE: 362-494 kcal; AEE: - 487-259 kcal). In the laboratory, Oura tended to underestimate EE with increasing discrepancy as intensity increased. The combined activities and slow running in the laboratory, and all MET placements, TEE hip and wrist, and step count in free-living had acceptable measurement errors (< 10% MAPE), whereas the remaining free-living variables showed close to (≤13.2%) acceptable limits. CONCLUSION: This is the first study investigating the validity of Oura Ring EE against gold standard methods. Oura successfully identified major changes between activities and/or intensities but was less responsive to detailed deviations within activities. In free-living, Oura step-count and EE variables tightly correlated with reference monitors, though with systemic over- or underestimations indicating somewhat low intra-individual validity of the ring versus the reference monitors. However, the correlations between the devices were high, suggesting that the Oura can detect differences at group-level for active and total energy expenditure, as well as step count.


Subject(s)
Accelerometry , Energy Metabolism , Humans , Accelerometry/methods , Actigraphy , Fitness Trackers , Wrist
2.
PLoS One ; 18(2): e0281778, 2023.
Article in English | MEDLINE | ID: covidwho-2258815

ABSTRACT

One of the main factors in controlling infectious diseases such as COVID-19 is to prevent touching preoral and prenasal regions. Face touching is a habitual behaviour that occurs frequently. Studies showed that people touch their faces 23 times per hour on average. A contaminated hand could transmit the infection to the body by a facial touch. Since controlling this spontaneous habit is not easy, this study aimed to develop and validate a technology to detect and monitor face touch using dynamic time warping (DTW) and KNN (k-nearest neighbours) based on a wrist-mounted inertial measurement unit (IMU) in a controlled environment and natural environment trials. For this purpose, eleven volunteers were recruited and their hand motions were recorded in controlled and natural environment trials using a wrist-mounted IMU. Then the sensitivity, precision, and accuracy of our developed technology in detecting the face touch were evaluated. It was observed that the sensitivity, precision, and accuracy of the DTW-KNN classifier were 91%, 97%, and 85% in controlled environment trials and 79%, 92%, and 79% in natural environment trials (daily life). In conclusion, a wrist-mounted IMU, widely available in smartwatches, could detect the face touch with high sensitivity, precision, and accuracy and can be used as an ambulatory system to detect and monitor face touching as a high-risk habit in daily life.


Subject(s)
COVID-19 , Touch Perception , Humans , Touch , COVID-19/prevention & control , Hand , Wrist
3.
Biomed Eng Online ; 22(1): 25, 2023 Mar 13.
Article in English | MEDLINE | ID: covidwho-2258493

ABSTRACT

Core body temperature (CBT) is a key vital sign and fever is an important indicator of disease. In the past decade, there has been growing interest for vital sign monitoring technology that may be embedded in wearable devices, and the COVID-19 pandemic has highlighted the need for remote patient monitoring systems. While wrist-worn sensors allow continuous assessment of heart rate and oxygen saturation, reliable measurement of CBT at the wrist remains challenging. In this study, CBT was measured continuously in a free-living setting using a novel technology worn at the wrist and compared to reference core body temperature measurements, i.e., CBT values acquired with an ingestible temperature-sensing pill. Fifty individuals who received the COVID-19 booster vaccination were included. The datasets of 33 individuals were used to develop the CBT prediction algorithm, and the algorithm was then validated on the datasets of 17 participants. Mean observation time was 26.4 h and CBT > 38.0 °C occurred in 66% of the participants. CBT predicted by the wrist-worn sensor showed good correlation to the reference CBT (r = 0.72). Bland-Altman statistics showed an average bias of 0.11 °C of CBT predicted by the wrist-worn device compared to reference CBT, and limits of agreement were - 0.67 to + 0.93 °C, which is comparable to the bias and limits of agreement of commonly used tympanic membrane thermometers. The small size of the components needed for this technology would allow its integration into a variety of wearable monitoring systems assessing other vital signs and at the same time allowing maximal freedom of movement to the user.


Subject(s)
COVID-19 , Wrist , Humans , Body Temperature , Pilot Projects , Pandemics/prevention & control , COVID-19/prevention & control , Monitoring, Physiologic
4.
Sensors (Basel) ; 22(19)2022 Oct 08.
Article in English | MEDLINE | ID: covidwho-2066356

ABSTRACT

Wearable sensors have traditionally been used to measure and monitor vital human signs for well-being and healthcare applications. However, there is a growing interest in using and deploying these technologies to facilitate teaching and learning, particularly in a higher education environment. The aim of this paper is therefore to systematically review the range of wearable devices that have been used for enhancing the teaching and delivery of engineering curricula in higher education. Moreover, we compare the advantages and disadvantages of these devices according to the location in which they are worn on the human body. According to our survey, wearable devices for enhanced learning have mainly been worn on the head (e.g., eyeglasses), wrist (e.g., watches) and chest (e.g., electrocardiogram patch). In fact, among those locations, head-worn devices enable better student engagement with the learning materials, improved student attention as well as higher spatial and visual awareness. We identify the research questions and discuss the research inclusion and exclusion criteria to present the challenges faced by researchers in implementing learning technologies for enhanced engineering education. Furthermore, we provide recommendations on using wearable devices to improve the teaching and learning of engineering courses in higher education.


Subject(s)
Wearable Electronic Devices , Human Body , Humans , Monitoring, Physiologic , Technology , Wrist
5.
Sensors (Basel) ; 22(17)2022 Sep 02.
Article in English | MEDLINE | ID: covidwho-2024051

ABSTRACT

This article presents a systematic review of the literature concerning scientific publications on wrist wearables that can help to identify stress levels. The study is part of a research project aimed at modeling a stress surveillance system and providing coping recommendations. The investigation followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In total, 38 articles were selected for full reading, and 10 articles were selected owing to their alignment with the study proposal. The types of technologies used in the research stand out amongst our main results after analyzing the articles. It is noteworthy that stress assessments are still based on standardized questionnaires, completed by the participants. The main biomarkers collected by the devices used in the selected works included: heart rate variation, cortisol analysis, skin conductance, body temperature, and blood volume at the wrist. This study concludes that developing a wrist wearable for stress identification using physiological and chemical sensors is challenging but possible and applicable.


Subject(s)
Occupational Stress , Wrist , Biomarkers , Heart Rate , Humans , Occupational Stress/diagnosis , Research Design
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2459-2463, 2022 07.
Article in English | MEDLINE | ID: covidwho-2018737

ABSTRACT

With healthcare professionals being the frontline warriors in battling the Covid pandemic, their risk of exposure to the virus is extremely high. We present our experience in building a system, aimed at monitoring the physiology of these professionals 24/7, with the hope of providing timely detection of infection and thereby better care. We discuss a machine learning approach and model using signals from a wrist wearable device to predict infection at a very early stage. In a double-blind test on a small group of patients, our model could successfully identify the infected versus non-infected cases with near 100% accuracy. We also discuss some of the challenges we faced, both technical and non-technical, to get this system off the ground as well as offer some suggestions that could help tackle these hurdles.


Subject(s)
COVID-19 , Wearable Electronic Devices , COVID-19/diagnosis , Health Personnel , Humans , Machine Learning , Wrist
7.
J Bone Joint Surg Am ; 104(6): 489-496, 2022 03 16.
Article in English | MEDLINE | ID: covidwho-1793405
8.
Int J Environ Res Public Health ; 19(6)2022 03 21.
Article in English | MEDLINE | ID: covidwho-1765727

ABSTRACT

OBJECTIVE: The relevance of growth determination in orthodontics is driving the search for the most precise and least invasive way of tracking the pubertal growth spurt. Our aim was to explore whether minimally invasive salivary estimation of biomarkers Insulin-like growth factor (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) could be used to estimate skeletal maturity for clinical convenience, especially in children and adolescent age groups. MATERIALS AND METHOD: The cross-sectional study was conducted on 90 participants (56 girls and 34 males) with ages ranging from 6 to 25 years. Each subject's hand-wrist radiograph was categorized based on skeletal maturity, and saliva samples were estimated for IGF-1 and IGFBP-3 using the respective ELISA kits. Kruskal-Wallis nonparametric ANOVA was applied to compare different skeletal stages. RESULTS: The study demonstrated low salivary IGF-1 levels at the prepubertal stage, with increase during pubertal onset and peak pubertal stage followed by a decline during pubertal deceleration to growth completion. Spearman's correlation coefficient demonstrated a strong positive association (r = 0.98 p < 0.01) between salivary IGF/IGFBP-3 ratio and different stages of skeletal maturity. CONCLUSION: Salivary IGF-1, IGFBP-3, and IGF/IGFBP-3 ratio could serve as a potential biochemical marker for predicting the completion of skeletal maturity.


Subject(s)
Insulin-Like Growth Factor Binding Protein 3 , Insulin-Like Growth Factor I , Adolescent , Adult , Child , Cross-Sectional Studies , Female , Humans , Insulin-Like Growth Factor I/metabolism , Male , Radiography , Wrist , Young Adult
9.
Am J Case Rep ; 23: e934833, 2022 Mar 12.
Article in English | MEDLINE | ID: covidwho-1742958

ABSTRACT

BACKGROUND Calcium pyrophosphate dihydrate deposition disease includes a variety of clinical syndromes, including acute calcium pyrophosphate (CPP) crystal arthritis. Most patients with CPP crystal arthritis have a primary/idiopathic form presenting with severe pain, swelling, and stiffness. COVID-19 infection, which originated in China in December 2019, required extraordinary efforts to develop and test new vaccines to halt the pandemic. The Vaxzervria vaccine has shown excellent safety and efficacy in phase 3 trials with a mechanism based on the expression of the SARS-CoV-2 spike protein gene coding for the S-antigen, which stimulates the immune response. CASE REPORT We describe an acute event of crystal arthritis after a carpal tunnel syndrome release followed by administration of the second dose of anti-COVID-19 Vaccine Oxford-AstraZeneca (ChAdOx1 nCoV-19). Medical treatment resulted in full resolution of the symptoms in 2 weeks. CONCLUSIONS Although most episodes of acute arthritis happen spontaneously, certain factors may trigger the acute CPP crystal arthritis such as intercurrent illnesses or surgeries. Although the association between carpal tunnel syndrome and CPP arthritis has been known for over 40 years, surgical release of the carpal ligament has always been associated with full resolution of symptoms. This is the first case report describing an exacerbation after carpal canal release, concomitant with the administration of the vaccine. According to our opinion, the vaccination associated with a prior surgery in the same anatomical site could have synergically triggered the arthritis flare-up, in a predisposed patient, with a mechanism still unknown.


Subject(s)
COVID-19 , Carpal Tunnel Syndrome , Chondrocalcinosis , Crystal Arthropathies , Calcium Pyrophosphate/therapeutic use , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/etiology , Carpal Tunnel Syndrome/surgery , ChAdOx1 nCoV-19 , Chondrocalcinosis/complications , Chondrocalcinosis/drug therapy , Chondrocalcinosis/metabolism , Humans , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Vaccination/adverse effects , Wrist
10.
Med Eng Phys ; 102: 103777, 2022 04.
Article in English | MEDLINE | ID: covidwho-1693116

ABSTRACT

Non-contact infrared sensors are widely used as a diagnostic tool for elevated body temperature during initial screening for coronaviruses. The aim of this study was to investigate the thermal differences at three anatomical points: temple, forehead, and wrist, in the initial screening for temperature indicative of febrile and non-febrile states in skin pigmentation variations in Black, Half-Black and Caucasian skins, correlated with height and weight variables. Temperatures were obtained by means of an infrared thermometer in 289 volunteers with mean age of 18.30 ± 0.76, in a controlled environment according to Singapore Standard, SS582 part 1 and 2, normative standard IEC 80601-2-59, with standard technical protocols established by the International Organization for Standardization, ISO / TR 13154. The data were processed in MATLAB® R2021a, and data normality verified by Kolmogorov-Smirnov test, non-parametric data paired between temple / forehead / wrist were compared using the Wilcoxon signed-rank test. The results show different median temperatures in these anatomical regions, 37.2°C at the temple, 36.8°C at the forehead and 36.4°C at the wrist. As the temple region presents a temperature higher than the other investigated regions and, therefore, close to the core temperature, it should be considered for the initial screening of SARS-CoV-2 when using non-contact infrared thermometers. Furthermore, no significant changes were found due to variation in skin tone, height, or weight.


Subject(s)
COVID-19 , Forehead , Adolescent , Adult , Body Temperature , COVID-19/diagnosis , Ethnicity , Humans , SARS-CoV-2 , Technology , Temperature , Wrist , Young Adult
11.
Int J Environ Res Public Health ; 19(2)2022 01 09.
Article in English | MEDLINE | ID: covidwho-1633758

ABSTRACT

The available data from electroneurography (ENG) studies on the transmission of neural impulses in the motor fibers of upper and lower extremity nerves following neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy in post-stroke patients during sixty-day observation do not provide convincing results. This study aims to compare the effectiveness of an NMFES of antagonistic muscle groups at the wrist and ankle and kinesiotherapy based mainly on proprioceptive neuromuscular facilitation (PNF). An ENG was performed once in a group of 60 healthy volunteers and three times in 120 patients after stroke (T0, up to 7 days after the incident; T1, after 21 days of treatment; and T2, after 60 days of treatment); 60 subjects received personalized NMFES and PNF treatment (NMFES+K), while the other 60 received only PNF (K). An ENG studied peripheral (M-wave recordings), C8 and L5 ventral root (F-wave recordings) neural impulse transmission in the peroneal and the ulnar nerves on the hemiparetic side. Both groups statistically differed in their amplitudes of M-wave recording parameters after peroneal nerve stimulation performed at T0 and T2 compared with the control group. After 60 days of treatment, only the patients from the NMFES+K group showed significant improvement in M-wave recordings. The application of the proposed NMFES electrostimulation algorithm combined with PNF improved the peripheral neural transmission in peroneal but not ulnar motor nerve fibers in patients after ischemic stroke. Combined kinesiotherapy and safe, personalized, controlled electrotherapy after stroke give better results than kinesiotherapy alone.


Subject(s)
Electric Stimulation Therapy , Ischemic Stroke , Stroke Rehabilitation , Ankle , Electric Stimulation , Electric Stimulation Therapy/methods , Follow-Up Studies , Humans , Lower Extremity , Muscles , Stroke Rehabilitation/methods , Synaptic Transmission , Treatment Outcome , Wrist
12.
Int J Environ Res Public Health ; 18(24)2021 12 15.
Article in English | MEDLINE | ID: covidwho-1594999

ABSTRACT

The sleep/wake rhythm is one of the most important biological rhythms. Quality and duration of sleep change during lifetime. The aim of our study was to determine differences in sleep efficiency, movement, and fragmentation during sleep period between genders and according to age. Sleep period was monitored by wrist actigraphy under home-based conditions. Seventy-four healthy participants-47 women and 27 men participated in the study. The participants were divided by age into groups younger than 40 years and 40 years and older. Women showed lower sleep fragmentation and mobility during sleep compared to men. Younger women showed a higher actual sleep and sleep efficiency compared to older women and younger men. Younger men compared to older men had a significantly lower actual sleep, lower sleep efficiency and significantly more sleep and wake bouts. Our results confirmed differences in sleep parameters between genders and according to age. The best sleep quality was detected in young women, but gender differences were not apparent in elderly participants, suggesting the impact of sex hormones on sleep.


Subject(s)
Actigraphy , Wrist , Adult , Aged , Circadian Rhythm , Female , Humans , Male , Movement , Sleep , Sleep Quality
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 2374-2377, 2021 11.
Article in English | MEDLINE | ID: covidwho-1566221

ABSTRACT

Stress is a physiological state that hampers mental health and has serious consequences to physical health. More-over, the COVID-19 pandemic has increased stress levels among people across the globe. Therefore, continuous monitoring and detection of stress are necessary. The recent advances in wearable devices have allowed the monitoring of several physiological signals related to stress. Among them, wrist-worn wearable devices like smartwatches are most popular due to their convenient usage. And the photoplethysmography (PPG) sensor is the most prevalent sensor in almost all consumer-grade wrist-worn smartwatches. Therefore, this paper focuses on using a wrist-based PPG sensor that collects Blood Volume Pulse (BVP) signals to detect stress which may be applicable for consumer-grade wristwatches. Moreover, state-of-the-art works have used either classical machine learning algorithms to detect stress using hand-crafted features or have used deep learning algorithms like Convolutional Neural Network (CNN) which automatically extracts features. This paper proposes a novel hybrid CNN (H-CNN) classifier that uses both the hand-crafted features and the automatically extracted features by CNN to detect stress using the BVP signal. Evaluation on the benchmark WESAD dataset shows that, for 3-class classification (Baseline vs. Stress vs. Amusement), our proposed H-CNN outperforms traditional classifiers and normal CNN by ≈5% and ≈7% accuracy, and ≈10% and ≈7% macro F1 score, respectively. Also for 2-class classification (Stress vs. Non-stress), our proposed H-CNN outperforms traditional classifiers and normal CNN by ≈3% and ≈5% accuracy, and ≈3% and ≈7% macro F1score, respectively.


Subject(s)
COVID-19 , Wrist , Humans , Neural Networks, Computer , Pandemics , Photoplethysmography , SARS-CoV-2
14.
Ir J Med Sci ; 191(5): 2117-2121, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1469767

ABSTRACT

BACKGROUND: Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction. AIMS: Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle. METHODS: A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification. FINDINGS: A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, - 0.976 (p = 0.00025), and Weber A ankle fractures, - 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, - 0.701 (p = 0.129) and Weber B ankle fractures, - 0.786 (p = 0.235), though not achieving statistical significance. CONCLUSIONS: Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.


Subject(s)
Ankle Fractures , COVID-19 , Ankle Fractures/diagnostic imaging , Ankle Fractures/therapy , Humans , Pandemics , Retrospective Studies , Wrist , X-Rays
15.
Sensors (Basel) ; 21(17)2021 Aug 25.
Article in English | MEDLINE | ID: covidwho-1379984

ABSTRACT

Smart sensors, coupled with artificial intelligence (AI)-enabled remote automated monitoring (RAMs), can free a nurse from the task of in-person patient monitoring during the transportation process of patients between different wards in hospital settings. Automation of hospital beds using advanced robotics and sensors has been a growing trend exacerbated by the COVID crisis. In this exploratory study, a polynomial regression (PR) machine learning (ML) RAM algorithm based on a Dreyfusian descriptor for immediate wellbeing monitoring was proposed for the autonomous hospital bed transport (AHBT) application. This method was preferred over several other AI algorithm for its simplicity and quick computation. The algorithm quantified historical data using supervised photoplethysmography (PPG) data for 5 min just before the start of the autonomous journey, referred as pre-journey (PJ) dataset. During the transport process, the algorithm continued to quantify immediate measurements using non-overlapping sets of 30 PPG waveforms, referred as in-journey (IJ) dataset. In combination, this algorithm provided a binary decision condition that determined if AHBT should continue its journey to destination by checking the degree of polynomial (DoP) between PJ and IJ. Wrist PPG was used as algorithm's monitoring parameter. PPG data was collected simultaneously from both wrists of 35 subjects, aged 21 and above in postures mimicking that in AHBT and were given full freedom of upper limb and wrist movement. It was observed that the top goodness-of-fit which indicated potentials for high data accountability had 0.2 to 0.6 cross validation score mean (CVSM) occurring at 8th to 10th DoP for PJ datasets and 0.967 to 0.994 CVSM at 9th to 10th DoP for IJ datasets. CVSM was a reliable metric to pick out the best PJ and IJ DoPs. Central tendency analysis showed that coinciding DoP distributions between PJ and IJ datasets, peaking at 8th DoP, was the precursor to high algorithm stability. Mean algorithm efficacy was 0.20 as our proposed algorithm was able to pick out all signals from a conscious subject having full freedom of movement. This efficacy was acceptable as a first ML proof of concept for AHBT. There was no observable difference between subjects' left and right wrists.


Subject(s)
Wearable Electronic Devices , Algorithms , Artificial Intelligence , Hospitals , Humans , Machine Learning , Monitoring, Physiologic , Signal Processing, Computer-Assisted , Wrist
16.
BMJ Case Rep ; 14(7)2021 Jul 15.
Article in English | MEDLINE | ID: covidwho-1315799
17.
J Med Internet Res ; 23(4): e27503, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1219469

ABSTRACT

BACKGROUND: A decrease in the level of pulse oxygen saturation as measured by pulse oximetry (SpO2) is an indicator of hypoxemia that may occur in various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and COVID-19. Currently, no mass-market wrist-worn SpO2 monitor meets the medical standards for pulse oximeters. OBJECTIVE: The main objective of this monocentric and prospective clinical study with single-blind analysis was to test and validate the accuracy of the reflective pulse oximeter function of the Withings ScanWatch to measure SpO2 levels at different stages of hypoxia. The secondary objective was to confirm the safety of this device when used as intended. METHODS: To achieve these objectives, we included 14 healthy participants aged 23-39 years in the study, and we induced several stable plateaus of arterial oxygen saturation (SaO2) ranging from 100%-70% to mimic nonhypoxic conditions and then mild, moderate, and severe hypoxic conditions. We measured the SpO2 level with a Withings ScanWatch on each participant's wrist and the SaO2 from blood samples with a co-oximeter, the ABL90 hemoximeter (Radiometer Medical ApS). RESULTS: After removal of the inconclusive measurements, we obtained 275 and 244 conclusive measurements with the two ScanWatches on the participants' right and left wrists, respectively, evenly distributed among the 3 predetermined SpO2 groups: SpO2≤80%, 80%

Subject(s)
COVID-19/blood , COVID-19/complications , Hypoxia/blood , Hypoxia/complications , Oximetry/standards , Wrist , Adult , Female , Healthy Volunteers , Humans , Lung Diseases/blood , Lung Diseases/complications , Male , Monitoring, Physiologic , Oximetry/adverse effects , Oxygen/blood , Prospective Studies , Single-Blind Method , Young Adult
18.
J Hand Surg Am ; 46(8): 660-665, 2021 08.
Article in English | MEDLINE | ID: covidwho-1220065

ABSTRACT

PURPOSE: Telehealth use is likely to increase as a result of practice changes during the COVID-19 pandemic, although the overall picture surrounding the billing, coding, and continued insurance coverage of these visits remains uncertain. The purpose of this study was to identify potential financial implications of continued telehealth use in hand and wrist surgery clinical practice. METHODS: Two hundred telehealth visits were randomly selected and matched 1:1 based on primary diagnosis code to in-person visits. Medical and billing records were reviewed to compare visit complexities, total visit charges, work relative value units (wRVUs), and approved insurance reimbursement. Postoperative visits and visits with radiographic evaluation were excluded. RESULTS: Level 4 visits were more common with in-person encounters compared to telehealth (11% vs 2%, respectively), and level 1 and 2 visits were more common with telehealth compared to in-person encounters (14% vs 6%, respectively). Twenty-seven in-person visits (13%) had at least 1 additional procedure code billed. The mean total visit charge was 26% less in telehealth compared to in-person. Based on the primary procedure code alone, the sum of wRVUs was 15.1 points less in the telehealth cohort compared to in-person (per visit average, 1.1 [telehealth] vs 1.2 [in-person]). The 28 additional services provided during in-person visits accounted for an added 20.7 wRVUs. Unpaid claims were more common among telehealth encounters (8% [telehealth] vs 3% [in-person]). CONCLUSIONS: Higher complexity visits and visits with additional procedural codes billed were more common with in-person visits. This led to a lower number of total wRVUs and lower total visit charges among the included telehealth visits compared to the matched in-person controls. CLINICAL RELEVANCE: It is important to understand and consider the long-term financial impact of telehealth implementation. Practices must develop strategies to incorporate radiographic evaluation into telehealth visits and effectively stratify those patients that may require procedural interventions for in-person visits. Understanding the economic implications of this changing care delivery paradigm, providers can continue to provide telehealth services while protecting the financial sustainability of hand surgery practices.


Subject(s)
COVID-19 , Telemedicine , Hand/surgery , Humans , Pandemics , SARS-CoV-2 , Wrist
19.
Appl Psychol Health Well Being ; 13(2): 394-405, 2021 05.
Article in English | MEDLINE | ID: covidwho-1093691

ABSTRACT

Previous studies identified the effects of daytime activity, sleep quality and ambient light exposure on individual well-being. These factors have been greatly changed as people are required to stay home during the COVID-19 pandemic; thus, it is necessary to verify whether these factors effect well-being during the pandemic. We recruited 70 adults (females: 46; age range: 31-60) during a high incidence of COVID-19 in China (17-27 February 2020). Both subjective measurements based on self-report scales and objective measurements collected using wrist actigraphy were employed to investigate the effects of night-time sleep and daytime activity on subjective well-being. The actigraphy data show that participants' total sleep time (>8 hr) is sufficient. Self-reported sleep quality was significantly worse than pre-pandemic, and self-reported daytime activity levels significantly decreased during the pandemic. Physical activity was positively related to well-being, both for self-reported daytime activity (r = .346, p = .003) and for objective measurements (r = .234, p = .051). Our study found that sleep and daytime activity levels were negatively affected by the pandemic. However, increased daytime physical activity could potentially reduce these negative effects.


Subject(s)
COVID-19/epidemiology , Emotional Adjustment , Exercise , Sleep , Actigraphy , Adult , China/epidemiology , Exercise/physiology , Exercise/psychology , Female , Humans , Male , Middle Aged , Sleep/physiology , Surveys and Questionnaires , Wrist
20.
Clin Orthop Relat Res ; 479(2): 335-345, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1041572

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, and its associated lockdowns in many parts of the world, have changed our daily lives and may have a psychological impact on around the globe. However, it is unknown how this influences the patient-reported outcome measures (PROMs) of patients involved in ongoing clinical research and medical care. For both the current and potential future lockdowns, it is important to determine if PROMs collected during such a period can be interpreted with confidence. QUESTIONS/PURPOSES: (1) Is there a difference in quality of life between patients in the COVID-19 period group (March 23, 2020 to May 4, 2020) and patients in a reference period group (from the same period in 2018 or 2019)? (2) Is there a difference in pain, hand function, anxiety, depression, and illness perception between patients in the COVID-19 period group and patients in the reference period group? METHODS: This study was part of a large cohort study with routine outcome measures of patients with hand and wrist conditions. To answer our research questions, we analyzed two samples because not all PROMs were sent to participants at the same time points after treatment. The first sample consisted of all participants who completed PROMs on quality of life (QoL), pain, and hand function at their final follow-up time point, which was either 3, 6, or 12 months post-treatment. The second sample consisted of participants who completed PROMs 3 months post-treatment on anxiety, depression, and illness perception. Each sample consisted of two groups: a COVID-19 period group and a reference period group. We included 1613 participants in the first sample (COVID-19 period group: n = 616; reference period group: n = 997) and 535 participants in the second sample (COVID-19 period group: n = 313; reference period group: n = 222). The primary outcome was QoL, expressed in the EuroQol 5-Dimensions questionnaire (EQ-5D) index score. Secondary outcomes were the other domains on the EQ-5D, as well as pain, hand function, anxiety, depression, and illness perception. RESULTS: We found no between-group differences in the EQ-5D index score (standardized mean difference 0.035; p = 0.98). Furthermore, there were no between-group differences in PROM scores for hand function, anxiety, or depression. There were, however, a few small differences in subdomain items regarding pain and illness perception, but we believe in aggregate that these are unlikely to make a clinically important difference in our main finding. CONCLUSION: The COVID-19 pandemic and its associated lockdown had no influence on QoL and had little influence on secondary outcomes in participants who were part of the Hand-Wrist Study Cohort. This finding implies that PROMs data collected during this period can be used with confidence in clinical research. Our findings indicate that when a pandemic like this occurs again, we can continue to use PROMs for analysis in clinical research or routine outcome measures. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
COVID-19 , Hand/physiopathology , Musculoskeletal Diseases/diagnosis , Patient Reported Outcome Measures , Quality of Life , Wrist/physiopathology , Adult , Aged , Anxiety/diagnosis , Anxiety/psychology , Case-Control Studies , Depression/diagnosis , Depression/psychology , Disability Evaluation , Female , Functional Status , Humans , Illness Behavior , Male , Mental Health , Middle Aged , Musculoskeletal Diseases/physiopathology , Musculoskeletal Diseases/psychology , Pain Measurement
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