Validity and usability of low-cost accelerometers for internet-based self-monitoring of physical activity in patients with chronic obstructive pulmonary disease.

BACKGROUND: The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life. OBJECTIVE: Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients' preferences with regards to the presentation of and feedback on monitored physical activity. METHODS: To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device RESULTS: The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices. CONCLUSIONS: The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients.

E-health applications and services for patient empowerment: directions for best practices in The Netherlands.

OBJECTIVE: E-health may enable the empowerment process for patients, particularly the chronically ill. However, e-health is not always designed with the requirements of patient empowerment in mind. Drawing on evidence-based e-health studies, we propose directions for best practices to develop e-health that promotes patient empowerment. METHODS: The concept of patient empowerment in the Dutch setting is discussed first. The prerequisites for patient empowerment are then described and translated into empowerment areas relevant to e-health. MATERIALS: We reviewed Dutch e-health studies that provide insights into what works, and what does not, in e-health. RESULTS: On the basis of the lessons learned from the studies, we propose directions for best practices to develop e-health that promotes patient empowerment. These directions cover various aspects, such as the design and implementation of e-health, its information content and usability, awareness, and acceptance. The studies also indicate the difficulty of establishing that e-health is really dedicated to patient empowerment. CONCLUSIONS: Despite the body of knowledge about patient empowerment, as well as the technological visibility of e-health, evidence for best practices in general and for patient empowerment in particular is scarce. We call for a more systematic evaluation of e-health for patient empowerment and more reliable evidence. Beyond the organizational and technical issues involved in e-health, there is also a need to demonstrate its practical benefits to patients. The Netherlands is active in developing sustainable e-health. National initiatives are now in place to support the processes with the aim of establishing the required evidence-based best practices.

Experimenting with Case-Based Reasoning to Present Educative Health Information on the Internet: The Example of SeniorGezond.

BACKGROUND: Information about health prevention can contribute to the awareness and the knowledge of consumers and patients about their own health. Messages originating from other users (cases) can be perceived as more credible and hence more persuasive. With this in mind, we have developed an informative website called SeniorGezond, which includes a case-based tailoring component, in the domain area of fall incidences. OBJECTIVES: To investigate whether the use of cases is suitable for presenting and tailoring educative health information; and to gain insights in the user's opinion about the use of cases to provide tailored preventive information. METHODS: We conducted a qualitative study using questionnaires, focus group discussions, interviews, and observations. Participants were elderly, family caregivers and healthcare professionals. RESULTS: Users were able to find relevant cases for their problems, but had a mixed reaction on the usefulness and appreciation of the cases. CONCLUSIONS: There is a need for a delicate balance between a recognizable story with all the important health information and good readable and concise information. A good text structure is required to support this. While cases do have potential in health education, further research is needed in order to identify the necessary requirements which will make the cases successful.