Measuring Daily Compliance With Physical Activity Tracking in Ambulatory Surgery Patients: Comparative Analysis of Five Compliance Criteria.

BACKGROUND: Physical activity trackers such as the Fitbit can allow clinicians to monitor the recovery of their patients following surgery. An important issue when analyzing activity tracker data is to determine patients' daily compliance with wearing their assigned device, using an appropriate criterion to determine a valid day of wear. However, it is currently unclear as to how different criteria can affect the reported compliance of patients recovering from ambulatory surgery. Investigating this issue can help to inform the use of activity data by revealing factors that may impact compliance calculations. OBJECTIVE: This study aimed to understand how using different criteria can affect the reported compliance with activity tracking in ambulatory surgery patients. It also aimed to investigate factors that explain variation between the outcomes of different compliance criteria. METHODS: A total of 62 patients who were scheduled to undergo total knee arthroplasty (TKA, ie, knee replacement) volunteered to wear a commercial Fitbit Zip activity tracker over an 8-week perioperative period. Patients were asked to wear the Fitbit Zip daily, beginning 2 weeks prior to their surgery and ending 6 weeks after surgery. Of the 62 patients who enrolled in the study, 20 provided Fitbit data and underwent successful surgery. The Fitbit data were analyzed using 5 different daily compliance criteria, which consider patients as compliant with daily tracking if they either register >0 steps in a day, register >500 steps in a day, register at least one step in 10 different hours of the day, register >0 steps in 3 distinct time windows, or register >0 steps in 3 out of 4 six-hour time windows. The criteria were compared in terms of compliance outcomes produced for each patient. Data were explored using heatmaps and line graphs. Linear mixed models were used to identify factors that lead to variation between compliance outcomes across the sample. RESULTS: The 5 compliance criteria produce different outcomes when applied to the patients' data, with an average 24% difference in reported compliance between the most lenient and strictest criteria. However, the extent to which each patient's reported compliance was impacted by different criteria was not uniform. Some individuals were relatively unaffected, whereas others varied by up to 72%. Wearing the activity tracker as a clip-on device, rather than on the wrist, was associated with greater differences between compliance outcomes at the individual level (P=.004, r=.616). This effect was statistically significant (P<.001) in the first 2 weeks after surgery. There was also a small but significant main effect of age on compliance in the first 2 weeks after surgery (P=.040). Gender and BMI were not associated with differences in individual compliance outcomes. Finally, the analysis revealed that surgery has an impact on patients' compliance, with noticeable reductions in activity following surgery. These reductions affect compliance calculations by discarding greater amounts of data under strict criteria. CONCLUSIONS: This study suggests that different compliance criteria cannot be used interchangeably to analyze activity data provided by TKA patients. Surgery leads to a temporary reduction in patients' mobility, which affects their reported compliance when strict thresholds are used. Reductions in mobility suggest that the use of lenient compliance criteria, such as >0 steps or windowed approaches, can avoid unnecessary data exclusion over the perioperative period. Encouraging patients to wear the device at their wrist may improve data quality by increasing the likelihood of patients wearing their tracker and ensuring that activity is registered in the 2 weeks after surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT03518866; https://clinicaltrials.gov/ct2/show/NCT03518866.

Assessing the Privacy of mHealth Apps for Self-Tracking: Heuristic Evaluation Approach.

BACKGROUND: The recent proliferation of self-tracking technologies has allowed individuals to generate significant quantities of data about their lifestyle. These data can be used to support health interventions and monitor outcomes. However, these data are often stored and processed by vendors who have commercial motivations, and thus, they may not be treated with the sensitivity with which other medical data are treated. As sensors and apps that enable self-tracking continue to become more sophisticated, the privacy implications become more severe in turn. However, methods for systematically identifying privacy issues in such apps are currently lacking. OBJECTIVE: The objective of our study was to understand how current mass-market apps perform with respect to privacy. We did this by introducing a set of heuristics for evaluating privacy characteristics of self-tracking services. METHODS: Using our heuristics, we conducted an analysis of 64 popular self-tracking services to determine the extent to which the services satisfy various dimensions of privacy. We then used descriptive statistics and statistical models to explore whether any particular categories of an app perform better than others in terms of privacy. RESULTS: We found that the majority of services examined failed to provide users with full access to their own data, did not acquire sufficient consent for the use of the data, or inadequately extended controls over disclosures to third parties. Furthermore, the type of app, in terms of the category of data collected, was not a useful predictor of its privacy. However, we found that apps that collected health-related data (eg, exercise and weight) performed worse for privacy than those designed for other types of self-tracking. CONCLUSIONS: Our study draws attention to the poor performance of current self-tracking technologies in terms of privacy, motivating the need for standards that can ensure that future self-tracking apps are stronger with respect to upholding users' privacy. Our heuristic evaluation method supports the retrospective evaluation of privacy in self-tracking apps and can be used as a prescriptive framework to achieve privacy-by-design in future apps.