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Title: Developing the Skeleton Avatar camera technique as a rapid, valid and sensitive measurement of mobility in COPD patients treated in primary care
Applicants: Cecilia Fagerström, Anders Halling, Linda Askenäs, Olof Björneld, Amanda Hellström, Mirjam Ekstedt
1. Research area of the proposal: eHealth 2. Problem definition and value:
Chronic obstructive pulmonary disease (COPD) is a common chronic disease in the population associated with recurrent hospitalization as the disease progresses. The diagnosis of COPD is made by estimating the lung function using spirometry, but the association between lung function and prognosis is poor. Physical activity and function has been found to be important for the prognosis in COPD measured as need for hospitalisation and mortality. Physical activity and function in patients with COPD is seldom measured in current primary care, but could potentially be measured using the 10 metre walk test (10MWT) and accelerometers. However, these tests are seldom used since they require resources and trained staff. Patients are often ignorant of the early signs that need to be aware of, and what measures to undertake to prevent or mitigate exacerbations. Lack of valid assessments that are easy to use, could be the reason why physical rehabilitation of COPD patients in primary care is used less than expected in spite of having shown a beneficial effect especially after exacerbations.
Thus, our group suggests to explore the feasibility of using new technologies adapted from other disciplines, (i.e. adoption of the Skeleton Avatar Technology - SAT), to capture the COPD patients’
movements under standardized conditions. The examination would be less strenuous for the patients, demand fewer resources from health care than current available methods and provide a decision support for treatment and rehabilitation of patients with COPD in primary care.
3. Objectives:
The overall objective of this proposal is to investigate if image visualization with the Skeleton Avatar of moving patterns could be viable and valid for early indication of impairment in mobility and health in COPD patients treated in primary care. More specifically, the objectives of the seed project is to:
1. in a pilot test the feasibility of the SAT for capturing the physical function under standardized conditions for patients’ with COPD. The results will be compared with mobility test that is available today (i.e. 10MWT, balance test and accelerometer)
2. apply for external funding to in a larger scale test if the assessment using SAT is sensitive and valid tool for health deterioration in COPD. More specifically the physical function measured using the SAT will be compared with COPD stages, function, health, quality of life and prognosis among patients in primary care.
3. create an arena for research collaboration, knowledge exchange and innovation between multiple disciplines, stakeholders in health care, industry and citizens (patients).
4. Expected Results: We expect that SAT has the potential to provide indicators and early signs of deteriorations in patients´ health, which helps avoiding unnecessary hospitalizations which is important for patients’ quality of life and keeps the costs for society down. This pilot project is expected to provide solid information about the Skeleton Avatar (digital camera technique) as a valid method for measuring physical function comparable to the more cumbersome test that is available today (i.e. 10MWT, balance test and accelerometer). The results from these preliminary tests,
including 10 patients, will create a basis for a future research proposal, where we intend to scale up the project, including sites in the Skåne and Blekinge regions, and also study association between physical function measured by the SAT with COPD stages, function, health, quality of life and prognosis. The
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seed proposal will further enable us to initiate co-operations with partners in healthcare and companies within the medical-technical industry that further co-develop and improve prognostic assessments and indicators. If this technique will be proven successful, the arena for further application in the field of decision support to patients with chronic diseases is regarded unlimited.
5. Consortium: The project will be conducted in cooperation with the primary care and rehabilitation centre at Region Kronoberg, which has shown interest in participating in the project if funded. Malin Elingfors malin.elingfors@kronoberg.se, |Rehabstrateg, and ‘ledningsstrateg’ for primary healthcare is our clinical contact person and facilitator for the clinical tests.
The research group comprises of researchers from technology, with skills in programming and analysing big data as well as developing the Skeleton Avatar for body imaging. We have researchers in health care, with knowledge of the specific patient group, health care professions and organization.
The group has a blend of experienced senior researchers as well as junior researchers, representing a great variety of methodological and theoretical skills. The combined skills and experiences within the group will provide a solid ground for technology development, testing and implementation in the clinical setting.
Prof. Anders Halling (anders.halling@med.lu.se) at Lund University: General Practice, epidemiology, statistics, Knowledge of diagnosis/treatment
Prof. Cecilia Fagerström (cecilia.fagerstrom@lnu.se) Linnaeus University, Blekinge County Council, Nursing science, implementation of eHealth and decision support system. Health outcome measures.
PhD. Linda Askenäs (linda.askenäs@lnu.se) at Linnaeus University: eHealth technology, eHealth tool development
PhD stud. Olof Björneld (olof.bj@ltkalmar.se) at Linnaeus University, Kalmar County council:
Computing and analysing big data
Prof. Mirjam Ekstedt (mirjam.ekstedt@lnu.se) at Linnaeus University, Karolinska Institutet, Behavioural and nursing sciences, Implementation science, eHealth, contact person for the project
PhD. Amanda Hellström (amanda.hellstrom@lnu.se) at Linnaeus University: eHealth tool development, health care outcomes
Prof. Welf Löwe (welf.lowe@lnu.se) at Linnaeus University, DISA: Technology development Skeleton Avatar
6. Activities and Time plan:
Nov/Dec 2018: A meeting the 20th November is planned with the management at Primärvårds- och rehabcentrum in Region Kronoberg to inform about the project and plan the details about when and where the project will be conducted and what physiotherapist that will be involved in the pilot.
Thereafter the study- and test protocol will be completed as well as the ethical vetting. Further, we will order accelerometers, build prototype SAT, introduce arena for knowledge exchange and cooperation (Objective: 1, 2, 3)
Jan-Mar 2019: Test and refine prototype of the SAT. (Objective: 1, 2, 3) April 2019: Training of staff and recruitment of 10 test patients (Objective: 1)
May/Jun 2019: Performing pilot study with the 10 test patients: using accelerometer test, 10MWT, Skeleton Avatar, Spirometry, patient survey (scales CAT, SGRQ) (Objective: 1, 2)
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Aug-Nov 2019: Analysing, summing up the feasibility study of SAT and mobility tests, Evaluation process of methods and results, Exchange and dissemination of knowledge, Application for scaling up finalized to Vinnova, Forte, KK-stiftelsen (Objective: 1, 2, 3)
7. Budget.
The table below specify the estimated costs for 2018 and 2019.
For 2018 we apply for salary for a postdoc [(Amanda Hellström; salary: 46 680 kr/month x OH 42% x LKP 50,5%) x 20% = 20 548 kr] for the practical planning of the study and writing the ethical
wetting. We also apply for the expenses for the ethical wetting (5000 kr) and the purchase of
accelerometers. Further, we apply for the technical adaptation of the current tool, and approximately 10% of the time of a post doc specialist (to be named) to perform the adaptations [46 680 kr/month x OH 42% x LKP 50,5%) x 10% = 10 270 kr.]
For 2019 we apply for a physiotherapist to perform the clinical tests. Estimated time 40% of a month full time, including introduction to the project protocol and recruitment of patients. [(Salary 36 000kr/month x 50,5% LKP x 36% OH) x 40% = 29 473 Kr]. Further, we estimate time for a postdoc of 20% of full time during 1 months, to set up the project, constitute the contact with the clinical setting and for project administration. For technical development of the avatar, we estimate a cost of 7 Tkr. In total we apply for 55,3 Tkr for 2018 and 57 Tkr for 2019.
7. Budget 2018 Budget 2019
Postdoc (1 month á 20%) 20,5 TKr Clinical staff (2 full weeks) 29,5 Tkr Application EPN 5 TKr Postdoc (1 month á 20%) 20,5 Tkr Accelerometer, 5 á 2500 12,5 TKr Technical development 7 Tkr Technical adaptations current tool 7 TKr
Postdoc (1 month á 10% ) 10,3 TKr
Total 2018: 55,3 Tkr Total 2019: 57 TKr
