Forty-eight patients were randomized to receive the Garmin vÃvosmart 4, a lifestyle watch, to be worn daily for 2 weeks. The watch recorded heart rate, accelerometer, ambient light, and pulsed blood oxygen saturation (Spo2). Investigators found the pulse oximeter function to be particularly relevant when it comes to COVID-19 symptomatology and remote monitoring. The biometric measurements were collected by an application called Nitrogen, which provided the data for database storage and services, processing services and message delivery (FIGURE 11).
The Nitrogen app presented wearers with daily yes / no questions about new or worsening cough, difficulty breathing, fever, unusual or worse than usual fatigue and general well-being. Patients could also choose the symptoms they were experiencing from a pre-determined list, including aches and chills; nausea; vomiting; loss of appetite, taste and smell; and abdominal pain. The Watch Could Also Provide Objective Spo Spot Check Measurements2 and continuous heart rate. Any COVID-19 type symptom was assessed daily for deterioration through the app, and an alert and notification was sent to patients for completion. Clinicians could monitor the device’s vital signs readings and those provided by patients on a web-based dashboard.
The measurements were monitored by the wristband, which was worn day and night for continuous heart rate measurement and nighttime Spo assessment.2.
Investigators reported that 40 patients (83%) recorded data, indicating that the technology was accessible to the majority of patients. In general, patients demonstrated high engagement (FIGURE 21) answering questions, recording symptoms for a median of 9 days. At week 5, 31 patients were still using the technology, and at week 21, 13 patients were using the device without any prompt, callback, or additional intervention from the clinical team.
A short feedback survey was implemented in a self-selected subgroup of 22 patients. Patient feedback revealed overall satisfaction with both the app and the wearable device (FIGURE 2), with levels shown on a 10-point Likert scale ranging from 0 (not at all) to 10 (a lot).
The investigators noted a number of assumptions and observed a number of limitations during the implementation, in particular with regard to the mastery of patient information technology. They “assumed that patients knew how to connect to Wi-Fi, navigate an app store, and use Bluetooth connectivity.” Of the 12 patients who had minimal use of the app, the majority had difficulty activating the Bluetooth connection on their mobile phone to allow the app to be linked to their portable device or mistakenly used the Garmin app. Connect, which prevented clinicians from receiving data on the Nitrogen Application. They noted that these limitations highlighted a subgroup that would need support.
The main concern of investigators was to strike a balance between a validated minimally invasive device that was easy to use for patients who might have poor eyesight or limited fine motor dexterity.
One finding that the researchers encouraged is that the majority of patients expressed an interest in tracking their own data directly on the app. Although this is a Phase 1 rollout, patients encouraged the development team to incorporate their feedback into Phase 2 and beyond. The researchers believe that adding this feature to future deployments will likely increase the length of patient engagement and engagement.
According to investigators, the initiative will have a three-phase process. Phase 2 will involve recruiting critically ill patients to monitor their progress as inpatients and outpatients. Phase 3 will involve the general recruitment of new patients, evaluation, reliability and quality controls of the monitoring device with medical grade applications.
Researchers predict that improved versions of the app will evolve over phases as patient-specific queries are optimized and cancer-specific pathways are integrated. A multidisciplinary team will provide a tailored and integrative approach, the investigators concluded.
1. Komarzynski S, Wreglesworth NI, Griffiths D, et al. Embrace Change: Lessons Learned from Implementing Remote Multidimensional Digital Surveillance of Oncology Patients in a District General Hospital During the COVID-19 Pandemic. JCO Clin Cancer Inform. 2021; 5: 216-220. doi: 10.1200 / CCI.20.00136