Quantified Self: de zin en onzin van het zelfmeten door patiëntenDr. Martijn de Groot

Lezing 2 apr 2016HuisartsbeursJaarbeurs, Utrecht

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Project program• Self quantification methods

and technology• ‘the big five for healthy life’

– Physical activity & sports– Food & drinks– Sleep & rest– Stress– Social interaction

• Availability,Validity, Efficacy, Creativity

• Applied research, higher education & new business development

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Source: Johnson, L., Adams Becker, S., Estrada, V., Freeman, A. (2014). NMC Horizon Report: 2014 Higher Education Edition. Austin, Texas: The New Media Consortium.

Education

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Gnothi seauton

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Self Experimentation

• 17de eeuw Sanctorius of Padua; weighed himself for 30 years (food andexcrements)

• 1750 Alan Storck; drank hemlock• ca. 1810 Friedrich Sertürner; morphine• 1929 Werner Fossman; heart catheder,

angiocardiography, Nobel prize

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Introduction into Quantified Self

Self management / Tracking

• 70’s Diabetics (paradox)

• Computing• Miniaturisation• Self management

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The rise of the Quantified Self

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Spits 7 mei 2013

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QS Community• 2010: TED talk by Gary Wolf (778 k

views)• 2011: Two International Conferences,

first in California, then in Europe• March 2016: 220 Meetup groups,

approximately >64 k people active worldwide

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...to support new discoveries about ourselves and our communities that are grounded in accurate observation and elivened by a spirit of friendship.

Principle questions

• What did you do?• How did you do it?• What did you learn?

www.meetup.com/qsgroningenwww.meetup.com/qsamsterdam

!! Next Meetup!!WednesdayJuni 15 at 1.30 p.m. @ Hanze University Groningen

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Self-tracking health data• ~50% Dutch adults

source (2012): Survey by Motivaction/Quantified Self Institute (n=1.045)

• ~70% U.S. Adultssource (2013): Survey by Pew Internet/ CHCF (n=3.014)21% of individuals who track use at least one form of technology such as apps or devices

• ~8% own wearable, 12% plan tosource (2014): the accenture survey (n=24.000)

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Self-tracking areas

Source: health data exploration project 2014 (www.calit2.net)29-8-2016 Introduction into Quantified Self

Motives for self tracking

• Curiosity• Self improvement• Problem solving• Gagdet freaks and data fetisjists

Adaptor styles

Fewer people stashing wearable devices in sock drawer

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Availability

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Reliability

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Dontje et al. Measuring steps with the Fitbit activity tracker: an inter-device reliability study. J Med Eng Technol. 2015 May 27:1-5

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Validity

• Lab condition– 30 minutes walking on a treadmill, 2

times. – N=33– Gold standard: Optogait system.

• Free-living condition– One day (9:00-16:30). – N=56– Gold standard: ActivPal.

Two conditions

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Kooiman et al. Reliability and validity of ten consumer activity trackers BMC Sports Science, Medicine and Rehabilitation 2015, 7:24

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1= Fitbit Zip2= Misfit Shine3= Nike+Fuelband4= Omron5 = Withings Pulse6 = Fitbit Flex7 = Digiwalker SW-200 8 = Lumoback9 = Jawbone Up10 = Moves app

Reliability and Validity of ten consumeractivity trackers.

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Results – Lab conditionMean number of steps walked (95 % CI), measured in the Lab condition.

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Results – free-living conditionMean number of steps (95% CI) walked in the free-living condition

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Test-retest reliability

Activity tracker Intraclass Correlation Coefficient

95% confidence Interval

Optogait .92** .85 - .96

ActivPAL .96** .90 - .99

Lumoback .90** .79 - .95

Fitbit Flex .81** .64 - .91

Jawbone UP .83** .66 - .91

Nike+ Fuelband .53** .22 - .75

Misfit Shine .86** .73 - .93

Withings Pulse .92** .83 - .96

Fitbit Zip .90** .80 - .95

Omron .14 -.24 - .47

Digiwalker .71 ** .47 - .86

Moves app .37* .02 - .64

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* P < .05, ** P < .01

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Validity and reliabilityAt three different walking speeds (tredmill only)

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1. Jawbone Move(clip)2. Misfit Flash (clip)3. Flyfit (enkel)4. Fitbit Charge HR (pols) 5. Polar Loop (pols) 6. Garmin Vivosmart (pols) 7. Apple watch (pols) 8. Pebble smartwatch (pols) 9. Samsung Gear (pols) 10. Moves App

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Conclusion

• Most trackers show high reliability• Many trackers have acceptable validity• Trackers worn on the body have higher validity than trackers

worn at the wrist• Fitbit Zip (high validity/reliability, low pricing)In writing• Apple Watch (high validity/reliability, high pricing)

Kooiman et al. Reliability and validity of ten consumer activity trackers BMC Sports Science, Medicine and Rehabilitation 2015, 7:24

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Apps

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Medische App CheckerSinds 25 februari 2016

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Octobre 2014

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Number of appsavailable in leading app stores as of July 2015

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Food applications

Ned Tijdschr voor Voeding & Dietetiek | 2013;68(3)

• 113 (Dec 2012)• 4417 (Dec 2014)• Survey• N = 15• 87.6%of the respondents becomes more aware of

their food behaviour thanks to the app.

Current research limitedBig 5 for healthy life

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Feedback loops (n=42)

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

1 2 3 4 5 6 7 8

Stap

pen

Weken

Feedback

Non-feedback

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1 2

3 4

Bring Data

Self-tracking;for personal reason

Self-tracking;at request of health

care provider

Care/cure Lifestyle, health/wellness

Bring Data

Adapted from: www.nictiz.nl

All about data…

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Teaching Quantified Self SInternational Minor and Summerschool Global Health & QS

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http://www.digitalezorggids.nl/blog/quantified-self-quantified-us-quantified-other

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Patients like meQuantified Us

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• Three studies demonstrate the platform improves patient outcomes

New research strategy• In 2008 small scientific paper

stated lithium carbonate could slow progression of ALS

• In 9 months 348 ALS patientsparticipiated in a study todemonstrate lithium does not slow progress of disease

New Research Strategies

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New Research Strategies

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N=1 versus RCT

Rise of Personal Science

Dr. Seth Roberts (1953-2014)Requirements for useful discoveryPersonal scientists versus professional scientistsThe probability of useful discovery is a function of• (material resources)• (knowledge)• (time)• (freedom)• (desire to be useful)

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Introduction into Quantified Self

The Single-Subject Design

Method• Continuous assessment• Baseline assessment• Internal control• “Multiple crossover”• Blinding and

randomization where possible

• Baseline, intervention and reversal

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Points of interest and debate

• Quality of the data (validity and reliability)

• Data acces and control (Privacy and safety)

• Data sharing(usability, interoperabilityand incentives)

• Medicalisation

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Digital Health

Digital health is the convergence of the digital and genomic revolutions with health, healthcare, living, and society. Digital health is empowering people to better track, manage, and improve their own and their family’s health, live better, more productive lives, and improve society. It’s also helping to reduce inefficiencies in healthcare delivery, improve access, reduce costs, increase quality, and make medicine more personalized and precise.

www.storyofdigital.com

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https://www.youtube.com/watch?v=oqnmpg2JmzM

Digital Health Landscape

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Digital disruption as we go

• …largest taxi company owns no cars (Uber)• …largest hotel company owns no accomodations (Airbnb)• …largest text messaging companies own no phones (Whatsapp,

Skype)• …most valuable retailer has no inventory (Alibaba)• …most popular media owner creates no content (Facebook)• …largest movie hous owns cinemas (Netflix)• …largest software vendors don’t write software (Apple and

Google)

World’s…

4929-8-2016 Titel presentatie (via kop- en voettekst)

Quantified Selfis a gamechanger…

Digital HealthcareFear for technology...

Bijdragen van ICT

Digital Healthcare...or time for change: more time for human interaction

Bijdragen van ICT

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The day before tomorrow

• Preventive and predictive• Personalised • Participatory

Source: www.p4mi.org

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Dr. Martijn de Grootma.de.groot@pl.hanze.nl@grootm75

www.qsinstitute.org

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