Self tracking

Definition

A growing number of small, relatively inexpensive devices and mobile apps are available that allow individuals to track many indicators of their daily lives. This area is often referred to as the quantified self, and many of these measures have important implications for healthcare management and Influencing behavior to promote healthier lifestyles [1].

Types of device and app

Nike Fuelband activity monitor

Activity Tracker – Typically records steps taken, but can also record heights gained (stairs and floors). A measure of calories burned is also usually estimated. Examples include Fitbit Nike Fuelband Jawbone UpStriiv and Withings Pulse. Modus StepWatch is specially designed For gait and gait analysis in clinical scenarios. Mike Reinold provided PT’s review of these devices.

Meal logging – log daily food intake by using photos of food types and quantities and meal databases to estimate calories and nutrients (such as Fitbit Food Database), or even use food scanners to automatically estimate meal composition (such as TellSpec Scanner) . Generally these tools Focus on calorie intake rather than the nutritional properties of the food you eat.

Symptom Logging – Log symptoms like pain and send reports to healthcare professionals (e.g. manage my pain app CamNtech PRO-Diary).

Medication Logging – Record and present medication reminders (eg Tonic).

Sleep Tracking – Measures activity levels during the night and sometimes body temperature and heart rate to determine how well sleep patterns are.

Physical Health Measures – Heart Rate Skin Temperature Perspiration (e.g. Basis Watch) Blood Pressure (e.g. iHealth Blood Pressure Monitor) Oxygen Saturation (e.g. iHealth Pulse Oximeter) ECG Trace (e.g. Alivecor CamNtech Actiwave Cardio)

Muscle/Motion Feedback – Provides form measurements during exercise (e.g. Athos)

Posture – Measures and suggests better spine and shoulder posture (e.g. Lumo Lift and Lumo Back)

Ownership Personal Goals Social Factors and Rewards

Online support systems provided by devices such as Fitbit offer several features that can encourage long-term behavioral changes for a healthier lifestyle:

• Ownership – Ownership of equipment and recorded data displayed in the online support system encourages long-term user commitment.
• Personal Goals – Allows you to define your own goals and reminds you when those goals are achieved.
• Social Factors – The ability to link/follow other users of the tracking system and compare activity levels encourages a competitive element to increase activity scores. Without medical supervision, this feature may encourage user overexertion!
• Rewards – For example, the Fitbit system offers a series of reward badges for reaching a predetermined level of activity, such as 15,000 steps per day. Laura Kalbag[2]’s comment suggests that these are crafted so infrequently that they actually feel meaningful (you won’t get badge for anything) but not so uncommon that they feel like they’re working hard.

However, there is evidence that these devices fail to drive long-term sustained engagement for most users [3]. This is something that the Apple Watch may or may not solve, and users are expected to want to wear and use and integrate seamlessly with other Apple products Data recording and analysis device [4].

Examples of medical use

A CNBC report describes how in the Basque Country of Spain, hospital visits for chronically ill patients have dropped dramatically, despite the use of medical tracking devices such as spirometers and pulse oximeters at home, combined with a home exercise program Teleport and monitor with Xbox Kinect. Data from patient movement and fitness measures are sent to health professionals who support the patient remotely and call the patient to the hospital only when necessary.

Using a self-tracking exercise device with predefined goals has been found to increase exercise levels in sedentary adults [5].

There is a lot of interest in using these techniques to treat chronic diseases like heart disease, obesity, COPD stroke, etc., and studies are being conducted to test the effectiveness of these approaches [6][7]. Studies have shown that activity levels increase (eg, for COPD patients using accelerometer/pedometer [8][9]). However, the choice of technology and the method of use appear to be important determinants of the impact. A Cochrane review of research on the use of text messaging to support noncommunicable disease self-management found that only In some cases, doing so has benefits for patients and healthcare providers [10].

Health 2050 is the concept of a healthcare system based on personalized preventive health maintenance, of which the quantified self is seen as an essential part [11].

Use in education

Chris Kennedy, a school superintendent in West Vancouver, British Columbia, focused on how teachers are using personal fitness tracking and how students are using it as part of physical education and connecting it to the study of biology.

Just as we want students to have greater autonomy in science and English learning, we see technology as part of this master plan, so should health education and physical activity. We want students to own their dataset goals rather than trying to compete with others others, but to better themselves. [12]

Impact on Physiotherapy/Physiotherapy Management

As this tracking movement grows, it becomes increasingly likely to need to work with patients who carry comprehensive data sets documenting every aspect of their condition. Mehta 2011 noted that physicians are already trying to help patients provide detailed sleep-related data [13].

Fitbit has been proven to be a reliable tool for measuring energy expenditure [14] and steps during exercise, but not distance covered [15]. Recording health data such as blood pressure in a real-world setting rather than a clinical setting can provide better data for more precise and accurate Timely diagnosis and disease management [16].

There are several ways in which physical therapists can utilize self-tracked patient-recorded data and work with patients to maximize the benefits they gain from self-tracking. E.g:

• Set appropriate goals for the patient’s daily level of exercise (eg, set an appropriate daily goal for the number of steps taken).
• Patients record subjective measures for review during the consultation, such as pain, energy levels, healthy feelings, etc.
• Keep track of the completion of your daily prescribed workouts.
• Set targets and alert levels for actions, and prompt patients to seek medical attention or return for a follow-up appointment when these conditions are met.
• Manage the competitive instincts of patients exposed to active leaderboards where appropriate.
• Help patients determine if they would benefit from viewing leaderboards showing activity levels of their peers.

Other resources

Know Yourself: Track Every Aspect of Your Life, From Sleep to Mood to Pain 24/7/365 – Gary Wolf’s article coined the name Quantified Self.

Quantified Self – Demos and visualizations from the QS community.

Red Dolphin – The latest news and reviews on wearable technology.

The Self Quantification Movement – Implications For Health Care Professionals – A good article with an early overview of QS from a medical perspective.

The Quantified Self and Its Implications for Physiotherapy/Physiotherapy – An article that outlines and discusses potential implications for PT/Physiotherapy.