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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29-8-2016 Introduction into Quantified Self
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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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