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Making advances in technology for healthy ageing matter: RRD at Ageing Well Week 2022

Written by: Lena Brandl

More than 40 parallel workshops, 30 poster presentations, and 50 exhibitors from industry, science, and communities dedicated to making healthy ageing possible gave rise to the Ageing Well Week 2022 in Gdańsk, Poland. Gdańsk is a buzzling city with a rich history, including its key role in the solidarity and oppositionist movements. It has therefore only been natural for the city to host the Ageing Well Week 2022, according to the city’s mayor, Aleksandra Dulkiewicz. The challenges that a rapidly ageing world population poses can only be met by a unified and solidary world community.

The next step to making technology for healthy ageing matter

After 14 years of practice-oriented research about health technologies for the increasingly ageing world population, the most important topic of this final edition of the Ageing Well Week was how the community can accomplish the transition of health technologies to the market. Put differently, how can we ensure that the repertoire of evidence-based health technologies gets into the hands of those to whom we dedicated our efforts: the ageing population?

Since this is a question RRD cares about deeply, we joined the event and the ongoing discussions about enabling ageing well. RRD presented two posters about our work in the AAL project LEAVES (Project No. AAL-2019-6-168-CP). Within the LEAVES project, together with 8 consortium partners, RRD has developed an online grief intervention to support older adults in processing the loss of their spouse:

The first poster, by Stephanie Jansen-Kosterink, demonstrated the preliminary results about technology acceptance and potential health effects of the LEAVES service.
The second poster, by Lena Brandl, discussed older adults’ use and appreciation of a monitoring system to guide users of LEAVES to offline support (if their situation deteriorates while working with the online grief service).

Our presented work was met with curiosity and praise for giving attention to a common, yet unfortunately, largely unrecognized aspect of healthy ageing: processing the loss of loved ones.

Do you want to take a look at our work presented at the Ageing Well Week 2022? You can find the poster about technology acceptance and potential health effects (preliminary results) of LEAVES here and the poster about older adults’ use and appreciation of a monitoring system here.

Do you have thoughts or ideas about how the health technology community can achieve their goals towards solving the challenges of the ageing world population through digital health solutions? We are happy to discuss, exchange ideas and collaborate to bring healthy ageing within everyone’s grasp!

Lena Brandl

Email: l.brandl@rrd.nl

Tel: 088 087 5768

11/03/2022

Involving stakeholders as co-researchers: Taking a first step in how to train them

Written by: Kira Oberschmidt

For almost three years now, RRD has been involved in the Pharaon project (Horizon 2020, grant agreement No. 857188). In Pharaon, we use action research to integrate technologies for smart and healthy ageing. At the end of the project, RRD is going to provide guidelines for action research that can be used in other projects.

In our work, we notice that the involvement of non-researcher stakeholders (for example patients and healthcare professionals) becomes increasingly important. Especially in participatory projects that make use of approaches like action research or citizen science, simply involving these stakeholders as participants is not enough. Instead, they should take on a more active and empowered role. However, as there are not formally trained as researchers, more knowledge and preparation might be required.

We see that stakeholder skill training is occasionally mentioned in literature as a way of preparing stakeholders to become co-researchers. However, little practical information about such training is given. This left us wondering:

What is being taught?
Who are the recipients of the training?
When do training activities take place?
What are identified training needs (why do we need this training)?
How is the training set up and which methods are used?

Workshop at NordiCHI 2022

To answer these questions, we decided to invite researchers with an interest in stakeholder skill training to a workshop. This session took part on 9 October 2022, as part of the pre-conference program at NordiCHI 2022. NordiCHI is a biannual, international conference on Human-Computer Interaction This took place in Aarhus, Denmark this year. The topic of this year’s event was Participative computing for sustainable futures.

During the workshop, our group of organisers engaged in some very interesting discussions with the participants. For example we talked about:

How to find a common language between stakeholders?
How can we identify training needs?
Is training even the correct term for such activities?

While working in smaller groups we also took some time to identify barriers and facilitators of good stakeholder skill training. (We were unable to settle on a better term, so for now we kept calling it ‘training’). While there are still a lot of open questions, it was nice to see that many participants took inspiration and ideas for their own practice from the session.

We look forward to continue this discussion with others. Would you like to learn more about this topic? Feel free to reach out to Kira or Christiane.

Kira Oberschmidt

Email: k.oberschmidt@rrd.nl

Tel: 088 087 5767

Christiane Grünloh

Email: c.grunloh@rrd.nl

Tel: 088 087 5723

10/26/2022

Extending CE certification under the Medical Device Regulation (MDR) to a new 'intended use' - A real-world example

In recent years, Roessingh Research and Development (RRD) has worked intensively to coordinate a multi-center intervention study. This intervention consisted of a soft-robotic glove, called Carbonhand, which was developed to support hand function for patients with reduced hand pinch strength. Bioservo, the manufacturer of Carbonhand and sponsor of the study, had the intended goal of extending CE certification of the system within the MDR to a new medical application. Carbonhand already had a CE for its operation as an aid in daily tasks. However, the new "intended use" is focused on the therapeutic effect of Carbonhand, or improving hand function after long-term use of the system as an aid during daily activities. RRD was therefore asked to design and conduct a clinical evaluation that could demonstrate whether or not that therapeutic effect is there.

For this, RRD set up an appropriate research protocol according to the Good Clinical Practice (GCP) guideline, an international ethical and scientific quality standard (ISO14155) for the design, recording and reporting of human-related research. In addition, RRD realized the approval at the Medical Ethics Review Committee (METC), we realized cooperation with 8 Dutch (rehabilitation) centers and trained all involved in the application of the Carbonhand system and the implementation of the research protocol. A monitor from an external party was involved to check the implementation of the GCP guideline and all collected data.

Intensive cooperation leads to success

Within this study 63 participants were included with reduced hand squeezing strength, independent of underlying diagnosis, who used the Carbonhand during a period of 6 weeks at home while performing daily activities. Three baseline measurements took place beforehand, followed by a post-measurement (within 1 week of intervention) and a follow-up measurement (4 weeks after the end of the intervention). Despite intervention of the COVID-19 pandemic, we managed to conduct the study successfully, not least due to the intensive and pleasant cooperation with the participating centers. On Tuesday, September 27, the final measurement took place and the data collection was officially completed. Of course, we could not have reached this milestone without the commitment of the clinical centers: Roessingh Center for Rehabilitation, University Medical Center Groningen, Isala clinics, Rijndam rehabilitation center, Reade center for rehabilitation and rheumatology, Hoogstraat rehabilitation, Sint Maartenskliniek with the location Canisius Wilhelmina Hospital, Klimmendaal.

In the coming period we will focus on the analysis of all outcome measures. Interim results were promising, now we need to see if this remains so after analysis of all data. If you are interested in the results of the study, keep a close eye on our news page for the latest developments.

Do you recognize the above process as a medical device manufacturer and have a similar issue? RRD is happy to advise and support you in the design and implementation of your clinical evaluation under the MDR!

Anke Kottink-Hutten
E-Mail: a.kottink@rrd.nl

Tel: 088 087 5733

10/18/2022

RE-SAMPLE: First meeting with all partners in the Netherlands

Written by: Marian Hurmuz

After a year and a half, the time had come: the ten European partners in the RE-SAMPLE project met together in the Netherlands at the University of Twente's DesignLab. This meeting was organized for three main reasons:

Sharing knowledge with the various project partners.
Brainstorming on topics the project will focus on over the next six months.
Working on the team spirit within the project! So that we all have our noses in the same direction.

Everyone was very happy that this could take place face-to-face. This way, we were able to organize many interactive group sessions.

The four-year RE-SAMPLE project (Horizon 2020, grant agreement No. 965315) focuses on people with COPD and other chronic conditions. The goal of RE-SAMPLE is to develop a technology that supports patients and their caregivers.

Workshops during the meeting

The meeting lasted two days during which energizing workshops were held by various partners. These workshops included:

The observational cohort within RE-SAMPLE. During this workshop, we had fun looking at how to involve more COPD experts in the cohort and reduce the burden on the COPD experts in the cohort.
Coaching. In this workshop, we went into groups to think about relevant coaching topics for the technology we are developing.
The Social Return on Investment (SROI) method. This workshop was organized by RRD. We worked with 4 groups to capture the main activities and outcomes of different stakeholders involved within RE-SAMPLE (click here for more information on the SROI method).

Social activities

In addition to these workshops, we also had time for social activities to get to know each other better. This started with a graffiti workshop!!! We were given a crash course in spraying graffiti and then we all got to create our own design. See below some examples of these designed. Afterwards a dinner was arranged at De Tropen in Enschede to close the evening with drinks and dishes. After 1.5 years of working online, it was really nice to meet the people in RE-SAMPLE in person.

10/11/2022

Social robots and rehabilitation care: What is the added value?

For the past 15 months, Roessingh Research and Development, BLEUCOMPANION and Roessingh, Center for Rehabilitation have been working together in the SCOTTY project to investigate what the added value of social robots in rehabilitation care might be.

The roles and functionalities of the PEPPER robot for rehabilitation care

The SCOTTY project, funded by DIH-HERO, started in March 2021 to define the functionalities of the PEPPER robot for rehabilitation care. The PEPPER robot is Softbank Robotics' social robot. Robot PEPPER is designed to communicate with people and is attentive to people's emotion. During two co-creation sessions, we worked with healthcare professionals to come up with four roles for the PEPPER robot. PEPPER as an assistant to the nurse, as a supporter of the physical therapist, as a host and as a companion.

Acceptance of the Pepper Robot in rehabilitation care

After all content for these roles was available, BLEUCOMPANION (technical partner in the project) started programming the PEPPER robot in the summer of 2021. By the end of 2021, the time had finally come and first user tests could be started at RRD with technical experts, healthcare professionals and patients. These first tests were mainly needed to detect all usability issues and also gave a lot of insight into the interaction between humans and robots. The expectations around the social robot were very high, but also critical. To gain more insight into the acceptance of a social robot in rehabilitation care, an acceptance study at Roessingh, center for rehabilitation among 10 care professionals and 6 patients was started in the spring of 2022. From these acceptance tests it appeared that the functionalities of the PEPPER robot are not sufficient to play a role in a clinical department now. The care professionals and patients certainly saw positive points, such as the friendly appearance of the robot.

An alternative role: The Pepper robot in the waiting room

To gain insight into the possibility of the PEPPER robot in the waiting room, a flash mob study was conducted in the last month of the project. In this study, we asked 23 waiting clients to have a conversation with the robot and fill out a questionnaire together. A role in a static setting, such as a waiting room seems to be a better fit for the PEPPER robot.

What is the social value of the PEPPER robot?

Through the Social Return on Investment (SROI) Method. A social business case for the PEPPER robot has been prepared. These analyses show that that social value of the PEPPER robot is currently very low and that social business case can only become positive when:

Expand the roles and functionalities of the robot
More patients can use the robot
The purchase and operating costs of the robot are lower

In order to share the outcomes of the SCOTTY project with others, an animation was created of the path the PEPPER robot took within the project. This animation of over 10 minutes gives a good overview of all project activities and results: https://youtu.be/pTcftwoA_T8

The June issue of Robot Magazine focuses on the SCOTTY project. For an article, researchers Marian Hurmuz and Stephanie Jansen-Kosterink were interviewed.

Click here to read the article.

Want to know more?

Have social robots and their application in healthcare worked your interest and would you like to know more about this topic? Then feel free to contact Sr. researcher Stephanie Jansen - Kosterink (s.jansen@rrd.nl - 0880 875 717).

07/28/2022

Evaluating E-Health: How do you go about it?

In practice and in science, there is still much ambiguity about how to properly evaluate eHealth. Especially when the technology (underlying the eHealth application) is still in development. Roessingh Research and Development (RRD) has years of experience in guiding such developmental processes, including the evaluation of innovative eHealth technologies. Under the leadership of senior researcher Stephanie Jansen - Kostering, RRD has developed its own method for eHealth evaluations and published it in Digital Health.

Continuous evaluation of eHealth

RRD's approach is characterized by the continuous evaluation of eHealth starting from the maturity of the technology with attention to different perspectives. These perspectives are; the user perspective, the clinical perspective and the societal perspective. The maturity of the technology is determined by the Technology Readiness Levels (TRLs). The 9 TRL levels (TRL 1 = low and TRL 9 = high) can be distinguished into three phases; TRL 1 to 3 is the research phase, TRL 4 to 6 is the development phase and TRL 7 to 9 is the implementation phase. In the research phase, for example, the user perspective is central and formative user testing in a laboratory is important to have a good alignment between the user and the technology. The paper gives several examples of studies in the different TRL phases.

Method of e-Health Evaluation

The RRD methodology for e-Health evaluation is published in Digital Health. Interested? Read the publication here: "Time to act mature - Gearing eHealth evaluations toward technology readiness levels"

Are you or will you be conducting an evaluation study of an e-Health application?

RRD is happy to think along with you. You can contact us for advice and/or to conduct evaluation studies.

For questions about evaluation studies, please contact Sr. researcher Stephanie Jansen - Kosterink (s.jansen@rrd.nl - 0880 875 717).

07/21/2022

The Gamification App - our work on the BIONIC project

By Valentina Bartali and Monique Tabak

Four years ago, RRD (with different partners from all around Europe) started working on the European project BIONIC. In May, this project came to an end and, now, we would like to look back at our work and what we have achieved in these years.

The description of the project is written in this way: Personalized Body Sensor Networks with Built-In Intelligence for Real-Time Risk Assessment and Coaching of Ageing workers.

I can imagine that, from an outsider, with this description, it can be complicated to understand what BIONIC actually is.

BIONIC was a project aiming to develop a technological innovation able to detect real-time risks in the workplace (think, for example, about the industrial sector or factories) and in everyday life. Additionally, this technology has monitoring and coaching functions in order to help preventing musculoskeletal disorders. The system consists of a suit with sensors in different parts of the body, a smartwatch to measure heart rate and steps, and two applications. One application was developed to give feedback on the user's movements, while the other application, Gamification app, was developed by RRD to motivate and coach users to live a healthy lifestyle, also outside the work environment.

On the picture on your left, you can see how the suit is and what is shown on the computer. On the picture on your right, you can see the smartwatch and the application we created.

In BIONIC, our work was focused on estimating fatigue from sensors by machine learning algorithms (which you can read more about in the papers [1] and [2] in the reference list below) and the development of coaching strategies for healthy lifestyle for the gamification application.

In this blog article, I would like to tell you a bit more about this gamification application we developed, which has the following components (to get a better idea, see video below):

Overview of measured daily activity: users can get insights on their daily activities (step counts). The application (through an algorithm) can estimate the moments in which the user shows sedentary behavior (staying too much sitting) and the periods in which (s)he is doing some activity.
Overview of subjective fatigue: Every day, users will be asked, with a question in the app, how tired they feel that day. The answers to this question will be shown in a graph.
Personalized exercise program: physiotherapy exercises advised to users in form of trainings and depending on which part of the body a user has the most issues (for instance, back, neck, or legs).
Motivational support via virtual coach bill and gamification elements: Proposing physiotherapy exercises according to the feedback received from the BIONIC system and the needs of the users. These exercises are given by a virtual coach, Bill, who guides, motivates, and supports users. The Gamification App has gamification features to prompt users to do the exercises proposed and to change their physical activity (when needed). These gamification features entail earning points through:
- Challenges: a set of goals that the user can set up for him-/herself
- Achievements: a set of tasks that the user can achieve whilst using the Gamification App

The Gamification App was also evaluated in clinical settings at Roessingh to investigate if this technology could be of added value. From this evaluation, we discovered that the application could really help patients to be more aware of their activity patterns and it could motivate them to change their activity behaviors and facilitate rehabilitation.

We are really proud of what we achieved in these years considering that we were able to develop a working application of which added value was seen. The project is now finished, but we will bring with us what we have learnt during these years and we hope to further develop and use the application for other purposes.

Reference list

[1] Marotta L, Buurke JH, van Beijnum B-JF, Reenalda J. Towards Machine Learning-Based Detection of Running-Induced Fatigue in Real-World Scenarios: Evaluation of IMU Sensor Configurations to Reduce Intrusiveness. Sensors. 2021; 21(10):3451.

[2] Marotta L, Scheltinga BL, van Middelaar R, Bramer WM, van Beijnum B-JF, Reenalda J, Buurke JH. Accelerometer-Based Identification of Fatigue in the Lower Limbs during Cyclical Physical Exercise: A Systematic Review. Sensors. 2022; 22(8):3008

07/14/2022

RE-SAMPLE: AI-powered care for patients with COPD and other chronic diseases

Written by Eline Te Braake and Christiane Grünloh

RE-SAMPLE is a European project targeting people with COPD and other chronic conditions. The goal of RE-SAMPLE is to develop a technology that supports patients and their caregivers. This technology will help patients manage their COPD and other chronic conditions. Along with 9 other partners, RRD is collaborating on this project to shape and develop the RE-SAMPLE technology. The project started in March 2021 and will run for a total of 4 years. RE-SAMPLE has received funding from Horizon (Grant agreement No. 965315).

USER-ORIENTED. When designing an eHealth intervention, it is important to consider the needs and desires of those who will use it. Ultimately, we want RE-SAMPLE to have an added value in practice for both people with COPD and their healthcare professionals. Of course, we also want that after the project, RE-SAMPLE is actually successfully implemented in the health care system. To do this, we need to learn from the attitudes, experiences, and needs of people with COPD and their caregivers. Since they are all experts in the field, they know best what is currently missing or what is already going very well. This information can help us develop a technology that is actually useful to them.

Since the inception of RE-SAMPLE, we have conducted many different surveys. We had the opportunity to talk to many people with COPD and caregivers to learn more about COPD, the experiences of living and coping with COPD, and preferences regarding COPD management. This provided a lot of useful information. This input helped us a lot in shaping the RE-SAMPLE technology. To give you an idea of what we have discovered so far, RRD has created a summary video with some highlights.

You can watch this video below!

Although much information is already being collected, we will also need ongoing input from both healthcare providers and people with COPD in the future! After hearing about RE-SAMPLE, would you like to join us and give us feedback?

Then feel free to contact us!

You can do this by sending an e-mail to Christiane Grünloh (c.grunloh@rrd.nl) or Eline te Braake (e.tebraake@rrd.nl)

07/05/2022

RRD at Supporting Health by Tech 2022

By Lena Brandl

At RRD, we do not do research by locking ourselves in an ivory tower to brood over the next scientific breakthrough. Part of our work is getting out into the world to meet other researchers and interested people and to discuss the progress of eHealth, while communicating our latest findings. The Supporting Health by Technology symposium brings together healthcare professionals, people from academia and organizations that develop eHealth - a perfect stage to present and discuss RRD's latest eHealth research with fellow colleagues across The Netherlands and beyond. For the 11th edition of the symposium, RRD colleagues Lena Brandl, Marian Hurmuz and Stephanie Jansen-Kosterink joined the event at Martini Plaza in Groningen, The Netherlands.

During the conference, current and important developments and challenges for eHealth were discussed:

The world has seen a rapid increase in the development of individual eHealth applications. Google's Play Store and Apple's App Store nowadays offer a wide range of eHealth apps with varying degrees of functionalities and pricing for all sorts of health problems. But it is less clear how we can join forces and develop a global eHealth strategy to exploit technology's potential to improve modern healthcare.
The inclusion of people from all regional, educational and ethnic backgrounds, including people who suffer from more than one disease (called multi-morbidity) is crucial for developing eHealth that actually helps people manage their health problems in everyday life. How can we include difficult-to-reach groups in eHealth research, and thereby prevent that the technology we develop makes today's digital divide worse?
What is the state of machine learning in eHealth, what tasks can it do and how can it be optimized for supporting healthcare professionals in their work?

These are some of the questions addressed at Supporting Health by Technology. RRD contributed to the discussion by presenting some of our recent eHealth research:

Marian Hurmuz presented the results of a social robot acceptance study conducted with patients and nurses in the Roessingh rehabilitation center, summarizing their acceptance and intention to use the social robot for daily care activities (SCOTTY project).
Stephanie Jansen - Kosterink demonstrated the value of the SROI (Social Return on Investment) method to access the societal impact of innovations in healthcare and how the method can help decide whether the societal impacts of employing a social robot in rehabilitation care outweigh the robot's monetary investments (SCOTTY project).
Lena Brandl presented an automatic decision-making algorithm using a method called Fuzzy Cognitive Maps (FCMs) in a self-help eHealth service for older mourners. The aim of the decision making algorithm is to guide the older mourner to offline support in case they find themselves in need of support beyond the online service (LEAVES project).

With new ideas and questions buzzing in our heads, we return to RRD to continue our work on eHealth!

05/19/2022

Flash mobs as a research method?

By Kira Oberschmidt

When you hear the words "flash mob" you probably think of people suddenly starting to dance inside a mall. Or maybe an orchestra giving an impromptu concert in a market square? A few years ago such seemingly spontaneous social activities were very popular. And now the 'flash mob' has found its way into research.

In academia, a "flash mob" of course doesn't include dancing or music. Instead it means trying to involve many different participants in a short period of time. And not only the conduction of the research is fast-paced, the analysis and reporting should also be done quickly.

The relatively new method came on our path when we were planning a final study for the SALSA project, and we decided to give it a shot. Within the SALSA Health project, we evaluate a technology that stimulates exercise in rehabilitation through the use of games. The system can be adjusted to the range of motion of a patient, and individual exercise schemes can be added and saved. After a previous six month testing period at a physiotherapist's, we were now interested in the potential of SALSA Health for the rehabilitation context.

So at the beginning of April, we set up a big tv screen and a Kinect sensor in the entry hall at Roessingh, Centre for Rehabilitation, Enschede. Patients and therapist could spontaneously stop by and try out the SALSA Health system. Then, they were asked to complete a short survey on their experience, and whether they would like to make use of SALSA Health in their treatment.

Both patients and healthcare professionals liked SALSA Health and saw its potential to enhance rehabilitation care. But what was equally important for us was the successful conduction of our first flash mob study. As expected, there were some teething problems, but also a lot of things that went well. Based on our experience, we came up with some tips for anybody who wants to conduct similar flash mob studies:

Give people time. In Dutch we call it 'kat uit de boom kijken' (see which way the cat jumps). People might walk by and look four times, and hopefully the fifth time they will stop and ask what you are doing. So allow enough time for this in your study.
Create awareness. Of course, a researcher should be present at all times to explain what you are doing there. But you should also make use of materials like banners or flyers for those who want to learn about your research, but don't want to commit to anything yet.
Involve insiders. The best way to get people to join is by having a peer (in our case another patient or a colleague) tell them about it. So stimulate participants to tell others! Maybe a therapist can email his colleagues, or a patient can bring her roommate along later.
Keep it short. Participation in the flash mob is meant to be short and spontaneous, so limit what you ask of people. This also allows you to involve those who have little time or walk by in between meetings.
Adjust the location to your target group. Find a place where your target group is sure to find you, but where they also feel comfortable to participate. Being seen by everybody is nice to draw attention to your research, but may also scare people off.

We will also be implementing these tips ourselves in the future, since this definitely wasn't our last flash mob. Actually we are planning a new one right now, so keep an eye out! And if you are interested or have any questions, get in touch!

If interested, you can learn more about the flash mob method here:

Moons, P. (2021). Flash mob studies: a novel method to accelerate the research process.

Or read about an example of a flash mob study here:

van Nassau, S. C., Bond, M. J., Scheerman, I., Van Breeschoten, J., Kessels, R., Valkenburg-van Iersel, L. B., ... & Roodhart, J. M. (2021). Trends in Use and Perceptions About Triplet Chemotherapy Plus Bevacizumab for Metastatic Colorectal Cancer. JAMA network open, 4(9), e2124766-e2124766.

05/09/2022