Activity data from wearables as an indicator of functional capacity in patients with cardiovascular disease

Neil Rens; Neil Gandhi; Jonathan Mak; Jeddeo Paul; Drew Bent; Stephanie Liu; Dasha Savage; Helle Nielsen-Bowles; Doran Triggs; Ghausia Ata; Julia Talgo; Santiago Gutierrez; Oliver Aalami

doi:10.1371/journal.pone.0247834

Peer Review History

Original SubmissionOctober 25, 2020
31 Dec 2020 Decision Letter - Chiara Lazzeri, Editor PONE-D-20-33554 Activity data from wearables as an indicator of functional capacity in patients with cardiovascular disease PLOS ONE Dear Dr. Rens, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 14 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is an interesting paper demonstrating the potential usefulness of remote monitoring of the performance status in cardiovascular patients. Although the protocol has some limitations (that were acknowledged by the Authors), I believe that the results are interesting and sound. Just one remark: although the passive data were continuously recorded, it is not possible to exclude that the participation to the study protocol acted itself as a "Motivator", inducing patients to be somehow more active than usual. Reviewer #2: The authors describe a study in which they monitored a cohort of preoperative/preprocedural cardiovascular disease patients smartphone data remotely to assess functional capacity and predict frailty The authors presents a well written and creatively designed protocol to assess passive data collection from iphone technology with a measured comparison with in clinic 6 min walk testing. � Future question – validate longitudinal outcomes with activity data � Dropout rate – suggests a possible current limitation of remote data as a reliable clinical tool in all clinical settings – this may be a barrier to reliance on this emerging technology for certain potentially marginalized patient cohorts � Would be interesting to assess “frailty” assessment with other indicators of comorbidity and or a total burden of comorbidities � Please comment on the determination of “frailty” and resource allocation in the context of care and or prognostic information � It is important to comment on the long term prospects for sustained patient engagement and use when incorporating novel digital technology and data collection in patient care (home, outpatient, inpatient settings) ****** 6. 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If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0247834.r001
Revision 1
11 Feb 2021 Author Response Dear Reviewers, Thank you for your thoughtful reading of our manuscript entitled Activity data from wearables as an indicator of functional capacity in patients with cardiovascular disease. You highlighted some important considerations that we address below point-by-point. The actual edits are included both in the Manuscript as well as in the Response Letter file that was uploaded. Below, we only include references to the line number where the edits may be seen. Reviewer #1: Although the passive data were continuously recorded, it is not possible to exclude that the participation to the study protocol acted itself as a "Motivator", inducing patients to be somehow more active than usual. Thank you for raising this important insight. We have included a few sentences in the discussion (line 268) addressing the fact that the study protocol itself may have been an activity motivator and therefore patient activity outside of a study protocol may differ. Reviewer #2: Future question – validate longitudinal outcomes with activity data We wholeheartedly agree that future studies should assess longitudinal outcomes. We acknowledged that we did not have enough interventions in our study cohort to apply regression analysis to assess outcomes. We have also added the following language to the discussion of study limitations (line 258). Reviewer #2: Dropout rate – suggests a possible current limitation of remote data as a reliable clinical tool in all clinical settings – this may be a barrier to reliance on this emerging technology for certain potentially marginalized patient cohorts You raise an important point about the potential for widespread adoption of remote monitoring. We have added additional discussion about the dropout rate in our study population and how that dropout rate may differ for other marginalized patient populations (line 248). Reviewer #2: Would be interesting to assess “frailty” assessment with other indicators of comorbidity and or a total burden of comorbidities Reviewer #2: Please comment on the determination of “frailty” and resource allocation in the context of care and or prognostic information Thank you for highlighting this question about the clinical utility of frailty. We have added a paragraph to the discussion to explain the clinical context for frailty and have added a citation for various other frailty measures. While other non-activity based measures of frailty use other indicators of comorbidity, our study did not have access to this data and therefore we could not compare frailty as predicted by remote monitoring these other frailty measures (line 216). Reviewer #2: It is important to comment on the long term prospects for sustained patient engagement and use when incorporating novel digital technology and data collection in patient care (home, outpatient, inpatient settings) While we agree this is an important topic to discuss, given the 6-month time period of this study, we do not feel we have the data to extrapolate about sustaining patient engagement beyond 6 months. However, we have added a reference to a relevant study on patient engagement during a home-based exercise intervention monitored with a wearable (line 258). Thank you for your consideration of our revised manuscript, Neil Rens On behalf of all authors Attachments Attachment Submitted filename: Resposne to Reviewers.pdf https://doi.org/10.1371/journal.pone.0247834.r002
15 Feb 2021 Decision Letter - Chiara Lazzeri, Editor Activity data from wearables as an indicator of functional capacity in patients with cardiovascular disease PONE-D-20-33554R1 Dear Dr. Rens, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Chiara Lazzeri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0247834.r003
Formally Accepted
1 Mar 2021 Acceptance Letter - Chiara Lazzeri, Editor PONE-D-20-33554R1 Activity data from wearables as an indicator of functional capacity in patients with cardiovascular disease Dear Dr. Rens: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Chiara Lazzeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0247834.r004

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