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Cited by 97Wireless Body Area NetworksNon-Invasive Vital Sign MonitoringContext-Aware Activity Recognition Systems

Wearability Assessment of a Wearable System for Parkinson’s Disease Remote Monitoring Based on a Body Area Network of Sensors

Open access
Cancela, Jorge, Pastorino, Matteo, Tzallas, Alexandros, Tsipouras, Markos, Rigas, Giorgios, Arredondo, Maria, Fotiadis, Dimitrios·2014·Sensors
DOI 10.3390/s140917235PMC PMC4208222
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Abstract

Wearable technologies for health monitoring have become a reality in the last few years. So far, most research studies have focused on assessments of the technical performance of these systems, as well as the validation of the clinical outcomes. Nevertheless, the success in the acceptance of these solutions depends not only on the technical and clinical effectiveness, but on the final user acceptance. In this work the compliance of a telehealth system for the remote monitoring of Parkinson’s disease (PD) patients is presented with testing in 32 PD patients. This system, called PERFORM, is based on a Body Area Network (BAN) of sensors which has already been validated both from the technical and clinical point for view. Diverse methodologies (REBA, Borg and CRS scales in combination with a body map) are employed to study the comfort, biomechanical and physiological effects of the system. The test results allow us to conclude that the acceptance of this system is satisfactory with all the levels of effect on each component scoring in the lowest ranges. This study also provided useful insights and guidelines to lead to redesign of the system to improve patient compliance.

AI snapshot

Written from the paper’s full text.

TL;DR

This study assessed wearability and patient acceptance of the PERFORM Body Area Network system for remote Parkinson’s disease monitoring in 32 PD patients. Using REBA, Borg CR-10, and Comfort Rating Scales, all wearability components scored in the lowest effect ranges, though attachment, anxiety, privacy, and data-logger weight were identified as areas for redesign.

Key findings

  • The overall wearability level was “Low,” with average scores: perceived exertion 0.71 (Borg CR-10), posture 0 (REBA), localized pain/discomfort 0.11 (Borg CR-10), emotion 1.4, attachment 2.5, harm 0.15, perceived change 0.67, movement 0.59, and anxiety 1.63 (all CRS).
  • Most patients reported no exertion or discomfort; only one 71-year-old female reported moderate physical stress, and eight of 32 patients reported extremely weak discomfort/pain at overall body or specific areas such as mid torso-waist, mid/lower back, wrists, and ankles.
  • The data logger was the most penalized component, with mid torso-waist, mid back, and lower back effects attributed to its weight and size.
  • Attachment was described as the weakest point: straps caused discomfort and made self-wearing difficult, especially wrist sensors; anxiety was linked to lack of feedback about correct placement/functioning, and privacy/appearance concerns were raised by six of 32 patients.

Methods

  • Wearability assessment of the PERFORM BAN system in 32 PD patients meeting criteria including diagnosis of PD, age 40–70, ambulatory, motor fluctuations, stable dopaminergic treatment, and caregiver support; exclusions included dementia, hallucinations, or significant systemic disease.
  • Evaluation combined REBA for posture/movement, Borg CR-10 with body map for perceived exertion and localized pain/discomfort, Comfort Rating Scales for six comfort dimensions, and an informal patient interview.
  • Posture was scored before and after wearing the device, using the difference between REBA scores to isolate wearable-induced postural effects; results were translated into a homogeneous five-level effect scale and summarized as wearability levels.

Limitations

  • The paper states that the evaluation would benefit from extending the analysis to a larger number of patients, though it notes the 32-patient sample is large compared with other wearability studies cited.
  • The paper states the proposed methodology is not applicable when implanted or invasive sensors are used, since other parameters such as weight, battery operation, and placement must be evaluated.
  • The text makes evident that findings rely on subjective self-report scales, observer-based REBA scoring, and informal interviews, with no control or comparator group described.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/s140917235

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 27 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The average emotion score was 1.4 on the CRS scale.

    “average emotion score (1.4 on the CRS scale)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The average perceived exertion score was 0.71 on the Borg CR-10 scale.

    “average perceived exertion score (0.71 on the Borg CR-10 scale)”
    Quote in the paperSubstantial claim
  • Findingown data

    The average localized pain/discomfort score was 0.11 on the Borg CR-10 scale.

    “average localized pain/discomfort score (0.11 on the Borg CR-10 scale)”
    Quote in the paperSubstantial claim
  • Findingown data

    The average perceived change score was 0.67 on the CRS scale.

    “average perceived change score (0.67 on the CRS scale)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The average anxiety score was 1.63 on the CRS scale.

    “average anxiety score (1.63 on the CRS scale)”
    Quote in the paperNot a substantial claim
  • May combine two claims. 12
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 16

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In 32 PD patients, the acceptance of the PERFORM system is satisfactory, with all levels of effect on each component scoring in the lowest ranges.

    “The test results allow us to conclude that the acceptance of this system is satisfactory with all the levels of effect on each component scoring in the lowest ranges.”
    • Also stated in: § The PERFORM System · boosted
      “A total of 32 PD patients have been involved in this study, showing an excellent acceptance of the BAN system in wearability terms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The subset of patients with appearance and emotional issues would feel much more comfortable wearing an invisible device or if the wearing time were limited to the home environment.

    “They would feel much more comfortable wearing an invisible device or if the wearing time were limited to the home environment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A common concern raised during the interview was whether the devices were waterproof because daily activities could wet the devices, especially the wrist sensors.

    “Also, a common concern raised during the interview was if the devices were waterproof since some daily and very common activities could wet the devices, especially the ones on the wrists, for example when washing the hands and washing dishes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    None of the patients had any concern about harm caused by the device, with answers ranging from Not at all and Not very much.

    “The feedback received is that none of the patients had such a concern, ranging in their answers from Not at all and Not very much.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The system did not restrict, obstruct or block patients' daily movement and activities.

    “Finally, the answer to the (Figure 9c) question shows that the system does not restrict the daily movement and activities of the patients.”
    • Also stated in: § Comfort · plain
      “In general, all participants in the study agree that the system did not obstruct or block them in everyday activities neither limit their activities.”
    • Also stated in: § Interview and Complementary Questions · hedged
      “On the other hand, the device would not prevent them from doing their daily tasks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patients in the study had concerns about the social impact of wearing the device and what other people might think about them.

    “The social impact from wearing the sensors and being seen by other people is a sensible concern for the PD patients involved in the study.”
    • Also stated in: § Comfort · hedged
      “Again the social component appears again since some patient expressed their concerns about what other people could think about them (Figure 11b).”
    • Also stated in: § Interview and Complementary Questions · plain
      “This subset of patients had some concerns about others' opinions when wearing the device.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The second posture evaluation had similar results for every single body part of each patient respectively, resulting in similar REBA scores.

    “This second posture evaluation had similar results for every single body part of each patient respectively; obviously resulting to similar REBA scores.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Borg CR-10 scale is used to measure perceived exertion and is usually employed to measure perceived exertion while exercising.

    “The method selected is the BORG CR-10 scales for perceived exertion [18] usually employed to measure the perceived exertion while exercising [21].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Knight, J.F., Deen-Williams, D., Arvanitis, T.N., Baber, C., Sotiriou, S., Anastopoulou, S., and Gargalakos, M. (2006, January 11–14). Assessing the wearability of wearable computers. Montreux, Switzerland. source

      Not checked in the free run.

    • cites [21] Borg, 1990, Psychophysical scaling with applications in physical work and the perception of exertion, Scand. J. Work Environ. Heal. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Assessing the wearability of a wearable system involves an evaluation of physiological, biomechanical, and comfort effects.

    “Assessing the wearability of a given wearable systems could thus involve an evaluation of the physiological, biomechanical and comfort effects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Knight, J.F., Deen-Williams, D., Arvanitis, T.N., Baber, C., Sotiriou, S., Anastopoulou, S., and Gargalakos, M. (2006, January 11–14). Assessing the wearability of wearable computers. Montreux, Switzerland. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Wearability directly impacts the usability of a wearable computer system; if the wearer is uncomfortable or placed under too much stress, the usability of the system will be reduced.

    “Wearability directly impacts the usability of a wearable computer system. If the wearer is uncomfortable or placed under too much stress then the usability of the system will be reduced.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Knight, J.F., Deen-Williams, D., Arvanitis, T.N., Baber, C., Sotiriou, S., Anastopoulou, S., and Gargalakos, M. (2006, January 11–14). Assessing the wearability of wearable computers. Montreux, Switzerland. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The REBA method is designed to be sensitive to the type of unpredictable working postures found in healthcare and other service industries.

    “The REBA method has been developed to fill a perceived need for a practitioner's field tool, specifically designed to be sensitive to the type of unpredictable working postures found in healthcare and other service industries [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Hignett, S., and McAtamney, L. Rapid Entire Body Assessment (REBA). Available online: http://www. ncbi.nlm.nih.gov/pubmed/10711982.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The wearability evaluation of a Body Area Network is mostly based on the work of Knight and Baber.

    “The wearability evaluation of BAN is mostly based on the work of Knight and Baber [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Knight, J.F., Deen-Williams, D., Arvanitis, T.N., Baber, C., Sotiriou, S., Anastopoulou, S., and Gargalakos, M. (2006, January 11–14). Assessing the wearability of wearable computers. Montreux, Switzerland. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Five Wearability Levels proposed by Knight and Baber allow homogeneous interpretation of different metrics and scales to provide a final wearability score.

    “From the levels of effect, five Wearability Levels (WL) have been proposed by Knight and Baber, as shown in Table 2 [18]. They allow the homogenous interpretation of the different metrics and scales in an easy and direct way providing a final score rating the wearability of the system.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Knight, J.F., Deen-Williams, D., Arvanitis, T.N., Baber, C., Sotiriou, S., Anastopoulou, S., and Gargalakos, M. (2006, January 11–14). Assessing the wearability of wearable computers. Montreux, Switzerland. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Part of the concern about social impact could come from the public disclosure of suffering a disease only by wearing a device.

    “As it was mentioned above, part of this concern could come from the public disclosure of suffering a disease only by wearing a device.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Feelings of anxiety indicate levels of discomfort arising from concerns about safety and reliability and from feelings of insecurity.

    “Feelings of anxiety indicate levels of discomfort arising from concerns about safety and reliability and from feelings of insecurity [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Knight, 2005, A tool to assess the comfort of wearable computers, Hum. Factors J. Hum. Factors Ergon. Soc. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Both the emotion and anxiety results suggest a significant concern of the patients about their privacy; most patients do not like what other people could think about them when they wear the device, especially in public spaces.

    “Regarding the comfort analysis, both the emotion and anxiety results suggest a significant concern of the patients about their privacy, most of the patients do not like what other people could think about them when they wear the device, especially in public spaces.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The way patients wear and attach the devices or sensors properly on their own is difficult and uncomfortable, and they might need some help from their caregivers.

    “The way that patients wear and attach the devices or sensors properly on their own is difficult and uncomfortable and they might need some help from their caregivers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Low scores for perceived exertion and posture suggest that even though the prototype is larger and heavier than a commercial device, it does suppose a substantial physical load for the users.

    “Starting this analysis with the energy cost and the biomechanical spaces the low scores for the perceived exertion and the posture values suggest that even the prototype is larger and heavier than a commercial device it does suppose a substantial physical load for the users.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prototype is larger and heavier than a commercial device.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Comfort Rating Scales (CRS) is a tool for comfort assessment of wearable devices that breaks down comfort analysis into six components.

    “Knight and Baber developed a tool for the comfort assessment of wearable devices called the CRS [23] which break down the comfort analysis into six different components.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Knight, 2005, A tool to assess the comfort of wearable computers, Hum. Factors J. Hum. Factors Ergon. Soc. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The anxiety caused to patients by the device is generated by a lack of feedback to the patient about the correct placement and functioning of the device.

    “The anxiety caused to patients by the device is generated by a lack of feedback to patient about the correct placement and functioning of the device.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Levels of both emotion and anxiety may be reduced with time and experience as the wearer becomes accustomed to the device.

    “Ultimately, levels of both emotion and anxiety may be reduced with time and experience as the wearer becomes accustomed to the device [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Knight, 2005, A tool to assess the comfort of wearable computers, Hum. Factors J. Hum. Factors Ergon. Soc. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 0-20 range was considered large enough to elicit a range of responses that could be used for detailed analysis.

    “According to Knight and Baber this range was considered large enough to elicit a range of responses that could be used for detailed analysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Knight, 2005, A tool to assess the comfort of wearable computers, Hum. Factors J. Hum. Factors Ergon. Soc. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The proposed methodology is not applicable when implanted or invasive sensors are used, since other parameters must be taken into account.

    “The proposed methodology is not applicable when implanted or invasive sensors are used, since other parameters must be taken into account.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Using the difference between REBA scores without and with the wearable device helps focus the posture analysis on the effects imposed by the wearable itself.

    “Thus, in order to identify these changes we use as score for our evaluation the difference between the REBA scores the patient gained (i) without and (ii) with the wearable device. This helps us to focus the posture analysis on the effects imposed by the wearable itself.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The REBA evaluation in PD patients is meaningful if the observer differentiates between postural changes caused by the disease and any postural changes caused by the wearable itself.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The analysis performed can be extended to the wearability analysis of similar systems for movement disorders monitoring or other diseases which require the use of sensors for continuous monitoring of physiological parameters.

    “The analysis performed can be extended to the wearability analysis of similar systems for movement disorders monitoring or other diseases which require the use of sensors for the continuous monitoring of physiological parameters.”
    Quote in the paperNot a substantial claim
25 of 25

  • The paper relies on this without support.

    Wearable health monitoring systems can be highly intrusive and uncomfortable for patients, which could cause the application to fail even if it benefits health.

    “The use of these systems can be highly intrusive and uncomfortable for the patients and this could lead the application to fail, even when it has been proven that it benefits patients' health.”

  • The paper relies on this without support.

    Most works during the prototyping phase focus exclusively on the technical performance of the system and ignore or bypass the wearability and compliance analysis.

    “Nevertheless, during the prototyping phase most works focus exclusively on the technical performance of the system and ignore or bypass the wearability and compliance analysis.”

  • The paper relies on this without support.

    The REBA evaluation in PD patients is meaningful if the observer differentiates between postural changes caused by the disease and any postural changes caused by the wearable itself.

    “As it was previously mentioned, the REBA evaluation in PD patients is meaningful if the observer differentiates between the postural changes caused by the disease and any postural changes caused by the wearable itself.”

  • The paper relies on this without support.

    The data logger is the heaviest and largest device of the BAN.

    “(the heaviest and largest device of the BAN)”

  • The paper relies on this without support.

    The prototype is larger and heavier than a commercial device.

    “even the prototype is larger and heavier than a commercial device”

  • The paper relies on this without support.

    A wearable device is an extra load attached to the human body and could have a direct effect on the energy consumed by the body and on posture.

    “As it was already mentioned a wearable device is an extra load that gets attached to the human body. Thus, it could have a direct effect both on the energy consumed by the body as the muscles need more energy in order to produce the force to counteract the weight of the device and the resulting movement and posture changes.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A participant falls outside the stated age eligibility range

    Minor

    The eligibility criteria limit participants to ages 40-70, but the results describe a 71-year-old patient in the study.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Baber, C., Wilson, J.R., and Corlett, E.N. (2005). Evaluation in Human-Computer Interaction, Taylor & Francis.

Cited by

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Related

Authors
Cancela, J., Pastorino, M., Tzallas, A., Tsipouras, M., Rigas, G., Arredondo, M., & Fotiadis, D.
Affiliations
  • Universidad Politécnica de Madrid (ES)
  • University of Ioannina (GR)
  • Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece
  • Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain
ORCID
Venue
Sensors
Publisher
MDPI AG
Published
2014-09-16
Volume
14
Issue
9
Pages
17235-17255
ISSN
1424-8220 (ISSN-L)
DOI
10.3390/s140917235
PMC
PMC4208222
OpenAlex
W2068361901
Semantic Scholar
171a4b6c4b1ba85f37c54be40d91d3476dc472b2
Cited by
97
References
25
Citations by year
2026: 3 · 2025: 2 · 2024: 7 · 2023: 4 · 2022: 15 · 2021: 11 · 2020: 13 · 2019: 9 · 2018: 8 · 2017: 9 · 2016: 9 · 2015: 6 · 2014: 1
FWCI
4.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Sensors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • European Commission (215952)
  • Universidad de Navarra
  • University of Ioannina
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Wireless Body Area Networks
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
Keywords
Parkinson's disease, wearable sensors, body area networks, remote patient monitoring, telemedicine, user acceptance, wearability, comfort evaluation, REBA, Borg scale, medication adherence, system redesign
MeSH terms
Aged, Computer Communication Networks, Equipment Design, Female, Humans, Male, Parkinson Disease, Patient Acceptance of Health Care, User-Computer Interface, Patient Satisfaction, Telemedicine, Monitoring, Ambulatory, Equipment Failure Analysis

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