Ambulatory monitoring: Patients become monitors of their own health

In the future, patients will become even more involved in the observation and monitoring of their own health or illnesses. For example, blood pressure can be checked 24 hours a day using a blood pressure cuff at home. “This is the classic example,” notes Professor Dr. Thomas Kubiak.

“As time goes on, we will have to increasingly integrate new health observation and monitoring techniques into our daily lives. This will influence the situations of both patients and doctors.” Kubiak is Professor of Health Psychology at Johannes Gutenberg University Mainz (JGU) in Germany. He has worked extensively with new ambulatory monitoring techniques and recently guest-edited a special issue of the scientific journal Psychosomatic Medicine on this topic in collaboration with Arthur A. Stone of Stony Brook University.

The two health psychologists believe that our everyday state of health and behavior is much more helpful in determining proper diagnoses and therapies than lab-only results or questionnaires in which patients are asked to provide retrospective information about their state of health over the last few weeks or months. For chronic headaches, for example, it helps to keep a regular diary that tracks when headaches occur and what might have triggered them. There are also many ways for diabetes patients to check their own blood sugar levels and continually keep track of the results through devices that then help determine the proper insulin dosage. Information about food, activities, and the perception of symptoms can also help these patients better manage their diabetes. In fact, there are already systems that can track everyday activity and even detect whether you are riding a bike or climbing stairs.

“The data that we can obtain about the everyday lives of our patients is really a very important kind of information,” says Thomas Kubiak. This kind of data has an enhanced 'ecological validity.' Real-life information about moods, stress, symptoms, blood pressure, hormone levels, and many other biologic or environment-related factors can be collected. According to Kubiak, these new techniques have gained in momentum over the last decade, even if they have yet to arrive in the offices of general practitioners or internists. The dissemination process is sure to speed up even more now thanks to the widespread use of new communication instruments, such as smartphones. For example, these devices can be used for documentation purposes such as in an activity study, where a phone call at specific times during the day prompts a patient to complete a questionnaire the results of which are then linked to GPS data. This kind of 'electronic diary' can be very useful as it can have preventive or therapeutic benefits for the patient. Pharmaceutical companies also benefit as these new instruments can be used effectively in clinical trials of their products.

In a special issue of the journal Psychosomatic Medicine, Kubiak and his co-editor Arthur A. Stone have brought together articles that discuss the most recent trends in computer technology, in the development of medical devices, and in data analysis to highlight new techniques and applications in ambulatory monitoring. Articles about statistical methods supplement the volume.

PUBLICATION:
T. Kubiak, A. Stone, Ambulatory Monitoring of Biobehavioral Processes in Health and Disease, Psychosomatic Medicine, 74:4, Mai 2012

doi:10.1097/PSY.0b013e31825878da