SMART, Wearable, and in Real-Time: Using the best design and data

collection strategies to advance

nursing science

Carolyn Porta PhD MPH RN FAAN

Erica Schorr PhD BSBA RN

4th International Conference on Prevention and Management of Chronic Conditions

Bangkok, Thailand

February 15 2019

Our Position Statements

• SMART (sequential multiple-assignment

randomized trial) designs will advance

personalized nursing evidence

Our Position Statements

• SMART (sequential multiple-assignment

randomized trial) designs will advance

personalized nursing evidence

• Wearable technologies should be sources

of objective and subjective data (and

intervention delivery tools) in our research

(e.g., fitbit, apple watch)

Our Position Statements

• SMART (sequential multiple-assignment randomized trial) designs will advance personalized nursing evidence

• Wearable technologies should be sources of objective and subjective data (and intervention delivery tools) in our research (e.g., fitbit, apple watch)

• Ecological Momentary Assessments (real-time data) should complement traditional collection methods (e.g. recall surveys)

SMART: Sequential multiple-

assignment randomized trial

Useful design for investigations that seek to:

• Develop and test an adaptive intervention

strategy

• Examine value of intensifying or augmenting

an intervention (treatment decision rules)

• Evaluate use and combination (and optimal

sequence) of efficacious interventions

• Define response/non-response

SMART design testing adaptive intervention strategies

I-Extended

2-Extended

2-Extended

1-Extended

Randomization

Randomization

MonitoringResponders

Non-Responders

Responders

Non-Responders

Randomization

EBP-1(I) Brief

EBP-2(2) Brief

Monitoring

OutcomeAssessment

Second StageIntervention

ResponseMeasure

First StageIntervention

Baseline Assessment

SMART design testing tech add-ons

SMART design testing tech add-ons

Ecological Momentary

Assessment (EMA)

Real-time assessment method to capture behavior

and psychological/physiological measures as they

are experienced in that moment.

Contextualized data to time and place.

Can be objective OR subjective

Objective EMA

• Wearables

– Apple watch

– Fitbit

• Measures

– Activity

– Sleep

– Heart rate

– So many more…

Example: Cardiac Rehab

• English speaking adults ≥ 55 years post-CV event (MI, CABG, PCI)

• Randomized – Control or Intervention for 15 weeks

• Within 4 weeks of completing CR

Control group: (n=15)

▪ Activity tracking device with deactivated display▪ Standard CR education materials▪ Face-to face visits every 3 weeks

Intervention group: (n=16)▪ Activity tracking device with activated display▪ Standard CR education materials▪ Face-to face visits every 3 weeks

Example: Cardiac Rehab

Subjective EMA

• Smart phone applications

– Expimetrics

– Ilumivu

– Or simply using SMS or IM

• Measures

– Social engagement

– Perceived safety

– Self-reported behaviors

– Location (objective- Lat/Long)

EMA Example: Expimetrics

Note that results are based on aggregate counts over 6 weeks time

EMA Example: Self-report

In Summary

• SMART (sequential multiple-assignment

randomized trial) designs will advance

personalized nursing evidence

• Wearable technologies yield objective and

subjective data and can be useful to

deliver nursing intervention elements

• Ecological Momentary Assessment data

should augment traditional data collection

tools to advance nursing science

Thank you!

Carolyn Porta PhD MPH RN FAAN

porta@umn.edu

Erica Schorr PhD BSBA RN

4th International Conference on Prevention and Management of Chronic Conditions

Bangkok, Thailand

February 2019

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