Project update - Power4FitFoot

Data-Driven Personalized Self-Management of Patients with Heart Failure & Diabetic Foot: An Integrative Approach to Predict and Manage High-Risk Factors

Reducing the number of sick individuals and improving healthcare is our goal. Healthcare is one of the largest expenditures, totaling around 75 billion euros annually. What if you could significantly reduce this amount by warning people in advance of a potential illness, enabling them to adjust their behavior in time or receive the right treatment promptly?

Diabetic foot ulcers are severe complications that deteriorate the lifestyle and health of patients. Recognizing symptoms, such as reduced sensation, should assist in preventing diabetes ulcers. New methods and monitoring techniques can be applied to optimize early detection and support patients in managing and maintaining their health, precisely the focus of the Power4FitFoot project. This project involves combining various data sources to develop an Early Warning System (EWS) for healthcare providers and patients. The Power4FitFoot project started in 2019 and is expected to continue until the end of 2023, with potential extensions due to delays incurred during the COVID-19 pandemic.

Technology & Behavior

In spring 2023, we spoke with Prof. Dr. Paul Havinga and Prof. Dr. Lisette van Gemert-Pijnen about the PowerFitFoot project. Paul is a Professor of Computer Science at the University of Twente and Director of Science at TNO - ICT. He has substantial experience as a project manager in various international research projects on wireless sensor networks. Lisette works as a Professor of Persuasive Health Technology at the University of Twente. Her research and education focus on designing, implementing, and evaluating technology in the healthcare sector to improve overall safety and health quality. "The research particularly targets human-centered and value-driven technology, making this study unique," says Lisette.

Foot Ulcers

People with diabetes often develop diabetic foot ulcers. Specialists estimate that about 10 percent of people with diabetes develop a foot ulcer at some point. A mild foot injury can be the beginning of a foot ulcer. People with longer-standing diabetes or less effective diabetes management are more likely to develop foot ulcers. Smoking, lack of physical activity, obesity, high cholesterol, or blood pressure can all increase the risk of diabetes foot ulcers. Better early detection and personalized interventions to improve treatment adherence and encourage self-control can prevent foot ulcers and, ultimately, amputations.

Three Studies

The Power4FitFoot project consists of three studies, each focusing on acquiring new scientific knowledge that can be used to develop the Early Warning System.

Study 1

Study 1 involves conducting cohort studies among patients with diabetic foot ulcers, examining predictors of ulcer-free days. "Afram Akturk uses both cardiovascular data and infection data in his research, as there is growing evidence that cardiovascular problems are predictors for developing a diabetic foot," explains Lisette. "He now has a good understanding of risk factors, including heart failure." Afram is a unique Ph.D. student, a vascular surgeon in training (AIOS) at Ziekenhuisgroep Twente (home to one of the largest diabetic foot clinics in the Netherlands), providing him access to extensive datasets, adds Lisette.

Study 2

Study 2 focuses on developing sensors to map walking patterns. Paul supervises Ph.D. student Jansi Rani Rathikumar. "We want to intervene as early as possible; if you get an ulcer, you're already too late. You want earlier insight into possible symptoms, which are hardly visible, and patients themselves often have poor visibility on them. However, it turns out that the further the disease develops, the more you can see, especially in the way people walk. We conducted tests with sensors and cameras for this purpose," says Paul.

Study 3

In Study 3, supervised by Ph.D. student Iris ten Klooster (also guided by Lisette), a prediction model for ulcers and amputations is developed based on electronic patient records. Interviews are conducted to identify the needs of end-users of the EWS. Interviews were conducted with diabetes patients and other stakeholders (including data steward ZGT, physician, diabetes nurse).

Partners

In addition to the University of Twente and Ziekenhuisgroep Twente (ZGT), the consortium for this research includes Stichting Reggeborgh, Thales, Voetencentrum Wender, Voetmax Orthopedie, Lab MicTA, Diabetesvereniging Nederland, and Stichting DIAVASC. "This consortium has been working together for a long time, each from a different perspective and involvement. The project is a multidisciplinary collaboration involving data, behavior, and technology. Simultaneously, there are adjacent studies - with these partners and ZonMw, among others - that examine aids such as orthopedic shoes and adherence to their use. This approach provides usable information from various perspectives, yielding richer data," explains Lisette.

Challenges

"We found that the healthcare chain around a diabetic foot has not been well mapped, both the availability of data and knowledge about data are often insufficient. We really need to make strides in this area," state Paul and Lisette. Another challenge was COVID-19. "We work with a very vulnerable patient group; for a long time, students were not allowed to visit hospitals by the University to prevent virus spread. Fortunately, we were able to organize extensions."

Future

The cohort studies and the needs of patients and healthcare providers will be used as context for developing the EWS and then translated into system requirements. The predictive model will be integrated into the system to provide an Early Warning, complemented by sensor data to further improve this prediction. "A significant interim result is also a closer collaboration between cardiologists and vascular surgeons, as cardiologists often treat high-risk patients. We hope to provide more and more valuable insights into improving healthcare through human and technological collaboration." For more information: www.power4fitfoot.nl