Abstract
Our research team is currently working on the use of AI-enhanced algorithms to predict oxygen needs in patients on ambulatory oxygen therapy. The training of the algorithms, for which rich data sets are required, was a challenge for engineers. The solution proposed was to build an automated version of the 6MWT (named A-6MWT). This serendipitous development is currently promoting the revision of current practices, including a more integrated care perspective.
The 6MWT is a simple test that measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes. This test helps to evaluate the global and integrated responses of all the systems involved during exercise, notably the pulmonary and cardiovascular systems. For most of the patients, the results accurately reflect the functional exercise level for activities of daily living. At present, the 6MWT is done by health professionals working at hospital departments (nurses, technicians, physiotherapists, doctors) and, in most locations, the test is still run on paper.
A few digital solutions are available but the A-6MWT is the only one that fully automates the process of data collection and recording with the goal to obtain richer data sets (acquisition frequency for oxygen saturation and heart rate is 1Hz). It is composed of:
1) Two light beacon devices that fit in the type of cones used to mark the walking course and detect that the patient passes by in the right direction.
2) A mobile app that is used to perform the 6MWT. This app connects the beacons and a pulse-oximetry device to gather and process test data. It also manages the test logic for time tracking and sends it to a database. The professional’s front-end can then access this database to display the required reports.
3) A desktop web-based interface that integrates all the information and computes the metrics that the professionals require to assess the results of the 6MWT.
In a cross-sectional study that included 45 patients with COPD or Pulmonary Hypertension, the A-6MWT demonstrated reliability and excellent agreement with the manual registration of oxygen saturation and heart rate.(1)
Other important advantages are a reinforcement of the standardisation and quality of the 6-MWT test, and the easiness of its use. These characteristics facilitate the extension to other clinical domains (rehabilitation, geriatrics, oncology…), as well as to the pharma (6-MWT is used in clinical trials to study exertion and gait).
Additionally, we are considering its transferring to primary care through a dedicated programme of coordination and support by hospital-based professionals. Potential benefits of such a programme could be a closer patient’s follow-up, increased facilities for rehab activities in primary care, and overall system-level efficiency.
There is a real element of serendipity in integrated care and its inclination to combine components in new, previously unthought, ways. Thus, leftovers from other research fields might be interesting and, eventually, become game changers. Keeping an eye on them seems advisable.
(1) doi:10.1016/j.pulmoe.2023.08.011