The 6th Vital Sign: a Mobile App for Population Health Surveillance of Walking Speed Miriam C. Morey, Ph.D. miriam.morey@duke.edu Older Americans Independence Center

Objectives Objective 1: Provide an overview of the 6th Vital sign smartphone application Objective 2: Describe demographics and test results of initial application users

EVIDENCE IS CLEAR For more than 20 years Bettger PCORI CER Overview

Fritz, Stacy et al., J. Geriatric Physical Therapy, 2009 0 mph 0.4 mph 0.9 mph 1.3 mph 1.8 mph 2.2 mph 2.7 mph 3.1 mph 10 meter walk time 50 sec 25 sec 16.7 sec 12.5 sec 10 sec 8.3 sec 7.1 sec 10 foot walk time 15.2 sec 7.6 sec 5 sec 3.8 sec 3 sec 2.5 sec 2.2 sec

Why did we create this research study for a smartphone? The 6th Vital Sign Study: Engaging New Partners to Reach New Populations Why did we create this research study for a smartphone? Vital signs are indicators of general physical health status Walking speed has also been shown to be an important vital sign Uptake of walk tests in healthcare is slow For more than 20 years Contact us for more information: sixthvitalsignapp@dm.duke.edu

Why did we create this research study for a smartphone? The 6th Vital Sign Study: Engaging New Partners to Reach New Populations Why did we create this research study for a smartphone? The 6th Vital Sign Study aims to establish walking speed as a new standard for measuring physical health on an iPhone easily, anywhere, and by anyone For more than 20 years Contact us for more information: sixthvitalsignapp@dm.duke.edu

LAUNCHED APRIL 10, 2016 For more than 20 years Bettger PCORI CER Overview

Sixth Vital Sign Study Aims To examine uptake of this approach to collecting data from under-reached populations To measure functional status, including gait speed and self-reported health, on an unlimited potential population across gender, race, and socio-geographical strata through 2020 to establish: region- and population-specific normative data minimal clinically important differences for improvement markers of clinical endpoints associations with other measures of health and well-being

Self-led Anytime from Anywhere Stop and complete later Participate 1x Compare to population norms Repeat test Share results For more than 20 years Bettger PCORI CER Overview

For more than 20 years Bettger PCORI CER Overview

Many Screens + Full Consent Document … Then Sign

After some basic demographics: For more than 20 years Bettger PCORI CER Overview

Accessed in iTunes and Number of Downloads FIRST 50 DAYS Accessed in iTunes and Number of Downloads Soft or Pre-Launch April 10 Duke Forward Launch May 4 N&O Web/Print Article May 9 Total Views in 50 days = 1,111 (29.6% pre-launch and 70.4% post) # of Downloads: 771 (69.4%) (52.9% pre-launch, 76.3% post) Consented to Participate 398 51.6% of downloads 35.8% of those viewed 1 – 10 11 – 20 21 – 30 31 – 40 41 - 50 Days

Study Participants by the Numbers FIRST 50 DAYS Study Participants by the Numbers 27 # of states with at least 1 study participant 65 % within a 100 mile radius of Duke 54 Median age of study participants 22 % 65 years or older 58 % female 89 % White 7 % with ≤12 years of ed. (high school) 76 % living with a chronic health condition (predominantly high cholesterol, hypertension, or joint pain)

Validation Study (N=60, ages 18-64 years) Differences between 6VS App and Standard Observer Gait Parameter Condition Tested 6VS App (Mean) Observer Mean Difference Steps Swinging Arm 214 229 15.22 * (number) Held in Front 231 16.24 * Bag 221 232 10.94 * Pocket 225 6.00 Distance 528 527 0.46 (feet) 502 526 23.56 534 538 4.11 471 533 61.86 * Speed 4.40 5.2 0.76 (ft / sec) 4.23 4.4 0.15 4.45 4.5 0.04 3.93 0.52 *

Older Adult Participation (no direct recruitment) Of 866 consented participants in the first year, 179 (20.7%) were ≥ 65 years (145 completed valid walk tests) Sex Older Old 88 female (49%) 46 participants ≥75 years (25.7%) 34 people used phones that were not capable of measuring distance (iPhone 5.3 or older)

Strata Sex (Age in Years) “Usual Pace” vs. Bohannon Meta-Analysis Mean m/sec Meta-Analysis* Men (60 to 69) 72 1.34 1.03 – 1.59 Men (70 to 79) 37 1.42 0.96 – 1.42 Men (80 to 99) 9 1.23 0.61 – 1.22 Women (60 to 69) 70 0.97 – 1.45 Women (70 to 79) 25 0.83 – 1.50 Women (80 to 99) 5 1.15 0.56 – 1.17 “Usual Pace” vs. Bohannon Meta-Analysis *Grand mean (95% CI) range

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Meet the Team

For questions and comments Janet.Bettger@duke.edu For questions and comments The 6th Optimizing and preserving physical functioning is a central goal for living a healthy life.

PHYSICAL ACTIVITY Physical activity is our cheapest and best “drug”. Reduces … Improves … Survey data overestimate measured activity, so we don’t really know the optimal “dose” Digital technology is shifting the field of measurement but activity is still a choice, its behavioral, and influenced by many things we can’t measure We need an easy, publicly available approach to objectively measure physical health at any point in time

Older Adult Participation (no direct recruitment) Of 871 consented participants in the first year, 221 (25.4%) were ≥ 65 years Sex Older Old 113 female 52 participants ≥ 75 years