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

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

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

4. 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

6. 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:

7. 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:

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

9. 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

10. 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

11. For more than 20 years
Bettger PCORI CER Overview

12. Many Screens + Full Consent Document … Then Sign

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

14. 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, % post)
Consented to Participate
398
51.6% of downloads
35.8% of those viewed
1 – – – –
Days

15. 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)

16. 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 *

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

18. 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

19. Take the test and join us
SIGN UP TODAY!!!!!!!
Take the test and join us
sixthvitalsign.researchkit.duke.edu

20. Meet the Team

21. For questions and comments
For questions and comments
The
6th
Optimizing and preserving physical functioning is a central goal for living a healthy life.

22. 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

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