iMedicalApps and JMIR Publications have partnered to help disseminate interesting & innovative digital health research being done worldwide. Each article in this series will feature summaries of interesting studies to help you keep up to date on the latest in digital health research. We invite you to share your thoughts on the study in the comments section.

Development of a wearable cardiac monitoring system for behavioural neurocardiac training

1. What was the motivation behind your study?

Behavioural Neurocardiac Training (BNT) is a complementary approach to blood pressure management that focuses on reducing the impact of stress from the external environment. It involves cognitive behavioural therapy and a paced breathing technique with heart rate variability (HRV) biofeedback. In-clinic delivery has been shown to improve autonomic regulation and lower blood pressure. Currently, BNT is limited to clinical settings, as it requires complex physiological monitoring tools and in-person clinician guidance. This creates accessibility barriers preventing alternative delivery methods.

2. Describe your study.

The objective of this project was to design, develop and evaluate a wearable ECG sensor system for the delivery of BNT in home settings. The sensor system consists of a wearable sensor that streams real-time ECG to a smartphone app. The app guides the users through the BNT exercises and presents HRV biofeedback derived from the ECG. A usability study was conducted at Toronto General Hospital to evaluate feasibility, user experience, and identify areas of improvement (n=6).

3. What were the results of the study?

The overall response to the design and user experience of the system was positive. Users found the sensor to be compact, comfortable and unobtrusive. They also indicated that the system had a positive impact on their stress management and that they would use it at home. Areas of improvement were identified, focusing primarily on the delivery of training and education on BNT in the application.

4. What is the main point that readers should take away from this study?

While behavioural therapy offers a complementary approach to blood pressure management, accessibility to this type of treatment remains limited to clinical environments. Wearable sensor systems, such as the one presented in this paper, offer an approach for delivery of BNT in home settings, empowering patients and reducing accessibility barriers. This study has shown that user perceptions and acceptability of this system is very positive, with users able to navigate and use it. This bodes well for the feasibility of such a system for home delivery for BNT.

5. What was the most surprising finding from your study?

Having extensive training and education sections does not always mean that users are fully understanding the content. In this study, the app provides comprehensive education sections (visual and audio) at the start, yet several users had trouble interpreting results within the app. This was traced to poor organization and information overload. A simpler training process with just-in-time guidance on concepts as they are required, refined through user testing, would address this issue.

6. What are the next steps? How do you envision this work ultimately translating into clinical practice or affecting R&D?

These results will inform the development of future mHealth sensors and apps by our team. For the wearable sensor, several key requirements were identified that would enable future applications in remote patient monitoring. Although further iterations and refinements are possible, this system is a step forward towards providing a complementary approach to blood pressure and stress management at home.

This Q&A was contributed by Akib Uddin, Biomedical Engineer at the Centre for Global eHealth Innovation, University Health Network in Toronto, Ontario.