Fatigability in Outcomes to monitor Resilience Targets in Older persons
According to the World Health Organization (WHO), in the next 30 years, the world’s population aged 60+ years is projected to double from 1 billion in 2020 to nearly 2.1 billion in 2050; although the benefits of a longer life span are indisputable, it is of utmost importance that these are experienced with as much good health, functionality, and quality of life as possible. Loss of intrinsic capacity is a common health condition associated with aging, which leads older adults to require significant help from others, and the rapid increase in population with functional decline introduces significant pressure on current social and healthcare structures, due to the escalating costs and demand for their services.
Our consortium is developing an integrated platform, composed of hardware, software, and data analytics, to assess intrinsic capacity and its changes in daily life. We also develop its related clinical pathways and business models for use in daily practice where we foresee 3 different pathways for:
- independent use as an early warning system for the functional decline
- professional guided use for early detection of functional decline related to chronic diseases
- professional guided use to monitor and optimize recovery after interventions like hip surgery
What’s our goal?
FORTO aims at developing a user-friendly device and supporting system for self-assessment of muscle fatigability in older persons. Early changes in health are difficult to assess as measurements that currently exist are insufficiently sensitive for changes. eforto® allows to identify small changes in intrinsic reserves. eforto® can be used for a variety of applications like acting as an early warning system for deterioration of the general health status long BEFORE it can be detected by other methods. eforto® can also be applied to monitor and detect delayed recovery in older patients when dismissed from the hospital (e.g. after acute infection or fracture).
Partners & Projects
VUB VRIJE UNIVERSITEIT BRUSSEL
The Frailty in Ageing (FRIA) research department at the Vrije Universiteit Brussel is a clinical and research team that typically represents multidisciplinary competence, needed for both fundamental and clinical research on frailty in the elderly. FRIA is chaired by Ivan Bautmans and counts now 39 members (14 senior, 4 postdoc and 17 pre-doc researchers, and 4 research assistants) with many different background profiles. FRIA runs a comprehensive research program to untangle the underlying mechanisms and to develop interventions for prevention and rehabilitation of frailty in the aged. (see also www.vub.ac.be/FRIA for details). The past 5 years FRIA published 206 articles in international peer-reviewed journals (most in rank Q1) and supervised 9 successfully PhD’s and ongoing 13 PhD’s. I Bautmans conceived the muscle fatigue resistance test in the early years 2000 and his work on muscle fatigability in frailty was awarded by 6 scientific prizes among which the 3 most prestigious Belgian gerontology awards: •2013 King Baudouin Foundation’s PRIZE MARIE-THÉRÈSE DE LAVA •2010 BORGERHOFF PRIZE •2009 DE COOMAN PRIZE. I Bautmans coordinates the Gerontopole Brussels, an ongoing Interdisciplinary Research Program @VUB on Active and Healthy Ageing (funded with 105k€/year) and an ongoing Strategic Growth Research Program @VUB on the anti-inflammatory effects of exercise in the aged (funded with 94k€/year). He also obtained external funding from FWO, Willy Gepts Fund, EU (FP7 program), WCF (The Netherlands) and sponsored clinical trials. Leading WP0, VUB is responsible for the coordination and management of the FORTO project. I Bautmans will act as coordinator of the FORTO project. The FRIA team of VUB will contribute to all other WP’s with a prominent role in the development of the clinical algorithm, the feasibility study and the scientific dissemination.
For this project, FRIA’s expertise will be complemented by prof. Kurt Barbé of the research department biostatistics and medical informatics (BISI) at the Vrije Universiteit Brussel. This group works on a variety of topics ranging from fundamental problems in biostatistics to the support of research in other research departments by assisting in the statistical analyses at hand. The team supervised by K Barbé is oriented towards the advancement of biostatistics under customized data assumptions. As a result, we aim at modifying the standard statistical methodology to match these with data properties present in medical sciences. As a result, we currently hold an interest in non-parametric statistics for multiway designs for pre-clinical trials, statistical tests for fMRI under Rician noise conditions, a study of the data properties needed for the application of random forests in clinical decision support, and time series analysis under anomalous diffusion inducing long-term memory effects. The BISI group holds 2 professors, 2 postdoctoral researchers and 5 PhD students. Barbé’s team published around 48 research papers where 70% is in various Q1 journals, complemented by mostly Q2 journals. Various project funding has been obtained from the research foundation Flanders as well as private companies outsourcing statistical analyses to obtain an unbiased report. The group holds 5 international scientific prizes including two personal recognitions to K Barbé, a best paper award, and 2 decorations marking the importance of the PhD topic of two PhD researchers to the field. K Barbé’s role in the FORTO project will consist in providing expertise for the refinement and validation of the clinical algorithm, and related mathematical/statistical modelling of the data captured by the prototype device.
As subcontractor of VUB, IntoTheMinds will be provide expertise regarding market research and business case building. IntoTheMinds is a 100% privately held market research firm which has been active in Belgium for more than 10 years. It has now offices in Pairs (France) too and focuses on scientific methods. IntoTheMinds does all research in-house with a team of 8 people (among whom 2 PhD’s) and combines techniques to deliver reliable insights. The techniques used span from qualitative (individual interviews, ethnography, focus groups) to quantitative techniques. Since 5 years IntoTheMinds has also added Big Data analysis (segmentation, structural equation modelling, PATH analysis) to reveal actual consumers behaviours. IntoTheMinds is active on the Belgian market (ca. 50% of its revenues) and abroad (mainly in France, Luxembourg and Germany). It realizes approximately 20 market research assignments per year for all types of customers (large companies, small and medium enterprises) and across all sectors of activity (projects of 2019 include sport, broadcasting, cosmetics, FMCG, banking, clothing, press, hospitality, medicine). In 2018 IntoTheMinds was contracted by the UCL Hospitals to conduct a similar research to this one, investigating the adoption of a e-Health device among doctors, nurses and patients. This project was supported by the FEDER fund. For the FORTO project, IntoTheMinds will carry out a market research and build a business case showing the market potential of the developed system.
INSTITUTO DE TELECOMUNICACOES
Instituto de Telecomunicações (IT) is a private, non-profit organization of public interest rooted in research and development in the field of telecommunications, and established with the mission to create and disseminate scientific knowledge in this field. IT is actively involved in fundamental and applied research both at national and international levels, as well as in hosting and tutoring graduate and post-graduate students. IT expertise spans all areas of telecommunications including wireless and optical communications, networks, and multimedia. By creating a common culture of excellence, IT managed to create a critical mass, enabling to compete for external funding and get international visibility and recognition.
At its Lisbon site (involved in the project), IT gathers more than 170 professionals (92 are permanent researchers), and in 2019 alone IT had a total of 159 running projects, funded both through national and international (EU, COST, and others) programs. Throughout the 25+ years of the existence of IT and to date, IT researchers have authored or co-authored more than 250 books, 840 book chapters, 5330 journal papers, 9760 conference communications and filed about 181 national and international patents; according to the ISI Web of Science citation rankings, an h-index of 107 is obtained. About 20% of IT patents are being exploited; also, IT developed technology has already been used to create 11 start-ups.
Within the Lisbon site, the Pattern and Image Analysis (PIA) group is ensuring the participation in the project. This group is focused on new ways of acquiring, communicating, accessing, processing, and presenting large volumes of multimedia data, with a core on machine learning. In FORTO, the group is applying its expertise in knowledge discovery and pattern recognition, together with its background on biomedical instrumentation for healthcare applications, to assist the project in terms of physiological signal acquisition and processing in long-term and ambulatory settings, as well as sensor integration towards usability. Particular relevance will be given to the development of non-intrusive data acquisition methods, of signal processing algorithms to support the extraction of relevant clinical indicators tuned to the requirements and current knowledge of the clinical partners.
RADBOUD UNIVERSITY MEDICAL CENTER
The Radboud University Medical Centre (Radboudumc) is one of eight university hospitals in the Netherlands. Major clinical and research themes include personalized healthcare and the patient as partner. Radboudumc consistently ranks high in national comparisons of the quality and outcome of care, with cardiothoracic surgery results among the best in Europe. The hospital has acquired an international reputation for innovative ways of working with patients and promoting their autonomy and self-management in health. Its ratings of patient experience and satisfaction are among the best in the country.
To promote patient centred research, the Radboudumc Institute of Health Science (RIHS) evaluates new healthcare technologies, with the latest methodologies to improve outcomes of health care and empower people to self-manage health and long term conditions. An external visitation committee in 2019 rated the quality of the RIHS research activities on average as ‘excellent’ across all aspects that were assessed.
The Department of Geriatric Medicine is part of the RIHS. The research of this department focuses on innovating healthcare for older people in general, and specifically for people living with dementia, from a complex systems perspective. Our research mission is to understand and influence disease heterogeneity. Recognizing the inherent complex nature of disease heterogeneity, the paradigm of complex dynamical systems is now the basis of pioneering work on systemic resilience in human health. We are a leading research institute on resilience, multimorbidity, frailty, dementia and cerebral autoregulation and cardiovascular aging.
UNIVERSITAIR ZIEKENHUIS BRUSSEL
Geriatrics-UZB is the Department of Geriatrics of the University Hospital (UZ Brussel) in close collaboration with the Vrije Universiteit Brussel. Geriatrics-UZB has a triple mission and is engaged in providing care, in teaching, and in research (fundamental, translational, and clinical), all functions are aiming at the highest level of competence. Geriatrics-UZB is embedded in the University Hospital (Universitair Ziekenhuis Brussel, abbreviated UZ-Brussel) of the Dutch-speaking Free University of Brussels (Vrije Universiteit Brussel, abbreviated VUB). The UZ-Brussel has all the necessary in- and out-patient departments to function as a complete general university hospital. The UZ-Brussel has obtained the JCI accreditation quality label. Further information about UZ-Brussel can be found at the website www.uzbrussel.be. The Geriatrics-UZB has the following structure: In-patient ward: 29 beds (mean length of stay in 2018 of 15 days); “Internal liaison” team: in charge of patients having a geriatric profile, who are hospitalized outside the geriatric ward (4300 interventions in 2018); Geriatric Day Hospital: out-patient facility for diagnosis and treatment (2500 patients in 2018); “External liaison”: cooperation conventions with rehabilitation hospitals (2) and long-term care facilities (25 centres). The Geriatrics-UZB functions according to a multidisciplinary approach. Besides geriatricians (8) and medical trainees (5), it has collaborators in the field of nursing, social workers, physiotherapy, medical psychology, occupational therapy and administration. Three collaborators have a master degree in gerontology. The Geriatrics-UZB is accredited by the Belgian Government as (1) a Training Centre in Geriatric Medicine and as a (2) Training Centre in General Medicine. Eight of the MDs of the DG have an accreditation as specialist in Geriatric Medicine. Four members have a Ph.D. degree. Geriatrics-UZB is member of Gerontonet (Association of European centers for Gerontology and Geriatric Medicine), and of the International Association of Gerontology and Geriatrics’ (IAGG) Global Ageing Research Network (GARN), ID ref N° 2011-268. Three physicians are members of the European Academy for Medicine of Ageing (EAMA) with a broad network of geriatricians across Europe. Geriatrics-UZB’ role is to explore the needs and preferences regarding the FORTO system from the perspective of the secondary end-users ((in)formal caregivers) and provide clinical support to VUB.
UniWeb develops and supports innovative web and mobile total solutions fitting the needs of highly regulated industries such as Healthcare, Biotech, Pharmaceutics and Clinical Research. We manage the whole software development lifecycle from analysis, design, implementation, validation through deployment following Healthcare and Clinical Research best practices (GAMP 5).
After deployment, we host, monitor and maintain the applications in a compliant environment. We also provide a service desk and solid SLAs. Our experienced development team has a strong focus on usability, security, data integrity, and compliance required by highly regulated sectors dealing with sensitive data. UniWeb’s has a vast experience with clinical trials, patient data privacy, and encryption of electronic health records (EHR). UniWeb customers include pharma industry, hospitals, authorities, and governmental organisations.
UniWeb’s certified Quality & Security management system is designed to comply with Health and Pharma requirements and is certified for both quality management (ISO 9001:2015) and information security management ( ISO 27001:2013). UniWeb successfully passed audits from certification bodies, regulators and its pharmaceutical customers.
UniWeb in numbers: Founded in 2000 as a Belgian SME, 100% privately held, 1.5 million EUR turnover in 2017 (latest figures) and a team of 20 experts.
In the FORTO project UniWeb will be responsible for the sensor integration, development of the wireless data acquisition system, development, integration and support of the mobile app and the data aggregation platform, and building the online platform for data transmission (Tasks 1.1, 1.2 and 1.3) and communication/dissemination with/to stakeholders (Task 3.2).
ZGT is a large teaching hospital in the eastern part of Holland, region Twente. ZGT contributes to the health of the people in our region and beyond in the form of prevention, diagnosis, treatment and nursing. ZGT serves approximately 250,000 people a year. ZGT is continuously working on the improvement of and innovation in health care. Concerning its scientific research ZGT acknowledges three research themes being patient empowerment, predictive care, fast and smart diagnostics. Quality assurance of scientific research is a very important element of scientific research and as part of this all principal investigators do have an acknowledged good clinical practice certificate. ZGT is partner of Vitaal Twente to contribute to sustainable implementation of technology supported services to improve the vitality of our inhabitants. In 2008 ZGT founded the Centre for Geriatric Traumatology (CvGT) by trauma surgeons to improve the quality of treatment. In 2017 the CvGT developed a transmural pathway with surrounding nursing homes to further improve the functional recovery. Return to independent living situation and patient empowerment are key aspects of this treatment. Each year over 300 patients are treated in this CvGT. ZGT participates in this project end user organisation.
FORTO 1.0 - Developing a smart self-assessment “Fatigability in Outcomes to monitor Resilience Targets in Older persons” measurement system
€ 472 500
€ 299 570
FORTO 2.0 - Evolving to integrated smart self-assessment “Fatigability in Outcomes to monitor Resilience Targets in Older persons” measurement & monitoring platform
€ 2 133 220.78
€ 1 370 383.97
AAL Joint Program
Milestones & Achievements
eforto® will allow self-assessment of self-perceived and muscle fatigability by measuring the maximum force older persons can apply and sustain until their handgrip strength drops to 50% of its maximum