Khetrapal, Pramit;
(2021)
Measuring health status using wearable devices for patients undergoing radical cystectomy.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Wearable devices (WDs) are an untapped resource for measuring patient health status during the peri-operative period. The overarching aim of this thesis is to explore the potential for WDs to be used in the clinical setting for patients undergoing radical cystectomy (RC) for bladder cancer. The lack of consensus regarding the optimal approach for RC presents an opportunity to design an RCT comparing open (ORC) and robotic (RARC) RC, in which a wearable device sub-study can be embedded. While the intracorporeal Robotic vs Open Cystectomy (iROC) trial will address the comparison between ORC and RARC, my thesis focuses on exploring the clinical utility of WDs. I present the results of a systematic review of RCTs comparing ORC and RARC. Meta-analysis shows no significant difference in peri-operative and oncological outcomes between ORC and RARC. Additionally, I systematically review healthcare studies using WDs and highlight the findings, device choices and device metrics used. Step-count is the most frequently collected WD metric, and chronic health conditions are the focus of majority of studies. Findings from these systematic reviews guided the design of the iROC trial protocol. I present the pre-planned interim analysis of the iROC trial, and explore associations between WD data and pre-operative health measures including cardiopulmonary exercise testing (CPET). Step-count correlates with the CPET variables (p < 0.01) routinely used to risk-stratify patients undergoing RC, and is the only predictor of major complications following RC in a logistic regression model. Finally, I evaluate recovery of baseline step-count at three months post-operatively as a predictor of overall survival. Applying a threshold of 50% recovery at 3 months, step-count predicts one-year survival to a sensitivity and specificity of 100% and 93% respectively. My findings highlight the potential of WDs in peri-operative care, and my post-doctoral work will progress this work further.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Measuring health status using wearable devices for patients undergoing radical cystectomy |
| Event: | UCL (University College London |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10125492 |
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