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A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study

BACKGROUND: Dental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral sel...

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Autores principales: Shetty, Vivek, Morrison, Douglas, Belin, Thomas, Hnat, Timothy, Kumar, Santosh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380983/
https://www.ncbi.nlm.nih.gov/pubmed/32579118
http://dx.doi.org/10.2196/17347
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author Shetty, Vivek
Morrison, Douglas
Belin, Thomas
Hnat, Timothy
Kumar, Santosh
author_facet Shetty, Vivek
Morrison, Douglas
Belin, Thomas
Hnat, Timothy
Kumar, Santosh
author_sort Shetty, Vivek
collection PubMed
description BACKGROUND: Dental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale. OBJECTIVE: The aim of this study is to leverage the ubiquity of electronic toothbrushes and smartphones with the development of a Remote Oral Behaviors Assessment System (ROBAS) and evaluate its feasibility for passively tracking brushing behaviors in real-world settings. METHODS: We developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprised of a smartphone app linked to a cloud platform. First, the criterion validity of ROBAS for accurately capturing brushing details was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 32 participants who used ROBAS daily for 1 month and maintained a diary of their brushing episodes. Semistructured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess the criterion validity, functionality, accuracy, and consistency of ROBAS. RESULTS: Using a stopwatch as the criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI –0.93 to 2.22 seconds, SE 0.79), and a connection failure rate of 6.7% (95% CI 0.8%-22.1%, SE 4.6%). In real-world testing, ROBAS showed close agreement with the daily diary recordings of brushing episodes; estimated average discrepancies between the diary and ROBAS were 0.13 sessions per day (95% CI 0.01-0.26, SE 0.06), 8.0 seconds per brushing session (95% CI 1.4-14.7, SE 3.3), and 30 seconds of brushing per day (95% CI 9.3-50.1, SE 10.0). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS was easy to use and expressed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported connectivity-related issues. CONCLUSIONS: ROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level.
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spelling pubmed-73809832020-08-06 A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study Shetty, Vivek Morrison, Douglas Belin, Thomas Hnat, Timothy Kumar, Santosh JMIR Mhealth Uhealth Original Paper BACKGROUND: Dental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale. OBJECTIVE: The aim of this study is to leverage the ubiquity of electronic toothbrushes and smartphones with the development of a Remote Oral Behaviors Assessment System (ROBAS) and evaluate its feasibility for passively tracking brushing behaviors in real-world settings. METHODS: We developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprised of a smartphone app linked to a cloud platform. First, the criterion validity of ROBAS for accurately capturing brushing details was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 32 participants who used ROBAS daily for 1 month and maintained a diary of their brushing episodes. Semistructured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess the criterion validity, functionality, accuracy, and consistency of ROBAS. RESULTS: Using a stopwatch as the criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI –0.93 to 2.22 seconds, SE 0.79), and a connection failure rate of 6.7% (95% CI 0.8%-22.1%, SE 4.6%). In real-world testing, ROBAS showed close agreement with the daily diary recordings of brushing episodes; estimated average discrepancies between the diary and ROBAS were 0.13 sessions per day (95% CI 0.01-0.26, SE 0.06), 8.0 seconds per brushing session (95% CI 1.4-14.7, SE 3.3), and 30 seconds of brushing per day (95% CI 9.3-50.1, SE 10.0). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS was easy to use and expressed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported connectivity-related issues. CONCLUSIONS: ROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level. JMIR Publications 2020-06-24 /pmc/articles/PMC7380983/ /pubmed/32579118 http://dx.doi.org/10.2196/17347 Text en ©Vivek Shetty, Douglas Morrison, Thomas Belin, Timothy Hnat, Santosh Kumar. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 24.06.2020. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Shetty, Vivek
Morrison, Douglas
Belin, Thomas
Hnat, Timothy
Kumar, Santosh
A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study
title A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study
title_full A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study
title_fullStr A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study
title_full_unstemmed A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study
title_short A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study
title_sort scalable system for passively monitoring oral health behaviors using electronic toothbrushes in the home setting: development and feasibility study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380983/
https://www.ncbi.nlm.nih.gov/pubmed/32579118
http://dx.doi.org/10.2196/17347
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