Stressing the dressing: Assessing stress during wound care in real-time using wearable sensors

Saman Parvaneh, Gurtej Singh Grewal, Ekta Grewal, Robert A. Menzies, Talal K. Talal, David G Armstrong, Esther Sternberg, Bijan Najafi

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Nearly all amputations in people with diabetes are preceded by a foot ulcer. It has been reported that stress is an important risk factor for slower wound healing and susceptibility to infection. The purpose of this study was to objectively monitor physiological stress response in patients with diabetic foot ulcer (DFU) during a clinical visit for wound dressing change. Methods: Physiological stress was continuously monitored in 20 patients (Age: 56.7. ±. 12.2 years) with DFU for duration of approximately 45. min including waiting, dressing change and post-dressing period. Stress was quantified using a custom algorithm based on standard deviation of R-R intervals, heart rate variability (HRV). To identify the change in level of stress, change in HRV was compared to baseline HRV. Medium and high-stress periods were defined when HRV was in the range of 60-85% and below 60% of baseline HRV, respectively. Results: During the entire time of visit medium and high stress episodes happened for 28. ±. 12.6% and 16. ±. 18% of the time respectively. Further analyses of wound dressing time revealed that medium and high stress episodes were experienced for 47. ±. 24% and 18.3. ±. 27% of dressing time respectively. In addition, the duration of medium stress was significantly increased in average by 66% (difference. = 21.8%, p= 0.002, 95%CI [7.5, 29.5]%) during dressing change compared to entire period of clinic visit. Conclusions: This pilot study shows that patients with DFU experience moderate to high stress while visiting a wound clinic, which may negatively impact wound healing outcomes. In particular, the highest stressful condition was during wound dressing change, which may be related to painful dressing or perception of pain. Further investigation is required to explore association between quantified stress and outcomes of wound healing. In addition, future studies need to explore benefit of stress management in enhancing the outcomes of wound healing in patients with diabetes.

Original languageEnglish (US)
Pages (from-to)21-26
Number of pages6
JournalWound Medicine
Volume4
DOIs
StatePublished - 2014

Fingerprint

Bandages
Wounds and Injuries
Heart Rate
Wound Healing
Diabetic Foot
Physiological Stress
Foot Ulcer
Pain Perception
Ambulatory Care
Amputation
Infection

Keywords

  • Diabetes
  • Heart rate variability
  • Stress
  • Wearable sensors
  • Wound healing

ASJC Scopus subject areas

  • Surgery

Cite this

Stressing the dressing : Assessing stress during wound care in real-time using wearable sensors. / Parvaneh, Saman; Grewal, Gurtej Singh; Grewal, Ekta; Menzies, Robert A.; Talal, Talal K.; Armstrong, David G; Sternberg, Esther; Najafi, Bijan.

In: Wound Medicine, Vol. 4, 2014, p. 21-26.

Research output: Contribution to journalArticle

Parvaneh, Saman ; Grewal, Gurtej Singh ; Grewal, Ekta ; Menzies, Robert A. ; Talal, Talal K. ; Armstrong, David G ; Sternberg, Esther ; Najafi, Bijan. / Stressing the dressing : Assessing stress during wound care in real-time using wearable sensors. In: Wound Medicine. 2014 ; Vol. 4. pp. 21-26.
@article{a646ed60e59b4245831e203f61ff4dc9,
title = "Stressing the dressing: Assessing stress during wound care in real-time using wearable sensors",
abstract = "Background: Nearly all amputations in people with diabetes are preceded by a foot ulcer. It has been reported that stress is an important risk factor for slower wound healing and susceptibility to infection. The purpose of this study was to objectively monitor physiological stress response in patients with diabetic foot ulcer (DFU) during a clinical visit for wound dressing change. Methods: Physiological stress was continuously monitored in 20 patients (Age: 56.7. ±. 12.2 years) with DFU for duration of approximately 45. min including waiting, dressing change and post-dressing period. Stress was quantified using a custom algorithm based on standard deviation of R-R intervals, heart rate variability (HRV). To identify the change in level of stress, change in HRV was compared to baseline HRV. Medium and high-stress periods were defined when HRV was in the range of 60-85{\%} and below 60{\%} of baseline HRV, respectively. Results: During the entire time of visit medium and high stress episodes happened for 28. ±. 12.6{\%} and 16. ±. 18{\%} of the time respectively. Further analyses of wound dressing time revealed that medium and high stress episodes were experienced for 47. ±. 24{\%} and 18.3. ±. 27{\%} of dressing time respectively. In addition, the duration of medium stress was significantly increased in average by 66{\%} (difference. = 21.8{\%}, p= 0.002, 95{\%}CI [7.5, 29.5]{\%}) during dressing change compared to entire period of clinic visit. Conclusions: This pilot study shows that patients with DFU experience moderate to high stress while visiting a wound clinic, which may negatively impact wound healing outcomes. In particular, the highest stressful condition was during wound dressing change, which may be related to painful dressing or perception of pain. Further investigation is required to explore association between quantified stress and outcomes of wound healing. In addition, future studies need to explore benefit of stress management in enhancing the outcomes of wound healing in patients with diabetes.",
keywords = "Diabetes, Heart rate variability, Stress, Wearable sensors, Wound healing",
author = "Saman Parvaneh and Grewal, {Gurtej Singh} and Ekta Grewal and Menzies, {Robert A.} and Talal, {Talal K.} and Armstrong, {David G} and Esther Sternberg and Bijan Najafi",
year = "2014",
doi = "10.1016/j.wndm.2014.01.003",
language = "English (US)",
volume = "4",
pages = "21--26",
journal = "Wound Medicine",
issn = "2213-9095",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Stressing the dressing

T2 - Assessing stress during wound care in real-time using wearable sensors

AU - Parvaneh, Saman

AU - Grewal, Gurtej Singh

AU - Grewal, Ekta

AU - Menzies, Robert A.

AU - Talal, Talal K.

AU - Armstrong, David G

AU - Sternberg, Esther

AU - Najafi, Bijan

PY - 2014

Y1 - 2014

N2 - Background: Nearly all amputations in people with diabetes are preceded by a foot ulcer. It has been reported that stress is an important risk factor for slower wound healing and susceptibility to infection. The purpose of this study was to objectively monitor physiological stress response in patients with diabetic foot ulcer (DFU) during a clinical visit for wound dressing change. Methods: Physiological stress was continuously monitored in 20 patients (Age: 56.7. ±. 12.2 years) with DFU for duration of approximately 45. min including waiting, dressing change and post-dressing period. Stress was quantified using a custom algorithm based on standard deviation of R-R intervals, heart rate variability (HRV). To identify the change in level of stress, change in HRV was compared to baseline HRV. Medium and high-stress periods were defined when HRV was in the range of 60-85% and below 60% of baseline HRV, respectively. Results: During the entire time of visit medium and high stress episodes happened for 28. ±. 12.6% and 16. ±. 18% of the time respectively. Further analyses of wound dressing time revealed that medium and high stress episodes were experienced for 47. ±. 24% and 18.3. ±. 27% of dressing time respectively. In addition, the duration of medium stress was significantly increased in average by 66% (difference. = 21.8%, p= 0.002, 95%CI [7.5, 29.5]%) during dressing change compared to entire period of clinic visit. Conclusions: This pilot study shows that patients with DFU experience moderate to high stress while visiting a wound clinic, which may negatively impact wound healing outcomes. In particular, the highest stressful condition was during wound dressing change, which may be related to painful dressing or perception of pain. Further investigation is required to explore association between quantified stress and outcomes of wound healing. In addition, future studies need to explore benefit of stress management in enhancing the outcomes of wound healing in patients with diabetes.

AB - Background: Nearly all amputations in people with diabetes are preceded by a foot ulcer. It has been reported that stress is an important risk factor for slower wound healing and susceptibility to infection. The purpose of this study was to objectively monitor physiological stress response in patients with diabetic foot ulcer (DFU) during a clinical visit for wound dressing change. Methods: Physiological stress was continuously monitored in 20 patients (Age: 56.7. ±. 12.2 years) with DFU for duration of approximately 45. min including waiting, dressing change and post-dressing period. Stress was quantified using a custom algorithm based on standard deviation of R-R intervals, heart rate variability (HRV). To identify the change in level of stress, change in HRV was compared to baseline HRV. Medium and high-stress periods were defined when HRV was in the range of 60-85% and below 60% of baseline HRV, respectively. Results: During the entire time of visit medium and high stress episodes happened for 28. ±. 12.6% and 16. ±. 18% of the time respectively. Further analyses of wound dressing time revealed that medium and high stress episodes were experienced for 47. ±. 24% and 18.3. ±. 27% of dressing time respectively. In addition, the duration of medium stress was significantly increased in average by 66% (difference. = 21.8%, p= 0.002, 95%CI [7.5, 29.5]%) during dressing change compared to entire period of clinic visit. Conclusions: This pilot study shows that patients with DFU experience moderate to high stress while visiting a wound clinic, which may negatively impact wound healing outcomes. In particular, the highest stressful condition was during wound dressing change, which may be related to painful dressing or perception of pain. Further investigation is required to explore association between quantified stress and outcomes of wound healing. In addition, future studies need to explore benefit of stress management in enhancing the outcomes of wound healing in patients with diabetes.

KW - Diabetes

KW - Heart rate variability

KW - Stress

KW - Wearable sensors

KW - Wound healing

UR - http://www.scopus.com/inward/record.url?scp=84896526466&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896526466&partnerID=8YFLogxK

U2 - 10.1016/j.wndm.2014.01.003

DO - 10.1016/j.wndm.2014.01.003

M3 - Article

AN - SCOPUS:84896526466

VL - 4

SP - 21

EP - 26

JO - Wound Medicine

JF - Wound Medicine

SN - 2213-9095

ER -