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Book ; Online: How Being Inside or Outside of Buildings Affects the Causal Relationship Between Weather and Pain Among People Living with Chronic Pain

Little, Claire L. / Schultz, David M. / Yimer, Belay B. / Beukenhorst, Anna L.

2024

Abstract: Although many people believe their pain fluctuates with weather conditions, both weather and pain may be associated with time spent outside. For example, pleasant weather may mean that people spend more time outside doing physical activity and exposed to ...

Abstract	Although many people believe their pain fluctuates with weather conditions, both weather and pain may be associated with time spent outside. For example, pleasant weather may mean that people spend more time outside doing physical activity and exposed to the weather, leading to more (or less) pain, and poor weather or severe pain may keep people inside, sedentary, and not exposed to the weather. We conducted a smartphone study where participants with chronic pain reported daily pain severity, as well as time spent outside. We address the relationship between four weather variables (temperature, dewpoint temperature, pressure, and wind speed) and pain by proposing a three-step approach to untangle their effects: (i) propose a set of plausible directed acyclic graphs (also known as DAGs) that account for potential roles of time spent outside (e.g., collider, effect modifier, mediator), (ii) analyze the compatibility of the observed data with the assumed model, and (iii) identify the most plausible model by combining evidence from the observed data and domain-specific knowledge. We found that the data do not support time spent outside as a collider or mediator of the relationship between weather variables and pain. On the other hand, time spent outside modifies the effect between temperature and pain, as well as wind speed and pain, with the effect being absent on days that participants spent inside and present if they spent some or all of the day outside. Our results show the utility of using directed acyclic graphs for studying causal inference. Comment: 24 pages, 1 figure, 3 tables
Keywords	Quantitative Biology - Other Quantitative Biology
Subject code	333
Publishing date	2024-01-31
Publishing country	us
Document type	Book ; Online
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Article ; Online: Smartphones for musculoskeletal research - hype or hope? Lessons from a decennium of mHealth studies.

Beukenhorst, Anna L / Druce, Katie L / De Cock, Diederik

BMC musculoskeletal disorders

2022 Volume 23, Issue 1, Page(s) 487

Abstract: Background: Smartphones provide opportunities for musculoskeletal research: they are integrated in participants' daily lives and can be used to collect patient-reported outcomes as well as sensor data from large groups of people. As the field of ... ...

Abstract	Background: Smartphones provide opportunities for musculoskeletal research: they are integrated in participants' daily lives and can be used to collect patient-reported outcomes as well as sensor data from large groups of people. As the field of research with smartphones and smartwatches matures, it has transpired that some of the advantages of this modern technology are in fact double-edged swords. BODY: In this narrative review, we illustrate the advantages of using smartphones for data collection with 18 studies from various musculoskeletal domains. We critically appraised existing literature, debunking some myths around the advantages of smartphones: the myth that smartphone studies automatically enable high engagement, that they reach more representative samples, that they cost little, and that sensor data is objective. We provide a nuanced view of evidence in these areas and discuss strategies to increase engagement, to reach representative samples, to reduce costs and to avoid potential sources of subjectivity in analysing sensor data. Conclusion: If smartphone studies are designed without awareness of the challenges inherent to smartphone use, they may fail or may provide biased results. Keeping participants of smartphone studies engaged longitudinally is a major challenge. Based on prior research, we provide 6 actions by researchers to increase engagement. Smartphone studies often have participants that are younger, have higher incomes and high digital literacy. We provide advice for reaching more representative participant groups, and for ensuring that study conclusions are not plagued by bias resulting from unrepresentative sampling. Costs associated with app development and testing, data storage and analysis, and tech support are substantial, even if studies use a 'bring your own device'-policy. Exchange of information on costs, collective app development and usage of open-source tools would help the musculoskeletal community reduce costs of smartphone studies. In general, transparency and wider adoption of best practices would help bringing smartphone studies to the next level. Then, the community can focus on specific challenges of smartphones in musculoskeletal contexts, such as symptom-related barriers to using smartphones for research, validating algorithms in patient populations with reduced functional ability, digitising validated questionnaires, and methods to reliably quantify pain, quality of life and fatigue.
MeSH term(s)	Humans ; Mobile Applications ; Quality of Life ; Smartphone ; Surveys and Questionnaires ; Telemedicine
Language	English
Publishing date	2022-05-23
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2041355-5
ISSN	1471-2474 ; 1471-2474
ISSN (online)	1471-2474
ISSN	1471-2474
DOI	10.1186/s12891-022-05420-8
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Article ; Online: SARS-CoV-2 elicits non-sterilizing immunity and evades vaccine-induced immunity: implications for future vaccination strategies.

Beukenhorst, Anna L / Koch, Clarissa M / Hadjichrysanthou, Christoforos / Alter, Galit / de Wolf, Frank / Anderson, Roy M / Goudsmit, Jaap

European journal of epidemiology

2023 Volume 38, Issue 3, Page(s) 237–242

Abstract: Neither vaccination nor natural infection result in long-lasting protection against SARS-COV-2 infection and transmission, but both reduce the risk of severe COVID-19. To generate insights into optimal vaccination strategies for prevention of severe ... ...

Abstract	Neither vaccination nor natural infection result in long-lasting protection against SARS-COV-2 infection and transmission, but both reduce the risk of severe COVID-19. To generate insights into optimal vaccination strategies for prevention of severe COVID-19 in the population, we extended a Susceptible-Exposed-Infectious-Removed (SEIR) mathematical model to compare the impact of vaccines that are highly protective against severe COVID-19 but not against infection and transmission, with those that block SARS-CoV-2 infection. Our analysis shows that vaccination strategies focusing on the prevention of severe COVID-19 are more effective than those focusing on creating of herd immunity. Key uncertainties that would affect the choice of vaccination strategies are: (1) the duration of protection against severe disease, (2) the protection against severe disease from variants that escape vaccine-induced immunity, (3) the incidence of long-COVID and level of protection provided by the vaccine, and (4) the rate of serious adverse events following vaccination, stratified by demographic variables.
MeSH term(s)	Humans ; SARS-CoV-2 ; Post-Acute COVID-19 Syndrome ; COVID-19/epidemiology ; COVID-19/prevention & control ; Vaccination ; Vaccines
Chemical Substances	Vaccines
Language	English
Publishing date	2023-02-04
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632614-6
ISSN	1573-7284 ; 0393-2990
ISSN (online)	1573-7284
ISSN	0393-2990
DOI	10.1007/s10654-023-00965-x
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Article: Exploring the Role of Antiviral Nasal Sprays in the Control of Emerging Respiratory Infections in the Community.

Hadjichrysanthou, Christoforos / Beukenhorst, Anna L / Koch, Clarissa M / Alter, Galit / Goudsmit, Jaap / Anderson, Roy M / de Wolf, Frank

Infectious diseases and therapy

2022 Volume 11, Issue 6, Page(s) 2287–2296

Abstract: Introduction: The COVID-19 pandemic has demonstrated that there is an unmet need for the development of novel prophylactic antiviral treatments to control the outbreak of emerging respiratory virus infections. Passive antibody-based immunisation ... ...

Abstract	Introduction: The COVID-19 pandemic has demonstrated that there is an unmet need for the development of novel prophylactic antiviral treatments to control the outbreak of emerging respiratory virus infections. Passive antibody-based immunisation approaches such as intranasal antibody prophylaxis have the potential to provide immediately accessible universal protection as they act directly at the most common route of viral entry, the upper respiratory tract. The need for such products is very apparent for SARS-CoV-2 at present, given the relatively low effectiveness of vaccines to prevent infection and block virus onward transmission. We explore the benefits and challenges of the use of antibody-based nasal sprays prior and post exposure to the virus. Methods: The classic susceptible-exposed-infectious-removed (SEIR) mathematical model was extended to describe the potential population-level impact of intranasal antibody prophylaxis on controlling the spread of an emerging respiratory infection in the community. Results: Intranasal administration of monoclonal antibodies provides only a short-term protection to the mucosal surface. Consequently, sustained intranasal antibody prophylaxis of a substantial proportion of the population would be needed to contain infections. Post-exposure prophylaxis against the development of severe disease would be essential for the overall reduction in hospital admissions. Conclusion: Antibody-based nasal sprays could provide protection against infection to individuals that are likely to be exposed to the virus. Large-scale administration for a long period of time would be challenging. Intranasal antibody prophylaxis alone cannot prevent community-wide transmission of the virus. It could be used along with other protective measures, such as non-pharmaceutical interventions, to bridge the time required to develop and produce effective vaccines, and complement active immunisation strategies.
Language	English
Publishing date	2022-10-30
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2701611-0
ISSN	2193-6382 ; 2193-8229
ISSN (online)	2193-6382
ISSN	2193-8229
DOI	10.1007/s40121-022-00710-z
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Article ; Online: A pan-influenza monoclonal antibody neutralizes H5 strains and prophylactically protects through intranasal administration.

Beukenhorst, Anna L / Frallicciardi, Jacopo / Rice, Keira L / Koldijk, Martin H / Moreira de Mello, Joana C / Klap, Jaco M / Hadjichrysanthou, Christoforos / Koch, Clarissa M / da Costa, Kelly A S / Temperton, Nigel / de Jong, Babette A / Vietsch, Helene / Ziere, Bertjan / Julg, Boris / Koudstaal, Wouter / Goudsmit, Jaap

Scientific reports

2024 Volume 14, Issue 1, Page(s) 3818

Abstract: Avian A(H5N1) influenza virus poses an elevated zoonotic threat to humans, and no pharmacological products are currently registered for fast-acting pre-exposure protection in case of spillover leading to a pandemic. Here, we show that an epitope on the ... ...

Abstract	Avian A(H5N1) influenza virus poses an elevated zoonotic threat to humans, and no pharmacological products are currently registered for fast-acting pre-exposure protection in case of spillover leading to a pandemic. Here, we show that an epitope on the stem domain of H5 hemagglutinin is highly conserved and that the human monoclonal antibody CR9114, targeting that epitope, potently neutralizes all pseudotyped H5 viruses tested, even in the rare case of substitutions in its epitope. Further, intranasal administration of CR9114 fully protects mice against A(H5N1) infection at low dosages, irrespective of pre-existing immunity conferred by the quadrivalent seasonal influenza vaccine. These data provide a proof-of-concept for broad, pre-exposure protection against a potential future pandemic using the intranasal administration route. Studies in humans should assess if autonomous administration of a broadly-neutralizing monoclonal antibody is safe and effective and can thus contribute to pandemic preparedness.
MeSH term(s)	Humans ; Animals ; Mice ; Influenza, Human ; Influenza Vaccines ; Antibodies, Monoclonal ; Antibodies, Neutralizing ; Influenza A Virus, H5N1 Subtype ; Administration, Intranasal ; Antibodies, Viral ; Epitopes ; Hemagglutinin Glycoproteins, Influenza Virus ; Mice, Inbred BALB C
Chemical Substances	Influenza Vaccines ; Antibodies, Monoclonal ; Antibodies, Neutralizing ; Antibodies, Viral ; Epitopes ; Hemagglutinin Glycoproteins, Influenza Virus
Language	English
Publishing date	2024-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-53049-5
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Article ; Online: Are weather conditions associated with chronic musculoskeletal pain? Review of results and methodologies.

Beukenhorst, Anna L / Schultz, David M / McBeth, John / Sergeant, Jamie C / Dixon, William G

Pain

2020 Volume 161, Issue 4, Page(s) 668–683

Abstract: Many people believe that weather influences chronic musculoskeletal pain. Previous studies on this association are narratively reviewed, with particular focus on comparing methodologies and summarising study findings in light of study quality. We ... ...

Abstract	Many people believe that weather influences chronic musculoskeletal pain. Previous studies on this association are narratively reviewed, with particular focus on comparing methodologies and summarising study findings in light of study quality. We searched 5 databases (Medline, Embase, Web of Science, PsycINFO, and Scopus) for observational studies on the association between weather variables and self-reported musculoskeletal pain severity. Of 4707 located articles, 43 were eligible for inclusion. The majority (67%) found some association between pain and a weather variable. Temperature, atmospheric pressure, relative humidity, and precipitation were most often investigated. For each weather variable, some studies found an association with pain (in either direction), and others did not. Most studies (86%) had a longitudinal study design, usually collecting outcome data for less than a month, from fewer than 100 participants. Most studies blinded participants to study aims but were at a high risk of misclassification of exposure and did not meet reporting requirements. Pain severity was most often self-reported (84%) on a numeric rating scale or visual analog scale. Weather data were collected from local weather stations, usually on the assumption that participants stayed in their home city. Analysis methods, preparation of weather data, and adjustment for covariates varied widely between studies. The association between weather and pain has been difficult to characterise. To obtain more clarity, future studies should address 3 main limitations of the previous literature: small sample sizes and short study durations, misclassification of exposure, and approach to statistical analysis (specifically, multiple comparisons and adjusting for covariates).
MeSH term(s)	Atmospheric Pressure ; Chronic Pain ; Humans ; Longitudinal Studies ; Musculoskeletal Pain/epidemiology ; Weather
Language	English
Publishing date	2020-03-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000001776
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Article ; Online: Understanding the Predictors of Missing Location Data to Inform Smartphone Study Design: Observational Study.

Beukenhorst, Anna L / Sergeant, Jamie C / Schultz, David M / McBeth, John / Yimer, Belay B / Dixon, Will G

JMIR mHealth and uHealth

2021 Volume 9, Issue 11, Page(s) e28857

Abstract: Background: Smartphone location data can be used for observational health studies (to determine participant exposure or behavior) or to deliver a location-based health intervention. However, missing location data are more common when using smartphones ... ...

Abstract	Background: Smartphone location data can be used for observational health studies (to determine participant exposure or behavior) or to deliver a location-based health intervention. However, missing location data are more common when using smartphones compared to when using research-grade location trackers. Missing location data can affect study validity and intervention safety. Objective: The objective of this study was to investigate the distribution of missing location data and its predictors to inform design, analysis, and interpretation of future smartphone (observational and interventional) studies. Methods: We analyzed hourly smartphone location data collected from 9665 research participants on 488,400 participant days in a national smartphone study investigating the association between weather conditions and chronic pain in the United Kingdom. We used a generalized mixed-effects linear model with logistic regression to identify whether a successfully recorded geolocation was associated with the time of day, participants' time in study, operating system, time since previous survey completion, participant age, sex, and weather sensitivity. Results: For most participants, the app collected a median of 2 out of a maximum of 24 locations (1760/9665, 18.2% of participants), no location data (1664/9665, 17.2%), or complete location data (1575/9665, 16.3%). The median locations per day differed by the operating system: participants with an Android phone most often had complete data (a median of 24/24 locations) whereas iPhone users most often had a median of 2 out of 24 locations. The odds of a successfully recorded location for Android phones were 22.91 times higher than those for iPhones (95% CI 19.53-26.87). The odds of a successfully recorded location were lower during weekends (odds ratio [OR] 0.94, 95% CI 0.94-0.95) and nights (OR 0.37, 95% CI 0.37-0.38), if time in study was longer (OR 0.99 per additional day in study, 95% CI 0.99-1.00), and if a participant had not used the app recently (OR 0.96 per additional day since last survey entry, 95% CI 0.96-0.96). Participant age and sex did not predict missing location data. Conclusions: The predictors of missing location data reported in our study could inform app settings and user instructions for future smartphone (observational and interventional) studies. These predictors have implications for analysis methods to deal with missing location data, such as imputation of missing values or case-only analysis. Health studies using smartphones for data collection should assess context-specific consequences of high missing data, especially among iPhone users, during the night and for disengaged participants.
MeSH term(s)	Humans ; Logistic Models ; Mobile Applications ; Odds Ratio ; Smartphone ; Surveys and Questionnaires
Language	English
Publishing date	2021-11-16
Publishing country	Canada
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2719220-9
ISSN	2291-5222 ; 2291-5222
ISSN (online)	2291-5222
ISSN	2291-5222
DOI	10.2196/28857
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Article ; Online: Using Smartphones to Reduce Research Burden in a Neurodegenerative Population and Assessing Participant Adherence: A Randomized Clinical Trial and Two Observational Studies.

Beukenhorst, Anna L / Burke, Katherine M / Scheier, Zoe / Miller, Timothy M / Paganoni, Sabrina / Keegan, Mackenzie / Collins, Ella / Connaghan, Kathryn P / Tay, Anna / Chan, James / Berry, James D / Onnela, Jukka-Pekka

JMIR mHealth and uHealth

2022 Volume 10, Issue 2, Page(s) e31877

Abstract: Background: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral ... ...

Abstract	Background: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral sclerosis at high frequencies for a long duration. However, the progressive decline in patients' cognitive and functional abilities could also hamper the feasibility of collecting patient-reported outcomes, audio recordings, and location data in the long term. Objective: The aim of this study is to investigate the completeness of survey data, audio recordings, and passively collected location data from 3 smartphone-based studies of people with amyotrophic lateral sclerosis. Methods: We analyzed data completeness in three studies: 2 observational cohort studies (study 1: N=22; duration=12 weeks and study 2: N=49; duration=52 weeks) and 1 clinical trial (study 3: N=49; duration=20 weeks). In these studies, participants were asked to complete weekly surveys; weekly audio recordings; and in the background, the app collected sensor data, including location data. For each of the three studies and each of the three data streams, we estimated time-to-discontinuation using the Kaplan-Meier method. We identified predictors of app discontinuation using Cox proportional hazards regression analysis. We quantified data completeness for both early dropouts and participants who remained engaged for longer. Results: Time-to-discontinuation was shortest in the year-long observational study and longest in the clinical trial. After 3 months in the study, most participants still completed surveys and audio recordings: 77% (17/22) in study 1, 59% (29/49) in study 2, and 96% (22/23) in study 3. After 3 months, passively collected location data were collected for 95% (21/22), 86% (42/49), and 100% (23/23) of the participants. The Cox regression did not provide evidence that demographic characteristics or disease severity at baseline were associated with attrition, although it was somewhat underpowered. The mean data completeness was the highest for passively collected location data. For most participants, data completeness declined over time; mean data completeness was typically lower in the month before participants dropped out. Moreover, data completeness was lower for people who dropped out in the first study month (very few data points) compared with participants who adhered long term (data completeness fluctuating around 75%). Conclusions: These three studies successfully collected smartphone data longitudinally from a neurodegenerative population. Despite patients' progressive physical and cognitive decline, time-to-discontinuation was higher than in typical smartphone studies. Our study provides an important benchmark for participant engagement in a neurodegenerative population. To increase data completeness, collecting passive data (such as location data) and identifying participants who are likely to adhere during the initial phase of a study can be useful. Trial registration: ClinicalTrials.gov NCT03168711; https://clinicaltrials.gov/ct2/show/NCT03168711.
MeSH term(s)	Activities of Daily Living ; Humans ; Mobile Applications ; Smartphone ; Surveys and Questionnaires ; Time Factors
Language	English
Publishing date	2022-02-04
Publishing country	Canada
Document type	Journal Article ; Observational Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2719220-9
ISSN	2291-5222 ; 2291-5222
ISSN (online)	2291-5222
ISSN	2291-5222
DOI	10.2196/31877
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Article ; Online: Heterogeneity in the association between weather and pain severity among patients with chronic pain: a Bayesian multilevel regression analysis.

Yimer, Belay B / Schultz, David M / Beukenhorst, Anna L / Lunt, Mark / Pisaniello, Huai L / House, Thomas / Sergeant, Jamie C / McBeth, John / Dixon, William G

Pain reports

2022 Volume 7, Issue 1, Page(s) e963

Abstract: Introduction: Previous studies on the association between weather and pain severity among patients with chronic pain have produced mixed results. In part, this inconsistency may be due to differences in individual pain responses to the weather.: ... ...

Abstract	Introduction: Previous studies on the association between weather and pain severity among patients with chronic pain have produced mixed results. In part, this inconsistency may be due to differences in individual pain responses to the weather. Methods: To test the hypothesis that there might be subgroups of participants with different pain responses to different weather conditions, we examined data from a longitudinal smartphone-based study, Cloudy with a Chance of Pain, conducted between January 2016 and April 2017. The study recruited more than 13,000 participants and recorded daily pain severity on a 5-point scale (range: no pain to very severe pain) along with hourly local weather data for up to 15 months. We used a Bayesian multilevel model to examine the weather-pain association. Results: We found 1 in 10 patients with chronic pain were sensitive to the temperature, 1 in 25 to relative humidity, 1 in 50 to pressure, and 3 in 100 to wind speed, after adjusting for age, sex, belief in the weather-pain association, mood, and activity level. The direction of the weather-pain association differed between people. Although participants seem to be differentially sensitive to weather conditions, there is no definite indication that participants' underlying pain conditions play a role in weather sensitivity. Conclusion: This study demonstrated that weather sensitivity among patients with chronic pain is more apparent in some subgroups of participants. In addition, among those sensitive to the weather, the direction of the weather-pain association can differ.
Language	English
Publishing date	2022-01-12
Publishing country	United States
Document type	Journal Article
ISSN	2471-2531
ISSN (online)	2471-2531
DOI	10.1097/PR9.0000000000000963
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Article ; Online: Development of a Mobile Digital Manikin to Measure Pain Location and Intensity.

Van Der Veer, Sabine N / Beukenhorst, Anna L / Ali, S Mustafa / James, Ben / Silva, Pedro / McBeth, John / Dixon, William G

Studies in health technology and informatics

2020 Volume 270, Page(s) 946–950

Abstract: Painful conditions are prevalent and substantially contribute to disability worldwide. Digital manikins are body-shaped drawings to facilitate self-reporting of pain. Some of them have been validated, but without allowing for recording of location- ... ...

Abstract	Painful conditions are prevalent and substantially contribute to disability worldwide. Digital manikins are body-shaped drawings to facilitate self-reporting of pain. Some of them have been validated, but without allowing for recording of location-specific pain intensity and for use on a smartphone. This paper describes the initial development of a digital pain manikin to support self-reporting of pain location and location-specific intensity using people's own mobile device. Subsequently, we conducted reliability and usability tests with eight researchers and seven patient representatives. Test-retest reliability depended on the manikin's level of detail, but was generally high with most intraclass correlation coefficients âĽě0.70 and all similarity coefficients âĽě0.50. Participants found the manikin easy to use, but suggested clearer orientation (front/back, certain body locations) and would value additional feedback and diary functions. We will address these issues in the next version of the manikin before conducting a validation study.
MeSH term(s)	Humans ; Manikins ; Pain ; Pain Measurement ; Reproducibility of Results ; Smartphone
Language	English
Publishing date	2020-05-29
Publishing country	Netherlands
Document type	Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI200301
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