Collaboration grants
Collaboration between the social welfare and healthcare systems and LiU in order to integrate a digital intervention to promote health behaviors among young adults with intellectual disability (Ulrika Müssener, HMV)
Within the fields of social welfare and healthcare, there’s a lack of scientific evidence for how to give support to young adults with ID to eat healthier, increase physical activity, reduce sedentary lifestyle, and reduce social exclusion in a systematic, sustainable, and practically viable way.
e-Health, where digital tools are used to give information and support, is a well-established method to promote healthy habits among young adults without ID. However, scientifically developed and evaluated health-promoting digital interventions adapted to young adults with ID are lacking.
The overall purpose of the research project is thus to develop, implement, and evaluate a digital intervention to promote good lifestyle habits among young adults with ID.
In order to prepare and implement this research, workshops will be arranged in close collaboration with professionals within both healthcare and social welfare. During the workshops, personnel from both these organizations will meet to discuss factors that promote or hinder health-promoting activities aimed at young adults with ID and give suggestions for actions that are needed to develop health-promoting activities. The participants will also make concrete how the work to develop a digital intervention can be carried out and how the intervention can be implemented within respective professional fields.
A co-production approach will be implemented, which means that the research will be performed together with, rather than on, the affected groups (young adults with ID, social welfare, and healthcare). The project is thus practice-oriented and will be performed in close collaboration between researchers and practitioners.
The collaboration grant is expected to contribute to increased understanding about how development of health-promoting digital interventions for this often excluded and marginalized group can be implemented. The project aims to promote knowledge building and development within healthcare and social welfare by using the opportunities of digitalization.
Diabetic foot ulcer treatment assisted by comprehensive functional microcirculation imaging (Tomas Strömberg, IMT)
Tomas Strömberg1*, Martin Hultman1,2, Ingemar Fredriksson1,2, Marcus Larsson1, Helene Zachrisson3,4, Håkan Pärsson3,5, Sofie Aronsson3,4. 1 Department of Biomedical Engineering, 2 Perimed AB, Järfälla Stockholm, 3 Department of Health, Medicine and Caring Sciences, 4 Östergötland County Council, 5 Kalmar County Council. * Main applicant.
Project summary
This project will develop protocols and data analysis algorithms for functional microcirculation imaging that are relevant for diabetic foot ulcer treatment. The target is patients referred to a multidisciplinary diabetes foot wound team typically found at a University Hospital. This costly specialized care lacks adequate methods for assessing the target: an improved microcirculation that allows for ulcer healing.
We have developed a new microcirculation imaging modality that integrates measurement of perfusion (blood flow) and hemoglobin oxygen saturation in the same skin tissue simultaneously. The method has been evaluated in patients with chronic limb-threatening ischemia by assessing foot microcirculation before and 1-day after vascular intervention. In a patient with a successful intervention (restored arterial flow to the foot), perfusion and oxygen saturation increased. Visually, local flushing was observed in the left foot, see photo on the right below.
- Develop a patient-friendly functional microcirculation assessment protocol, including local skin heating, leg elevation, and/or leg lowering, and standardization of critical measurement conditions.
- Evaluate the protocol in a cross-sectional study in healthy subjects and patients with diabetic foot ulcers. Identify microcirculation parameters that discriminate between healthy subjects and patients with diabetes.
This protocol will be used in longitudinal studies of foot microcirculation during wound treatment. The long-term goal is to develop a functional foot microcirculation assessment method assisting diabetic ulcer treatment.
Kristin Thomas, HMV
Seed grants
Supporting Physical Activity- Refusal´s Comeback – the SPARC study, a randomized controlled trial (Hanna Tigerstrand Grevnerts, HMV)
The fraction of adolescents with problematic absence from school has increased in Sweden the last decennia. Many of these youths suffer from problems with mental health that can make it even harder to return to school. As the youths often miss physical education and playtime during school, they also have a risk of lower physical activity than their classmates. Physical activity has been shown to have a clear positive effect on mental health problems, especially major depression and anxiety, and also have a preventative effect.
The exercise app, named Phystic, with accompanying exercise equipment have been developed by the research team with M.D. Oskar Lundgren. It contains exercise programs that are adapted to each individual participant regarding exercise accustomization, wishes, and interests (e.g. martial arts, dance, yoga, strength training, etc.). There are also motivation and mindfulness exercises in the app that are voluntary to use. The purpose of these are to promote long term motivation for exercise and physical activity as well as preventing the reduced motivation that often occurs after the initial phase when it is novel and fun to do exercises with the app.
We plan to include adolescents from the Swedish “högstadium” school level with a problematic absence of at least 15 % the previous semester. Included participants will wear a fitness tracker for 10 days prior to the intervention starts and answer a survey. Participants randomized to exercise with the app will do so for 12 weeks while the control group will get three reminders to be physically active during the same period. After 12 weeks, both groups will wear the fitness trackers and answer surveys again. After that, the participants in the intervention group get to choose whether they want to continue using the app and the participants in the control group get the option to start using the app. After 12 weeks more, the participants get to wear the fitness trackers and answer surveys again.
The surveys are about e.g. attitude to and confidence in own ability for physical activity, estimation of own physical activity, and mental wellbeing. We also collect data for each participant through Phystic on amount of physical exercise, choice of exercises, etc. As a support function, there is a chat in the app where each participant can ask questions when needed and where we every week also ask how the exercises go. This is both to ensure that the participants feel secure in asking questions when needed and as support to maintain the exercises. We plan to begin the pilot study in the spring 2024 and hope to initiate the main study a year later.
Developing an innovative eHealth intervention to Support Patients’ Nutrition Care during Pain Rehabilitation - a Feasibility Study (Huan-Ji Dong, HMV)
Nutrition care and healthy dietary patterns for pain management have recently attracted great interest in pain research. , Funding provided by e-Health for our feasibility study will be used to include nutrition care in pain management integrated in the current pain rehabilitation process. We would like to perform a mobile phone-based intervention in promoting healthy lifestyles and supporting individuals in behavior change (i.e., eating behavior). Patients with unhealthy BMI will be invited to use the Diet4painrelief app as a platform for implementing nutrition care in a specialist pain rehabilitation clinic. Diet4painrelief includes a screening tool to assess basic nutritional status as well as their intake of key unhealthy and healthy foods and drinks (through three 24-hour dietary recordings). Thereafter, the patients will receive a personalized behavior change program for dietary optimization. During the rehabilitation process, our dietician will follow up the progress of each participant in different timepoints with personal meetings and via a chat function in Diet4painrelief.
A great advantage for this approach is that nutrition care will be part of the everyday clinical practice and that the participants are patients in need of pain rehabilitation. Since e-health provides the potential to deliver healthcare tailored to patients’ needs, we expect that this feasibility study can give guidance for designing a larger trial to reach more patients with chronic pain and comorbidities (e.g. obesity).
Effects of Tele-Yoga in patients with Pulmonary Arterial Hypertension (PAH) - a digitally delivered national randomized controlled study (Joanna-Maria Papageorgiou, HMV)
Pulmonary Arterial Hypertension (PAH) is a rare, progressive, and serious condition which primarily affects the arterioles in the pulmonary vascular bed. PAH leads to wall thickening and increased flow resistance, which results in the right ventricle needing to work harder to maintain normal cardiac output. Untreated PAH leads to right ventricular failure and death.
PAH patients have many symptoms. The most common is shortness of breath on exertion, but chest pains and fainting can also occur. The patients report reduced health-related quality of life and also a fear of exercise. However, the European Society of Cardiology recommends regular exercise for patients with stable illness in their latest published guidelines.
The e-Health grant will be used for a study including PAH patients from the whole of Sweden. The patients will be randomized into two groups. One will be the control group and obtain the current health advice and the other will be the Tele-Yoga group who will do 1 h distance mode yoga sessions twice a week for 12 weeks. Live-streamed yoga sessions will be led by a medical yoga instructor and the patients will also be encouraged to exercise at home for the remaining days with the help of an app.
The overall aim of the study is to evaluate the effects of digital yoga in patients with PAH considering physical activity, health-related quality of life, anxiety, depression, sleep, and cognition.
Measurements of 6 minutes walking distance (digitally performed with help of an app) as well as answering different questionaries will be done before the randomization, after 12 weeks and after 1 year.
Evaluation of an Internet-Based Support and Education Program for Patients Awaiting Deceased Donor Kidney Transplantation - A feasibility study (Kristina Nilsson, HMV)
Kidney transplantation is the first choice for treatment of end-stage renal failure and the majority (80 %) of the transplanted patients receive a kidney from a deceased donor. A challenge is that the demand for kidneys exceeds the supply, leading to long waiting times, often 2–5 years, and frequently requiring necessary dialysis treatment. Studies show that the waiting times are taxing physically and psychologically. Many patients experience uncertainty, anxiety, and depression. Patients waiting for transplantation have a lack of energy and often have unrealistic expectations on life after the transplantation. There is thus a demand for support and education programs for those who await kidney transplantation. An internet-based support and education program that the patients can use in their homes at a time that is convenient for them could thus be a solution to provide accessible and equal support and education. Such a program has not been available previously for this patient group.
Our research team has developed an internet-based support and education program for these patients. Several groups of stakeholders (patients waiting for or having received kidney transplantation, their relatives, and health professionals with competence and experience within kidney and transplantation care) have been involved regarding the contents and design of the program. The support parts of the program consist of cognitive behavioral therapy. With aid of the e-Health seed grant, we will study the feasibility of the program in a randomized controlled trial with 80 patients. The participants will be randomized between immediate participation and a delayed start control group. The study will measure, for example, knowledge about kidney transplantation, self-care ability, mental health, acceptance of chronic illness, and quality of life before and after intervention. The experiences of the participants will be collected through interviews. The feasibility study is expected to provide guidance for a larger future randomized controlled trial.
Telemonitoring of patients with chronic obstructive pulmonary disease: Home testing and increased inclusion (Petra Jacobson, HMV)
Systems for telemonitoring of patients with different chronic diseases are being tested and used clinically to varying degrees among the healthcare regions of Sweden. In general, telemonitoring of COPD patients is still not as widespread as e.g. monitoring of patients with heart failure or hypertension, but the need is as great. Periods of severe deterioration, called exacerbations, among COPD patients are associated with considerable morbidity and mortality. The recovery of the patients is slow and severe exacerbations become a great burden, both for patients, relatives, and healthcare. Telemonitoring of COPD patients with the aim of early detection of exacerbations is thus of utmost importance and should be in more widespread use. However, the lack of nurses has been an obstacle to initializing telemonitoring on a larger scale.
The first part of the pilot study is thus focusing on also involving assistant nurses in the telemonitoring of COPD patients in their homes through the system ImagineCare, which is a digital platform for telemonitoring that is used within Region Östergötland. We plan to evaluate how assistant nurse support can increase the inclusion rate of COPD patients in this digital environment. We will evaluate the monitoring and ensure that the quality is maintained.
The second part of the study aims at investigating the possibility for COPD patients to take CRP (C-reactive protein) tests themselves at home. According to new guidelines from GOLD 2023 and the Medical Products Agency of Sweden’s report about COPD from 2023, the severity of COPD exacerbations should be assessed from objective parameters primarily, e.g. the CRP value. By supplying a CRP test kit, we want to give the patients a tool for active participation in their own care and at the same time facilitate earlier detection of exacerbations. We want to investigate and evaluate the ability of COPD patients to perform CRP tests themselves at home. The method is also particularly relevant regarding the increased use of digital healthcare consultations. In addition, it is of value to check CRP as a differential diagnosis as the patient may have a bacterial respiratory infection such as pneumonia. We believe these interventions can have a central role in the future care of COPD patients. The received grant makes it possible to carry out our pilot study to evaluate these methods and create a foundation for a larger randomized controlled study named eKOL.
Developing and first testing a culturally appropriate website to support self-care in migrants with type 2 diabetes. (Sara Pettersson, HMV
Migrants from the Middle East, living in Europe, is a vulnerable group regarding self-care for type 2 diabetes and often show poor glycemic control with a risk of developing diabetes-related complications. Diabetes healthcare often adds to the inequality between the native population and migrants. Factors that can increase inequality within healthcare include cultural obstacles to healthcare access, language and cultural differences, varying levels of literacy and health literacy, and also awareness about diabetes healthcare. Research has shown benefits of culturally appropriate patient education compared to conventional diabetes care and that there is a need for further patient education where culture of the patient is considered.
We believe that a culturally appropriate website can improve self-care for migrants with diabetes type 2. A website has been developed in collaboration between patients from the Middle East with type 2 diabetes, healthcare providers within primary healthcare, and a research team, www.typ2diabetes.online). The website is divided into six different fields: medical information, diet, physical activity, self-care, contacts, and 1177 where all information is collected from Swedish, Norwegian, or English diabetes organizations. The website contains written information, videos, and audio files and can be used through a mobile phone, computer, or other technical aids. However, the website needs further development and thanks to funding from e-Health, we can now take the next step and develop and test the website in a larger study.
A Novel Approach for Computing Intracardiac Blood Flow Using Photon-Counting Computed Tomography (Jonas Lantz, HMV)
In our previous work, we discovered that time-resolved cardiac CT imaging holds a wealth of information beyond what meets the eye. By employing engineering methods on readily available clinical imaging data, we were able to compute intricate details of blood flow within the heart (Lantz, 2016). Our patient-specific flow simulations, derived solely from CT scans, have proven to be both accurate and insightful, matching the quality of results obtained from 4D flow MRI (Lantz, 2018, 2019). This establishes confidence in our approach and its practicality.
While 4D Flow MRI provides valuable intracardiac flow data, our 4D flow CT method offers unique advantages. It extracts this information from a CT scan without the need for additional MRI scans. Moreover, our simulation-based CT approach allows for higher resolution, the extraction of additional parameters not measurable by other methods, and the exploration of hypothetical scenarios for different treatment options.
However, our current simulation framework has limitations, requiring substantial computational resources and expert manual intervention. Complex cardiac motion, including myocardial contraction and valve leaflet motion, introduces challenges that extend the time from CT acquisition to simulation results. Integrating spatially high-resolution Photon-Counting Computed Tomography data, which describes cardiac morphology in finer detail, poses feasibility challenges.
To overcome these hurdles, we propose a novel approach using an Immersed Boundary simulation framework. This technique addresses the complexities of structural motion that conventional flow solvers struggle with, replacing the boundaries defining the blood pool with a forcing function. While technically demanding, this approach holds the promise of including more intricate geometry and cardiac motion in flow simulations. Notably, the Immersed Boundary methodology has not been applied to high-resolution photon-counting CT data involving complex cardiac motion, making our project particularly intriguing.
Our goal is to conduct a pilot study to assess the viability of a groundbreaking method for simulating intracardiac blood flow directly from clinical CT images. Leveraging the Immersed Boundary technique, known for handling complex structural motion, we aim to overcome the challenges faced by traditional fluid flow solvers. The integration of this technique with high-resolution photon-counting CT image data provides an ideal testing environment.
Development of an online co-designed support programme together with and for informal carers to persons with heart failure. (Hanna Allemann, HMV)
Heart failure is common and in addition to the affected person becoming more tired, breathless, and having reduced ability to be physically active over time, the person often also experiences symptoms of depression and anxiety and may experience a decreased quality of life. The broad impact and unpredictable course of heart failure thus also affect informal carers. To support informal carers who provide care and who want and can continue to support the person who is ill, we have co-designed a support programme with and for informal carers. The purpose of the programme is for informal carers to become more aware of their situation and to gain more knowledge about heart failure. One hope is that it will offer support that can help informal carers to feel good themselves, with an additional hope that it can also lead to the person with heart failure receiving good support.
The support programme is published on 1177 (a national health portal for Swedish citizens) but is currently part of a randomised controlled trial and is therefore not available to the public. The support programme consists of 15 different modules covering various topics such as about difficulties in sleeping, changing relationships, planning for the future with serious illness, and about the end-of-life. In the modules, there are, for example, texts, images, interviews, and video-recorded lectures. The broad content is intended to be adaptable to that informal carers may have different relationships with the person who is ill and to that they may have been in a caregiving situation for a shorter or longer period.
In the process of developing the programme, considerations have been made regarding creating support that is sustainable over time and also possible to implement in regular healthcare. For this reason, there is no opportunity for informal carers to communicate with each other or with healthcare personnel, although these were things informal carers expressed through the co-design process that they would have appreciated. In interviews, informal carers who have used the finished programme have expressed that the support programme was useful, but it also emerged that it could be perceived as extensive and time-consuming to access the content.
Therefore, we want to test whether with the help of a ‘large language model’ such as OpenAI's ChatGPT, we can support informal carers in getting personally tailored answers to their questions and concerns. The project aims to explore whether it is feasible to use a language model specifically trained on the content of the support programme to provide informal carers with relevant and credible answers. Within the framework of this project, which started in January 2024, the goal is to develop and test a prototype. This includes developing test scenarios and documenting development and testing processes to evaluate the prototype.
In this project, we collaborate with researchers at the technical and philosophical faculties at Linköping University.
Inviting physiologist Apostolos Theos from Umeå University to Linköping University and Crown Princess Victoria's Children and Youth Hospital, for the development of a multi-center obesity research program with a novel e-health solution to the movement paradox*. (Oskar Lundgren, H.R.H. Crown Princess Victoria's Children and Youth Hospital and BKV)
Overweight and obesity among children and adolescents is a growing problem that so far has been notoriously difficult to create functioning treatment programs for. There are many reasons why it is particularly difficult to treat obesity in adolescents. One of the reasons is that previous models and interventions have underestimated the importance of psychological factors that hinder or facilitate changes in life habits that can be sustainable over time.
William Lövfors, IMT
Grants to invite guest researchers
Oskar Lundgren, senior physician at H.R.H. Crown Princess Victoria's Children’s Hospital and associate professor at the Division of Children's and Women's Health (BKH), has together with a group of colleagues developed a mobile app that addresses the fundamental motivation problem behind the development and perpetuation of overweight and obesity.
Inviting physiologist Apostolos Theos from Umeå University to Linköping University and Crown Princess Victoria's Children and Youth Hospital, for the development of a multi-center obesity research program with a novel e-health solution to the movement paradox*. (Oskar Lundgren, H.R.H. Crown Princess Victoria's Children and Youth Hospital and BKV)
Overweight and obesity among children and adolescents is a growing problem that so far has been notoriously difficult to create functioning treatment programs for. There are many reasons why it is particularly difficult to treat obesity in adolescents. One of the reasons is that previous models and interventions have underestimated the importance of psychological factors that hinder or facilitate changes in life habits that can be sustainable over time.
Oskar Lundgren, senior physician at H.R.H. Crown Princess Victoria's Children’s Hospital and associate professor at the Division of Children's and Women's Health (BKH), has together with a group of colleagues developed a mobile app that addresses the fundamental motivation problem behind the development and perpetuation of overweight and obesity.
The mobile app Phystic, together with a weight in stainless steel, delivers instructions for daily physical exercise and from day one, the user also gets mental training in the form of motivation exercises, reflection, relaxation, and mindfulness. The app has been developed in cooperation with LiU Innovation, LEAD, and Region Östergötland. Prototypes are being tested right now in a first pilot study on adolescents with obesity in Linköping, Norrköping, and Motala.
The research team has recently initiated cooperation with a team at Umeå University and has started to draft a multicenter study that takes a comprehensive approach to the problem with obesity among adolescents. The Umeå team is led by muscle physiologist Apostolos Theos and contains pediatricians, physiotherapists, and researchers who have long experience in studying molecular and endocrine changes in obesity.
The cooperation grant from Strategic Research area e-Health means that the research teams will get a unique opportunity to learn from each other’s experience and quickly proceed with the practical work of launching the multicenter study where new elements of e-Health and digital care can be further developed and benefit a large number of adolescents. The grant also means that more colleagues both in Linköping and Umeå are given the opportunity to participate in the planning and execution of the study and thus contribute to the recruitment of the next generation of researchers within e-Health.
* The movement paradox is sometimes used as a term for the phenomenon that many individuals know it is good for the health to be physically active but still live a sedentary life. The term has also been used to describe the unrelated fact that physical activity done during manual labor is not associated with the same health benefits gained from leisure physical activity.