Research theme: Monitoring

Over the past decades, we have become increasingly aware of the variability of mental and somatic health symptoms over time. This variability is related to the underlying vulnerability (following a gene-environment interaction paradigm) and to the evolution over time by progressive deterioration (or chronicity) of illness or increased resilience. These temporal fluctuations of symptoms and associated biological parameters have scientific and clinical implications.

Functional variability can be captured over short or long time-scales using strategies requiring user involvement and/or with user-independent sensor-based assessments. Timeframes can vary from seconds to months or even years, and relevant signals can include self-report about psychological states or everyday activities, activity data captured by a smartphone, heart rate and blood pressure, accelerometry or electrophysiological data. However, the expertise that is needed overlaps and will be further developed and applied in the monitoring theme.

A specific expertise with international reference for Maastricht is the Experience Sampling Method (ESM) also called Ecological Momentary Assessment (EMA). Restricting assessment to symptom occurrence or symptom severity changes is insufficient to make sense of this variability. In addition, non-occurrence of events (no pain, no hallucinations, no tinnitus) is diagnostically relevant. We developed innovative assessment strategies to collect contextual data and facilitate interpretations. Modern information technologies dramatically improve the logistics of data collection and open up ESM technology for broad scale research and clinical practice.

Further applications of mobile monitoring technology include the development of closed-loop deep brain stimulation protocols (in collaboration with the neuro-modulation theme) and early detection of clinical events in panic disorder and epilepsy.  

The aim of the monitoring theme is to:

• Develop better indicators of health for research.
• Develop an expertise in assessment methodology of time related data.
• Evaluate the technology for assessment in regular clinical practice:
  - Fuzzy symptomatology.
  - Contextualized variability.
  - Patterns of change.
• Develop and evaluate the technology for mobile interventions in regular clinical practice:
  - Learning in the ‘natural environment’ (ecological validity) where symptoms occur.
  - Solutions for long-term support in daily life.

Another very established research line of the monitoring theme, which has already been implemented in clinical practice worldwide, is focused on intra- and peri-operative monitoring of brain function.

Research Focus

The research focus of the monitoring theme is:

• Develop generic PatientRelatedOutcomeMeasureS (in the context of positive health).
• Develop and validate user independent sensor-based data collection strategies in the field of mental health.
• Further develop expertise in the statistics of repeated assessments on different time frames and with different mobile data input.
• Further validate ESM in the field of clinical research (in psychiatry and beyond, in physical illnesses e.g. pain, tinnitus).
• Develop a web based training program in the field of chronic pain after surgery.
• Develop personalised medicine:
  - daily symptom patterns
  - adaptational strategies
  - outcome driven
• Further develop the PsyMate™ platform to allow custom tool development and evaluation in collaboration with users and clinicians.
• Investigating factors influencing treatment outcome.
• Investigating factors affecting the reliability and validity of this innovative data collection.

Research and Impact

Within the monitoring theme, we develop innovative diagnostic tools and intervention strategies embedded in daily life. These solutions were developed for mental health but can easily be implemented in somatic care, for:

• Disease management of chronic illnesses.
• Prevention.
• Life style changes.

ESM based mHealth solutions and sensor data are generic tools that use time sampling allowing assessments of moments without or less pronounced symptom levels.

Currently, the monitoring theme supports more than 60 protocols in research and clinical practice. The research is conducted in collaboration with university colleagues, the Maastricht UMC+ partners, regional collaborators in primary care (ZIO), specialist care (Kempenhaeghe Epilepsy Centre) and mental health (Mondriaan, GGZ Eindhoven, GGZ Centraal) and research centers in Europe and beyond.