Use of technology for the objective evaluation of scratching behavior: A systematic review

Yang, Albert F.; Nguyen, Morgan; Li, Alvin W.; Lee, Brad; Chun, Keum San; Wu, Ellen; Fishbein, Anna; Paller, Amy S.; Xu, Shuai

doi:10.1016/j.jdin.2021.06.005

Cited by 11 publications

(10 citation statements)

References 40 publications

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“…Objective measures of pruritus focus on binary classification of scratching behaviors, which indicate whether a patient is scratching or not [14]. Tracking of these scratching behaviors provides insight into the effect of itch on an individual over time.…”

Section: Introductionmentioning

confidence: 99%

“…Tracking of these scratching behaviors provides insight into the effect of itch on an individual over time. Video recording using cameras (sometimes infrared) is the current standard in many studies [14,15]. However, this method is time intensive as it requires manual labeling of scratching events by researchers.…”

Section: Introductionmentioning

confidence: 99%

“…This method can additionally suffer from blind spots, has privacy concerns, and is only possible while a patient is sleeping. Wearable devices have shown promise for automatic, objective classification of scratching at night [14,[16][17][18][19][20]. Yet, advancements are needed to develop devices that perform well in daytime when participants still itch and when there are many confounding movements.…”

Section: Introductionmentioning

confidence: 99%

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A Multimodal Sensing Ring for Quantification of Scratch Intensity

Padmanabha¹,

Choudhary²,

Majidi³

et al. 2023

Preprint

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An objective measurement of the debilitating symptom, chronic itch, is necessary for improvements in patient care for numerous medical conditions. While wearable devices have shown promise for scratch detection, they are currently unable to estimate scratch intensity, preventing a comprehensive understanding of the effect of itch on an individual. In this work, we present a framework for the estimation of scratch intensity in addition to scratch detection consisting of a multimodal wearable ring device and machine learning algorithms for regression of scratch intensity on a 0-600 mW mechanical power scale that can be mapped to a 0-10 continuous scale. We evaluate the performance of our algorithms on 20 individuals using Leave One Subject Out (LOSO) Cross Validation (CV) and using data from 14 additional participants, we show that our algorithms achieve clinically-relevant discrimination of scratching intensity levels. This work demonstrates that a finger-worn device can provide multidimensional, objective, real-time measures for the action of scratching.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Multimodal Sensing Ring for Quantification of Scratch Intensity

Padmanabha¹,

Choudhary²,

Majidi³

et al. 2023

Preprint

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“…Many of these wearable sensor studies explore nocturnal scratch detection from wrist-worn actigraphy or smartwatch applications. Yang et al 9 provide a systematic review of studies published before 2021 to compare methods of measuring scratch objectively and pointed out the large variability in performance and limited evaluation of specificity due to imbalanced data. In addition, lack of generalizability and failure to capture finger scratches would bring additional errors.…”

Section: Introductionmentioning

confidence: 99%

Assessing nocturnal scratch with actigraphy in atopic dermatitis patients

Venderley

Zhang

et al. 2023

npj Digit. Med.

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Nocturnal scratch is one major factor leading to impaired quality of life in atopic dermatitis (AD) patients. Therefore, objectively quantifying nocturnal scratch events aids in assessing the disease state, treatment effect, and AD patients’ quality of life. In this paper, we describe the use of actigraphy, highly predictive topological features, and a model-ensembling approach to develop an assessment of nocturnal scratch events by measuring scratch duration and intensity. Our assessment is tested in a clinical setting against the ground truth obtained from video recordings. The new approach addresses unmet challenges in existing studies, such as the lack of generalizability to real-world applications, the failure to capture finger scratches, and the limitations in the evaluation due to imbalanced data in the current literature. Furthermore, the performance evaluation shows agreement between derived digital endpoints and the video annotation ground truth, as well as patient-reported outcomes, which demonstrated the validity of the new assessment of nocturnal scratch.

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“…During periods of rest and sleep, the willful regulation of behaviors subsides, and other regular daily movements do not interfere with scratching movements. That is why nocturnal scratching has been recognized as a promising novel measurement [ 10 ] that brings new insight complementary to current AD measures, offering an opportunity for continuous measurements out of the clinic but also with a certain degree of objectivity. Digital health technologies (DHTs) allow researchers of nocturnal scratch and AD to collect and assess quantifiable information about the behavior of scratching and its impact on sleep and, hence, enhancing our toolbox of assessments to uncover complex relationships between itch, scratching, and sleep, as well as the changes induced by treatments [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Defining the Digital Measurement of Scratching During Sleep or Nocturnal Scratching: Review of the Literature

Wang¹,

Cesnakova²,

Goldsack³

et al. 2023

J Med Internet Res

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Background Digital sensing solutions represent a convenient, objective, relatively inexpensive method that could be leveraged for assessing symptoms of various health conditions. Recent progress in the capabilities of digital sensing products has targeted the measurement of scratching during sleep, traditionally referred to as nocturnal scratching, in patients with atopic dermatitis or other skin conditions. Many solutions measuring nocturnal scratch have been developed; however, a lack of efforts toward standardization of the measure’s definition and contextualization of scratching during sleep hampers the ability to compare different technologies for this purpose. Objective We aimed to address this gap and bring forth unified measurement definitions for nocturnal scratch. Methods We performed a narrative literature review of definitions of scratching in patients with skin inflammation and a targeted literature review of sleep in the context of the period during which such scratching occurred. Both searches were limited to English language studies in humans. The extracted data were synthesized into themes based on study characteristics: scratch as a behavior, other characterization of the scratching movement, and measurement parameters for both scratch and sleep. We then developed ontologies for the digital measurement of sleep scratching. Results In all, 29 studies defined inflammation-related scratching between 1996 and 2021. When cross-referenced with the results of search terms describing the sleep period, only 2 of these scratch-related papers also described sleep-related variables. From these search results, we developed an evidence-based and patient-centric definition of nocturnal scratch: an action of rhythmic and repetitive skin contact movement performed during a delimited time period of intended and actual sleep that is not restricted to any specific time of the day or night. Based on the measurement properties identified in the searches, we developed ontologies of relevant concepts that can be used as a starting point to develop standardized outcome measures of scratching during sleep in patients with inflammatory skin conditions. Conclusions This work is intended to serve as a foundation for the future development of unified and well-described digital health technologies measuring nocturnal scratching and should enable better communication and sharing of results between various stakeholders taking part in research in atopic dermatitis and other inflammatory skin conditions.

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Use of technology for the objective evaluation of scratching behavior: A systematic review

Cited by 11 publications

References 40 publications

A Multimodal Sensing Ring for Quantification of Scratch Intensity

A Multimodal Sensing Ring for Quantification of Scratch Intensity

Assessing nocturnal scratch with actigraphy in atopic dermatitis patients

Defining the Digital Measurement of Scratching During Sleep or Nocturnal Scratching: Review of the Literature

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