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Study supported by pilot grant program receives $3 million grant

People are likely to experience kidney stones again after getting them the first time. By drinking more water, people can prevent the reappearance of kidney stones. Though this may seem easy, fewer than 50% of people who had kidney stones drink the recommended amount of fluids.

A team of Penn State researchers recently received a five-year, $2.97 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases to address this problem. David Conroy, PhD, professor of kinesiology and human development and family studies, Necole Streeper, MD, assistant professor of surgery at Penn State College of Medicine, and their collaborators are developing a technology-based intervention called sipIT.

Penn State Clinical and Translational Science Institute funded initial sipIT research through its Bridges to Translation Pilot Grant Program. The program invests in novel research ideas to promote collaboration across Penn State to collect information to lead to external funding and future research.

“The Penn State Clinical and Translational Science Institute Bridges to Translation Pilot Grant Program was critical for developing this new line of research,” Conroy said. “That support allowed us to engage patients in focus groups to learn what they would find helpful and acceptable, to develop the algorithm for detecting drinking gestures on smartwatches, and to evaluate the feasibility of the initial sipIT intervention with patients.”

The pilot grant also allowed the research team to adjust their idea as the project progressed.

“The institute gave us the flexibility to adapt our plans as we learned from patients and new consumer technologies became available,” Conroy said. “For example, about halfway through our project, Fitbit gave developers access to the accelerometer and gyroscope signals in their smartwatches. We pivoted our approach to leverage their hardware and increase the scalability of our solution. We couldn’t have started this line of research without Penn State Clinical and Translational Science Institute.”

SipIT combines a smartphone app, smartwatch and connected water bottle to track fluid intake. The researchers developed an algorithm that enables smartwatches to detect when someone drinks.

“One of the best strategies for preventing kidney stones is to increase fluid intake,” Streeper said. “Clinical guidelines recommend drinking enough to produce at least 2.5 liters of urine daily. However, adherence is commonly below 50%, and thirst is not sufficient to meet that goal. People often forget to drink when they are not thirsty.

“The sipIT intervention reminds people to drink when they haven’t recently, to better adhere to daily fluid intake goals,” Streeper continued. “It provides a semi-automated way to track fluid intake and reminds patients only at times when they have not been drinking, so they don’t get annoyed by unnecessary reminders.”

The researchers designed SipIT to promote habit formation. Once people have used sipIT for some time, they will continue to consume fluids even without using the sipIT tools.

“Our work on sipIT is unique because it leverages evidence-based strategies from behavioral science and some of the latest digital technology to address an important clinical problem,” Conroy explained. “If patients in this trial benefit from using sipIT, it can be applied to help patients manage several other dehydration-related health problems and risks, such as preventing urinary tract infections, reducing the effects of heat stress for older adults, and preventing post-surgical hospital readmissions.”

National Institute of Diabetes and Digestive and Kidney Diseases funding will allow sipIT to be refined for use in a large clinical trial, but a prototype tool has already been developed and pilot tested. The research team collaborated with two companies, Fitabase and West Arete, to create the project’s algorithms. The researchers also recruited people with a history of kidney stones to participate in focus groups about the design. These people provided input on which features were useful and which features were too burdensome to use regularly.

“We learned early on from focus groups with patients that there was limited interest in using some of the wearables we had in mind initially, so we focused on sensors that many people already wear on their wrist — namely, accelerometers and gyroscopes,” Conroy said. “We also learned that patients were very interested in connected water bottles. We had been completely focused on wearable sensors and hadn’t anticipated that interest. By working with patients, we were able to develop a less burdensome and more engaging tool than we would have otherwise.”

Penn State Social Science Research Institute also funded earlier work on this project.

Other investigators working on this grant include Nilam Ram, PhD,  professor of communications and psychology at Stanford University, and Edison Thomaz, PhD, assistant professor of electrical and computer engineering at The University of Texas at Austin.

Read more in this Penn State News story.

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