Forto 2.0: Evolving to an integrated smart self-assessment “Fatigability in Outcomes to monitor Resilience Targets in Older persons” measurement & monitoring platform

Specific challenge and end users’ involvement Maintaining intrinsic capacity and being able to recruit those resources is crucial for being able to adapt and self-manage when facing the (health) stressors that will inevitably occur over the life course. As such, early identification of changes in intrinsic capacity is key to better prevention of disease burden and thus healthy aging. However, we currently lack tools to monitor intrinsic capacity and the FORTO 2.0 monitoring system is going to fill that gap. Together with older persons as primary end-users and hospitals and care collaboratives as secondary end-users, we are developing a proof-of-concept FORTO 1.0 monitoring system, that will offer reliable, valid and easy-to-use direct measurement of the capacity to recruit available reserves across high, declining and lower levels of intrinsic capacity. FORTO 1.0 allows for self-monitoring and professional monitoring. With our engaged group of stakeholders and end-users we will further develop the smartphone based FORTO 2.0 (Fatigability Outcomes to monitor Resilience Targets in Older persons) system to be ready for market introduction (Technology Readiness Level - TRL 7), evaluate our propositions about the predictive value of the FORTO 2.0 monitoring system and – in a iterative user centered approach – design scalable implementation strategies for FORTO’s introduction in free-living and care settings. Unique selling proposition The scarce technologies that are available today focus on the detection of disability once when the older person is already frail or dependent, or require cumbersome and costly instruments that can only be operated by professionals. FORTO 2.0 is an approach that measures the capacity to recruit available reserves in older adults based on a combination of (muscle) fatigability and self-reported fatigue. The approach of actively testing muscle fatigability repeatedly ensures high sensitivity and specificity for early declines in intrinsic capacity. A second unique selling proposition is that FORTO 2.0 can be used either independently by the older person or in a supervised care pathway to monitor changes and early warning signs for diminishing resistance to and delayed recovery from health stressors. Commercialisation leader Commercialisation will be led the Belgian SME Uniweb BV, whom develops and supports innovative digital solutions for Healthcare and Life Sciences, including health apps ecosystems and medical devices. Uniweb’s approach meets the needs of highly regulated industries such as Healthcare, Biotech, Pharmaceutics and Clinical Research. UniWeb’s has a vast experience with clinical trials, patient data privacy, and encryption of electronic health records (EHR). UniWeb customers include pharma industry, hospitals, authorities, and governmental organisations. UniWeb’s certified Quality & Security management system is designed to comply with Healthcare and Pharma requirements and is certified for both quality management (ISO 9001:2015) and information security management (ISO 27001:2013). Route to market UniWeb will be in charge of commercialization of the results of the project, with the support of sub-contracted partner IntoTheMinds, a Belgian market research firm employing scientific methods, for business plan development and validation. The envisioned product will include a one-time purchase hardware, and software subscriptions aimed at connecting patients with HCPs. We will adopt a push strategy, in which FORTO 2.0 is prescribed by HCP or insurer, and a pull strategy, in which health-conscious people can purchase FORTO 2.0. We will start by the push strategy where HCPs serving patient populations that will benefit from the FORTO 2.0 solution are reached and represent 45% of all people of 65+yrs old. Sales channels include direct sales (online), commission-based affiliate channels, and distribution channels / retail. Dissemination and target groups Our mission is to bring (self)monitoring of intrinsic capacity to older persons across all levels of intrinsic capacity, to support self-management as well as personalized care. Persons with high intrinsic capacity can self-monitor their intrinsic capacity regularly and declines in fatigability, to elicit intervention before permanent health loss has occurred. In persons with declining intrinsic capacity, such as those in rehabilitative care, the FORTO 2.0 monitoring will allow to detect delays in recovery early on and adapt the rehabilitative regimen accordingly. In persons with low intrinsic capacity, such as in geriatric care settings, FORTO 2.0 monitoring will help to tailor treatment to the reserve capacity present: more aggressive were needed and more lenient were possible.