A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial

A First Step Towards Behavioral Coaching for Managing Stress: A Case Study on Optimal Policy Estimation with Multi-stage Threshold Q-learning

Psychological stress is a major contributor to the adoption of unhealthy behaviors, which in turn accounts for 41% of global cardiovascular disease burden. While the proliferation of mobile health apps has offered promise to stress management, these apps do not provide micro-level feedback with regard to how to adjust one's behaviors to achieve a desired health outcome. In this paper, we formulate the task of multi-stage stress management as a sequential decision-making problem and explore the application of reinforcement learning to provide micro-level feedback for stress reduction. Specifically, we incorporate a multi-stage threshold selection into Q-learning to derive an interpretable form of a recommendation policy for behavioral coaching. We apply this method on an observational dataset that contains Fitbit ActiGraph measurements and self-reported stress levels. The estimated policy is then used to understand how exercise patterns may affect users' psychological stress levels and to perform coaching more effectively.

Keppi: A Tangible User Interface for Self-Reporting Pain

Motivated by the need to support those self-managing chronic pain, we report on the development and evaluation of a novel pressure-based tangible user interface (TUI) for the self-report of scalar values representing pain intensity. Our TUI consists of a conductive foam-based, force-sensitive resistor (FSR) covered in a soft rubber with embedded signal conditioning, an ARM Cortex-M0 microprocessor, and Bluetooth Low Energy (BLE). In-lab usability and feasibility studies with 28 participants found that individuals were able to use the device to make reliable reports with four degrees of freedom as well map squeeze pressure to pain level and visual feedback. Building on insights from these studies, we further redesigned the FSR into a wearable device with multiple form factors, including a necklace, bracelet, and keychain. A usability study with an additional 7 participants from our target population, elderly individuals with chronic pain, found high receptivity to the wearable design, which offered a number of participant-valued characteristics (e.g., discreetness) along with other design implications that serve to inform the continued refinement of tangible devices that support pain self-assessment.

Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review

Background

Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management.

Methods

Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion.

Results

Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system.

Conclusions

Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12911-018-0591-0) contains supplementary material, which is available to authorized users.

Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review

BACKGROUND

Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions.

OBJECTIVE

The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation.

METHODS

A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported.

RESULTS

A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=-0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group.

CONCLUSIONS

The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public.

Tailored Web-Based Interventions for Pain: Systematic Review and Meta-Analysis

BACKGROUND

Efforts have multiplied in the past decade to underline the importance of pain management. For both acute and chronic pain management, various barriers generate considerable treatment accessibility issues, thereby providing an opportunity for alternative intervention formats to be implemented. Several systematic reviews on Web-based interventions with a large emphasis on chronic pain and cognitive behavioral therapy have been recently conducted to explore the influence of these interventions on pain management However, to our knowledge, the specific contribution of tailored Web-based interventions for pain management has not been described and their effect on pain has not been evaluated.

OBJECTIVE

The primary aim of this systematic review was to answer the following research question: What is the effect of tailored Web-based pain management interventions for adults on pain intensity compared with usual care, face-to-face interventions, and standardized Web-based interventions? A secondary aim was to examine the effects of these interventions on physical and psychological functions.

METHODS

We conducted a systematic review of articles published from January 2000 to December 2015. We used the DerSimonian-Laird random effects models with 95% confidence intervals to calculate effect estimates for all analyses. We calculated standardized mean differences from extracted means and standard deviations, as outcome variables were measured on different continuous scales. We evaluated 5 different outcomes: pain intensity (primary outcome), pain-related disability, anxiety, depression, and pain catastrophizing. We assessed effects according to 3 time intervals: short term (<1 month), medium term (1-6 months), and long term (6-12 months).

RESULTS

After full-text review, we excluded 31 articles, resulting in 17 eligible studies. Only 1 study concerned acute pain and was removed from the meta-analysis, resulting in 16 studies available for quantitative assessment. Compared with standard care or a waiting list, tailored Web-based intervention showed benefits immediately after, with small effect sizes (<0.40) for pain intensity (10 randomized controlled trials [RCTs], n=1310, P=.003) and pain-related disability (6 RCTs, n=953, P<.001). No other improvements were observed at follow-up in the medium and long terms. Compared with the active control group, no improvements were found for the primary outcome (pain intensity) or any of the outcomes except for a small effect size on pain catastrophizing (2 RCTs, n=333, P<.001) immediately after the intervention.

CONCLUSIONS

Tailored Web-based interventions did not prove to be more efficacious than standardized Web-based interventions in terms of pain intensity, pain-related disability, anxiety, and depression. An interesting finding was that some efficacy was shown on pain catastrophizing compared with active control interventions. Considering the diversity of approaches used in tailored Web-based interventions for chronic pain management, their efficacy is yet to be explored. Moreover, their contribution to acute pain management is embryonic.

TRIAL REGISTRATION

International prospective register of systematic reviews (PROSPERO): CRD42015027669; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015027669 (Archived by WebCite at http://www. webcitation.org/6uneWAuyR).

Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain

PURPOSE

This study investigated change processes resulting from a randomized controlled trial smartphone-delivered maintenance intervention with daily electronic diaries and personalized written feedback based on acceptance and commitment therapy (ACT) following a rehabilitation program for patients with chronic widespread pain.

METHOD

This study included 48 women who during a 5-week period completed electronic diaries three times daily, totaling 3372 entries. In response to the completed diaries, they received daily feedback from a therapist for 4 weeks (excluding weekends), totaling 799 feedback messages. To analyze the change processes, we explored the associations between feedback and daily ratings of participants' physical activities, positive emotions, pain fear and avoidance, pain acceptance, and self-management. Commitment to physical activities and the participants' evaluation of feedback were also analyzed. Multilevel models were used in the statistical analyses.

RESULTS

Participants' average pain fear and avoidance decreased over the intervention period (mean -0.019, P = 0.05). Self-management, pain acceptance, and positive feelings increased (mean -0.030, P < 0.01; mean -0.015, P < 0.01; and mean -0.011, P = 0.01, respectively). Participants' performance of physical activities decreased slightly over time, but the level of commitment was high and they evaluated the feedback as supportive for staying sufficiently active. No correlation between diary contents and feedback messages was found, even though most of the participants evaluated the feedback as supportive.

CONCLUSION

No support was found for an association between diary content and feedback based on ACT. However, diary measures were consistent with the ACT model and may have influenced positively the change processes.

Ethical Issues of Social Media Usage in Healthcare

OBJECTIVE

Social media, web and mobile technologies are increasingly used in healthcare and directly support patientcentered care. Patients benefit from disease self-management tools, contact to others, and closer monitoring. Researchers study drug efficiency, or recruit patients for clinical studies via these technologies. However, low communication barriers in socialmedia, limited privacy and security issues lead to problems from an ethical perspective. This paper summarizes the ethical issues to be considered when social media is exploited in healthcare contexts.

METHODS

Starting from our experiences in social-media research, we collected ethical issues for selected social-media use cases in the context of patient-centered care. Results were enriched by collecting and analyzing relevant literature and were discussed and interpreted by members of the IMIA Social Media Working Group.

RESULTS

Most relevant issues in social-media applications are confidence and privacy that need to be carefully preserved. The patient-physician relationship can suffer from the new information gain on both sides since private information of both healthcare provider and consumer may be accessible through the Internet. Physicians need to ensure they keep the borders between private and professional intact. Beyond, preserving patient anonymity when citing Internet content is crucial for research studies.

CONCLUSION

Exploiting medical social-media in healthcare applications requires a careful reflection of roles and responsibilities. Availability of data and information can be useful in many settings, but the abuse of data needs to be prevented. Preserving privacy and confidentiality of online users is a main issue, as well as providing means for patients or Internet users to express concerns on data usage.

Telephone-Based versus In-Person Delivery of Cognitive Behavioral Treatment for Veterans with Chronic Multisymptom Illness: A Controlled, Randomized Trial

BACKGROUND

The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI).

METHOD

Veterans (N=128) who endorsed symptoms of CMI were randomized to: usual care (n=43), in-person (n=42) or telephone-delivered cognitive behavioral stress management (n=43). Assessments were conducted at baseline, three months, and twelve months. The primary outcome was limitation in roles at work and home (i.e., 'role physical'). Reductions in catastrophizing cognitions were evaluated as a mechanism of action.

RESULTS

Intent-to-treat analyses showed no statistically significant main effect (F(2, 164)=.58, p=.56) or interaction effect (F(4,164)=.94, p=.45) for role physical. Over time, veterans improved in their physical function (F(2,170)=5.34, p<.01; ὴ2 partial=.06), PTSD symptoms (F(2,170)=9.39, p<.01; ὴ2 partial=.10), depressive symptoms (F(2,170)=10.81, p<.01, ὴ2 partial=.11), and physical symptoms (F(2, 172)=12.65, p<.01; ὴ2 partial=.13), but these improvements did not differ across study arms over time. Completer analyses yielded similar results. There were no differences in catastrophizing between arms.

CONCLUSION

Findings suggest stress reduction may not be the right target for improving disability among veterans with CMI. Veterans with CMI may need intervention that directly impacts medical self-management to improve disability.

Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps

Cognitive behavioral therapy (CBT) is one of the most effective psychotherapy modalities used to treat depression and anxiety disorders. Homework is an integral component of CBT, but homework compliance in CBT remains problematic in real-life practice. The popularization of the mobile phone with app capabilities (smartphone) presents a unique opportunity to enhance CBT homework compliance; however, there are no guidelines for designing mobile phone apps created for this purpose. Existing literature suggests 6 essential features of an optimal mobile app for maximizing CBT homework compliance: (1) therapy congruency, (2) fostering learning, (3) guiding therapy, (4) connection building, (5) emphasis on completion, and (6) population specificity. We expect that a well-designed mobile app incorporating these features should result in improved homework compliance and better outcomes for its users.

Supporting the Self-Management of Chronic Pain Conditions with Tailored Momentary Self-Assessments

To better support the self-management of chronic pain, this paper investigates how those living with the condition prefer to self-assess their pain levels using smartphones. Our work consists of three stages: design ideation and review, an in-lab user study with 10 participants resulting in nine candidate interfaces, and a 3 week field trial of two further honed measures with 12 participants. This research firstly yields a better understanding of participants' strong and sometimes contrasting preferences regarding their self-assessment of pain intensity. We additionally contribute two novel interfaces that support accurate, quick, and repeated use along with other participant-valued interactions (e.g., familiar, relatable, and highly usable). In particular, we focus on designing tailored measures that both enhance respondent motivation as well as minimize the difficulty of meaningful self-assessment by supporting the cog-nitive effort in translating a subjective experience into a single numerical value.

Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study

Background

Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients’ experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published.

Objectives

The aim of this study was to explore older persons’ common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP.

Methods

A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi’s principles of psychological phenomenological analysis.

Results

The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises.

Conclusions

It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed.

The use of a mobile app to motivate evidence-based oral hygiene behaviour

INTRODUCTION

Mobile apps are software programmes that run on smartphones and other mobile devices. Mobile health apps can help people manage their own health and wellness, promote healthy living and gain access to useful information when and where they need it. The Brush DJ oral health app was developed to use the opportunity mobile apps offer to motivate an evidence-based oral hygiene routine. A literature review has found no research investigating the use of a mobile app to motivate evidence-based oral hygiene behaviour.

OBJECTIVE

The objective of this preliminary investigation was to assess user perception of an oral health app to give a basis for future research and development of app technology in relation to oral health.

METHOD

A cross-sectional qualitative user perception questionnaire.RESULTS :One hundred and eighty-nine people responded to the questionnaire. Seventy percent (n = 113) of respondents reported that their teeth felt cleaner since using the app. Eighty-eight percent (n = 133) reported the app motivated them to brush their teeth for longer and 92.3% (n = 144) would recommend the app to their friends and family. Four broad themes relating to how the app helped toothbrushing were reported. These themes were motivation, education, compliance and perceived benefits.

CONCLUSION

A mobile app is a promising tool to motivate an evidence-based oral hygiene routine.

The Integration of Technology into Treatment Programs to Aid in the Reduction of Chronic Pain

In the United States, roughly $600 billion is spent on pain management - usually in the form of addictive opioid drugs. Due to the dangers associated with long-term opiate-based pain medication, the development of additional strategies for chronic pain management is warranted. The advent of smartphones and associated technology has provided healthcare providers with a unique opportunity to provide pain management support. This review summarizes of the use of technology to supplement chronic pain management regimens. Smartphone and internet-based applications that employ online journals facilitate improved communication between patient and clinician and allow for more personalized care and improved pain management. For instance, the e-Ouch application provides a platform for pain logs as well as feedback and coaching to patients via Twitter postings and blogs. Other applications provide online resources and blogs to improve patient education, which has shown to relieve patient symptoms through lifestyle modification. Internet-delivered cognitive behavioral therapy (CBT) focuses on the psychological coping mechanisms. The application of technology and smartphone apps toward pain management shows promise toward reducing the use of opioids in pain management, but has yet to be incorporated as a standard practice. More robust studies critically evaluating the efficacy of these technology-based therapies need to be conducted before standardization and insurance coverage can become reality.

The Efficacy of Internet-based Intervention on Quality of Life for Patients with Chronic Post-surgical Pain

BACKGROUND

The objective of the present study was to explore the efficacy of internet-based intervention on quality of life of patients with chronic post-surgical pain (CPSP).

METHODS

A retrospective analysis was performed on 81 patients diagnosed with CPSP after radical resection for lung cancer between January 2013 and July 2014. They were enrolled either as part of the conventional care group which included 40 cases or the internet-based pain intervention group which included 41 cases. The patients in the conventional care group were treated weekly in the outpatient clinic, while patients in internet-based group were treated via smartphone or the internet. The 36-Item Short Form Health Survey (SF-36) was utilized to assess the quality of life of patients who were suffering from CPSP, 1 month and 3 months after therapy.

RESULTS

The patients in the internet-based pain intervention group demonstrated similar health-related qualities of life and overall satisfaction rates compared with the conventional care group (P>0.05).

CONCLUSION

Internet-based pain management is a suitable option to improve the quality of life of patients with CPSP after radical resection for lung cancer.

Longitudinal trial of a smartphone pain application for chronic pain patients: Predictors of compliance and satisfaction

Introduction This study was designed to determine the feasibility, tolerability, safety and efficacy of a smartphone pain application (app) among chronic pain patients over a six-month trial. The app was designed for both Android and iPhone devices and enabled users with chronic pain to assess, monitor, and communicate their status to their providers. Methods We recruited 90 chronic pain patients to use the pain app. All subjects completed baseline measures and were asked to record their progress every day. All participants were supplied an activity monitor. Results Average age of the participants was 46.7 years (range 18-79), 64.4% were female and 31.1% reported multiple pain sites. Satisfaction was rated at three and six months. The app was found to be easily introduced and well tolerated. In general, those who used the app more often were more satisfied with the program ( p < 0.05), although satisfaction ratings of the pain app diminished with time. Greater use of the app and frequent daily assessment entries were found to be related to an overall improvement in mood. However, contrary to our hypotheses, frequent use of the app did not have a positive effect on pain or activity. Those who were more satisfied with the app reported more pain-related disability and were less active than those who were less satisfied with the app. No safety issues were encountered. Discussion Strategies to make the program more engaging and to improve motivation to use the app would be important in the future development and use of a smartphone pain app.

The Norwegian versions of the Chronic Pain Acceptance Questionnaire CPAQ-20 and CPAQ-8 - validation and reliability studies

PURPOSE

The aim of this study was to test the validity and reliability of the translated Norwegian version of the Chronic Pain Acceptance Questionnaire (CPAQ-20) and the shorter version CPAQ-8 based on the same data.

METHOD

The sample consisted of 120 women with chronic widespread musculoskeletal pain (CWP). The respondents completed CPAQ-20 and visual analogue scales (pain, fatigue, sleep problems and depression), General Health Questionnaire-12, The Pain Catastrophizing Scale, Fibromyalgia Impact Questionnaire and SF-8. Confirmatory factor analyses were performed on a one-factor baseline model, the previous validated CPAQ-20 and CPAQ-8 models, as well as an exploratory generated model based on the current sample.

RESULTS

The two-factor model of CPAQ-20 and a two-factor model of CPAQ-8 obtained adequate model fit and outperformed the baseline model. The exploratory factor, analysis-generated two-factor model obtained only a marginally better fit, supporting the two-dimensional model of CPAQ-20. CPAQ-20 and CPAQ-8 had Cronbach's alphas between 0.75 (Pain Willingness subscales both versions) and 0.85. Both scales correlated significantly in the hypothesised direction with all the other scales.

CONCLUSION

The Norwegian versions of CPAQ-20 and CPAQ-8 are reliable assessment tools with good construct validity for measurement of acceptance. Future studies should validate the scales in other Norwegian samples. Implication for Rehabilitation CPAQ-20 and CPAQ-8 are valid Norwegian instruments for measuring acceptance of pain. Acceptance of pain is an important process in the rehabilitation of persons with chronic widespread pain. Treatment models supporting acceptance can now be developed and measured further in Norway.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.

OBJECTIVE

To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.

METHODS

A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.

RESULTS

Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.

CONCLUSIONS

Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain: Looking Across Treatment Modalities

OBJECTIVES

The use of technology to provide chronic pain self-management interventions has increased in the recent years. Individual studies have primarily focused on a single technology-assisted modality and direct comparisons of different technology-assisted modalities are rare. Thus, little is known about the relative strengths and weaknesses of each technology-assisted modality.

MATERIALS AND METHODS

This article is a systematic review of technology-assisted self-management interventions for chronic nonheadache, noncancer pain in adults. We examined 3 treatment modalities: telephone, interactive voice response, and Internet. Electronic searches of OVID MEDLINE, OVID PsychINFO, and the Cochrane Database of Systematic Reviews were conducted. Forty-four articles including 9890 participants were reviewed.

RESULTS

Across modalities, the existing evidence suggests that technology-assisted psychological interventions are efficacious for improving self-management of chronic pain in adults. All modalities have been shown to provide benefit and no clearly superior modality has emerged. The primary gaps in the literature are lack of in-person comparison groups, lack of direct comparison among technology-assisted modalities, and heterogeneity of methods and interventions that limit comparability across studies and modalities.

DISCUSSION

Future trials should focus on direct comparisons of technology-assisted interventions with in-person treatment and head to head comparisons of different technology-assisted modalities. Additional areas of focus include quantifying the cost of technology-assisted interventions, examining the effect of treatment "dose" on outcomes, and establishing guidelines for developing treatments for the technology-assisted environment.

Internet interventions for chronic pain including headache: A systematic review

Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = - 0.39, for pain intensity Hedge's g = - 0.33, for catastrophizing Hedge's g = - 0.49 and for mood variables (depression) Hedge's g = - 0.26.

Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service

The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets (p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use.

Using a Smartphone Application to Promote Healthy Dietary Behaviours and Local Food Consumption

Smartphone "apps" are a powerful tool for public health promotion, but unidimensional interventions have been ineffective at sustaining behavioural change. Various logistical issues exist in successful app development for health intervention programs and for sustaining behavioural change. This study reports on a smartphone application and messaging service, called "SmartAPPetite," which uses validated behaviour change techniques and a behavioural economic approach to "nudge" users into healthy dietary behaviours. To help gauge participation in and influence of the program, data were collected using an upfront food survey, message uptake tracking, experience sampling interviews, and a follow-up survey. Logistical and content-based issues in the deployment of the messaging service were subsequently addressed to strengthen the effectiveness of the app in changing dietary behaviours. Challenges included creating relevant food goal categories for participants, providing messaging appropriate to self-reported food literacy and ensuring continued participation in the program. SmartAPPetite was effective at creating a sense of improved awareness and consumption of healthy foods, as well as drawing people to local food vendors with greater frequency. This work serves as a storehouse of methods and best practices for multidimensional local food-based smartphone interventions aimed at improving the "triple bottom line" of health, economy, and environment.

Mobile technology boosts the effectiveness of psychotherapy and behavioral interventions: a meta-analysis

We conducted a meta-analysis on the effects of mobile technology on treatment outcome for psychotherapy and other behavioral interventions. Our search of the literature resulted in 26 empirical articles describing 25 clinical trials testing the benefits of smartphone applications, personal digital assistants (PDAs), or text messaging systems either to supplement treatment or substitute for direct contact with a clinician. Overall, mobile technology use was associated with superior treatment outcome across all study designs and control conditions, effect size (ES) = .34, p < .0001. For the subset of 10 studies that looked specifically at the added benefit of mobile technology using a rigorous "Treatment" versus "Treatment + Mobile" design, effect sizes were only slightly more modest (ES = .27) and still significant (p < .05). Overall, the results support the role of mobile technology for the delivery of psychotherapy and other behavioral interventions.

Establishing a Personal Health Record System in an Academic Hospital: One Year's Experience

BACKGROUND

Personal health records (PHRs) are web based tools that help people to access and manage their personalized medical information. Although needs for PHR are increasing, current serviced PHRs are unsatisfactory and researches on them remain limited. The purpose of this study is to show the process of developing Seoul National University Bundang Hospital (SNUBH)'s own PHR system and to analyze consumer's use pattern after providing PHR service.

METHODS

Task force team was organized to decide service range and set the program. They made the system available on both mobile application and internet web page. The study enrolled PHR consumers who assessed PHR system between June 2013 and June 2014. We analyzed the total number of users on a monthly basis and the using pattern according to each component.

RESULTS

The PHR service named Health4U has been provided from June 2013. Every patient who visited SNUBH could register Health4U service and view their medical data. The PHR user has been increasing, especially they tend to approach via one way of either web page or mobile application. The most frequently used service is to check laboratory test result.

CONCLUSION

For paradigm shift toward patient-centered care, there is a growing interest in PHR. This study about experience of establishing and servicing the Health4U would contribute to development of interconnected PHR.

The PREEMPT study - evaluating smartphone-assisted n-of-1 trials in patients with chronic pain: study protocol for a randomized controlled trial

Background

Chronic pain is prevalent, costly, and clinically vexatious. Clinicians typically use a trial-and-error approach to treatment selection. Repeated crossover trials in a single patient (n-of-1 trials) may provide greater therapeutic precision. N-of-1 trials are the most direct way to estimate individual treatment effects and are useful in comparing the effectiveness and toxicity of different analgesic regimens. The goal of the PREEMPT study is to test the ‘Trialist’ mobile health smartphone app, which has been developed to make n-of-1 trials easier to accomplish, and to provide patients and clinicians with tools for individualizing treatments for chronic pain.

Methods/design

A randomized controlled trial is being conducted to test the feasibility and effectiveness of the Trialist app. A total of 244 participants will be randomized to either the Trialist app intervention group (122 patients) or a usual care control group (122 patients). Patients assigned to the Trialist app will work with their clinicians to set up an n-of-1 trial comparing two pain regimens, selected from a menu of flexible options. The Trialist app provides treatment reminders and collects data entered daily by the patient on pain levels and treatment side effects. Upon completion of the n-of-1 trial, patients review results with their clinicians and develop a long-term treatment plan. The primary study outcome (comparing Trialist to usual care patients) is pain-related interference with daily functioning at 26 weeks.

Discussion

Trialist will allow patients and clinicians to conduct personalized n-of-1 trials. In prior studies, n-of-1 trials have been shown to encourage greater patient involvement with care, which has in turn been associated with better health outcomes. mHealth technology implemented using smartphones may offer an efficient means of facilitating n-of-1 trials so that more patients can benefit from this approach.

Trial registration

ClinicalTrials.gov: NCT02116621, first registered 15 April 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-015-0590-8) contains supplementary material, which is available to authorized users.

Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients

Background

A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed.

Objective

In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)—both as a website and as a mobile app—was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs.

Methods

In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors.

Results

The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users.

Conclusions

This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors.

Trial Registration

Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D).

Developing mental health mobile apps: Exploring adolescents’ perspectives

Mobile applications or ‘apps’ have significant potential for use in mental health interventions with adolescents. However, there is a lack of research exploring end users’ needs from such technologies. The aim of this study was to explore adolescents’ needs and concerns in relation to mental health mobile apps. Five focus groups were conducted with young people aged 15–16 years ( N = 34, 60% male). Participants were asked about their views in relation to the use of mental health mobile technologies and were asked to give their responses to a mental health app prototype. Participants identified (1) safety, (2) engagement, (3) functionality, (4) social interaction, (5) awareness, (6) accessibility, (7) gender and (8) young people in control as important factors. Understanding end users’ needs and concerns in relation to this topic will inform the future development of youth-oriented mental health apps that are acceptable to young people.

Understanding usage of a hybrid website and smartphone app for weight management: a mixed-methods study

Background

Advancements in mobile phone technology offer huge potential for enhancing the timely delivery of health behavior change interventions. The development of smartphone-based health interventions (apps) is a rapidly growing field of research, yet there have been few longitudinal examinations of how people experience and use these apps within their day-to-day routines, particularly within the context of a hybrid Web- and app-based intervention.

Objective

This study used an in-depth mixed-methods design to examine individual variation in (1) impact on self-reported goal engagement (ie, motivation, self-efficacy, awareness, effort, achievement) of access to a weight management app (POWeR Tracker) when provided alongside a Web-based weight management intervention (POWeR) and (2) usage and views of POWeR Tracker.

Methods

Thirteen adults were provided access to POWeR and were monitored over a 4-week period. Access to POWeR Tracker was provided in 2 alternate weeks (ie, weeks 1 and 3 or weeks 2 and 4). Participants’ goal engagement was measured daily via self-report. Mixed effects models were used to examine change in goal engagement between the weeks when POWeR Tracker was and was not available and whether the extent of change in goal engagement varied between individual participants. Usage of POWeR and POWeR Tracker was automatically recorded for each participant. Telephone interviews were conducted and analyzed using inductive thematic analysis to further explore participants’ experiences using POWeR and POWeR Tracker.

Results

Access to POWeR Tracker was associated with a significant increase in participants’ awareness of their eating (β₁=0.31, P=.04) and physical activity goals (β₁=0.28, P=.03). The level of increase varied between individual participants. Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes). POWeR Tracker was mostly accessed in short bursts (mean 3 minutes, SD 2 minutes) during convenient moments or moments when participants deemed the intervention content most relevant. The qualitative data indicated that nearly all participants agreed that it was more convenient to access information on-the-go via their mobiles compared to a computer. However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker.

Conclusions

This study provides evidence that smartphones have the potential to improve individuals’ engagement with their health-related goals when used as a supplement to an existing online intervention. The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement. A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools.

Do weather changes influence pain levels in women with fibromyalgia, and can psychosocial variables moderate these influences?

The aim of this study was to examine the association between fibromyalgia pain and weather, and to investigate whether psychosocial factors influence this relationship. Women with chronic widespread pain/fibromyalgia (N = 50) enrolled in a larger study, were recruited from a 4-week inpatient rehabilitation program in Norway ( 2009-2010), and reported their pain and psychological factors up to three times per day (morning, afternoon, evening) for 5 weeks. These ratings were then related to the official local weather parameters. Barometric pressure recorded simultaneously impacted pain significantly while temperature, relative humidity, and solar flux did not. No psychological variables influenced the weather-pain interaction. No weather parameter predicted change in the subsequent pain measures. The magnitude of the inverse association between pain and barometric pressure was very small, and none of the psychological variables studied influenced the association between pain and barometric pressure. All in all, the evidence for a strong weather-pain association in fibromyalgia seems limited at best.

Clinical laboratory data: acquire, analyze, communicate, liberate

The availability of portable healthcare devices, which can acquire and transmit medical data to remote experts would dramatically affect healthcare in areas with poor infrastructure. Smartphones, which feature touchscreen computer capabilities and sophisticated cameras, have become widely available with over billion units shipped in 2013. In the clinical laboratory, smartphones have recently brought the capabilities of key instruments such as spectrophotometers, fluorescence analyzers and microscopes into the palm of the hand. Several research groups have developed sensitive and low-cost smartphone-based diagnostic assay prototypes for testing cholesterol, albumin, vitamin D, tumor markers, and the detection of infectious agents. This review covers the use of smartphones to acquire, analyze, communicate, and liberate clinical laboratory data. Smartphones promise to dramatically improve the quality and quantity of healthcare offered in resource-limited areas.

mHealth: a strategic field without a solid scientific soul. a systematic review of pain-related apps

BACKGROUND

Mobile health (mHealth) has undergone exponential growth in recent years. Patients and healthcare professionals are increasingly using health-related applications, at the same time as concerns about ethical issues, bias, conflicts of interest and privacy are emerging. The general aim of this paper is to provide an overview of the current state of development of mHealth.

METHODS AND FINDINGS

To exemplify the issues, we made a systematic review of the pain-related apps available in scientific databases (Medline, Web of Science, Gale, Psycinfo, etc.) and the main application shops (App Store, Blackberry App World, Google Play, Nokia Store and Windows Phone Store). Only applications (designed for both patients and clinicians) focused on pain education, assessment and treatment were included. Of the 47 papers published on 34 apps in scientific databases, none were available in the app shops. A total of 283 pain-related apps were found in the five shops searched, but no articles have been published on these apps. The main limitation of this review is that we did not look at all stores in all countries.

CONCLUSIONS

There is a huge gap between the scientific and commercial faces of mHealth. Specific efforts are needed to facilitate knowledge translation and regulate commercial health-related apps.

Psychological therapies (Internet-delivered) for the management of chronic pain in adults

BACKGROUND

Chronic pain (i.e. pain lasting longer than three months) is common. Psychological therapies (e.g. cognitive behavioural therapy) can help people to cope with pain, depression and disability that can occur with such pain. Treatments currently are delivered via hospital out-patient consultation (face-to-face) or more recently through the Internet. This review looks at the evidence for psychological therapies delivered via the Internet for adults with chronic pain.

OBJECTIVES

Our objective was to evaluate whether Internet-delivered psychological therapies improve pain symptoms, reduce disability, and improve depression and anxiety for adults with chronic pain. Secondary outcomes included satisfaction with treatment/treatment acceptability and quality of life.

SEARCH METHODS

We searched CENTRAL (Cochrane Library), MEDLINE, EMBASE and PsycINFO from inception to November 2013 for randomised controlled trials (RCTs) investigating psychological therapies delivered via the Internet to adults with a chronic pain condition. Potential RCTs were also identified from reference lists of included studies and relevant review articles. In addition, RCTs were also searched for in trial registries.

SELECTION CRITERIA

Peer-reviewed RCTs were identified and read in full for inclusion. We included studies if they used the Internet to deliver the primary therapy, contained sufficient psychotherapeutic content, and promoted self-management of chronic pain. Studies were excluded if the number of participants in any arm of the trial was less than 20 at the point of extraction.

DATA COLLECTION AND ANALYSIS

Fifteen studies met the inclusion criteria and data were extracted. Risk of bias assessments were conducted for all included studies. We categorised studies by condition (headache or non-headache conditions). Four primary outcomes; pain symptoms, disability, depression, and anxiety, and two secondary outcomes; satisfaction/acceptability and quality of life were extracted for each study immediately post-treatment and at follow-up (defined as 3 to 12 months post-treatment).

MAIN RESULTS

Fifteen studies (N= 2012) were included in analyses. We assessed the risk of bias for included studies as low overall. We identified nine high 'risk of bias' assessments, 22 unclear, and 59 low 'risk of bias' assessments. Most judgements of a high risk of bias were due to inadequate reporting.Analyses revealed seven effects. Participants with headache conditions receiving psychological therapies delivered via the Internet had reduced pain (number needed to treat to benefit = 2.72, risk ratio 7.28, 95% confidence interval (CI) 2.67 to 19.84, p < 0.01) and a moderate effect was found for disability post-treatment (standardised mean difference (SMD) ‒0.65, 95% CI ‒0.91 to ‒0.39, p < 0.01). However, only two studies could be entered into each analysis; hence, findings should be interpreted with caution. There was no clear evidence that psychological therapies improved depression or anxiety post-treatment (SMD -0.26, 95% CI -0.87 to 0.36, p > 0.05; SMD -0.48, 95% CI -1.22 to 0.27, p > 0.05), respectively. In participants with non-headache conditions, psychological therapies improved pain post-treatment (p < 0.01) with a small effect size (SMD -0.37, 95% CI -0.59 to -0.15), disability post-treatment (p < 0.01) with a moderate effect size (SMD -0.50, 95% CI -0.79 to -0.20), and disability at follow-up (p < 0.05) with a small effect size (SMD -0.15, 95% CI -0.28 to -0.01). However, the follow-up analysis included only two studies and should be interpreted with caution. A small effect was found for depression and anxiety post-treatment (SMD -0.19, 95% CI -0.35 to -0.04, p < 0.05; SMD -0.28, 95% CI -0.49 to -0.06, p < 0.01), respectively. No clear evidence of benefit was found for other follow-up analyses. Analyses of adverse effects were not possible.No data were presented on satisfaction/acceptability. Only one study could be included in an analysis of the effect of psychological therapies on quality of life in participants with headache conditions; hence, no analysis could be undertaken. Three studies presented quality of life data for participants with non-headache conditions; however, no clear evidence of benefit was found (SMD -0.27, 95% CI -0.54 to 0.01, p > 0.05).

AUTHORS' CONCLUSIONS

There is insufficient evidence to make conclusions regarding the efficacy of psychological therapies delivered via the Internet in participants with headache conditions. Psychological therapies reduced pain and disability post-treatment; however, no clear evidence of benefit was found for depression and anxiety. For participants with non-headache conditions, psychological therapies delivered via the Internet reduced pain, disability, depression, and anxiety post-treatment. The positive effects on disability were maintained at follow-up. These effects are promising, but considerable uncertainty remains around the estimates of effect. These results come from a small number of trials, with mostly wait-list controls, no reports of adverse events, and non-clinical recruitment methods. Due to the novel method of delivery, the satisfaction and acceptability of these therapies should be explored in this population. These results are similar to those of reviews of traditional face-to-face therapies for chronic pain.

Mobile medical and health apps: state of the art, concerns, regulatory control and certification

This paper examines the state of the art in mobile clinical and health-related apps. A 2012 estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals and consumers continue to express concerns about the quality of many apps, calling for some form of app regulatory control or certification to be put in place. We describe the range of apps on offer as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps that have been conducted to date, covering a range of clinical disciplines and topics. Our survey includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps. We discuss the concept of ‘apps as a medical device’ and the relevant regulatory controls that apply in USA and Europe, offering examples of apps that have been formally approved using these mechanisms. We describe the online Health Apps Library run by the National Health Service in England and the calls for a vetted medical and health app store. We discuss the ingredients for successful apps beyond the rather narrow definition of ‘apps as a medical device’. These ingredients cover app content quality, usability, the need to match apps to consumers’ general and health literacy levels, device connectivity standards (for apps that connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy. ‘Happtique Health App Certification Program’ (HACP), a voluntary app certification scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many “similar” quality benchmarking tools and codes of conduct for information publishers were proposed to appraise and rate online medical and health information. It is probably impossible to rate and police every app on offer today, much like in those early days of the Web, when people quickly realised the same regarding informational Web pages. The best first line of defence was, is, and will always be to educate consumers regarding the potentially harmful content of (some) apps.

Web-based, self-management enhancing interventions with e-diaries and personalized feedback for persons with chronic illness: a tale of three studies

OBJECTIVE

Chronic illness places high demands on patients. Interventions supporting self-management and providing personalized feedback might help patients to gain new perspectives and enhance use of constructive self-management strategies. We developed three comparable web-based CBT-grounded interventions including e-diaries and feedback delivered through PDAs/smartphones. The feasibility and efficacy of these interventions have been investigated for patients with irritable bowel syndrome (in an RCT), chronic widespread pain (RCT) and type 2 diabetes (feasibility study).

METHODS

This is a descriptive study that summarizes the content, feasibility and efficacy of the interventions and discusses issues relevant for implementing this type of web-based therapeutic interventions in clinical practice.

RESULTS

The web-based interventions appear feasible, acceptable and supportive. In a short and midterm time frame, the interventions promote self-management.

CONCLUSION

Booster sessions may be needed for prolonged effects. Given the physical and mental symptoms of the patients under study and the nature of the intervention, providers who deliver the feedback need a health care background and training in this specific way of counseling.

PRACTICE IMPLICATIONS

The results of the three studies suggest that personalized web-based interventions are effective and have the potential to support self-management in daily healthcare. Studies concerning clinical significance and implementation are needed.

Mindfulness-based mobile applications: literature review and analysis of current features

Background

Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce.

Objective

Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting.

Methods

We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature.

Results

The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs.

Conclusions

While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored.

The Effectiveness of Internet-Based Mindfulness Interventions for Physical and Mental Illnesses

The rapid growth of information technologies, such as the internet, smartphones, and videoconferencing has improved the access to mindfulness therapies, which focus on enhancing one’s awareness of the present moment. This review paper attempts to provide an overall picture of the effectiveness of internet-based mindfulness therapies. After a brief introduction to the concept of mindfulness and a presentation of the literature search methods, this review focuses on the effectiveness of internet-based mindfulness therapies. Specifically, the review discusses the role of internet mindfulness therapies in the treatment of physical illnesses, such as chronic pain, irritable bowel syndrome, tinnitus, diabetes, and cardiovascular illness. Then, the applications of online mindfulness therapy to the treatment of mental illnesses, such as depression, stress, binge eating disorder, and suicidal ideation, are described. The review concludes with a discussion of potential future research directions.

A smartphone-based intervention with diaries and therapist feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain. part 2: 11-month follow-up results of a randomized trial

Background

Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited.

Objective

The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups.

Methods

140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress.

Results

By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen’s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen’s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up.

Conclusion

The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention.

Trial Registration

Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0)