Feasibility of Interactive Technology for Symptom Monitoring in Patients with Fibromyalgia

Evidence for telemedicine heterogeneity in rheumatic and musculoskeletal diseases care: a scoping review

Telemedicine and digital health represent alternative approaches for clinical practice; indeed, its potential in healthcare services for prevention, diagnosis, treatment, rehabilitation, and disease monitoring is widely acknowledged. These are all crucial issues to consider when dealing with chronic Rheumatic and Musculoskeletal Diseases (RMDs). The aim was to determine the current state of telemedicine in the field of rheumatology, considering the tools and devices in use as well as the Patient Reported Outcomes. A scoping review was performed following the PRISMA-ScR, retrieving articles through five databases from 1990 to 2022. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) original research papers in the English language with available abstracts, and (III) telehealth and telemedicine are provided as healthcare services. Within the 62 included studies, multiple tools of telemedicine were used: 21/62 websites/online platforms, 18/62 mobile applications, 16/62 telephone contacts, 5/62 video-consultations, and 1/62 wearable devices. Outcomes were classified based on the economic, clinical, and humanistic framework. Clinical outcomes assessed through digital tools were pain, disease activity, and serum uric acid levels. Humanistic outcomes have been grouped according to four categories (e.g., mental and physical function, health management, and health perception). The heterogeneity of digital tools in the field of rheumatology highlights the challenge of implementing reliable research into clinical practice. Effective telerehabilitation models have been presented, and the use of a tight control strategy has also been mentioned. Future research should focus on establishing studies on other RMDs as well as summarizing and formulating clinical guidelines for RMDs. Key Points • Evidence for the usefulness of telemedicine and digital health for managing and monitoring rheumatic and musculoskeletal diseases is progressively increasing. • Several digital tools effectively measure clinical and humanistic and patient reported outcomes in rheumatic and musculoskeletal diseases. • Integrating diverse digital tools in rheumatology is challenging yet promising. • Future research should focus on developing standardized recommendations for practical use of telemedicine in daily practice.

A randomized-controlled pilot trial of telemedicine-delivered cognitive-behavioral therapy tailored for interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating urologic pain condition with few treatment advances in the past 25 years. Individuals with IC/BPS often experience significant psychological distress, which worsens symptoms and functioning. To date, there have been no large-scale, randomized controlled trials (RCTs) of comprehensive psychological interventions for IC/BPS. We conducted a 2:1 RCT of an 8-session patient-informed cognitive-behavioral therapy (CBT) intervention designed for IC/BPS for reducing pain-related symptoms and improving quality of life, delivered through telemedicine. Individuals with IC/BPS (N = 78) were randomized to receive either 8 weeks of CBT specifically designed for IC/BPS (n = 52) or an attention control condition (n = 26). Urologic symptoms (Genitourinary Pain Index, GUPI), pain-related symptoms, affective distress, and quality of life were evaluated before, immediately after, and 3 months posttreatment. Both conditions reported significant but similar reductions (P = 0.922) in the a priori primary outcome of genitourinary symptoms at posttreatment (GUPI reduction = 6.6 vs 4.8, for CBT and control, respectively) and long-term follow-up (8.1 vs 6.6, for CBT and control). However, the CBT group had significantly greater improvement in Patient Global Impression of Change (PGIC) scores and was significantly more likely to be treatment responders (PGIC ≥ 6) (37% vs 8%, P = 0.019 for CBT and control), with a large relative effect size (OR = 6.68). A subgroup analysis of CBT recipients showed that responders (PGIC 6) displayed significant reductions in genitourinary symptoms (P = 0.023), pain intensity (P = 0.027), and pain interference (P = 0.013) posttreatment. Telemedicine-delivered pain CBT for IC/BPS shows promise for improving outcomes, and this trial demonstrates the need for larger RCTs of CBT for IC/BPS.

Mobile App Use among Persons with Fibromyalgia: A Cross-sectional Survey

Persons with fibromyalgia experience a diverse set of symptoms. Recommendations for management generally focus on multidisciplinary approaches involving multiple modalities. Mobile apps can be an essential component for self-management, yet little is known about how persons with fibromyalgia use mobile apps for health-related purposes. A cross-sectional survey (N = 663) was conducted to understand the real-world use of apps among persons with fibromyalgia. The survey included 2 main foci: 1) eHealth literacy and use of information sources, and 2) mobile app use patterns and preferences for health-related purposes, including the types of apps used and usage characteristics of apps currently in use, as well as those that had been discontinued. Respondents' average eHealth literacy as measured by eHealth Literacy Scale (eHEALS) was 31.4 (SD = 7.1), and they utilized diverse information sources. Approximately two-thirds of the sample used mobile apps; the remaining one-third did not. Diverse health management needs were represented in the apps reported, including scheduling/time management, notetaking, fitness, and wellness. Compared to apps that had been discontinued, participants rated apps that they still used higher in terms of ease of use and used them more frequently. Reasons for discontinuing app use included issues with privacy, the effort required, lack of interest, and lack of perceived quality. Other reasons for app nonuse were lack of awareness and how-to knowledge, indicating that disseminating information about apps and addressing other barriers, such as providing user support, are critical to increasing uptake. These study findings can inform both app design and dissemination. PERSPECTIVE: This article presents how persons with fibromyalgia use mobile apps to manage their health. The findings could inform the development of digital interventions or programs for this population.

A systematic review of engagement reporting in remote measurement studies for health symptom tracking

Remote Measurement Technologies (RMTs) could revolutionise management of chronic health conditions by providing real-time symptom tracking. However, the promise of RMTs relies on user engagement, which at present is variably reported in the field. This review aimed to synthesise the RMT literature to identify how and to what extent engagement is defined, measured, and reported, and to present recommendations for the standardisation of future work. Seven databases (Embase, MEDLINE and PsycINFO (via Ovid), PubMed, IEEE Xplore, Web of Science, and Cochrane Central Register of Controlled Trials) were searched in July 2020 for papers using RMT apps for symptom monitoring in adults with a health condition, prompting users to track at least three times during the study period. Data were synthesised using critical interpretive synthesis. A total of 76 papers met the inclusion criteria. Sixty five percent of papers did not include a definition of engagement. Thirty five percent included both a definition and measurement of engagement. Four synthetic constructs were developed for measuring engagement: (i) engagement with the research protocol, (ii) objective RMT engagement, (iii) subjective RMT engagement, and (iv) interactions between objective and subjective RMT engagement. The field is currently impeded by incoherent measures and a lack of consideration for engagement definitions. A process for implementing the reporting of engagement in study design is presented, alongside a framework for definition and measurement options available. Future work should consider engagement with RMTs as distinct from the wider eHealth literature, and measure objective versus subjective RMT engagement.Registration: This review has been registered on PROSPERO [CRD42020192652].

"No one wants to look after the fibro patient". Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence

Fibromyalgia is a common and complex long-term pain condition. Despite advancements in our understanding and treatment of fibromyalgia, patients report patchy health care provision and frustrating journeys through the health care system. To inform how best to deliver care, we undertook 2 narrative reviews examining existing evidence on (1) models of care for fibromyalgia and (2) patients' experiences, preferences, and unmet needs regarding their health care. Seven databases were systematically searched. Quantitative data was narratively synthesised and qualitative data thematically analysed. No evidence-based model of care covering the patient journey through the entire health care system was identified. Limited evidence suggests no clear benefit for ongoing care in secondary care settings. Patients with fibromyalgia report difficult interactions with the health care system that might equally be expressed by those with other long-term conditions, such as inconsistent and poorly coordinated care. However, they also face unique problems; fibromyalgia was often not viewed as a real condition, resulting in difficult encounters with health care staff, in particular not feeling believed or listened to. Significant delays in diagnosis were commonplace. Positive care experiences such as being listened to and shared decision-making made patients feeling better informed, well supported, and more satisfied. There is little evidence to inform how best to organise health care for patients with fibromyalgia and ensure care is delivered in a coordinated and consistent way. These findings provide a strong rationale for developing a new model of care for fibromyalgia.

Methodological Quality of Manuscripts Reporting on the Usability of Mobile Applications for Pain Assessment and Management: A Systematic Review

BACKGROUND

There has been increasing use of mobile mHealth applications, including pain assessment and pain self-management apps. The usability of mHealth applications has vital importance as it affects the quality of apps. Thus, usability assessment with methodological rigor is essential to minimize errors and undesirable consequences, as well as to increase user acceptance.

OBJECTIVE

this study aimed to synthesize and evaluate existing studies on the assessment of the usability of pain-related apps using a newly developed scale.

METHODS

an electronic search was conducted in several databases, combining relevant keywords. Then titles and abstracts were screened against inclusion and exclusion criteria. The eligible studies were retrieved and independently screened for inclusion by two authors. Disagreements were resolved by discussion until consensus was reached.

RESULTS

a total of 31 articles were eligible for inclusion. Quality assessment revealed that most manuscripts did not assess usability using valid instruments or triangulation of methods of usability assessment. Most manuscripts also failed to assess the three domains of usability (effectiveness, efficiency and satisfaction).

CONCLUSIONS

future studies should consider existing guidelines on usability assessment design, development and assessment of pain-related apps.

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.

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.

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.

Acute Pain Management/Regional Anesthesia

Effective and efficient acute pain management strategies have the potential to improve medical outcomes, enhance patient satisfaction, and reduce costs. Pain management records are having an increasing influence on patient choice of health care providers and will affect future financial reimbursement. Dedicated acute pain and regional anesthesia services are invaluable in improving acute pain management. In addition, nonpharmacologic and alternative therapies, as well as information technology, should be viewed as complimentary to traditional pharmacologic treatments commonly used in the management of acute pain. The use of innovative technologies to improve acute pain management may be worthwhile for health care institutions.