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Jackson AN, Sandhu R, Finlayson M. Perspectives on and use of assistive technology by persons with MS: a scoping review. Disabil Rehabil Assist Technol 2024:1-17. [PMID: 39066674 DOI: 10.1080/17483107.2024.2385052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/05/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
Assistive technology (AT) provides persons with Multiple Sclerosis (PwMS) ability to engage in daily activities, however acquiring AT can be challenging. Understanding current state of knowledge about perspectives and use of AT by PwMS may support critical thinking about AT acquisition process. The aim of this scoping review was to map what is known about AT use by PwMS, to identify gaps in knowledge to guide future research and practice for AT matching. A scoping review of qualitative research on perspectives and use of AT by PwMS searched four databases (Medline, CINAHL, PsychNet, and Engineering Village). Papers included focused on non-institutional settings, addressed participant's feelings/perceptions/experiences, and were in English. Initial search October 2021, updated 2022 and 2023. Two reviewers conducted screening, review, and extraction, with a third resolving disagreements. Data extraction guided by the Canadian Model of Occupational Performance and Engagement, categorised AT use by productivity, self-care, and/or leisure occupations. Covidence® was used for extraction. Findings were exported into a spreadsheet to facilitate thematic analysis. Search identified 22 peer-reviewed journals and 11 consumer publications (n = 33). Most common AT was mobility devices. Primary purposes were self-care and leisure. Common use included functional mobility, transportation, personal care, household management, recreation, and socialisation. Perceptions focused on AT need, adjusting to AT, influencing factors, performance and engagement improvements, and seeking acquisition advice. Lack of research on experiences and use of AT beyond mobility equipment, and for engagement of daily activities. Evidence provides some insights for future directions and implications to support AT acquisition for PwMS.
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Affiliation(s)
- Alexandra N Jackson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Rebekah Sandhu
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
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Reid K, Beswick E, Tam J, Symonds A, Lyle D, Newton J, Perry D, Neale J, Chandran S, Pal S. Perceptions of digital technology use for monitoring health in people living with neurological disorders. J Neurol Sci 2024; 462:123072. [PMID: 38885541 DOI: 10.1016/j.jns.2024.123072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Digital technology offers individuals the opportunity to monitor their symptoms. Information gathered from apps, devices, and web platforms may be used to direct clinical care and to support research. AIM Using this survey, we aim to explore the views of people attending the Anne Rowling Regenerative Neurology Clinic (ARRNC) and their relatives/caregivers regarding the use of digital health technologies to monitor health. METHOD People attending the ARRNC were invited to complete a structured 18-item questionnaire evaluating their experience and attitudes to using technology for monitoring health. People with neurodegenerative disease (pwND) and their caregivers completed a mix of closed and open-ended questions. RESULTS 249 people responded, 51 relatives/caregivers and 198 pwND. 67.1% (n= 167) of respondents do not use technology for monitoring their health, but 98.2% (n = 164) of these are interested in their future use. 29.7% (n = 74) respondents currently use a smartphone for health monitoring, 20.9% (n = 52) use a wearable device, and 13.3% (n = 33) use a tablet. 79.3% (n = 65) of users use their technology for monitoring physical activity, 37.8% (n = 31) use it for assisting with self-management, and 41.5% (n = 34) use it for tracking sleep. Factors which would encourage use of technology are ease of access to devices and ability to monitor health. Respondents reported data security concerns and difficulty using technology as potential barriers. CONCLUSION People attending a neurology clinic, and their relatives/caregivers, support the use of digital technologies as an adjunct to routine care. There is a need for coordinated digital strategies for development and delivery of validated measures.
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Affiliation(s)
- Katie Reid
- The College of Medicine and Vet Medicine, University of Edinburgh, United Kingdom
| | - Emily Beswick
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Euan MacDonald Centre for MND Research University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Johnny Tam
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Euan MacDonald Centre for MND Research University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Alexander Symonds
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Dawn Lyle
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Euan MacDonald Centre for MND Research University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Judy Newton
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Euan MacDonald Centre for MND Research University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - David Perry
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Jonathan Neale
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Euan MacDonald Centre for MND Research University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; United Kingdom Dementia Research Institute, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Suvankar Pal
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Euan MacDonald Centre for MND Research University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
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Jesus VEAD, Ribeiro MDCR, Lana RDC, Schaper FC, Amaral JMSDS, Azevedo SG, Vieira RGK, Aguiar LT. The telephone-based application of the modified fatigue impact scale in individuals with multiple sclerosis: An investigation of measurement properties. Mult Scler Relat Disord 2024; 87:105674. [PMID: 38735203 DOI: 10.1016/j.msard.2024.105674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 12/08/2023] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Fatigue is one of the most common symptoms reported by individuals with multiple sclerosis and it contributes to the reduction of the functionality. Therefore, it is important to assess the impact of fatigue on daily living of individuals with multiple sclerosis. The Modified Fatigue Impact Scale (MFIS) is an instrument to assess the perception of the impact of fatigue. However, there have been no investigations about the measurement properties of this instrument administered over the telephone for individuals with multiple sclerosis. OBJECTIVES To verify the concurrent validity, the test-retest reliability, the standard error of measurement (SEM) and the minimal detectable change (MDC) of the MFIS applied over the telephone to assess the perception of the impact of fatigue of individuals with multiple sclerosis. METHODS The MFIS, composed of 21 items covering three domains: physical, cognitive and psychosocial, was applied at three different moments with an interval of 5-7 days. To establish the concurrent criterion validity, the face-to-face application and the first evaluation by telephone were used. The two telephone assessments were used to assess the test-retest reliability The intraclass correlation coefficient (ICC) with 95 % confidence interval (CI) and the Bland-Altman method were used. The standard error of measurement (SEM) and the MDC was calculated according to reliability results. RESULTS Thirty individuals (40.83 ± 10.61, 60 % female) were included. The median score on the Expanded Disability Status Scale was 2.00 (±4.00). The majority of participants experienced fatigue (n = 17; 56.67 %). A significant and high magnitude correlation (0.70 ≤ ICC ≤ 0.87, p < 0.001) was found in the investigation of concurrent criterion validity. The Bland-Altman method showed a mean difference between 0.70 to 2.17 points between face-to-face and telephone-based application of the MFIS. For test-retest reliability, a significant and very high magnitude correlation (0.91 ≤ ICC ≤ 0.97, p < 0.001) was found. The Bland-Altman method showed a mean difference between -0.03 and -0.77 points between two telephone-based applications. The SEM and the MDC were 0.71 and 1.97 points. CONCLUSION The telephone-based application of the MFIS to assess the perceived impact of fatigue in individuals with multiple sclerosis demonstrated adequate measurement properties, and may be a valuable tool to assess patients in clinical practice.
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Vacchi L, Zirone E, Strina V, Cavaletti G, Ferrarese C. Mobile Applications to Support Multiple Sclerosis Communities: The Post-COVID-19 Scenario. Telemed J E Health 2024; 30:e1615-e1628. [PMID: 38452336 DOI: 10.1089/tmj.2023.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Introduction: The increase in the use of mobile apps since the COVID-19 pandemic, even among people with multiple sclerosis (PwMS) and health care providers (HCPs), has enabled access to reliable information, symptoms monitoring and management, and social connections. The pandemic has undoubtedly contributed to the acceleration of the "digital revolution." But how far has it progressed for the MS communities? Methods: Italian Google Play and App Store were queried, selecting MS-specific apps in English or Italian language and usable by a wide public. Results: Fifty-four (n = 54) MS-specific apps were identified; most were PwMS-oriented (83%), free of charge (94%), and in English language (76%). The 45 PwMS-oriented apps focused on increasing MS knowledge (71%), tracking symptoms (33%), and promoting networking with peers or HCPs (38%). The 13 HCPs-oriented tools addressed education and updates on MS (62%), disease assessment and management (54%), and research (15%). Google Search tool was also queried to find non-MS-specific apps to fulfill some unmet domains (as sleep, pain, sexual or mental health). Twenty-four additional apps were listed to provide a valuable contribution. Conclusion: The "digital revolution" led to increasingly customized tools for PwMS, especially as m-health or social-networking apps. However, apps to support other specific MS-relevant domains, appealing HCPs-oriented apps, and specific mobile tools for MS caregivers are still lacking. The absence of data assessing the usability and quality of MS apps in ecologically contexts leads to not reliable conclusions about potential benefits. A strong dialogue between MS communities and the digital industry is encouraged to fill this gap.
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Affiliation(s)
- Laura Vacchi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
| | - Eleonora Zirone
- Department of Neuroscience and Mental Health, Neurophysiopathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Strina
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
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Grijalvo M, Ordieres-Meré J, Villalba-Díez J, Aladro-Benito Y, Martín-Ávila G, Simon-Hurtado A, Vivaracho-Pascual C. Sufficiency for PSS tracking gait disorders in multiple sclerosis: A managerial perspective. Heliyon 2024; 10:e30001. [PMID: 38707444 PMCID: PMC11066638 DOI: 10.1016/j.heliyon.2024.e30001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
This study primarily aimed to explore the capabilities of digitalisation in the healthcare context, focusing on a specific disease. In this case, the study examined the potential of remote monitoring of gait to address the sensitivity of multiple sclerosis progression to gait characteristics by adopting a non-invasive approach to remotely quantify gait disturbances in a patient's daily life. To better understand the managerial aspects associated with this approach, the researchers conducted a literature review along with a set of semi-structured interviews. The target population included MS patients as well as the key agents involved in their care: patients' family members, neurologists, MS nurses, physiotherapists, medical directors, and pharmacist. The study identifies the perceived barriers and drivers that could contribute to the successful deployment of PSS remote gait monitoring as a healthcare service: i) At mega-level governance. Implications on privacy and security data are notable barriers missing on the speech. ii) At macro level, funding is highlighted as main barrier. The cost and lack of health system subsidies may render initiatives unsustainable, as emphasised by the interviewees. iii) At meso level, useable data is recognised as a driver. The data collection process can align with diverse interests to create value and business opportunities for the ecosystem actors, enhance care, attract stakeholders, such as insurers and pharma, and form partnerships. iv) At micro-level processes, we find two potential barriers: wearable device and app usability (comfort, navigation, efficiency) and organisational/behavioural aspects (training, digital affinity, skills), which are crucial for value creation in innovation ecosystems among patients and healthcare professionals. Finally, we find an interesting gap in the literature and interviews. Stakeholders' limited awareness of technological demands, especially from information technologies, for a successful long-term service, can be consider two key barriers for PSS.
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Affiliation(s)
- Mercedes Grijalvo
- Department of Organizational Engineering, Business Administration and Statistics, Universidad Politécnica de Madrid, Madrid, Spain
| | - Joaquín Ordieres-Meré
- Department of Organizational Engineering, Business Administration and Statistics, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Yolanda Aladro-Benito
- Department of Neurology, Getafe University Hospital, Madrid, Spain
- Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | | | - Arancha Simon-Hurtado
- Departamento de Informática, Escuela de Ingeniería Informática de Valladolid, Universidad de Valladolid, Paseo de Belén 15, 47011, Valladolid, Spain
| | - Carlos Vivaracho-Pascual
- Departamento de Informática, Escuela de Ingeniería Informática de Valladolid, Universidad de Valladolid, Paseo de Belén 15, 47011, Valladolid, Spain
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Lu Z, Signer T, Sylvester R, Gonzenbach R, von Wyl V, Haag C. Implementation of Remote Activity Sensing to Support a Rehabilitation Aftercare Program: Observational Mixed Methods Study With Patients and Health Care Professionals. JMIR Mhealth Uhealth 2023; 11:e50729. [PMID: 38064263 PMCID: PMC10746974 DOI: 10.2196/50729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physical activity is central to maintaining the quality of life for patients with complex chronic conditions and is thus at the core of neurorehabilitation. However, maintaining activity improvements in daily life is challenging. The novel Stay With It program aims to promote physical activity after neurorehabilitation by cultivating self-monitoring skills and habits. OBJECTIVE We examined the implementation of the Stay With It program at the Valens Rehabilitation Centre in Switzerland using the normalization process theory framework, focusing on 3 research aims. We aimed to examine the challenges and facilitators of program implementation from the perspectives of patients and health care professionals. We aimed to evaluate the potential of activity sensors to support program implementation and patient acceptance. Finally, we aimed to evaluate patients' engagement in physical activity after rehabilitation, patients' self-reported achievement of home activity goals, and factors influencing physical activity. METHODS Patients were enrolled if they had a disease that was either chronic or at risk for chronicity and participated in the Stay With It program. Patients were assessed at baseline, the end of rehabilitation, and a 3-month follow-up. The health care professionals designated to deliver the program were surveyed before and after program implementation. We used a mixed methods approach combining standardized questionnaires, activity-sensing data (patients only), and free-text questions. RESULTS This study included 23 patients and 13 health care professionals. The diverse needs of patients and organizational hurdles were major challenges to program implementation. Patients' intrinsic motivation and health care professionals' commitment to refining the program emerged as key facilitators. Both groups recognized the value of activity sensors in supporting program implementation and sustainability. Although patients appreciated the sensor's ability to monitor, motivate, and quantify activity, health care professionals saw the sensor as a motivational tool but expressed concerns about technical difficulties and potential inaccuracies. Physical activity levels after patients returned home varied considerably, both within and between individuals. The self-reported achievement of activity goals at home also varied, in part because of vague definitions. Common barriers to maintaining activity at home were declining health and fatigue often resulting from heat and pain. At the 3-month follow-up, 35% (8/23) of the patients withdrew from the study, with most citing deteriorating physical health as the reason and that monitoring and discussing their low activity would negatively affect their mental health. CONCLUSIONS Integrating aftercare programs like Stay With It into routine care is vital for maintaining physical activity postrehabilitation. Although activity trackers show promise in promoting motivation through monitoring, they may lead to frustration during health declines. Their acceptability may also be influenced by an individual's health status, habits, and technical skills. Our study highlights the importance of considering health care professionals' perspectives when integrating new interventions into routine care.
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Affiliation(s)
- Ziyuan Lu
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Tabea Signer
- Valens Rehabilitation Centre, Valens, Switzerland
| | | | | | - Viktor von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Jonsdottir J, Santoyo-Medina C, Kahraman T, Kalron A, Rasova K, Moumdjian L, Coote S, Tacchino A, Grange E, Smedal T, Arntzen EC, Learmonth Y, Pedulla L, Quinn G, Kos D. Changes in physiotherapy services and use of technology for people with multiple sclerosis during the COVID-19 pandemic. Mult Scler Relat Disord 2023; 71:104520. [PMID: 36724646 DOI: 10.1016/j.msard.2023.104520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to reorganization or reduction of neurorehabilitation services for people with multiple sclerosis (PwMS). The aim of this study was to explore the changes in the organizational framework and technology usage in physiotherapy services for PwMS during the COVID-19 pandemic. METHODS This international cross-sectional survey study was designed, developed, and disseminated by RIMS European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation. Physiotherapists from nine countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, Turkey) who provided physiotherapy services to PwMS, were invited to complete an online survey to compare physiotherapy delivery to PwMS prior to and during the pandemic period. RESULTS The survey was completed by 215 physiotherapists. Accessibility, the average number, length and perceived effectiveness of physiotherapy sessions provided to PwMS were significantly reduced during the COVID-19 pandemic (p=0.001). Physiotherapists increased the advice of mobile apps, recorded videos for rehabilitation and exercise websites during the pandemic (p<0.001) while the use of telerehabilitation and virtual reality technology did not change. CONCLUSION There was of a reduction in the number, duration and perceived effectiveness of rehabilitation sessions for people with multiple sclerosis during the COVID-19 pandemic while use of remote technologies for physiotherapy did not change. To ensure the continuity of physiotherapy for PwMS with complex healthcare needs also during pandemics, the provision of guidelines and training in telehealth technologies in professional education becomes crucial.
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Affiliation(s)
| | - Carme Santoyo-Medina
- Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain; Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/ Josep Trueta sn, 08195 Sant Cugat del Vallès, Barcelona, Spain.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lousin Moumdjian
- UMSC Hasselt, Pelt, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; IPEM Institute of Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium.
| | - Susan Coote
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland; Multiple Sclerosis Society of Ireland and Physical Activity for Health Research Centre, Ireland.
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy.
| | - Erica Grange
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - Tori Smedal
- Department of Physiotherapy, Haukeland University Hospital, Helse Bergen, Bergen, Norway,; Department of Neurology, Multiple Sclerosis Competence Centre, Haukeland University Hospital, Helse Bergen, Bergen, Norway.
| | | | - Yvonne Learmonth
- Discipline of Exercise Science, Murdoch University, Murdoch, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Australia; Perron Institute for Neurological and Translational Science, Nedlands, Australia.
| | - Ludovico Pedulla
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
| | - Gillian Quinn
- Physiotherapy Department, St. James's Hospital, Dublin, Ireland
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Leuven 1501-3001, Belgium; National MS Center, Melsbroek, Belgium.
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Salimzadeh Z, Damanabi S, Ferdousi R, Shaafi S, Kalankesh LR. A mobile app (IDoThis) for multiple sclerosis self-management: development and initial evaluation. BMC Med Inform Decis Mak 2022; 22:328. [PMID: 36514043 PMCID: PMC9745928 DOI: 10.1186/s12911-022-02078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most common neurological disorders worldwide, and self-management is considered an essential dimension in its control. This study aimed to develop an evidence-based mobile application for MS self-management and evaluate it. METHODS This study was undertaken in three phases: content preparation, design, and evaluation. In the content preparation phase, the researchers extracted MS self-management needs based on related guidelines and guides, existing apps on the self-management of MS, and the field experts' views and confirmation. The design phase was conducted in five steps: defining app functionalities, depicting the wireframe, preparing the media, coding the app, and testing the app's performance. The app was developed using the Android Studio environment and Java programming language for the Android operating system. The performance of the developed app was tested separately in several turns, and existing defects were corrected in each turn. Finally, after using the app for three weeks, the app was evaluated for its short-term impact on MS management and user-friendliness using a researcher-constructed questionnaire from participants' (N = 20) perspectives. RESULTS The IDoThis app is an offline app for people with MS that includes five main modules: three modules for training or informing users about different aspects of MS, one module for monitoring the user's MS condition, and a reporting module. In the initial evaluation of the app, 75% (n = 15) of participants mentioned that using this app improved MS self-management status at intermediate and higher levels, but 25% (n = 5) of the participants mentioned that the effect of using the app on the self-management tasks was low or was very low. The majority of users rated the user-friendliness of the app as high. The users found the sections "exercises in MS" and "monitoring of MS status" beneficial to their self-management. Still, the fatigue and sleep management sections are needed to meet users' expectations. CONCLUSION Using IDoThis app as a self-management tool for individuals with MS appears feasible, that can meet the need for a free and accessible self-management tool for individuals with MS. Future directions should consider the users' fatigue and sleep management expectations.
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Affiliation(s)
- Zeinab Salimzadeh
- grid.412888.f0000 0001 2174 8913Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran
| | - Shahla Damanabi
- grid.412888.f0000 0001 2174 8913Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran
| | - Reza Ferdousi
- grid.412888.f0000 0001 2174 8913Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran
| | - Sheida Shaafi
- grid.412888.f0000 0001 2174 8913Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila R. Kalankesh
- grid.412888.f0000 0001 2174 8913Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Health Care Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Research Center of Psychiatry and Behavioural Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Nikniaz L, Tabrizi JS, Farhangi MA, Pourmoradian S, Allameh M, Hoseinifard H, Tahmasebi S, Nikniaz Z. Community-Based Interventions to Reduce Fat Intake in Healthy Populations: A Systematic Review and Meta-Analysis. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401318666220308125105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Reducing fat intake is a major focus of most dietary recommendations aiming to prevent chronic diseases. Thus, this study aimed to summarize community-based interventions for reducing fat consumption among healthy people.
Methods:
According to PRISMA guidelines, in this systematic review and meta-analysis databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched up to January 2021. Randomized clinical trials (RCTs) or quasi-experimental studies reporting the effect of community-based interventions to reduce fat intake in a healthy populations were included. The quality of studies was assessed using the Cochrane Collaboration tool and The Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was performed using CMA2 software.
Results:
Our search strategy resulted in a total of 1,621 articles, 43 of which were included in the study after screening. Of the 43 included studies, 35 studies reported a significant decrease in fat intake using educational and multiple intervention methods. About 82% of studies using the technology were effective (significant decrease in fat intake) in reducing fat intake. Moreover, studies specifically designed to change fat intake were more effective than multicomponent interventions. The meta-analysis of high-quality studies showed that the differences in total fat (-0.262 g/d) and saturated fat (-0.350 g/d) intake between the intervention and control groups were statistically significant (P<0.05).
Conclusion:
Based on the high-quality studies, educational and multiple interventions are suggested in the community settings to decrease fat intake. For a concise conclusions, long-term and high frequency interventions focusing on reducing fat intake are desirable.
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Affiliation(s)
- Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Samira Pourmoradian
- Nutrition research center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Motahareh Allameh
- Adolescent, Youth and Schools Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Hosein Hoseinifard
- MSc in biostatistics, Iranian Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Tahmasebi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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10
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Knox L, McDermott C, Hobson E. Telehealth in long-term neurological conditions: the potential, the challenges and the key recommendations. J Med Eng Technol 2022; 46:506-517. [PMID: 35212580 DOI: 10.1080/03091902.2022.2040625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Long-term neurological conditions (LTNCs) cause physical and psychological symptoms that have a significant impact on activities of daily living and quality of life. Multidisciplinary teams are effective at providing treatment for people with LTNCs; however, access to such services by people with disabilities can be difficult and as a result, good quality care is not universal. One potential solution is telehealth. This review describes the potential of telehealth to support people with LTNCs, the challenges of designing and implementing these systems, and the key recommendations for those involved in telehealth to facilitate connected services that can benefit patients, carers and healthcare professionals. These recommendations include understanding the problems posed by LTNCs and the needs of the end-user through a person-centred approach. We discuss how to work collaboratively and use shared learning, and consider how to effectively evaluate the intervention at every stage of the development process.
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Affiliation(s)
- Liam Knox
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Christopher McDermott
- Department of Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neuroscience, Sheffield Teaching Hospitals, Sheffield, UK
| | - Esther Hobson
- Department of Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neuroscience, Sheffield Teaching Hospitals, Sheffield, UK
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11
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Damanabi S, Salimzadeh Z, Kalankesh LR, Shaafi S, Ferdousi R. Exploring Self-management Needs of Persons With Multiple Sclerosis: A Qualitative Study for Mobile Application Development. Int J MS Care 2022; 24:1-7. [PMID: 35261564 PMCID: PMC8883810 DOI: 10.7224/1537-2073.2019-129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a common cause of neurologic disability in young adults. Individuals with MS deal with the day-to-day effects of the disease on their lives. Self-management can help with these challenges. This study aimed to explore MS self-management needs according to experiences of persons with MS and was conducted as part of a research project to develop an MS self-management mobile application. METHODS We used a qualitative method to elicit self-management needs among 12 individuals with MS and conducted semistructured interviews with them. The participants were chosen based on snowball sampling. The interviews were recorded and transcribed verbatim. Finally, qualitative data were analyzed using a content analysis method (inductive way) to identify the underlying themes and subthemes. RESULTS The analysis resulted in the emergence of 7 themes: the source of information, basic needs, understanding MS, physical exercises in MS, useful nutrition in MS, MS monitoring, and communication. Within these 7 themes we identified 23 subthemes. CONCLUSIONS The themes that emerged in this study show what needs are essential to help persons with MS improve their self-management capacity. These findings can help in the development of self-management mobile applications for supporting individuals in managing MS.
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Affiliation(s)
- Shahla Damanabi
- From the Department of Health Information Technology, School of Management and Medical Informatics (SD, ZS, LRK, RF), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Salimzadeh
- From the Department of Health Information Technology, School of Management and Medical Informatics (SD, ZS, LRK, RF), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila R. Kalankesh
- From the Department of Health Information Technology, School of Management and Medical Informatics (SD, ZS, LRK, RF), Tabriz University of Medical Sciences, Tabriz, Iran
- Health Care Services Management Research Center (LRK), Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center of Psychiatry and Behavioural Sciences (LRK), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sheida Shaafi
- From the Department of Health Information Technology, School of Management and Medical Informatics (SD, ZS, LRK, RF), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ferdousi
- Department of Neurology (SS), Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Barrios L, Amon R, Oldrati P, Hilty M, Holz C, Lutterotti A. Cognitive fatigability assessment test (cFAST): Development of a new instrument to assess cognitive fatigability and pilot study on its association to perceived fatigue in multiple sclerosis. Digit Health 2022; 8:20552076221117740. [PMID: 36046638 PMCID: PMC9421030 DOI: 10.1177/20552076221117740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Fatigue is a common symptom of many diseases, including multiple sclerosis. It manifests as a cognitive or physical condition. Fatigue is poorly understood, and effective therapies are missing. Furthermore, there is a lack of methods to measure fatigue objectively. Fatigability, the measurable decline in performance during a task, has been suggested as a complementary method to quantify fatigue. Objective To develop a new and objective measurement of cognitive fatigability and investigate its association with perceived fatigue. Methods We introduced the cognitive fatigability assessment test (cFAST), a novel smartphone-based test to quantify cognitive fatigability. Forty-two people with multiple sclerosis (23 fatigued and 19 non-fatigued, defined by the Fatigue Scale for Motor and Cognitive Functions) took part in our validation study. Patients completed cFAST twice. We used t-tests, Monte Carlo sampling, and area under the receiver operating characteristic curves to evaluate our approach using two sets of proposed metrics. Results When classifying fatigue, our fatigability metric Δresponse time has a mean area under the receiver operating characteristic curve of 0.74 (95% CI 0.64–0.84), making it the best performing metric for this task. Furthermore, Δresponse time shows a statistically significant difference between the fatigued and non-fatigued groups (t = 2.27, P = .03). Particularly, cognitively-fatigued patients decline in performance, while non-fatigued patients do not. Conclusions We introduce cFAST, a new instrument to quantify cognitive fatigability. Our pilot study provides evidence that cognitive fatigability assessment test produces a quantifiable drop in cognitive performance in a short period. Furthermore, our results indicate that cFAST may have the potential to serve as a surrogate for subjective cognitive fatigue. cFAST is significantly shorter than the existing fatigability assessments and does not require specialized equipment. Thus, it could enable frequent and remote monitoring, which could substantially aid clinicians in better understanding and treating fatigue.
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Affiliation(s)
- Liliana Barrios
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Rok Amon
- University Hospital of Zurich, Zurich, Switzerland
| | - Pietro Oldrati
- University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Marc Hilty
- University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christian Holz
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Andreas Lutterotti
- University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Neurozentrum Bellevue and Department of Neurology Hirslanden, Zurich, Switzerland
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13
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Thomas S, Pulman A, Dogan H, Jiang N, Passmore D, Pretty K, Fairbanks B, Davies Smith A, Thomas PW. Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study. JMIR Form Res 2021; 5:e19230. [PMID: 34889744 PMCID: PMC8704114 DOI: 10.2196/19230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/29/2020] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages. Methods Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue.
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Affiliation(s)
- Sarah Thomas
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Andy Pulman
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Huseyin Dogan
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Nan Jiang
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - David Passmore
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Keith Pretty
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Beth Fairbanks
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Angela Davies Smith
- Bristol & Avon Multiple Sclerosis Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Peter W Thomas
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
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14
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Personalizing Medicine and Technologies to Address the Experiences and Needs of People with Multiple Sclerosis. J Pers Med 2021; 11:jpm11080791. [PMID: 34442434 PMCID: PMC8401762 DOI: 10.3390/jpm11080791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 01/23/2023] Open
Abstract
There is enormous variation in the manifestations of disease experienced by people with multiple sclerosis (PwMS). While this variation makes personalized medicine an attractive goal, there are many challenges to be overcome before this opportunity can be realized. Personalized medicine often focuses on targeted therapies and detailed monitoring, but we also need to recognize that there will be variation in acceptance of these approaches by different PwMS. In other words, deep personalization of medicine will encompass targeted therapy, precision monitoring, tailored to variation in personal attitudes to these transformations in health care. In order to meet the promise of personalized medicine for MS, understanding the experiences of PwMS is necessary both to aid in the uptake of personalized medicine, and to ensure that personalized approaches to monitoring disease and treatment provide a net benefit to PwMS rather than placing additional burdens and stressors on them. Here, we describe recent research that identified five experiential themes for PwMS, and then interpret these themes according to the foundations of personalized medicine to provide a road map for implementation of personalized medicine solutions for PwMS.
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15
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Gromisch ES, Turner AP, Haselkorn JK, Lo AC, Agresta T. Mobile health (mHealth) usage, barriers, and technological considerations in persons with multiple sclerosis: a literature review. JAMIA Open 2021; 4:ooaa067. [PMID: 34514349 PMCID: PMC8423420 DOI: 10.1093/jamiaopen/ooaa067] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Persons with multiple sclerosis (MS) can face a number of potential healthcare-related barriers, for which mobile health (mHealth) technology can be potentially beneficial. This review aimed to understand the frequency, current uses, and potential barriers with mHealth usage among persons with MS. METHODS A query string was used to identify articles on PubMed, MEDLINE, CINAHL, and IEEE Xplore that were published in English between January 2010 and December 2019. Abstracts were reviewed and selected based on a priori inclusion and exclusion criteria. Fifty-nine peer-reviewed research studies related to the study questions are summarized. RESULTS The majority of persons with MS were reported as using smartphones, although rates of mHealth utilization varied widely. mHealth usage was grouped into 3 broad categories: (1) disability and symptom measurement; (2) interventions and symptom management; and (3) tracking and promoting adherence. While there have been an increasing number of mHealth options, certain limitations associated with MS (eg, poor dexterity, memory problems) may affect usage, although including persons with MS in the design process can address some of these issues. DISCUSSION Given the increased attention to mHealth in this population and the current need for telehealth and at home devices, it is important that persons with MS and healthcare providers are involved in the development of new mHealth tools to ensure that the end product meets their needs. Considerations for addressing the potential mHealth use barriers in persons with MS are discussed.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Aaron P Turner
- Multiple Sclerosis Center for Excellence West, Veterans Affairs, Seattle, Washington, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitative Medicine, University of Washington, Seattle, Washington, USA
| | - Jodie K Haselkorn
- Multiple Sclerosis Center for Excellence West, Veterans Affairs, Seattle, Washington, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitative Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Albert C Lo
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
| | - Thomas Agresta
- Department of Family Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Center for Quantitative Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
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16
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Bevens W, Gray K, Neate SL, Nag N, Weiland TJ, Jelinek GA, Simpson-Yap S. Characteristics of mHealth app use in an international sample of people with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103092. [PMID: 34246024 DOI: 10.1016/j.msard.2021.103092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
The management of multiple sclerosis (MS) has progressed significantly with the emergence of mHealth technologies. Uptake of mHealth apps amongst people with MS, and clinical and demographic characteristics of mHealth adopters is unknown outside North America. Participants of the HOLISM study were queried about their mHealth apps use. We summarize mHealth app usage, and clinical and demographic characteristics of mHealth app adopters using descriptive statistics. Overall, 3.1% of respondents reported using an mHealth app, most of whom were located in Australasia and North America. This study provides insight regarding mHealth app usage within a large international cohort of people with MS.
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Affiliation(s)
- W Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - K Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Australia
| | - S L Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - T J Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - G A Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia
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17
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A Smartphone-based Application for Self-Management in Multiple Sclerosis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6749951. [PMID: 34221301 PMCID: PMC8225446 DOI: 10.1155/2021/6749951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022]
Abstract
Background Multiple sclerosis (MS) is a chronic inflammation of the central nervous system and self-management is necessary for MS patients. The purpose of the present study was to develop a smartphone-based application for self-management in multiple sclerosis. Methods This research was conducted in two phases. In the first phase, users' requirements were investigated by using a questionnaire. The participants were 120 MS patients and six neurologists. In the second phase, a prototype of the application was designed and its usability was evaluated by using QUIS questionnaire. Results Most of the proposed educational content, data elements, and the application functions, such as medication time reminder, assessing the severity of fatigue, and calculating the score of the Fatigue Severity Scale were found necessary to be included in the application. Finally, the usability of the application was evaluated by the users and the average of mean values was 7.6 out of 9 which indicated a “good” level of user satisfaction. Conclusions The application designed in this study was able to collect patient data and facilitated consulting physicians at the point of need. It is expected that the patients' quality of life and health status can be improved by using this application. However, more research is required to investigate the efficiency and effectiveness of this application in terms of reducing the number of visits to the medical centers, improving self-management skills of MS patients and their quality of life.
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18
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A Mobile App to Optimize Social Participation for Individuals with Physical Disabilities: Content Validation and Usability Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041753. [PMID: 33670222 PMCID: PMC7916924 DOI: 10.3390/ijerph18041753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/23/2022]
Abstract
Background: Social participation is beneficial for individuals’ health. However, people with disabilities that may lead to mobility limitations tend to experience lower levels of social participation. Information and communication technologies such as the OnRoule mobile application (app) can help promote social participation. Objectives: To obtain potential users’ perceptions on the usability and content of the OnRoule app for providing information on accessibility, as well as its potential to optimize social participation. Materials and Methods: Cross-sectional user-centered design study. Individuals with physical disabilities (n = 18) were recruited through community organizations and interviewed using a semi-structured guide. Interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Three main themes were identified: (1) “user-friendliness”; (2) “balance between the amount and relevance of information”; and (3) “potential use of the app”. Discussion and Conclusion: Findings from this study indicated that the app was easy to use, had pertinent information, and enabled a positive experience of finding information. However, several areas of improvement were identified, such as the clarity of specific elements, organization and amount of information, optimization of features, and inclusiveness. Apps such as OnRoule could optimize social participation by facilitating the process of finding resources in the community and building a sense of connectedness between users.
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19
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Design considerations for a multiple sclerosis fatigue mobile app MS Energize: A pragmatic iterative approach using usability testing and resonance checks. Internet Interv 2021; 24:100371. [PMID: 33614414 PMCID: PMC7878181 DOI: 10.1016/j.invent.2021.100371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/21/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological condition affecting around 2.2 million people worldwide. The illness includes a range of symptoms, with fatigue considered to be one of the most disabling. This paper describes how a pragmatic and iterative approach, supported by usability and resonance testing, was used to build a minimum viable product of MS Energize-or MS Energise in UK English regions. MS Energise is a mobile application focused on self-management of fatigue for people with MS. The iterative approach included various stages of testing, during which user feedback including comments about interface, navigation and content, was sought to inform incremental app development and continual improvement. Usability testing was conducted with 11 people with longstanding multiple sclerosis in New Zealand and the United Kingdom, and focused on particular sections of the app as well as the accessibility of the app to users with MS. Two participants contributed to further resonance testing post-release to ensure the app was perceived as relevant and useful to the user. The usability testing and resonance testing phases suggested that user experience of MS Energise was mostly positive. Participants provided a number of suggestions for improvements to aspects of content and design; some of which we implemented during our app development process. Findings will also contribute to future planning and design iteration to enhance the user experience. The next step is further improvement of MS Energise prior to a trial of its clinical and cost effectiveness.
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20
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Lam KH, Meijer KA, Loonstra FC, Coerver E, Twose J, Redeman E, Moraal B, Barkhof F, de Groot V, Uitdehaag B, Killestein J. Real-world keystroke dynamics are a potentially valid biomarker for clinical disability in multiple sclerosis. Mult Scler 2020; 27:1421-1431. [PMID: 33150823 PMCID: PMC8358561 DOI: 10.1177/1352458520968797] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Clinical measures in multiple sclerosis (MS) face limitations that may be overcome by utilising smartphone keyboard interactions acquired continuously and remotely during regular typing. Objective: The aim of this study was to determine the reliability and validity of keystroke dynamics to assess clinical aspects of MS. Methods: In total, 102 MS patients and 24 controls were included in this observational study. Keyboard interactions were obtained with the Neurokeys keyboard app. Eight timing-related keystroke features were assessed for reliability with intraclass correlation coefficients (ICCs); construct validity by analysing group differences (in fatigue, gadolinium-enhancing lesions on magnetic resonance imaging (MRI), and patients vs controls); and concurrent validity by correlating with disability measures. Results: Reliability was moderate in two (ICC = 0.601 and 0.742) and good to excellent in the remaining six features (ICC = 0.760–0.965). Patients had significantly higher keystroke latencies than controls. Latency between key presses correlated the highest with Expanded Disability Status Scale (r = 0.407) and latency between key releases with Nine-Hole Peg Test and Symbol Digit Modalities Test (ρ = 0.503 and r = −0.553, respectively), ps < 0.001. Conclusion: Keystroke dynamics were reliable, distinguished patients and controls, and were associated with clinical disability measures. Consequently, keystroke dynamics are a promising valid surrogate marker for clinical disability in MS.
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Affiliation(s)
- K H Lam
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - K A Meijer
- Neurocast B.V., Amsterdam, The Netherlands
| | - F C Loonstra
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Eme Coerver
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - J Twose
- Neurocast B.V., Amsterdam, The Netherlands
| | - E Redeman
- Neurocast B.V., Amsterdam, The Netherlands
| | - B Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - F Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands/Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bmj Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
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21
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Patel NA, Alagappan PN, Pan C, Karth P. A mobile vision testing application based on dynamic distance determination from the human corneal limbus. Health Informatics J 2020; 26:3037-3055. [PMID: 32993413 DOI: 10.1177/1460458220958537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Here we present a mobile application that accurately determines the distance between an optical sensor and the human corneal limbus for visual acuity assessment. The application uses digital image processing and randomized circle detection to locate the cornea. Then, a reference scaling measurement is employed to calculate distance from the sensor to a user. To determine accuracy and generalizability, testing was conducted both with 200 static images, 25 images each of males and females for four ethnic groups from a facial image database, and live image streams from a test subject. Average absolute corneal radius error over 10 trials for the static images was 6.36%, while average absolute distance error for the live image streams was less than 1%. Subsequently, distance measurements were used to scale letter sizes for a Snellen Chart-based visual acuity assessment. This system enables monitoring of chronic retinal diseases, as patients can quickly and accurately measure their visual acuity through the mobile eye exam suite.
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22
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Agher D, Sedki K, Tsopra R, Despres S, Jaulent MC. Influence of Connected Health Interventions for Adherence to Cardiovascular Disease Prevention: A Scoping Review. Appl Clin Inform 2020; 11:544-555. [PMID: 32814353 DOI: 10.1055/s-0040-1715649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Recent health care developments include connected health interventions to improve chronic disease management and/or promote actions reducing aggravating risk factors for conditions such as cardiovascular diseases. Adherence is one of the main challenges for ensuring the correct use of connected health interventions over time. OBJECTIVE This scoping review deals with the connected health interventions used in interventional studies, describing the ways in which these interventions and their functions effectively help patients to deal with cardiovascular risk factors over time, in their own environments. The objective is to acquire knowledge and highlight current trends in this field, which is currently both productive and immature. METHODS A structured literature review was constructed from Medline-indexed journals in PubMed. We established inclusion criteria relating to three dimensions (cardiovascular risk factors, connected health interventions, and level of adherence). Our initial search yielded 98 articles; 78 were retained after screening on the basis of title and abstract, 49 articles underwent full-text screening, and 24 were finally retained for the analysis, according to preestablished inclusion criteria. We excluded studies of invasive interventions and studies not dealing with digital health. We extracted a description of the connected health interventions from data for the population or end users. RESULTS We performed a synthetic analysis of outcomes, based on the distribution of bibliometrics, and identified several connected health interventions and main characteristics affecting adherence. Our analysis focused on three types of user action: to read, to do, and to connect. Finally, we extracted current trends in characteristics: connect, adherence, and influence. CONCLUSION Connected health interventions for prevention are unlikely to affect outcomes significantly unless other characteristics and user preferences are considered. Future studies should aim to determine which connected health design combinations are the most effective for supporting long-term changes in behavior and for preventing cardiovascular disease risks.
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Affiliation(s)
- Dahbia Agher
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France.,BeWellConnect, Research and Development, Visiomed Group 75016 Paris, France
| | - Karima Sedki
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France
| | - Rosy Tsopra
- INSERM, Université Paris Descartes, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France.,Department of Medical Informatics, H⊚pital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Sylvie Despres
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France
| | - Marie-Christine Jaulent
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France
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23
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Zhai Y, Nasseri N, Pöttgen J, Gezhelbash E, Heesen C, Stellmann JP. Smartphone Accelerometry: A Smart and Reliable Measurement of Real-Life Physical Activity in Multiple Sclerosis and Healthy Individuals. Front Neurol 2020; 11:688. [PMID: 32922346 PMCID: PMC7456810 DOI: 10.3389/fneur.2020.00688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Mobility impairment is common in persons with multiple sclerosis (pwMS) and can be assessed with clinical tests and surveys that have restricted ecological validity. Commercial research-based accelerometers are considered to be more valuable as they measure real-life mobility. Smartphone accelerometry might be an easily accessible alternative. Objective: To explore smartphone accelerometry in comparison to clinical tests, surveys, and a wrist-worn ActiGraph in pwMS and controls. Methods: Sixty-seven pwMS and 70 matched controls underwent mobility tests and surveys. Real-life data were collected with a smartphone and an ActiGraph over 7 days. We explored different smartphone metrics in a technical validation course and computed afterward correlation between ActiGraph (steps per minute), smartphone accelerometry (variance of vector magnitude), clinical tests, and surveys. We also determined the ability to separate between patients and controls as well as between different disability groups. Results: Based on the technical validation, we found the variance of the vector magnitude as a reliable estimate to discriminate wear time and no wear-time of the smartphone. Due to a further association with different activity levels, it was selected for real-life analyses. In the cross-sectional study, ActiGraph correlated moderately (r = 0.43, p < 0.05) with the smartphone but less with clinical tests (rho between |0.211| and |0.337|). Smartphone data showed stronger correlations with age (rho = −0.487) and clinical tests (rho between |0.565| and |0.605|). ActiGraph only differed between pwMS and controls (p < 0.001) but not between disability groups. At the same time, the smartphone showed differences between pwMS and controls, between RRMS and PP-/SPMS, and between participants with/without ambulatory impairment (all p < 0.001). Conclusions: Smartphone accelerometry provides better estimates of mobility and disability than a wrist-worn standard accelerometer in a free-living context for both controls and pwMS. Given the fact that no additional device is needed, smartphone accelerometry might be a convenient outcome of real-life ambulation in healthy individuals and chronic diseases such as MS.
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Affiliation(s)
- Yuyang Zhai
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Navina Nasseri
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eghbal Gezhelbash
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Academy for Training and Career, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,APHM, Hopital de la Timone, CEMEREM, Marseille, France.,Aix Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
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24
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Giunti G, Rivera-Romero O, Kool J, Bansi J, Sevillano JL, Granja-Dominguez A, Izquierdo-Ayuso G, Giunta D. Evaluation of More Stamina, a Mobile App for Fatigue Management in Persons with Multiple Sclerosis: Protocol for a Feasibility, Acceptability, and Usability Study. JMIR Res Protoc 2020; 9:e18196. [PMID: 32749995 PMCID: PMC7435635 DOI: 10.2196/18196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the world's most common neurologic disorders leading to severe disability in young adults. MS-related fatigue directly impacts on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, an mHealth solution called More Stamina was created to help persons with MS manage their fatigue. OBJECTIVE The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. METHODS A mixed-methods, multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the third and fourth quarters of 2020 (Q3-Q4 2020) in 3 locations: Argentina, Spain, and Switzerland. A longitudinal cohort study will take place, and think-aloud protocols, open-ended interviews, and short answer questionnaires will be used. Persons with MS will be recruited from the different locations. This study seeks to enroll at least 20 patients that meet the criteria from each site for the longitudinal cohort study (total n=60). RESULTS Ethical approval has been granted in Argentina and is pending in Spain and Switzerland. Outcomes will be published in peer-reviewed medical journals and presented at international conferences. CONCLUSIONS Findings from this study will be used to help understand the role that mHealth can play in fatigue management in MS. TRIAL REGISTRATION ClinicalTrials.gov NCT04244214; https://clinicaltrials.gov/ct2/show/NCT04244214. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/18196.
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Affiliation(s)
| | | | - Jan Kool
- Kliniken Valens, Valens, Switzerland
| | | | | | | | | | - Diego Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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25
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Abstract
OBJECTIVES To survey international regulatory frameworks that serve to protect privacy of personal data as a human right as well as to review the literature regarding privacy protections and data ownership in mobile health (mHealth) technologies between January 1, 2016 and June 1, 2019 in order to identify common themes. METHODS We performed a review of relevant literature available in English published between January 1, 2016 and June 1, 2019 from databases including PubMed, Google Scholar, and Web of Science, as well as relevant legislative background material. Articles out of scope (as detailed below) were eliminated. We categorized the remaining pool of articles and discrete themes were identified, specifically: concerns around data transmission and storage, including data ownership and the ability to re-identify previously de-identified data; issues with user consent (including the availability of appropriate privacy policies) and access control; and the changing culture and variable global attitudes toward privacy of health data. RESULTS Recent literature demonstrates that the security of mHealth data storage and transmission remains of wide concern, and aggregated data that were previously considered "de-identified" have now been demonstrated to be re-identifiable. Consumer-informed consent may be lacking with regard to mHealth applications due to the absence of a privacy policy and/or to text that is too complex and lengthy for most users to comprehend. The literature surveyed emphasizes improved access control strategies. This survey also illustrates a wide variety of global user perceptions regarding health data privacy. CONCLUSION The international regulatory framework that serves to protect privacy of personal data as a human right is diverse. Given the challenges legislators face to keep up with rapidly advancing technology, we introduce the concept of a "healthcare fiduciary" to serve the best interest of data subjects in the current environment.
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Affiliation(s)
- Hannah K. Galvin
- Cambridge Health Alliance, Cambridge, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Paul R. DeMuro
- Chief Legal Officer Health and Wellness, Royal Palm Companies, Miami, Florida
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26
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Winberg C, Kylberg M, Pettersson C, Harnett T, Hedvall PO, Mattsson T, Månsson Lexell E. Feeling controlled or being in control? Apps for self-management among older people with neurological disability. Disabil Rehabil Assist Technol 2019; 16:603-608. [PMID: 31711351 DOI: 10.1080/17483107.2019.1685017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this paper was to describe how people living with a neurological disability such as multiple sclerosis, Parkinson's disease and stroke reason regarding using apps to facilitate self-management in everyday life. MATERIAL AND METHODS A qualitative research approach with a focus group methodology was used. The sample comprised 16 participants, 11 men and 5 women, with an average age of 64 years (ranging from 51-80 years). Six participants were diagnosed with multiple sclerosis, six with Parkinson's disease and four with stroke. Data were analyzed using thematic analysis, which is a method for identifying, analyzing and reporting patterns. RESULTS The results formed two themes. The first theme "using apps to have control of my health" comprises two subthemes; "monitor and take responsibility for a healthy lifestyle" and "compensate to facilitate everyday life". The second theme "using the app as a tool and means for communication" also comprised two subthemes; "dare to trust the app" and "feeling safe when sharing information with health care professionals". CONCLUSIONS The use of apps put increased responsibility on the person and had the possibility to make them more involved in their own care. The use of an app can facilitate a healthy lifestyle and help to monitor disease-specific symptoms. In order to be able to use apps for communication with the health care sector legislation and safety issues need to be considered.Implications for rehabilitationApps can be used for self-management if they are safe and can be trusted.People with neurological disabilities want to be involved in their healthcare and needs to be addressed by health care professionals.The use of apps grasp over a wide variety of areas this is something that may be considered in health care and something that can be addressed by interdisciplinary approaches.Ordinary health-oriented apps and disease-specific apps were used differently and for different purposes.
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Affiliation(s)
- C Winberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - M Kylberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - C Pettersson
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of School of Health Sciences, Örebro University, Örebro, Sweden
| | - T Harnett
- School of Social Work, Lund University, Lund, Sweden
| | - P-O Hedvall
- Department of Design Sciences, Lund University, Lund, Sweden
| | - T Mattsson
- Department of Law, Lund University, Lund, Sweden
| | - E Månsson Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
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27
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Wendrich K, van Oirschot P, Martens MB, Heerings M, Jongen PJ, Krabbenborg L. Toward Digital Self-monitoring of Multiple Sclerosis: Investigating First Experiences, Needs, and Wishes of People with MS. Int J MS Care 2019; 21:282-291. [PMID: 31889935 DOI: 10.7224/1537-2073.2018-083] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Digital self-monitoring, such as through smartphone applications (apps) or activity trackers, could be applied to monitor the health of people with multiple sclerosis (MS). This self-monitoring could facilitate personalized therapies and self-management of MS. The acceptance of digital self-monitoring tools by patients depends on them being able and willing to use these tools in their daily lives. Methods In-depth interviews were conducted with seven adults with MS before and after participation in a study in which they used an activity tracker and an MS-specific smartphone app for 4 weeks. We inquired about experiences with the tools in daily life and needs and wishes regarding further development and implementation of digital self-monitoring for people with MS. Results The smartphone app and the activity tracker increased respondents' awareness of their physical status and stimulated them to act on the data. Challenges, such as confrontation with their MS and difficulties with data interpretation, were discussed. The respondents desired 1) adaptation of digital self-monitoring tools to a patient's personal situation, 2) guidance to increase the value of the data, and 3) integration of digital self-monitoring into treatment plans. Conclusions These findings show that patients can provide detailed descriptions of their daily life experiences with new technologies. Mapping these experiences could help in better aligning the development and implementation of digital self-monitoring tools, in this case smartphones and activity trackers, with the needs and wishes of people with MS.
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28
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Simblett SK, Evans J, Greer B, Curtis H, Matcham F, Radaelli M, Mulero P, Arévalo MJ, Polhemus A, Ferrao J, Gamble P, Comi G, Wykes T. Engaging across dimensions of diversity: A cross-national perspective on mHealth tools for managing relapsing remitting and progressive multiple sclerosis. Mult Scler Relat Disord 2019; 32:123-132. [PMID: 31125754 DOI: 10.1016/j.msard.2019.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/23/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Smartphone apps and wearable devices could augment clinical practice by detecting changes in health status for multiple sclerosis (MS). This study sought to investigate potential barriers and facilitators for uptake and sustained use in (i) people with both relapsing remitting MS (RRMS) and progressive MS (PMS) and (ii) across different countries. METHODS Twenty four participants with MS took part in four focus groups held in three countries (2 in the UK, 1 in Spain, and 1 in Italy) to investigate potential barriers and facilitators for mHealth technology. A systematic thematic analysis was used to extract themes and sub-themes. RESULTS Facilitators and barriers were organised into functional technology-related factors and non-functional health-related and user-related factors. Twelve themes captured all requirements across the three countries for both RRMS and PMS. Key requirements included accommodation for varying physical abilities, providing information and memory aids. Potential negative effects on mood and providing choice and control as part of overcoming practical challenges were identified. CONCLUSIONS We took a cross-national perspective and found many similarities between three European countries across people with RRMS and PMS. Future provision should accommodate the key requirements identified to engage people with MS in scalable mHealth interventions.
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Affiliation(s)
- Sara K Simblett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Joanne Evans
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ben Greer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Hannah Curtis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Marta Radaelli
- Neurology services, San Raffaele Hospital MS centre, Milan, Italy
| | - Patricia Mulero
- Centre d´esclerosi multiple de Catalunya, Hospital Vall d´Hebron, Barcelona, Spain
| | - Maria Jesús Arévalo
- Centre d´esclerosi multiple de Catalunya, Hospital Vall d´Hebron, Barcelona, Spain
| | | | - Jose Ferrao
- MSD IT Global Innovation Center, Prague, Czech Republic
| | - Peter Gamble
- MSD IT Global Innovation Center, Prague, Czech Republic
| | - Giancarlo Comi
- Neurology services, San Raffaele Hospital MS centre, Milan, Italy
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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29
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Marrie RA, Leung S, Tyry T, Cutter GR, Fox R, Salter A. Use of eHealth and mHealth technology by persons with multiple sclerosis. Mult Scler Relat Disord 2019; 27:13-19. [DOI: 10.1016/j.msard.2018.09.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/15/2022]
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30
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Salimzadeh Z, Damanabi S, Kalankesh LR, Ferdousi R. Mobile Applications for Multiple Sclerosis: a Focus on Self-Management. Acta Inform Med 2019; 27:12-18. [PMID: 31213737 PMCID: PMC6511265 DOI: 10.5455/aim.2019.27.12-18] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction The explosion of mobile phone users along with the importance of user's role in managing their health provides a unique opportunity for m-Health applications in the management of chronic illnesses such as Multiple sclerosis (MS). Aim To identify available MS applications and to characterize the content of MS self-management applications. Methods Two popular online application stores (iTunes, Google play) were searched for multiple sclerosis -related apps using the following keywords: multiple sclerosis, disseminated multiple sclerosis, disseminated sclerosis, and MS. Apps were considered eligible if they had been customized only on multiple sclerosis. First, data was extracted from the description page for any eligible application. To achieve the study goal, the secondary analysis was performed only for self-management applications. Results Search of two popular markets identified 1042 applications (747 applications from Google play, and 295 applications from iTunes). Of these, 104 unique applications met the inclusion criteria. Almost a quarter of eligible applications (26%) had been designed for multiple sclerosis self-management. Other purposes of the identified applications were diagnosing & treating (7.7%), doing tests (7.7%), connecting & communication for MS patients (4.8%), raising awareness of multiple sclerosis (15.4%), accessing to journals & news (6.7%), conferences & meetings (17.3%), supporting & donating to MS community (14.4%). Conclusion It appears the mobile applications provide a multidimensional tool for patient with Multiple Sclerosis to improve their condition self-management. These applications can contribute to empowerment of the patients, and help their adherence to the therapeutic and management regimen of their conditions. Moreover, they can be utilized to collect information on the MS progress pattern in personal level for each individual patient. This information may provide health care professionals with evidence to help their patients toward enhancing self-management of their disease.
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Affiliation(s)
- Zeinab Salimzadeh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz, Iran
| | - Shahla Damanabi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz, Iran
| | - Leila R Kalankesh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz, Iran.,Tabriz Health Services Management Research center, Tabriz, Iran.,Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences
| | - Reza Ferdousi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz, Iran.,Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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31
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Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study. JMIR Form Res 2018; 2:e11977. [PMID: 30684408 PMCID: PMC6334710 DOI: 10.2196/11977] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.
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Affiliation(s)
| | - Mireille Menzel
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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