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Dobija L, Lechauve JB, Mbony-Irankunda D, Plan-Paquet A, Dupeyron A, Coudeyre E. Smartphone applications are used for self-management, telerehabilitation, evaluation and data collection in low back pain healthcare: a scoping review. F1000Res 2024; 11:1001. [PMID: 38846061 PMCID: PMC11153999 DOI: 10.12688/f1000research.123331.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Background Smartphone use has grown in providing healthcare for patients with low back pain (LBP), but the literature lacks an analysis of the use of smartphone apps. This scoping review aimed to identify current areas of smartphone apps use for managing LBP. We also aimed to evaluate the current status of the effectiveness or scientific validity of such use and determine perspectives for their potential development. Methods We searched PubMed, PEDro and Embase for articles published in English up to May 3 rd, 2021 that investigated smartphone use for LBP healthcare and their purpose. All types of study design were accepted. Studies concerning telemedicine or telerehabilitation but without use of a smartphone were not included. The same search strategy was performed by two researchers independently and a third researcher validated the synthesis of the included studies. Results We included 43 articles: randomised controlled trials (RCTs) (n=12), study protocols (n=6), reliability/validity studies (n=6), systematic reviews (n=7), cohort studies (n=4), qualitative studies (n=6), and case series (n=1). The purposes of the smartphone app were for 1) evaluation, 2) telerehabilitation, 3) self-management, and 4) data collection. Self-management was the most-studied use, showing promising results derived from moderate- to good-quality RCTs for patients with chronic LBP and patients after spinal surgery. Promising results exist regarding evaluation and data collection use and contradictory results regarding measurement use. Conclusions This scoping review revealed a notable interest in the scientific literatures regarding the use of smartphone apps for LBP patients. The identified purposes point to current scientific status and perspectives for further studies including RCTs and systematic reviews targeting specific usage.
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Affiliation(s)
- Lech Dobija
- UNH, INRAE, Université Clermont-Auvergne, Clermont-Ferrand, Puy de Dôme, 63000, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Jean-Baptiste Lechauve
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Didier Mbony-Irankunda
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Anne Plan-Paquet
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Arnaud Dupeyron
- Université Montpellier, Nimes, 30900, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Nimes, Nimes, 30900, France
| | - Emmanuel Coudeyre
- UNH, INRAE, Université Clermont-Auvergne, Clermont-Ferrand, Puy de Dôme, 63000, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
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Scholz C, Schmigalle P, Plessen CY, Liegl G, Vajkoczy P, Prasser F, Rose M, Obbarius A. The effect of self-management techniques on relevant outcomes in chronic low back pain: A systematic review and meta-analysis. Eur J Pain 2024; 28:532-550. [PMID: 38071425 DOI: 10.1002/ejp.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Among many treatment approaches for chronic low back pain (CLBP), self-management techniques are becoming increasingly important. The aim of this paper was to (a) provide an overview of existing digital self-help interventions for CLBP and (b) examine the effect of these interventions in reducing pain intensity, pain catastrophizing and pain disability. DATABASES AND DATA TREATMENT Following the PRISMA guideline, a systematic literature search was conducted in the MEDLINE, EMBASE, PsychInfo, CINAHL and Cochrane databases. We included randomized controlled trials from the last 10 years that examined the impact of digital self-management interventions on at least one of the three outcomes in adult patients with CLBP (duration ≥3 months). The meta-analysis was based on random-effects models. Standardized tools were used to assess the risk of bias (RoB) for each study and the quality of evidence for each outcome. RESULTS We included 12 studies (n = 1545). A small but robust and statistically significant pooled effect was found on pain intensity (g = 0.24; 95% CI [0.09, 0.40], k = 12) and pain disability (g = 0.43; 95% CI [0.27, 0.59], k = 11). The effect on pain catastrophizing was not significant (g = 0.38; 95% CI [-0.31, 1.06], k = 4). The overall effect size including all three outcomes was g = 0.33 (95% CI [0.21, 0.44], k = 27). The RoB of the included studies was mixed. The quality of evidence was moderate or high. CONCLUSION In summary, we were able to substantiate recent evidence that digital self-management interventions are effective in the treatment of CLBP. Given the heterogeneity of interventions, further research should aim to investigate which patients benefit most from which approach. SIGNIFICANCE This meta-analysis examines the effect of digital self-management techniques in patients with CLBP. The results add to the evidence that digital interventions can help patients reduce their pain intensity and disability. A minority of studies point towards the possibility that digital interventions can reduce pain catastrophizing. Future research should further explore which patients benefit most from these kinds of interventions.
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Affiliation(s)
- C Scholz
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Schmigalle
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Y Plessen
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - G Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Vajkoczy
- Department for Neurosurgery with Pediatric Neurosurgery, Center for Neurology, Neurosurgery und Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Prasser
- Center of Health Data Sciences, Berlin Institut of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Boston, Massachusetts, USA
| | - A Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Digital Clinician Scientist Program, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
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Hunter R, Beattie M, O'Malley C, Gorely T. Mobile apps to self-manage chronic low back pain: A realist synthesis exploring what works, for whom and in what circumstances. PEC INNOVATION 2023; 3:100175. [PMID: 38213759 PMCID: PMC10782115 DOI: 10.1016/j.pecinn.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 01/13/2024]
Abstract
Objective Chronic low back pain places a significant burden on healthcare services and sufferers. Clinical guidelines state that it is a condition that requires self-management. This realist synthesis explores how a mobile app could help people to self-manage chronic low back pain. Method Six databases and several non-academic sources were searched. In addition, nineteen realist interviews were conducted with stakeholders. Sources were selected and appraised for relevancy, richness, and rigour. Data was coded with analytical memos making retroductive inferences. Causal explanations were presented in context-mechanism-outcome configurations to form three programme theories. Results Data from 57 sources was synthesised to create 16 context-mechanism-outcome configurations and presented as three refined programme theories. The findings suggest people need to feel believed before they will engage with a self-management app. For those who feel abandoned by the healthcare service, a self-management app for chronic low back pain can be a valuable source of ongoing support and reduce feelings of social isolation. Conclusion A self-management app, if introduced appropriately and as adjunct to care, can be an empowering tool to self-manage chronic low back pain. Innovation Using input from key stakeholders enhances our understanding of the hidden generative mechanisms underpinning a programme's success or failure.
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Affiliation(s)
- Rebecca Hunter
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Michelle Beattie
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Chris O'Malley
- Specialist Librarian (Learning and Information Services), University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Trish Gorely
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
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D Delgado A, Salazar SI, Rozaieski K, Putrino D, Tabacof L. Engagement in an mHealth-Guided Exercise Therapy Program Is Associated With Reductions in Chronic Musculoskeletal Pain. Am J Phys Med Rehabil 2023; 102:984-989. [PMID: 37026894 DOI: 10.1097/phm.0000000000002257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
CONTEXT Chronic musculoskeletal pain costs the US $980 billion annually. Conservative treatments are the criterion standard, but scalable methods of treatment remain to be evaluated. OBJECTIVE The aim of the study is to determine the effects of pain reduction and the perceived benefits of an mHealth exercise therapy program. DESIGN This is a retrospective observational study on data from 3109 people (18-98, 49% female) with musculoskeletal pain in an mHealth exercise program. Presession pain was measured via 11-point numeric rating scale and nonstandardized single-item questions for work and quality of life; all were analyzed using mixed-effects models. RESULTS By 11 sessions, there was an estimated a 2.09-point decrease in average numeric rating scale pain levels. There was an average percent increase of approximately 0.7 points for work life and quality of life ( tdf =6,632 = 12.06, P < 0.001). User engagement was high; 46% of participants were performing more than one session per day, and 88% were engaging within a week, indicating the feasibility of the deployment of an mHealth exercise app. CONCLUSIONS An mHealth exercise program was associated with significant decrease in pain and increased perceived benefits in a large population. These findings serve as preliminary findings of the feasibility for mHealth exercise interventions as scalable tools to improve chronic musculoskeletal pain outcomes.
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Affiliation(s)
- Andrew D Delgado
- From the Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (ADD, SIS, DP, LT); and Cape May Veterans Affairs Community Based Outpatient Clinic, Wilmington VAMC, Wilmington, Delaware (KR)
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Barreveld AM, Rosén Klement ML, Cheung S, Axelsson U, Basem JI, Reddy AS, Borrebaeck CAK, Mehta N. An artificial intelligence-powered, patient-centric digital tool for self-management of chronic pain: a prospective, multicenter clinical trial. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1100-1110. [PMID: 37104747 DOI: 10.1093/pm/pnad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To investigate how a behavioral health, artificial intelligence (AI)-powered, digital self-management tool affects the daily functions in adults with chronic back and neck pain. DESIGN Eligible subjects were enrolled in a 12-week prospective, multicenter, single-arm, open-label study and instructed to use the digital coach daily. Primary outcome was a change in Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores for pain interference. Secondary outcomes were changes in PROMIS physical function, anxiety, depression, pain intensity scores and pain catastrophizing scale (PCS) scores. METHODS Subjects logged daily activities, using PainDrainerTM, and data analyzed by the AI engine. Questionnaire and web-based data were collected at 6 and 12 weeks and compared to subjects' baseline. RESULTS Subjects completed the 6- (n = 41) and 12-week (n = 34) questionnaires. A statistically significant Minimal Important Difference (MID) for pain interference was demonstrated in 57.5% of the subjects. Similarly, MID for physical function was demonstrated in 72.5% of the subjects. A pre- to post-intervention improvement in depression score was also statistically significant, observed in 100% of subjects, as was the improvement in anxiety scores, evident in 81.3% of the subjects. PCS mean scores was also significantly decreased at 12 weeks. CONCLUSION Chronic pain self-management, using an AI-powered, digital coach anchored in behavioral health principles significantly improved subjects' pain interference, physical function, depression, anxiety, and pain catastrophizing over the 12-week study period.
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Affiliation(s)
- Antje M Barreveld
- Department of Anesthesiology, Tufts University School of Medicine, Newton-Wellesley Hospital, Newton, MA 02462, United States
| | - Maria L Rosén Klement
- Department of Immunotechnology, Lund University, Lund 221 00, Sweden
- PainDrainer AB, Sheeletorget, Medicon Village, Lund 223 81, Sweden
| | - Sophia Cheung
- Office of Clinical Research, Newton-Wellesley Hospital, Newton, MA 02462, United States
| | - Ulrika Axelsson
- PainDrainer AB, Sheeletorget, Medicon Village, Lund 223 81, Sweden
| | - Jade I Basem
- Department of Anesthesiology, Division of Pain Management, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anika S Reddy
- Department of Anesthesiology, Division of Pain Management, Weill Cornell Medicine, New York, NY 10065, USA
| | - Carl A K Borrebaeck
- Department of Immunotechnology, Lund University, Lund 221 00, Sweden
- PainDrainer AB, Sheeletorget, Medicon Village, Lund 223 81, Sweden
| | - Neel Mehta
- Department of Anesthesiology, Division of Pain Management, Weill Cornell Medicine, New York, NY 10065, USA
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Leonard KS, Pauley AM, Guo P, Hohman EE, Rivera DE, Savage JS, Downs DS. Feasibility and user acceptability of Breezing ™, a mobile indirect calorimetry device, in pregnant women with overweight or obesity. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2023; 27:100372. [PMID: 36687500 PMCID: PMC9851426 DOI: 10.1016/j.smhl.2022.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Emerging evidence has suggested that prenatal resting energy expenditure (REE) may be an important determinant of gestational weight gain. Advancements in technology such as the real-time, mobile indirect calorimetry device (Breezing™) have offered the novel opportunity to continuously assess prenatal REE while also potentially capturing fluctuations in REE. The purpose of this study was to examine feasibility and user acceptability of Breezing™ to assess weekly REE from 8-36 weeks gestation in pregnant women with overweight or obesity participating in the Healthy Mom Zone intervention study. Participants (N=27) completed REE assessments once per week from 8-36 gestation using Breezing™. Feasibility of the device was calculated as compliance (# of weeks used/total # of weeks). User acceptability was measured by asking women to report on the device's enjoyability and barriers. Median compliance was 68%. However, when weeks women experienced technical difficulties (11 of 702 total events) and the device was unavailable were removed (13 of 702 total events), median compliance increased to 71%. Over half (56%) of the women reported that the device was enjoyable or they had neutral feelings about it whereas the remaining 44% reported that it was not enjoyable. The most common barrier reported (44%) was the experience of technical issues. Study compliance data suggest the feasibility of using Breezing™ to assess prenatal REE is promising. However, acceptability data suggest future interventionists should develop transparent and informative protocols to address any barriers prior to implementing the device to increase use.
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Affiliation(s)
- Krista S Leonard
- College of Health Solutions, Arizona State University, 425 N 5 St, Phoenix, AZ, 85004, USA
| | - Abigail M Pauley
- Department of Kinesiology, The Pennsylvania State University, 268 Recreation Building, University Park, PA, 16802, USA
| | - Penghong Guo
- School for Engineering of Matter, Transport, and Energy, Arizona State University, Engineering Research Center, 974 S. Myrtle Ave, Tempe, AZ, 85281, USA
| | - Emily E Hohman
- Department of Nutritional Sciences and Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA
| | - Daniel E Rivera
- School for Engineering of Matter, Transport, and Energy, Arizona State University, Engineering Research Center, 974 S. Myrtle Ave, Tempe, AZ, 85281, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences and Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA
| | - Danielle Symons Downs
- Department of Kinesiology, The Pennsylvania State University, 268 Recreation Building, University Park, PA, 16802, USA
- Department of OBGYN, College of Medicine, The Pennsylvania State University, 700 HMC Cres Rd, Hershey, PA, 17033, USA
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Wolff AL, Kwasnicki RM, Farnebo S, Horwitz MD. Dynamic assessment of the upper extremity: a review of available and emerging technologies. J Hand Surg Eur Vol 2023; 48:404-411. [PMID: 36803302 DOI: 10.1177/17531934231153559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The purpose of this review article is to provide an update on the realm of emerging technology available for the assessment of dynamic functional movement of the hand and upper limb. A critical overview of the literature and a conceptual framework for use of such technologies is proposed. The framework explores three broad purpose categories including customization of care, functional surveillance and interventions through biofeedback strategies. State-of-the-art technologies are described, from basic activity monitors to feedback-enabled robotic gloves, along with exemplar trials and clinical applications. The future of technologies innovation in hand pathology is proposed in the context of the current obstacles and opportunities for hand surgeons and therapists.
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Affiliation(s)
- Aviva L Wolff
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | | | - Simon Farnebo
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maxim D Horwitz
- Chelsea & Westminster Hospital, London, United Kingdom; Imperial College London, London, UK
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Hutchison MG, Di Battista AP, Loenhart M. A Continuous Aerobic Resistance Exercise (CARE) Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App: Feasibility Study (Preprint). JMIR Form Res 2022. [DOI: 10.2196/45321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Kawai Y, Waki K, Yamaguchi S, Shibuta T, Miyake K, Kimura S, Toyooka T, Nakajima R, Uneda K, Wakui H, Tamura K, Nangaku M, Ohe K. The Use of Information and Communication Technology-Based Self-management System DialBeticsLite in Treating Abdominal Obesity in Japanese Office Workers: Prospective Single-Arm Pilot Intervention Study. JMIR Diabetes 2022; 7:e40366. [PMID: 36441577 DOI: 10.2196/40366] [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: 06/19/2022] [Revised: 09/07/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Making lifestyle changes is an essential element of abdominal obesity (AO) reduction. To support lifestyle modification and self-management, we developed an information and communication technology-based self-management system-DialBeticsLite-with a fully automated dietary evaluation function for the treatment of AO. OBJECTIVE The objective of this study was to evaluate the preliminary efficacy and feasibility of DialBeticsLite among Japanese office workers with AO. METHODS A 2- to 3-month prospective single-arm pilot intervention study was designed to assess the effects of the intervention using DialBeticsLite. The information and communication technology system was composed of 4 modules: data transmission (body weight, blood pressure, blood glucose, and pedometer count); data evaluation; exercise input; and food recording and dietary evaluation. Eligible participants were workers who were aged ≥20 years and with AO (waist circumference ≥85 cm for men and ≥90 cm for women). Physical parameters, blood tests, nutritional intake, and self-care behavior were compared at baseline and after the intervention. RESULTS A total of 48 participants provided completed data for analysis, which yielded a study retention rate of 100%. The average age was 46.8 (SD 6.8) years, and 92% (44/48) of participants were male. The overall average measurement rate of DialBeticsLite, calculated by dividing the number of days with at least one measurement by the number of days of the intervention, was 98.6% (SD 3.4%). In total, 85% (41/48) of the participants reported that their participation in the study helped them to improve their lifestyle. BMI, waist circumference, and visceral fat area decreased significantly after the intervention (P<.001). In addition, the daily calorie intake reduced significantly (P=.02). There was a significant improvement in self-care behavior in terms of exercise and diet (P=.001). CONCLUSIONS Using DialBeticsLite was shown to be a feasible and potentially effective method for reducing AO by providing users with a motivational framework to evaluate their lifestyle behaviors.
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Affiliation(s)
- Yuki Kawai
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kayo Waki
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomomi Shibuta
- Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kana Miyake
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Shigeko Kimura
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tsuguyoshi Toyooka
- Healthcare and Medical Business Smart-Life Solutions Department, NTT DOCOMO, Inc, Chiyoda City, Japan
| | - Ryo Nakajima
- Healthcare and Medical Business Smart-Life Solutions Department, NTT DOCOMO, Inc, Chiyoda City, Japan
| | - Kazushi Uneda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Vad VB, Madrazo-Ibarra A, Estrin D, Pollak JP, Carroll KM, Vojta D, Vad A, Trapness C. "Back Rx, a personalized mobile phone application for discogenic chronic low back pain: a prospective pilot study". BMC Musculoskelet Disord 2022; 23:923. [PMID: 36261825 PMCID: PMC9580128 DOI: 10.1186/s12891-022-05883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intervertebral disc pathology is the most common identifiable cause of chronic lower back pain (CLBP). There are limited conservative alternatives to treat discogenic axial CLBP. Back Rx is a mobile application (app) developed to treat patients with this condition, following the Back Rx exercise program, assisted by a virtual coach. Methods Patients 18 to 65 years of age, with axial CLBP (more than 3 months), and evidence of lumbar disc pathology by magnetic resonance imaging (MRI) were enrolled to the study. Patients’ symptomatology was prospectively evaluated at baseline and after 3 months of using the Back Rx app. The main outcome of the study was back pain evaluated using the visual analog scale (VAS) for pain. Secondary outcomes were the patient's functionality, the weekly pain medication intake, the patients’ adherence to the app, and the patients´ satisfaction rate. Results Seventy-five patients with CLBP were enrolled in the study. All patients had a statistically significant improvement from baseline to final follow-up in the average VAS scores, and the functionality evaluations. Average VAS scores decreased from 5.17 ± 2.1 at baseline to 3.8 ± 2.6 at final follow-up (P = 0.016). Patients showed a significant decrease in the number of pain medications taken during a week (P = 0.001). Overall compliance with the app was 52%, and 65% of the patients rated the overall experience as good or excellent. Conclusion The Back Rx app decreased pain and increased function in patients with discogenic axial CLBP compared to their baseline status. Further measures are needed to increase patients' compliance with the app and the Back Rx program. Trial registration Retrospectively registered in 2/2/2017 NCT03040310 (ClinicalTrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05883-9.
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Affiliation(s)
- Vijay B Vad
- Assistant Professor, Hospital for Special Surgery, New York, NY, USA
| | - Antonio Madrazo-Ibarra
- Hospital for Special Surgery, Research Fellow, New York, NY, USA. .,Research Fellow, Department of Physiatry, Hospital for Special Surgery, 519 E 72nd St, New York, NY, 10021, USA.
| | - Deborah Estrin
- Associate Dean of Computer Science, Cornell Tech, New York, NY, USA
| | - John P Pollak
- Cornell Tech, Senior Research-in-Residence, New York, NY, USA
| | | | - Deneen Vojta
- Executive Vice President, UnitedHealth Group Research & Development, Minnetonka, MN, USA
| | - Amoli Vad
- Hospital for Special Surgery, Research Assistant, New York, NY, USA
| | - Camilla Trapness
- Hospital for Special Surgery, Research Coordinator, New York, NY, USA
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11
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Kaul U, Scher C, Henderson CR, Kim P, Dyhrberg M, Rudin V, Lytle M, Bundy N, Reid MC. A mobile health + health coaching application for the management of chronic non-cancer pain in older adults: Results from a pilot randomized controlled study. FRONTIERS IN PAIN RESEARCH 2022; 3:921428. [PMID: 35959237 PMCID: PMC9362151 DOI: 10.3389/fpain.2022.921428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe rapid growth of mobile health (mHealth) devices holds substantial potential for improving care and care outcomes in aging adults with chronic non-cancer pain (CNCP), however, research evaluating these devices in older adults remains limited.ObjectiveTo ascertain the feasibility and preliminary efficacy of an mHealth intervention (Mymee) that combines symptom, diet, and behavior tracking via a smartphone application with data analytics to detect associations between symptoms and lifestyle factors along with weekly health coaching sessions to mitigate CNCP in adults 55 years of age and older.MethodsParticipants (N = 31) in this pilot study were recruited from one primary care practice in New York City and randomized to an intervention [app + up to 12 health coaching sessions (scheduled approximately once weekly) + usual care] or a control (app + usual care) arm. Feasibility measures included recruitment (proportion of eligible persons who enrolled) and retention rates (proportion of subjects completing a follow-up assessment) as well as adherence with the weekly coaching sessions and logging daily data on the app. Efficacy outcomes (e.g., pain intensity, self-efficacy, disability, anxiety) were assessed at baseline and follow-up (~16 weeks after baseline). Descriptive statistics were obtained and general linear mixed models used for primary analyses.ResultsParticipants had a mean (standard deviation) age of 67.32 (9.17) and were mostly female (61%). Feasibility outcomes were mixed as evidenced by recruitment and retention rates of 74% and 65%, respectively. The mean number of weekly coaching sessions attended by intervention participants was 6.05 (SD = 5.35), while the average number of days logging data on the app was 44.82 (34.02). We found a consistent trend in favor of the intervention, where pain intensity, affect, and quality of life measures improved considerably more among intervention (vs. control) participants. Finally, the proportion of participants with GAD-7 scores at follow up decreased by 0.35 to 0, whereas controls did not change, a significant effect in favor of the intervention (p = 0.02).ConclusionsThis study supports the need for future research that seeks to enhance feasibility outcomes and confirm the efficacy of the Mymee intervention among aging adults with CNCP.
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Affiliation(s)
- Usha Kaul
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, United States
| | - Clara Scher
- Rutgers School of Social Work, New Brunswick, NJ, United States
| | | | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, United States
| | | | | | | | | | - M. Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, United States
- *Correspondence: M. Carrington Reid
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A systematic review of engagement reporting in remote measurement studies for health symptom tracking. NPJ Digit Med 2022; 5:82. [PMID: 35768544 PMCID: PMC9242990 DOI: 10.1038/s41746-022-00624-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/01/2022] [Indexed: 01/25/2023] Open
Abstract
Remote Measurement Technologies (RMTs) could revolutionise management of chronic health conditions by providing real-time symptom tracking. However, the promise of RMTs relies on user engagement, which at present is variably reported in the field. This review aimed to synthesise the RMT literature to identify how and to what extent engagement is defined, measured, and reported, and to present recommendations for the standardisation of future work. Seven databases (Embase, MEDLINE and PsycINFO (via Ovid), PubMed, IEEE Xplore, Web of Science, and Cochrane Central Register of Controlled Trials) were searched in July 2020 for papers using RMT apps for symptom monitoring in adults with a health condition, prompting users to track at least three times during the study period. Data were synthesised using critical interpretive synthesis. A total of 76 papers met the inclusion criteria. Sixty five percent of papers did not include a definition of engagement. Thirty five percent included both a definition and measurement of engagement. Four synthetic constructs were developed for measuring engagement: (i) engagement with the research protocol, (ii) objective RMT engagement, (iii) subjective RMT engagement, and (iv) interactions between objective and subjective RMT engagement. The field is currently impeded by incoherent measures and a lack of consideration for engagement definitions. A process for implementing the reporting of engagement in study design is presented, alongside a framework for definition and measurement options available. Future work should consider engagement with RMTs as distinct from the wider eHealth literature, and measure objective versus subjective RMT engagement.Registration: This review has been registered on PROSPERO [CRD42020192652].
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Bremer W, Sarker A. Recruitment and retention in mobile application-based intervention studies: a critical synopsis of challenges and opportunities. Inform Health Soc Care 2022; 48:139-152. [PMID: 35656732 DOI: 10.1080/17538157.2022.2082297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Use of mobile health applications (mHealth apps) is becoming increasingly popular for the management of chronic illnesses, but mHealth-based intervention studies often have limitations associated with subject recruitment and retention. In this synopsis, we focus on targeted aspects of mHealth-based intervention studies, specifically: (i) subject recruitment, (ii) cohort sizes, and (iii) retention rates. We used the Google Scholar (meta-search) and Galileo search engines to identify sample articles focusing on mHealth apps and interventions published between 2010 and 2020 and selected 21 papers for detailed review. Most studies recruited relatively small cohorts (minimum: 20, maximum: 510). Retention rates had high variance with only five studies managing >80% subject retention throughout the study duration, 10.4% being the lowest. Eighty-five percent of the studies expressed concerns regarding study duration, app usage, and lack of proper implementation. The use of mHealth interventions generally yielded positive outcomes, but most studies discussed facing challenges associated with recruitment and retention. There is a clear need to identify strategies for recruiting larger cohorts and improving retention rates, and ultimately increasing the reliability of mHealth app-based intervention studies. We advise that potential underutilized opportunities lie at the intersection of mHealth and social media to address the limitations identified in the synopsis.
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Affiliation(s)
- Whitney Bremer
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
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14
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Amagai S, Pila S, Kaat AJ, Nowinski CJ, Gershon RC. Challenges in Participant Engagement and Retention using Mobile Health Apps: A Literature Review (Preprint). J Med Internet Res 2021; 24:e35120. [PMID: 35471414 PMCID: PMC9092233 DOI: 10.2196/35120] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps. Objective This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention. Methods We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention. Results Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained. Conclusions Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention.
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Affiliation(s)
- Saki Amagai
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Pila
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Aaron J Kaat
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cindy J Nowinski
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard C Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Lewkowicz D, Slosarek T, Wernicke S, Winne A, Wohlbrandt AM, Bottinger E. Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review. JMIR Rehabil Assist Technol 2021; 8:e26612. [PMID: 34807837 PMCID: PMC8663573 DOI: 10.2196/26612] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/26/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.
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Affiliation(s)
- Daniel Lewkowicz
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Tamara Slosarek
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Sarah Wernicke
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Antonia Winne
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Attila M Wohlbrandt
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Erwin Bottinger
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany.,Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
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16
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Oakley-Girvan I, Yunis R, Longmire M, Ouillon JS. What Works Best to Engage Participants in Mobile App Interventions and e-Health: A Scoping Review. Telemed J E Health 2021; 28:768-780. [PMID: 34637651 PMCID: PMC9231655 DOI: 10.1089/tmj.2021.0176] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Despite the growing popularity of mobile app interventions, specific engagement components of mobile apps have not been well studied. Methods: The objectives of this scoping review are to determine which components of mobile health intervention apps encouraged or hindered engagement, and examine how studies measured engagement. Results: A PubMed search on March 5, 2020 yielded 239 articles that featured the terms engagement, mobile app/mobile health, and adult. After applying exclusion criteria, only 54 studies were included in the final analysis. Discussion: Common app components associated with increased engagement included: personalized content/feedback, data visualization, reminders/push notifications, educational information/material, logging/self-monitoring functions, and goal-setting features. On the other hand, social media integration, social forums, poor app navigation, and technical difficulties appeared to contribute to lower engagement rates or decreased usage. Notably, the review revealed a great variability in how engagement with mobile health apps is measured due to lack of established processes. Conclusion: There is a critical need for controlled studies to provide guidelines and standards to help facilitate engagement and its measurement in research and clinical trial work using mobile health intervention apps.
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Affiliation(s)
| | - Reem Yunis
- Medable, Inc., Palo Alto, California, USA
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Sockolow PS, Buck HG, Shadmi E. An integrative review of chronic illness mHealth self-care interventions: Mapping technology features to patient outcomes. Health Informatics J 2021; 27:14604582211043914. [PMID: 34488478 DOI: 10.1177/14604582211043914] [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: 11/15/2022]
Abstract
Mobile health (mHealth)-hand-held technologies to address health priorities-has significant potential to answer the growing need for patient chronic illness self-care interventions. Previous reviews examined mHealth effect on patient outcomes. None have a detailed examination and mapping of specific technology features to targeted health outcomes. Examine recent chronic illness mHealth self-care interventions; map the study descriptors, mHealth technology features, and study outcomes. (1) Information extracted from PubMed, CINAHL, and Web of Science databases for clinical outcomes studies published 2010-January 2020; and (2) realist synthesis techniques for within and across case analysis. From 652 records, 32 studies were examined. Median study duration was 19.5 weeks. Median sample size was 62 participants. About 47% of interventions used solely patient input versus digital input; 50% sent tailored messages versus generic messages; 22% augmented the intervention with human interaction. Studies with positive clinical outcomes had higher use of digital input. Software descriptions were lacking. Most studies built interventions: only two incorporated target audience participation in development. We recommend researchers provide sufficient system description detail. Future research includes: data input characteristics; impact of augmentation with human interaction on outcomes; and development decisions.
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18
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Song T, Deng N, Cui T, Qian S, Liu F, Guan Y, Yu P. Measuring Success of Patients' Continuous Use of Mobile Health Services for Self-management of Chronic Conditions: Model Development and Validation. J Med Internet Res 2021; 23:e26670. [PMID: 34255685 PMCID: PMC8317034 DOI: 10.2196/26670] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/18/2021] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mobile health services are gradually being introduced to support patients' self-management of chronic conditions. The success of these services is contingent upon patients' continuous use of them. OBJECTIVE This study aims to develop a model to measure the success of patients' continuous use of mobile health services for the self-management of chronic conditions. METHODS The proposed model was derived from the information systems continuance model and the information systems success model. This model contains 7 theoretical constructs: information quality, system quality, service quality, perceived usefulness, user satisfaction, perceived health status, and continuous use intention. A web-based questionnaire survey instrument was developed to test the model. The survey was conducted to collect data from 129 patients who used a mobile health app for hypertension management from 2017 to 2019. The questionnaire items were derived from validated instruments and were measured using a 5-point Likert scale. The partial least squares modelling method was used to test the theoretical model. RESULTS The model accounted for 58.5% of the variance in perceived usefulness (R2=0.585), 52.3% of the variance in user satisfaction (R2=0.523), and 41.4% of the variance in patients' intention to make continuous use of mobile health services (R2=0.414). The continuous use intention was significantly influenced by their perceived health status (β=.195, P=.03), perceived usefulness (β=.307, P=.004), and user satisfaction (β=.254, P=.04) with the mobile health service. Information quality (β=.235, P=.005), system quality (β=.192, P=.02), and service quality (β=.494, P<.001) had a significantly positive influence on perceived usefulness but not on user satisfaction. Perceived usefulness had a significantly positive influence on user satisfaction (β=.664, P<.001). In a result opposite to the original hypothesis, perceived health status did not negatively influence patients' intention to continue using the mobile health service but showed a significantly positive correlation. CONCLUSIONS This study developed a theoretical model to predict and explain patients' continuous use of mobile health services for self-management of chronic conditions and empirically tested the model. Perceived usefulness, user satisfaction, and health status contributed to patients' intention to make continuous use of mobile health services for self-managing their chronic conditions.
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Affiliation(s)
- Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ning Deng
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Huangzhou, China
| | - Tingru Cui
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Fang Liu
- Department of Health Examination, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yingping Guan
- Department of Health Examination, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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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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Obro LF, Heiselberg K, Krogh PG, Handberg C, Ammentorp J, Pihl GT, Osther PJS. Combining mHealth and health-coaching for improving self-management in chronic care. A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:680-688. [PMID: 33143907 DOI: 10.1016/j.pec.2020.10.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Self-management approaches are widely used to improve chronic care. In this context, health care professionals call for efficient tools to engage patients in managing their illness. Mobile health (mHealth), defined by WHO as medical and public health practice supported by mobile devices, is demonstrated to enhance self-management and health-coaching as an engaging tool in supporting behaviour change. Nevertheless, it is unclear how health-coaching and mHealth can benefit from each other. OBJECTIVE We conducted a scoping review to provide a literature-overview and identify any existing gaps in knowledge of mHealth in combination with health-coaching interventions for improving self-management in patients with chronic diseases. PATIENT INVOLVEMENT No patients were involved in the review process. METHODS The five-stage framework by Arksey and O'Malley was used. The review surveys; PubMed, CINAHL, Embase, Scopus, and PsycInfo. Two independent reviewers performed review selection and characterization. RESULTS The review points at two approaches; (i) coaching used to support mHealth and (ii) mHealth as support for coaching. The findings suggest that patients prefer physical interactions to telecommunication. mHealth was primarily used to facilitate telecommunication and to monitor disease aspects. DISCUSSION We found that mHealth and health-coaching interventions benefit from each other. The review report on a considerable unclarity in the coaching-methods and that the patients were more satisfied with physical interactions than mHealth. We suggest to prioritize human contact and to explore more personalized health technology. PRACTICAL VALUE This scoping review can provide a framework for researchers and care providers to support discussion and introduction of new approaches and technology in self-management for patients with chronic diseases, thereby improving patients' quality of life.
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Affiliation(s)
- Louise Faurholt Obro
- Urological Research Center, Lillebaelt Hospital, Vejle, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Kasper Heiselberg
- Urological Research Center, Lillebaelt Hospital, Vejle, Denmark; Department of Engineering, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Charlotte Handberg
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark; Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Palle Jörn Sloth Osther
- Urological Research Center, Lillebaelt Hospital, Vejle, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Mallick-Searle T, Sharma K, Toal P, Gutman A. Pain and Function in Chronic Musculoskeletal Pain-Treating the Whole Person. J Multidiscip Healthc 2021; 14:335-347. [PMID: 33603392 PMCID: PMC7882444 DOI: 10.2147/jmdh.s288401] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Chronic pain is often associated with functional limitations that have a huge impact on patients' lives. However, despite being relatively common, chronic musculoskeletal pain is still viewed by some as a symptom of another disease rather than its own condition, and is therefore poorly addressed. This is compounded by other challenges in the field, including education gaps for both healthcare professionals and patients, a lack of universal and comprehensive assessment tools, poor societal perceptions of chronic pain, and the current stigma around the use of opioids. Here, we review the current chronic musculoskeletal pain management landscape in the United States and offer professional insight into emerging methods that can be used to improve patient outcomes, in particular, the achievement of meaningful functional goals. This perspective incorporates our combined multidisciplinary (psychiatry, psychology, nursing, physical therapy, and general medicine) experience and insights. We believe that chronic pain is a multifactorial experience and treatment requires an integrated, multidisciplinary approach from a range of healthcare providers. For the best patient outcomes, this team should work together to assess and treat the patient as a whole, addressing their pain and also providing education, empowerment, and support to enable patients to set and achieve meaningful functional goals that will provide real improvement in their quality of life. We believe that the healthcare community should elevate the conversation around chronic musculoskeletal pain management beyond that of just pain, to encompass the meaningful benefits that improvement in functional outcomes brings to patients.
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Affiliation(s)
| | - Kristin Sharma
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Philip Toal
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland, OH, USA
| | - Asya Gutman
- New York Pain Relief Medicine, New York, NY, USA
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22
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Coe-O’Brien R, Joseph L, Kuisma R, Paungmali A, Sitilertpisan P, Pirunsan U. Outcome measures used in the smartphone applications for the management of low back pain: a systematic scoping review. Health Inf Sci Syst 2020; 8:5. [PMID: 31938540 PMCID: PMC6940412 DOI: 10.1007/s13755-019-0097-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/21/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Smartphone applications (SPApps) have become a key tool for the self-management of low back pain (LBP). However, the scientific evidence behind the outcome measures used in SPApps for LBP is never investigated before. Therefore, this systematic review firstly assess the quality of the free SPApps for LBP, secondly examines the outcome measures used and thirdly evaluates the outcome measures against the International Classification of Functioning, Disability and Health (ICF) core set classifications for LBP. METHODS A systematic scoping review was conducted in the iTunes and Google Play™ on-line stores for LBP SPApps which are free to download. These searches were conducted using keywords suggested by the Cochrane Back and Neck Group. SPApps were screened and downloaded to assess the quality using the Mobile App Rating Scale (MARS). SPApps using outcome measures were reviewed separately to evaluate whether their outcome measures represented any of the ICF components for LBP. RESULTS The overall quality of the apps has a mean MARS score of 2.5/5. Out of 74 apps reviewed, only four apps had outcome measures that could be linked to ICF components for LBP. Two of the four categories comprising the LBP core set were well represented. CONCLUSION The overall quality of the SPApps for LBP is low. Only very few SPApps offer outcome measures to monitor their effectiveness in the management of LBP. There is very limited evidence to show that the outcome measures used in the apps represents all the four core sets of LBP criteria set by ICF.
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Affiliation(s)
- Rachel Coe-O’Brien
- Croydon University Hospital, National Health Service Trust, 530 London Road, Croydon, CR7 7YE UK
| | - Leonard Joseph
- School of Health Science, University of Brighton, Robert Dodd Building, 49, Darley Road, Eastbourne, East Sussex BN20 7UR UK
| | - Raija Kuisma
- Karelia University of Applied Sciences, Tikkarinne 9, FI-80200 Joensuu, Finland
| | - Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Patraporn Sitilertpisan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Meyerowitz-Katz G, Ravi S, Arnolda L, Feng X, Maberly G, Astell-Burt T. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e20283. [PMID: 32990635 PMCID: PMC7556375 DOI: 10.2196/20283] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/05/2023] Open
Abstract
Background Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have significant issues with sustained use, with up to 98% of people only using the app for a short time before dropping out and/or dropping use down to the point where the app is no longer effective at helping to manage disease. Objective Our objectives are to systematically appraise and perform a meta-analysis on dropout rates in apps for chronic disease and to qualitatively synthesize possible reasons for these dropout rates that could be addressed in future interventions. Methods MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, Cochrane CENTRAL (Central Register of Controlled Trials), and Embase were searched from 2003 to the present to look at mobile health (mHealth) and attrition or dropout. Studies, either randomized controlled trials (RCTs) or observational trials, looking at chronic disease with measures of dropout were included. Meta-analysis of attrition rates was conducted in Stata, version 15.1 (StataCorp LLC). Included studies were also qualitatively synthesized to examine reasons for dropout and avenues for future research. Results Of 833 studies identified in the literature search, 17 were included in the review and meta-analysis. Out of 17 studies, 9 (53%) were RCTs and 8 (47%) were observational trials, with both types covering a range of chronic diseases. The pooled dropout rate was 43% (95% CI 29-57), with observational studies having a higher dropout rate (49%, 95% CI 27-70) than RCTs in more controlled scenarios, which only had a 40% dropout rate (95% CI 16-63). The studies were extremely varied, which is represented statistically in the high degree of heterogeneity (I2>99%). Qualitative synthesis revealed a range of reasons relating to attrition from app-based interventions, including social, demographic, and behavioral factors that could be addressed. Conclusions Dropout rates in mHealth interventions are high, but possible areas to minimize attrition exist. Reducing dropout rates will make these apps more effective for disease management in the long term. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019128737; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128737
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Affiliation(s)
- Gideon Meyerowitz-Katz
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown NSW, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Sumathy Ravi
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown NSW, Australia
| | - Leonard Arnolda
- School of Health and Society, University of Wollongong, Wollongong, Australia.,Illawarra Health & Medical Research Institute, Wollongong, Australia
| | - Xiaoqi Feng
- School of Health and Society, University of Wollongong, Wollongong, Australia.,School of Public Health and Community Medicine, University of New South Wales, Kingsford NSW, Australia.,Menzies Centre for Health Policy, University of Sydney, Camperdown NSW, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown NSW, Australia.,Menzies Centre for Health Policy, University of Sydney, Camperdown NSW, Australia
| | - Thomas Astell-Burt
- School of Health and Society, University of Wollongong, Wollongong, Australia.,Menzies Centre for Health Policy, University of Sydney, Camperdown NSW, Australia
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Buck HG, Shadmi E, Topaz M, Sockolow PS. An integrative review and theoretical examination of chronic illness mHealth studies using the Middle-Range Theory of Self-care of Chronic Illness. Res Nurs Health 2020; 44:47-59. [PMID: 32931601 DOI: 10.1002/nur.22073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
Self-management, or self-care, by individuals and/or families is a critical element in chronic illness management as more care shifts to the home setting. Mobile device-enhanced health care, or mHealth, is being touted as a means to support self-care. Previous mHealth reviews examined the effect of mHealth on patient outcomes, however, none used a theoretical lens to examine the interventions themselves. The aims of this integrative review were to examine recent (e.g., last 10 years) chronic illness mHealth empiric studies and (1) categorize self-care behaviors engaged in the intervention according to the Middle-Range Theory of Self-care of Chronic Illness, and (2) conduct an analysis of gaps in self-care theory domains and behaviors utilized. Methods included: (1) Best practice study identification, collection, and data extraction procedures and (2) realist synthesis techniques for within and across case analysis. From a pool of 652 records, 33 primarily North American clinical trials, published between 2010 and 2019 were examined. Most mHealth interventions used apps, clinician contact, and behavioral prompts with some wireless devices. Examination found self-care maintenance behaviors were supported in most (n = 30) trials whereas self-care monitoring (n = 12) and self-care management behaviors (n = 8) were less so. Few trials (n = 2) targeted all three domains. Investigation of specific behaviors uncovered an overexamination of physical activity and diet behaviors and an underexamination of equally important behaviors. By examining chronic illness mHealth interventions using a theoretical lens we have categorized current interventions, conducted a gap analysis uncovering areas for future study, and made recommendations to move the science forward.
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Affiliation(s)
- Harleah G Buck
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Efrat Shadmi
- Department of Nursing, University of Haifa, Haifa, Israel
| | - Maxim Topaz
- School of Nursing, Columbia University, New York City, New York, USA
| | - Paulina S Sockolow
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Guo X, Gu X, Jiang J, Li H, Duan R, Zhang Y, Sun L, Bao Z, Shen J, Chen F. A Hospital-Community-Family-Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e13229. [PMID: 31833835 PMCID: PMC6935047 DOI: 10.2196/13229] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/06/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. Objective This study aimed to evaluate the feasibility of a hospital-community-family (HCF)–based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. Methods This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure–related health behaviors. Results As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91% (21/23) of physicians believed the program was effective, and 87% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60% (40/66) of participants showed good adherence to the care plan in the study period, and 79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006). Conclusions The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants’ and their families’ access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program’s effectiveness.
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Affiliation(s)
- Xiaorong Guo
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Xiang Gu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Jiang Jiang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Hongxiao Li
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Ruoyu Duan
- Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Yi Zhang
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Lei Sun
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Zhengyu Bao
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Jianhua Shen
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Fukun Chen
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
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Yin AL, Hachuel D, Pollak JP, Scherl EJ, Estrin D. Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review. J Med Internet Res 2019; 21:e14630. [PMID: 31429410 PMCID: PMC6718080 DOI: 10.2196/14630] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together. Objective This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities. Methods We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (“mobile health” OR “eHealth” OR “digital health” OR “smart phone” OR “mobile app” OR “mobile applications” OR “mHealth” OR “smartphones”) AND (“IBD” OR “Inflammatory bowel disease” OR “Crohn's Disease” (CD) OR “Ulcerative Colitis” (UC) OR “UC” OR “CD”), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion. Results A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up. Conclusions While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses.
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Affiliation(s)
- Andrew Lukas Yin
- Medical College, Weill Cornell Medicine, New York, NY, United States.,Cornell Tech, New York, NY, United States
| | - David Hachuel
- Cornell Tech, New York, NY, United States.,augGI Technologies, New York, NY, United States
| | | | - Ellen J Scherl
- Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medicine, New York, NY, United States
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Abstract
INTRODUCTION Artificial intelligence (AI) technologies continue to attract interest from a broad range of disciplines in recent years, including health. The increase in computer hardware and software applications in medicine, as well as digitization of health-related data together fuel progress in the development and use of AI in medicine. This progress provides new opportunities and challenges, as well as directions for the future of AI in health. OBJECTIVE The goals of this survey are to review the current state of AI in health, along with opportunities, challenges, and practical implications. This review highlights recent developments over the past five years and directions for the future. METHODS Publications over the past five years reporting the use of AI in health in clinical and biomedical informatics journals, as well as computer science conferences, were selected according to Google Scholar citations. Publications were then categorized into five different classes, according to the type of data analyzed. RESULTS The major data types identified were multi-omics, clinical, behavioral, environmental and pharmaceutical research and development (R&D) data. The current state of AI related to each data type is described, followed by associated challenges and practical implications that have emerged over the last several years. Opportunities and future directions based on these advances are discussed. CONCLUSION Technologies have enabled the development of AI-assisted approaches to healthcare. However, there remain challenges. Work is currently underway to address multi-modal data integration, balancing quantitative algorithm performance and qualitative model interpretability, protection of model security, federated learning, and model bias.
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Affiliation(s)
- Fei Wang
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, NY, USA
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28
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Setiawan IMA, Zhou L, Alfikri Z, Saptono A, Fairman AD, Dicianno BE, Parmanto B. An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies. JMIR Form Res 2019; 3:e12982. [PMID: 31021324 PMCID: PMC6658284 DOI: 10.2196/12982] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 01/02/2023] Open
Abstract
Background Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs’ self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs’ evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs.
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Affiliation(s)
- I Made Agus Setiawan
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Computer Science, Udayana University, Badung, Bali, Indonesia
| | - Leming Zhou
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zakiy Alfikri
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andi Saptono
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea D Fairman
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, United States
| | - Brad Edward Dicianno
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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