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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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2
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Masanneck L, Pawlitzki MG, Meuth SG. [Digital medicine in neurological research-Between hype and evidence]. Nervenarzt 2024; 95:230-235. [PMID: 38095660 DOI: 10.1007/s00115-023-01581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND The rapid advancement of digital medicine and health technologies in neurology offers both significant potential and challenges. This article outlines fundamental aspects of digital medicine related to neurological research and highlights application examples of digital technologies in neurological research. AIM To provide a comprehensive overview of current digital developments in neurology and their impact on neurological research. MATERIAL AND METHODS In this narrative review articles from various sources and references related to digital medicine and health technologies in neurology were compiled and analyzed. RESULTS AND DISCUSSION The data presented indicate that digital health technologies and digital therapeutics have the potential to decisively shape neurological care and research; however, it is emphasized that a critical evaluation and evidence-based approach to these technologies are essential to determine their actual value in neurology.
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Affiliation(s)
- Lars Masanneck
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
- Hasso-Plattner-Institut, Potsdam, Deutschland.
| | - Marc G Pawlitzki
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Sven G Meuth
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
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Coucke P. [Get used to digital therapeutics (DTx) : they will take the scene in health care !]. Rev Med Liege 2024; 79:186-190. [PMID: 38487914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Digital therapeutics are making headways in medical treatment at large. They are used alone or in combination with standard medical treatment in various fields, aiming at essentially behavioral changes. As we are facing a growing imbalance between demand and resources, these digital treatments offer a powerful way for patient empowerment.
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Carrera A, Manetti S, Lettieri E. Rewiring care delivery through Digital Therapeutics (DTx): a machine learning-enhanced assessment and development (M-LEAD) framework. BMC Health Serv Res 2024; 24:237. [PMID: 38395905 PMCID: PMC10885456 DOI: 10.1186/s12913-024-10702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Digital transformation has sparked profound change in the healthcare sector through the development of innovative digital technologies. Digital Therapeutics offer an innovative approach to disease management and treatment. Care delivery is increasingly patient-centered, data-driven, and based on real-time information. These technological innovations can lead to better patient outcomes and support for healthcare professionals, also considering resource scarcity. As these digital technologies continue to evolve, the healthcare field must be ready to integrate them into processes to take advantage of their benefits. This study aims to develop a framework for the development and assessment of Digital Therapeutics. METHODS The study was conducted relying on a mixed methodology. 338 studies about Digital Therapeutics resulting from a systematic literature review were analyzed using descriptive statistics through RStudio. Machine learning algorithms were applied to analyze variables and find patterns in the data. The results of these analytical analyses were summarized in a framework qualitatively tested and validated through expert opinion elicitation. RESULTS The research provides M-LEAD, a Machine Learning-Enhanced Assessment and Development framework that recommends best practices for developing and assessing Digital Therapeutics. The framework takes as input Digital Therapeutics characteristics, regulatory aspects, study purpose, and assessment domains. The framework produces as outputs recommendations to design the Digital Therapeutics study characteristics. CONCLUSIONS The framework constitutes the first step toward standardized guidelines for the development and assessment of Digital Therapeutics. The results may support manufacturers and inform decision-makers of the relevant results of the Digital Therapeutics assessment.
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Lazaridou A, Paschali M, Bernstein C, Curiel M, Moore S, Edwards RR. sEMG Biofeedback for Episodic Migraines: A Pilot Randomized Clinical Trial. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-023-09615-0. [PMID: 38280149 DOI: 10.1007/s10484-023-09615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/29/2024]
Abstract
The aim of this study was to assess the feasibility and potential effectiveness of a 6-week virtual sEMG biofeedback intervention for patients with episodic migraines. Patients with episodic migraines were randomized to treatment with a novel surface EMG (sEMG) at-home biofeedback device or a treatment as usual control group; they completed validated baseline and post-intervention assessments of migraine related disability (migraine-specific quality of life, anxiety and depression). Participants also underwent a series of Quantitative Sensory Testing (QST) procedures referring to several different tests that quantitatively assess responses to mechanical stimuli during two separate visits (baseline and post intervention). No adverse events were reported during the study. Compared to the treatment as usual comparison group, patients in the sEMG biofeedback group reported lower migraine disability (p < 0.05). Compared to baseline, participants in the sEMG biofeedback group demonstrated statistically significant reductions in anxiety (p < 0.01), and significant increases in quality of life (p < 0.001), and significant decreases in temporal summation (p < 0.05) assessed by QST. No significant changes were observed in any of the outcomes in the control comparison group (p > 0.05). No significant changes were observed in migraine frequency in either of the two groups (p > 0.05). In addition, mediation analyses revealed that changes in migraine related quality of life mediated group effects on changes in migraine disability. Virtual sEMG biofeedback shows promise as a potential therapy for reducing disability, anxiety and depression and improving quality of life in individuals with episodic migraines. These results demonstrate the feasibility of a digital intervention for migraines and set the basis for conducting a future, larger scale randomized controlled trial to confirm these preliminary findings.
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Affiliation(s)
- Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, USA.
- Fielding Graduate University, Santa Barbara, CA, USA.
| | - Myrella Paschali
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, USA
| | - Carolyn Bernstein
- Department of Neurology, Harvard Medical School, Brigham & Women's Hospital, Boston, USA
| | - Marie Curiel
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, USA
| | - Sara Moore
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, USA
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Yoo SG, Kim DJ, Chun JW, Choi IY. Developing a Cost-Effectiveness Model of Digital Therapeutics for Smoking Cessation. Stud Health Technol Inform 2024; 310:1548-1549. [PMID: 38269739 DOI: 10.3233/shti231287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The purpose of this research was to construct a Markov model of digital therapeutics to predict the lifetime costs and consequences that would be incurred by a hypothetical group of adult smokers in Korea who only made a single attempt to stop smoking. To determine the efficacy of DTx, we created an annual cycle Markov model. The result shows that the NRT strategy is determined as the dominant strategy. Digital therapeutics acts as a complement to pharmacotherapy and is a low-cost option.
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Affiliation(s)
- Sung Goo Yoo
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea
| | - Dai Jin Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ji Won Chun
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea
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Suero-Pineda A, Oliva-Pascual-Vaca A, Rodríguez-Piñero Durán M, Rodríguez Sánchez-Laulhé P, García-Frasquet MA, J Blanquero. [Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture]. Rehabilitacion (Madr) 2024; 58:100818. [PMID: 37890425 DOI: 10.1016/j.rh.2023.100818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/06/2023] [Accepted: 05/12/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. MATERIAL AND METHODS A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. RESULTS The experimental group required fewer physiotherapy sessions (MD: -16.94; 95%CI: -32.5 to -1.38) and rehabilitation consultations (MD: -1.7; 95%CI: -3.39 to -0.02) compared to the control group. CONCLUSIONS In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.
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Affiliation(s)
- A Suero-Pineda
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España.
| | - A Oliva-Pascual-Vaca
- Instituto de Biomedicina de Sevilla (IBiS); Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, España
| | - M Rodríguez-Piñero Durán
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen Macarena, Sevilla, España
| | - P Rodríguez Sánchez-Laulhé
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España
| | - M A García-Frasquet
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J Blanquero
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España
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Hisaki F, Aga M, Tomitani N, Okawara Y, Harada N, Kario K. Daily self-reported behavioural efficacy records on hypertension digital therapeutics as digital metrics associated with the reduction in morning home blood pressure: post-hoc analysis of HERB-DH1 trial. Hypertens Res 2024; 47:120-127. [PMID: 37717116 DOI: 10.1038/s41440-023-01434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
Digital therapeutics for hypertension, proven effective in the HERB-DH1 trial, enable patients to record and track their daily actions and achievements to improve their lifestyles using an app. However, the association between recording daily behaviours and blood pressure (BP) reduction has not yet been investigated. We conducted a post-hoc analysis to investigate the relationship between them in the HERB-DH1 trial. We defined the counts of daily records of antihypertensive behaviour taken by the patient into the app as daily self-reported behavioural efficacy records (SER). SER was categorised into quartiles, and the trend of changes from baseline to week 12 in morning home systolic blood pressure (SBP), salt intake checklist score, and body weight was assessed. A total of 156 patients with hypertension were included in the analysis. A higher total count of SER was associated with greater SBP reduction (P for trend: 0.049). Patients with a higher SER for salt intake and weight reduction showed reductions in SBP (P for trend: 0.034 and 0.027, respectively). Furthermore, patients with higher salt intake SER exhibited a decrease in the salt intake checklist scores, and patients with greater weight reduction SER experienced a reduction in body weight (P for trend: 0.001 and 0.007, respectively). SER during digital therapeutics is associated with a reduction in morning home SBP in patients with hypertension. Enhancing patients' intrinsic motivation and self-efficacy, as evaluated by the SER, can play an important role in reducing BP by promoting lifestyle improvement. Daily self-reported behavioural efficacy records (SER) defined as the number of patient's app inputs of recall of day-by-day activity of behaviours at the end of the day, is partially affected by self-efficacy and affinity of app, resulting in the effectiveness of digital therapeutics.
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Affiliation(s)
- Fumi Hisaki
- CureApp, Inc. Medical Division, Tokyo, Japan
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Noriko Harada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
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Liu T, Zhan Y, Chen S, Zhang W, Jia J. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis. Cost Eff Resour Alloc 2023; 21:82. [PMID: 37932748 PMCID: PMC10626728 DOI: 10.1186/s12962-023-00489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In recent years, numerous guidelines and expert consensus have recommended the inclusion of digital technologies and products in cardiac rehabilitation. Digital therapeutics (DTx) is an evidence-based medicine that uses digital means for data collection and monitoring of indicators to control and optimize the treatment, management, and prevention of disease. OBJECTIVE This study collected and reviewed real-world data and built a model using health economics assessment methods to analyze the potential cost-effectiveness of DTx applied to home-based cardiac rehabilitation for patients with chronic heart failure. From the perspective of medical and health decision-makers, the economic value of DTx is evaluated prospectively to provide the basis and reference for the application decision and promotion of DTx. METHODS Markov models were constructed to simulate the outcomes of DTx for home-based cardiac rehabilitation (DT group) compared to conventional home-based cardiac rehabilitation (CH group) in patients with chronic heart failure. The model input parameters were clinical indicators and cost data. Outcome indicators were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The robustness of the evaluation methods and results was tested using sensitivity analyses. Clinical indicators, cost data, and health utility values were obtained from real-world data, including clinical study data, published literature, and public website information. RESULTS The Markov model simulated a time span of 10 years, with a cycle set at one month, for 120 cycles. The results showed that the per capita cost of the CH group was 38,442.11 CNY/year, with a QALY of 0.7196 per person per year. The per capita cost of the DT group was 42,300.26 CNY/year, with a QALY of 0.81687 per person per year. The ICER per person was 39,663.5 CNY/QALY each year, which was below the willingness-to-pay threshold of 85,698 CNY (China's GDP per capita in 2022). CONCLUSIONS DTx for home-based cardiac rehabilitation is an extremely cost-effective rehabilitation option compared with conventional home-based cardiac rehabilitation. DTx for home-based cardiac rehabilitation is potentially valuable from the perspective of healthcare decision-makers.
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Affiliation(s)
- Tianyi Liu
- School of Business, Nanjing University, Nanjing, 210093, China
| | - Yiyang Zhan
- Departments of Geriatric Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Silei Chen
- Medical School, Nanjing University, Nanjing, China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, 210093, China.
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
| | - Jian Jia
- School of Business, Nanjing University, Nanjing, 210093, China.
- Departments of General Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Kario K. Digital hypertension towards to the anticipation medicine. Hypertens Res 2023; 46:2503-2512. [PMID: 37612370 DOI: 10.1038/s41440-023-01409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
"Digital Hypertension" is a new research field proposed by the Japanese Society of Hypertension that integrates digital technology into hypertension management and proactively promotes research activities. This novel approach includes the development of new technologies for better BP management, such as sensors for detecting environmental factors that affect BP, information processing, and machine learning. To facilitate "Digital Hypertension," a more sophisticated BP monitoring system capable of measuring an individual's BP more frequently in various situations would be required. With the use of these technologies, hypertension management could shift from the current "dots" management based on office BP readings during clinic visits to a "line" management system based on seamless home BP or individual BP data taken by a wearable BP monitoring device. DTx is the innovation to change hypertension management from "dots" to "line", completely achieved by wearable BP.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan.
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Higgins ST. Behavior change, health, and health disparities 2023: Contingency management for treating substance use disorders and promoting health in vulnerable populations. Prev Med 2023; 176:107746. [PMID: 37898183 DOI: 10.1016/j.ypmed.2023.107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This Special Issue (SI) of Preventive Medicine is the 10th in a series on behavior change, health, and health disparities. This issue focuses on Contingency Management (CM), a highly efficacious behavior-change intervention for substance use disorders (SUDs) and other behavioral health conditions wherein patients receive material incentives (e.g., vouchers exchangeable for retail items) contingent on objectively verified behavior change. Despite substantial support for its efficacy, CM remains largely unavailable in U.S. community SUD treatment facilities and other healthcare settings. This is especially concerning regarding stimulant use disorder for which CM is the only reliably efficacious intervention in controlled studies and yet is unavailable to the vast majority of those in need. This SI details recent promising developments in efforts to surmount longstanding implementation obstacles while also detailing other promising advances from meta-analyses and controlled trials examining CM's efficacy in treating other difficult-to-treat problems including smoking among pregnant women and mothers of young children as well among those as those experiencing homelessness and alcohol use disorder, the promise of digital CM, and a potential new application in promoting adherence with SUD medications.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, 1 South Prospect St., UHC, MS482 Burlington, VT 05401, USA.
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Courtet P, Amiot O, Baca-Garcia E, Bellardita L, Cerveri G, Clair AH, De Leo D, Drapier D, Fakra E, Gheysen F, Giner L, Gonzalez-Pinto A, Gussoni G, Haffen E, Lecardeur L, Mayoral-Cleries F, Mennini FS, Sáiz PA, Vieta E, Hidalgo DA, Volpe U. Understanding the potential of digital therapies in implementing the standard of care for depression in Europe. Eur Psychiatry 2023; 66:e82. [PMID: 37872705 PMCID: PMC10755564 DOI: 10.1192/j.eurpsy.2023.2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/25/2023] Open
Abstract
Depressive disorders represent the largest proportion of mental illnesses, and by 2030, they are expected to be the first cause of disability-adjusted life years [1]. The COVID-19 pandemic exacerbated prevalence and burden of depression and increased the occurrence of depressive symptoms in general population [2]. The urgency of implementing mental health services to address new barriers to care persuaded clinicians to use telemedicine to follow patients and stay in touch with them, and to explore digital therapeutics (DTx) as potential tools for clinical intervention [2]. The combination of antidepressants and psychotherapy is widely recommended for depression by international guidelines [3] but is less frequently applied in real-world practice. Commonly used treatments are pharmacological, but while being effective, some aspects such as adherence to the drug regimen, residual symptoms, resistance, lack of information, and stigma may hinder successful treatment. In case of less severe depression, standalone psychological therapies should be the first-line treatment option [3], but access to trained psychotherapists remains inequitable. DTx are evidence-based therapies driven by software programs to treat or complement treatment of a specific disease. DTx are classified as Medical Devices, and given their therapeutic purpose, they need to be validated through randomized controlled clinical trials, as for drug-based therapies. In the last 10 years, studies of digital interventions have proliferated; these studies demonstrate that digital interventions increase remission rates and lower the severity of depressive symptoms compared with waitlist, treatment as usual, and attention control conditions [4]. Despite the efficacy demonstrated in clinical trials, many of these tools never reach real-life patients; thus, it might be necessary to implement DTx in the public health system to expand access to valid treatment options. In this framework, DTx represent a good opportunity to help people with depression receive optimal psychotherapeutic care [5].
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Affiliation(s)
- Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Odile Amiot
- GH Paul Guiraud, Boulogne Billancourt, France
| | - Enrique Baca-Garcia
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain
- Department of Psychiatry, General Hospital of Villalba, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
- Department of Psychiatry, Madrid Autonomous University, Madrid, Spain
- Centro de Investigacion en Salud Mental (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | | | | | - Anne-Hélène Clair
- Institut du Cerveau – Paris Brain Institute – ICM, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Diego De Leo
- Department of Psychology, Primorska University, Koper, Slovenia
| | - Dominique Drapier
- Centre Hospitalier Guillaume régnier, Pôle Hospitalo universitaire de psychiatrie, CIC Rennes INSERM, Rennes, France
| | - Eric Fakra
- Saint Étienne University Hospital, University Jean Monnet, Saint Étienne, France
- PsyR2 Team, Centre de Recherche en Neurosciences de Lyon (CRNL), INSERM U1028, CNRS UMR 5292, Université Jean Monnet Saint Etienne, Université Lyon 1, Saint-Étienne, France
| | | | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Ana Gonzalez-Pinto
- BIOARABA, Department of Psychiatry, Hospital Universitario de Alava, UPV/EHU, CIBERSAM, Vitoria, Spain
| | - Gualberto Gussoni
- Clinical Research Department, Italian Scientific Society of Internal Medicine (FADOI), Milan, Italy
| | - Emmanuel Haffen
- UR LINC, Service de psychiatrie de l’adulte, CIC-1431 INSERM, CHU de Besançon, Université de Franche-Comté, Besançon, France
| | | | - Fermin Mayoral-Cleries
- Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Francesco Saverio Mennini
- EEHTA-CEIS, DEF Department, Faculty of Economic, University of Rome Tor Vergata, Roma, Italy
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - Pilar A Sáiz
- Centro de Investigacion en Salud Mental (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), University of Oviedo, Oviedo, Spain
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Eduard Vieta
- Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Diego Alberto Hidalgo
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Umberto Volpe
- Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università Politecnica delle Marche, Ancona, Italy
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Wang T, Ho MH, Tong MCF, Chow JCH, Voss JG, Lin CC. Effects of Patient-Reported Outcome Tracking and Health Information Provision via Remote Patient Monitoring Software on Patient Outcomes in Oncology Care: A Systematic Review and Meta-Analysis. Semin Oncol Nurs 2023; 39:151473. [PMID: 37516624 DOI: 10.1016/j.soncn.2023.151473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES The authors sought to 1) review the literature on the remote care model that uses remote patient monitoring software (RPMS) as key mechanisms in oncology care for symptom tracking and health information provision and (2) compare the remote care model to standard care in terms of health-related quality of life, symptom burden, health management self-efficacy, anxiety, and depression. DATA SOURCES The search was conducted on March 23, 2022, in the Cochrane Library, MEDLINE/PubMed, PsycINFO, and CINAHL databases. RESULTS The primary strategies for applying digital technology in remote care models are patient-reported outcomes (PRO) tracking and health information delivery. Common PRO measurements applied in the RPMS include quality of life, symptom burden, self-efficacy, anxiety, and depression. Nine randomized controlled trials testing seven RPMS interventions were examined. Compared to standard care, remote patient monitoring via RPMS was related to greater quality of life and lower physical symptom burden during cancer therapy. The RPMS incorporated into routine clinical care with nurses providing remote monitoring performed better on PRO than that not integrated. CONCLUSION The RPMS-based remote care model improves patient outcomes during cancer treatment, and it is not inferior to standard care until the RPMS function is more integrated with existing clinical care. IMPLICATIONS FOR NURSING PRACTICE Nurses are well-positioned to engage patients in self-care skills via RPMS and can play a vital role in integrating such a model of remote patient care into routine care practices.
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Affiliation(s)
- Tongyao Wang
- Research Assistant Professor, School of Nursing, LKS Faculty of Medicine, The University Hong Kong, Pokfulam, Hong Kong
| | - Mu-Hsing Ho
- Assistant Professor, School of Nursing, LKS Faculty of Medicine, The University Hong Kong, Pokfulam, Hong Kong
| | - Michael C F Tong
- Professor and Head, Graduate Division of Otorhinolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery; Director, Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR
| | - James Chung-Hang Chow
- Associate Consultant, Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Joachim G Voss
- Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chia-Chin Lin
- Head and Professor, School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Nomura A. Digital health, digital medicine, and digital therapeutics in cardiology: current evidence and future perspective in Japan. Hypertens Res 2023; 46:2126-2134. [PMID: 37258624 PMCID: PMC10230462 DOI: 10.1038/s41440-023-01317-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023]
Abstract
Ten years passed since Japan set out the Action Plan of Growth Strategy that declared the initiatives of digitalization for medicine, nursing care, and healthcare to achieve the world's most advanced medical care. The initiatives formed the foundation of the Japanese national strategy and have been continuously refined, resulting in the current environment of digital health and digital medicine. Digital health-related terminologies are organized, such as "digital health," "digital medicine," and "digital therapeutics" (DTx), as well as several common digital technologies, including artificial intelligence, machine learning, and mobile health (mHealth). DTx is included in mHealth and is a novel disease treatment option. Also, this article thoroughly describes DTx in Japan and compares it with those in the US and Germany, the leading countries in digital health-related policies, regulations, and their development status. In Japan, two of three DTx applications that have been approved and reimbursed by the Ministry of Health, Labor, and Welfare are explained in detail in relation to cardiovascular medicine. When added to a standard smoking cessation program, the DTx system for nicotine dependence significantly improved the continuous abstinence rate. Moreover, the DTx for hypertension together with the guideline-based hypertension management was effective in patients aged 65 years or younger who were diagnosed with essential hypertension without antihypertensive agents, and it was also found to be cost-effective. DTx in cardiovascular medicine, with consideration on safety, efficacy, and cost-effectiveness, could be widely used not only through basic experiments and clinical studies but also through social implementation.
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Affiliation(s)
- Akihiro Nomura
- College of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan.
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
- Frontier Institute of Tourism Sciences, Kanazawa University, Kanazawa, Japan.
- Department of Biomedical Informatics, CureApp Institute, Karuizawa, Japan.
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15
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Rodler S, Kowalewski KF, Scheibert H, Bensel M, Stadelmeier LF, Styn A, Belenchon IR, Taratkin M, Puliatti S, Gomez Rivas J, Veccia A, Piazza P, Checcucci E, Michel MS, Stief CG, Cacciamani G. Digital Therapeutics in Urology: An Innovative Approach to Patient Care and Management. EUR UROL SUPPL 2023; 55:23-27. [PMID: 37593208 PMCID: PMC10432164 DOI: 10.1016/j.euros.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
Digital therapeutics (DTx) are a new class of intervention involving evidence-based software applications and have been used in neurology and psychiatry. To assess the potential of DTx in urology, we conducted a survey to assess the current prevalence of the digital infrastructure required for DTx, areas of support expected by patients, and requirements for uptake. Between November 2022 and January 2023, we conducted an anonymized survey at two German academic centers among patients with urologic conditions. We found that among patients aged <65 yr versus ≥65 yr, digital devices including smartphones (93.6% vs 77.3%; p < 0.001), computers (80.4% vs 70.1%; p < 0.001), tablets (51.7% vs 38.1%; p < 0.001), and smartwatches (24.7% vs 7.7%; p < 0.001) are already widely used, especially in the younger age group. Apps (95.6% vs 74.4%; p < 0.001) and health apps (57.6% vs 30.4%; p < 0.001) are already frequently used, but certified DTx apps are not (7.3% vs 5.4%; p = 0.25). Patients favor solutions that provide access to validated information (49.6%), give medical advice based on data or symptoms captured by the app (43.0%), or replace a physiotherapist (41.7%). Patients feel that optimization of therapy (78.4%), significant positive health outcomes (76.9%), and better patient autonomy (73.4%) are important requirements for DTx in urology. Regulatory and reimbursement changes mean that DTx might play an increasing role in urology. Patient summary Patients can use digital therapeutics (DTx), which are mainly smartphone apps, to improve their health status or treat medical conditions. We assessed the current and future use of DTx in urology. Patients are already widely using smartphones and frequently use uncertified health apps, but do not use DTx. Patients would like to use DTx to optimize therapy that provides a significant health improvement.
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Affiliation(s)
- Severin Rodler
- Depatment of Urology, LMU University Hospital, Munich, Germany
| | | | | | - Moritz Bensel
- Depatment of Urology, LMU University Hospital, Munich, Germany
| | | | - Amelie Styn
- Depatment of Urology, LMU University Hospital, Munich, Germany
| | - Ines Rivero Belenchon
- Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Alessandro Veccia
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Maurice S. Michel
- Department of Urology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Giovanni Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - the Young Academic Urologists Urotechnology Group of the European Association of Urology
- Depatment of Urology, LMU University Hospital, Munich, Germany
- Department of Urology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
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Karia J, Mohamed R, Petrushkin H. Patient-targeted mobile applications in healthcare. Br J Hosp Med (Lond) 2023; 84:1-5. [PMID: 37646550 DOI: 10.12968/hmed.2023.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
There has been an increase in the number of healthcare-related applications targeted at patients for use on mobile phones. With an increasing proportion of the population using such applications, it is important to understand the associated limitations, safety concerns and challenges of legalisation. This article explores the impact of these applications on frontline care and patient wellbeing, evaluating the literature surrounding the benefits and challenges of patient-targeted mobile applications in health care and analysing the limitations of existing research. The proclaimed benefits of such applications are not always evidence based. Furthermore, many healthcare applications are created by laypeople and not validated by healthcare authorities, creating a potential to cause patient harm. Further research is needed to identify long-term effects on both healthcare systems and individuals' psychosocial wellbeing. However, research in this field often lacks a universal perspective and may be influenced by underlying financial motives to promote use of the applications.
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Affiliation(s)
- Janvi Karia
- Division of Medicine, University College London, London, UK
| | - Ryian Mohamed
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Harry Petrushkin
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Great Ormond Street Hospital, London, UK
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17
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Rahaman T. Empowering Patients One App at a Time: An Introduction to Digital Therapeutics. Med Ref Serv Q 2023; 42:301-307. [PMID: 37459489 DOI: 10.1080/02763869.2023.2225352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The growth of digital health has led to more app-based solutions entering the market which aim to provide therapeutic outcomes for a variety of diseases. This column explores the emerging field of digital therapeutics (DTx) as evidence-based and FDA-cleared digital interventions - setting them apart from the majority of commercially available solutions. In an effort to identify high quality and evidence-based options, medical and health science librarians can benefit from recognizing the qualifications of DTx, types of available DTx, and use cases for their patrons.
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Affiliation(s)
- Tariq Rahaman
- Tampa Bay Regional Campus Library, Nova Southeastern University, Clearwater, FL, USA
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Lee JH, Lee TS, Yoo SY, Lee SW, Jang JH, Choi YJ, Park YR. Metaverse-based social skills training programme for children with autism spectrum disorder to improve social interaction ability: an open-label, single-centre, randomised controlled pilot trial. EClinicalMedicine 2023; 61:102072. [PMID: 37483546 PMCID: PMC10359727 DOI: 10.1016/j.eclinm.2023.102072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is characterised by abnormalities in social interactions and restricted and repetitive behaviors. Children with high-functioning ASD (HFASD), lack social communication skills, do not interact with others, and lack peer relationships. We aimed to develop, and evaluate the feasibility of, a metaverse-based programme to enhance the social skills of children with HFASD. Methods This open-label, single-centre, pilot parallel randomised controlled trial (RCT) was conducted on boys aged 7-12 years with HFASD. Children were recruited from a treatment centre for children with HFASD in Korea or by self-referral through online community webpages for the parents of children with HFASD. Participants were randomly assigned (1:1) by a blinded researcher to receive either four weeks of a metaverse-based social skills training programme or a control group. Randomisation was stratified by age (children aged 7-9 and 10-12 years) using permuted blocks (block size 4). The metaverse-based social skills training programme was delivered via the metaverse platforms (Roblox) and Zoom. Children in the intervention group completed the metaverse-based social skills training programme at home for four weeks. The intervention consisted of four sessions, one session per week, for 60 min each. The control group did not receive any interventions. The primary outcome measure was the median change in the Social Responsiveness Scale-2 (SRS-2) scores from pre-to post-intervention. SRS-2 is an assessment tool used to confirm the effectiveness of social interactions. Higher scores indicate lower social functioning. The trial is registered with CRIS Registration Number; KCT0006859. Findings Between February 14, 2022, and March 31, 2022, 20 participants were enrolled. Overall, 15 children (median [Interquartile range (IQR)] age, intervention group: 9.0 [8.0-10.0]; control group: 8.5 [8.0-10.0]) participated in the programme. The intervention group included nine participants (60%), and the control group included six participants (40%). The SRS-2 total scores for the intervention group decreased from baseline 96.0 (IQR: 74.0-112.0) to post-intervention 85.0 (IQR: 84.0-103.0). The group median difference in SRS-2 scores between the intervention and control groups was 11.5 (95% CI: 8.5-14.0), with a further reduction in the intervention group. Similar trends were seen for social cognition (group median difference, 95% CI: 2.0, 1.0-4.0), social communication (group median difference, 95% CI: 2.0, 1.0-4.0), and autistic mannerism (group median difference, 95% CI: 4.0, 1.0-5.0). There were no adverse events related to study participation. Interpretation The findings of this feasibility study suggest that children with HFASD can potentially be familiarised, through metaverse-based programmes, with real-life social situations to improve sociality and reduce emotional and behavioural problems. Such interventions could be delivered at home and possibly be extended to target groups that have difficulty in interacting with peers offline. Funding The Institute of Information & Communications Technology Planning & Evaluation grant, via the Ministry of Science and ICT of the South Korean Government.
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Affiliation(s)
- Joo Hyun Lee
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Seon Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
- Center for Medical Education, Graduate School of Medicine, Nagoya University, Japan
| | - Su Young Yoo
- DoBrain Co., Ltd., Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Seung Woo Lee
- Graduate School of Information and Communication Technology, Ajou University, Suwon, South Korea
| | - Ji Hye Jang
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
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Lan L, Sikov J, Lejeune J, Ji C, Brown H, Bullock K, Spencer AE. A Systematic Review of using Virtual and Augmented Reality for the Diagnosis and Treatment of Psychotic Disorders. Curr Treat Options Psychiatry 2023; 10:1-21. [PMID: 37360960 PMCID: PMC10264872 DOI: 10.1007/s40501-023-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/28/2023]
Abstract
Objective Immersive virtual reality (VR) and augmented reality (AR) have the potential to improve the treatment and diagnosis of individuals experiencing psychosis. Although commonly used in creative industries, emerging evidence reveals that VR is a valuable tool to potentially improve clinical outcomes, including medication adherence, motivation, and rehabilitation. However, the efficacy and future directions of this novel intervention require further study. The aim of this review is to search for evidence of efficacy in enhancing existing psychosis treatment and diagnosis with AR/VR. Methods 2069 studies involving AR/VR as a diagnostic and treatment option were reviewed via PRISMA guidelines in five databases: PubMed, PsychInfo, Embase, and CINAHL. Results Of the initial 2069 articles, 23 original articles were eligible for inclusion. One study applied VR to the diagnosis of schizophrenia. Most studies demonstrated that the addition of VR therapies and rehabilitation methods to treatment-as-usual (medication, psychotherapy, social skills training) was more effective than traditional methods alone in treating psychosis disorders. Studies also support the feasibility, safety, and acceptability of VR to patients. No articles using AR as a diagnostic or treatment option were found. Conclusions VR is efficacious in diagnosing and treating individuals experiencing psychosis and is a valuable augmentation of evidence-based treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s40501-023-00287-5.
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Affiliation(s)
- Lucy Lan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94304 USA
| | - Jennifer Sikov
- Department of Psychology, Florida International University, Miami, Fl USA
| | - Julia Lejeune
- Department of Psychology, University of Illinois Chicago, Chicago, IL USA
| | - Chelsea Ji
- Chronic Traumatic Encephalopathy Center, Boston University, Boston, MA USA
| | - Hannah Brown
- Department of Psychiatry, Boston Medical Center, Boston, MA USA
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94304 USA
| | - Andrea E. Spencer
- Department of Psychiatry and Behavioral Health, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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Verma R, Bhardwaj S, Lathia T, Kalra S, Ranadive R, Tanna S, Padsalge M, Juneja A, Samundra K, Thakkar PB, Jain V, Kini V, Kothari S, Guntur S, Joshi S, Singal A. Personalized glycemic response led digital therapeutics program improves time in range in a period of 14 days. Int J Diabetes Dev Ctries 2023; 43:425-432. [PMID: 35892065 PMCID: PMC9303844 DOI: 10.1007/s13410-022-01111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control. Methods Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI). Results Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL (p < 0.0001). TIR and GMI improved from 70.50 (50.75 to 83.50) % to 75.00 (58.25 to 89.00) % (p = 0.0001) and 6.64 (6.13 to 7.35) % to 6.23 (5.74 to 6.86) % (p < 0.0001) respectively. TAR reduced significantly from 17.00 (4.25 to 38.0) % to 6.00 (1.25 to 26.0) % (p < 0.0001). No significant increase in TBR was observed (p = 0.198). Conclusion Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D.
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Affiliation(s)
- Ritika Verma
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Shefali Bhardwaj
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | | | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology, Haryana, India
| | - Ruchira Ranadive
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | | | | | | | | | | | - Vandana Jain
- Advanced Eye Hospital and Institute, Navi Mumbai, India
| | - Vishal Kini
- Care n Cure Speciality Clinic, Navi Mumbai, India
| | | | - Saimala Guntur
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Shilpa Joshi
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Arbinder Singal
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
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Kim EJ, Kim JY. The Metaverse for Healthcare: Trends, Applications, and Future Directions of Digital Therapeutics for Urology. Int Neurourol J 2023; 27:S3-12. [PMID: 37280754 DOI: 10.5213/inj.2346108.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
In recent years, the emergence of digital therapeutics as a novel approach to managing conditions has garnered significant attention. This approach involves using evidence-based therapeutic interventions that are facilitated by high-quality software programs to treat, manage, or prevent medical conditions. The incorporation of digital therapeutics into the Metaverse has increased the feasibility of their implementation and application in all areas of medical services. In urology, substantial digital therapeutics are being produced and researched, including mobile apps, bladder devices, pelvic floor muscle trainers, smart toilet systems, mixed reality-guided training and surgery, and training and telemedicine for urological consultations. The purpose of this review article is to provide a comprehensive overview of the current impact of the Metaverse on the field of digital therapeutics and identify its current trends, applications, and future perspectives in the field of urology.
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Affiliation(s)
- Eun Joung Kim
- Culture Contents Technology Institute, Gachon University, Seongnam, Korea
| | - Jung Yoon Kim
- Department of Game Media, College of Future Industry, Gachon University, Seongnam, Korea
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Wilde JA, Zawislak K, Sawyer-Morris G, Hulsey J, Molfenter T, Taxman FS. The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study. Int J Drug Policy 2023; 116:104024. [PMID: 37086698 DOI: 10.1016/j.drugpo.2023.104024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND This study explored whether participants with substance use disorder (SUD) would adopt and use a smart-phone app with a cognitive behavioral therapy program, weekly Brief Addiction Monitor (BAM) assessments, daily check-ins, tools to track sobriety and treatment, and other patient-centered resources. In addition, participants with SUD could access a social worker and peer support specialists. METHODS The study sought participants from two groups: those referred by a justice-related agency and participants who responded to outreach from the Addiction Policy Forum (APF). The Connections smart-phone app was offered to both groups. The study examined use of the app and social worker/peer recovery support services by participants who downloaded and used the app; those referred by a justice-related agency and those who self-referred through APF. The app provided primary data, including socio-demographics, referral status, dates of use, activities completed, and BAM scores. RESULTS The app was offered to 1973 participants, 40% of whom downloaded it. Three groups emerged from among the 350 who used the app: those who used only the cognitive behavioral aspects of the app, those who used only the recovery support services offered, and those who used both the app and recovery support services. Looking at the two referral groups, the justice-referred group preferred telehealth recovery support services with the social worker; the self-referred group used the app and the app plus the recovery support services equally. Scores on the BAM improved across time. Justice-referred participants' protective behaviors improved more than those of the self-referred participants while self-referred participants' risk behaviors improved more than those of justice-referred participants. Older participants were more likely to use the app, and to report fewer risky behaviors, as measured by the BAM. CONCLUSIONS Use of a digital therapeutic appears to support recovery of participants with SUD although many clients need and want the integration of social worker-driven recovery support services. Basically, the app can be an extension to personal services, but many people with SUD (particularly during COVID-19) crave human interaction. It also appears that those who seek assistance on their own, rather than being referred by a justice-related agency, may be more likely to benefit from digital therapeutics such as the Connections app.
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Affiliation(s)
- Judith A Wilde
- Schar School of Policy and Government, George Mason University, Van Metre Hall, Fifth Floor, 3351 Fairfax Drive, MS 3B1, Arlington, VA 22201, United States.
| | - Kayla Zawislak
- Addiction Policy Forum, 4701 Sangamore Rd, Suite 100N, Bethesda, MD 20816, United States.
| | - Ginnie Sawyer-Morris
- Addiction Policy Forum, 4701 Sangamore Rd, Suite 100N, Bethesda, MD 20816, United States.
| | - Jessica Hulsey
- Addiction Policy Forum, 4701 Sangamore Rd, Suite 100N, Bethesda, MD 20816, United States.
| | - Todd Molfenter
- College of Engineering, University of Wisconsin, 1513 University Ave., 4103 Mechanical Engineering Building, Madison, WI 53706, United States.
| | - Faye S Taxman
- Schar School of Policy and Government, George Mason University, Van Metre Hall, Fifth Floor, 3351 Fairfax Drive, MS 3B1, Arlington, VA 22201, United States.
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Kim I, Lim JY, Kim SW, Shin DW, Kim HC, Park YA, Lee YS, Kwak JM, Kang SH, Lee JY, Hwang JH. Effectiveness of personalized treatment stage-adjusted digital therapeutics in colorectal cancer: a randomized controlled trial. BMC Cancer 2023; 23:304. [PMID: 37013485 PMCID: PMC10069348 DOI: 10.1186/s12885-023-10728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Colorectal cancer survivors often experience decline in physical performance and poor quality of life after surgery and during adjuvant therapies. In these patients, preserving skeletal muscle mass and high-quality nourishment are essential to reduce postoperative complications and improve quality of life and cancer-specific survival. Digital therapeutics have emerged as an encouraging tool for cancer survivors. However, to the best of our knowledge, randomized clinical trials applying personalized mobile application and smart bands as a supportive tool to several colorectal patients remain to be conducted, intervening immediately after the surgical treatment. METHODS This study is a prospective, multi-center, single-blinded, two-armed, randomized controlled trial. The study aims to recruit 324 patients from three hospitals. Patients will be randomly allocated to two groups for one year of rehabilitation, starting immediately after the operation: a digital healthcare system rehabilitation (intervention) group and a conventional education-based rehabilitation (control) group. The primary objective of this protocol is to clarify the effect of digital healthcare system rehabilitation on skeletal muscle mass increment in patients with colorectal cancer. The secondary outcomes would be the improvement in quality of life measured by EORTC QLQ C30 and CR29, enhanced physical fitness level measured by grip strength test, 30-sec chair stand test and 2-min walk test, increased physical activity measured by IPAQ-SF, alleviated pain intensity, decreased severity of the LARS, weight, and fat mass. These measurements will be held on enrollment and at 1, 3, 6 and 12 months thereafter. DISCUSSION This study will compare the effect of personalized treatment stage-adjusted digital health interventions on immediate postoperative rehabilitation with that of conventional education-based rehabilitation in patients with colorectal cancer. This will be the first randomized clinical trial performing immediate postoperative rehabilitation in a large number of patients with colorectal cancer with a tailored digital health intervention, modified according to the treatment phase and patient condition. The study will add foundations for the application of comprehensive digital healthcare programs focusing on individuality in postoperative rehabilitation of patients with cancer. TRIAL REGISTRATION NCT05046756. Registered on 11 May 2021.
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Affiliation(s)
- Inah Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, 06351, Seoul, Republic of Korea
| | - Ji Young Lim
- Research Institute for Future Medicine, Samsung Medical Center, 06351, Seoul, Republic of Korea
| | - Sun Woo Kim
- Research Institute for Future Medicine, Samsung Medical Center, 06351, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, 06351, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351, Seoul, Republic of Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351, Seoul, Republic of Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Myun Kwak
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, 02841, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea.
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, 06351, Seoul, Republic of Korea.
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Gangl C, Krychtiuk K. Digital health-high tech or high touch? Wien Med Wochenschr 2023; 173:115-124. [PMID: 36602630 PMCID: PMC9813878 DOI: 10.1007/s10354-022-00991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/07/2022] [Indexed: 01/06/2023]
Abstract
Digital transformation in medicine refers to the implementation of information technology-driven developments in the healthcare system and their impact on the way we teach, share, and practice medicine. We would like to provide an overview of current developments and opportunities but also of the risks of digital transformation in medicine. Therefore, we examine the possibilities wearables and digital biomarkers provide for early detection and monitoring of diseases and discuss the potential of artificial intelligence applications in medicine. Furthermore, we outline new opportunities offered by telemedicine applications and digital therapeutics, discuss the aspects of social media in healthcare, and provide an outlook on "Health 4.0."
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Affiliation(s)
- Clemens Gangl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Konstantin Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
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Labinsky H, Gupta L, Raimondo MG, Schett G, Knitza J. Real-world usage of digital health applications (DiGA) in rheumatology: results from a German patient survey. Rheumatol Int 2023; 43:713-719. [PMID: 36543961 PMCID: PMC9770561 DOI: 10.1007/s00296-022-05261-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Mobile health applications and digital therapeutics (DTx) aim to improve current patient care. Real-world data on DTx are, however, scarce. The aim of this study was to evaluate the adherence, acceptance, and efficacy of DTx in a clinical routine rheumatology setting. We conducted a prospective observational cohort study assessing the use, adherence, acceptance, and efficacy of the DTx DiGA (Digitale Gesundheitsanwendungen) by survey over 12 weeks. Patients included had to have a rheumatic disease and had been prescribed a DiGA. Acceptance was assessed using the Net promoter score (NPS). 48 patients were prescribed DiGA. Of these, 39/48 (81%) completed the follow-up survey. 21/39 (54%) patients downloaded the DTx and 20/39 (51%) used the DTx at least once. 9/39 (23%) of patients stopped quickly afterward and 5/39 (13%) reported having completed the whole DTx program. Lack of time and commitment were reported as the main reasons for non-use. Overall acceptance of DiGA was high (Net promoter score (NPS) mean (SD) 7.8/10 (2.3)). While the majority of patients (60%) reported no improvement, one subgroup of patients (7/20, 35%) who regularly used an exercise-based DTx for back pain reported symptom improvement. Acceptance of DTx in patients with rheumatic diseases is high, however onboarding to DTx use and adherence to DTx is still challenging in patients with rheumatic diseases. In a subgroup of patients with back pain, however, the use of an exercise-based DTx led to symptom improvement.
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Affiliation(s)
- Hannah Labinsky
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Maria Gabriella Raimondo
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
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Kario K, Tomitani N, Harada N, Okura A, Hisaki F, Tanigawa T, Hoshide S. Home blood pressure-lowering effect of digital therapeutics in hypertension: impact of body weight and salt intake. Hypertens Res 2023. [PMID: 36899182 DOI: 10.1038/s41440-023-01245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Lifestyle modifications, including body weight reduction and salt restriction, help reduce blood pressure (BP). This study investigated the effects of body mass index (BMI) and salt intake on home BP reductions in unmedicated patients with hypertension receiving guideline-based lifestyle modification from doctors (control group) or with the addition of a digital therapeutics intervention. Data from the HERB Digital Hypertension 1 (HERB-DH1) pivotal trial were analyzed. Home BP was measured for 7 days before each study visit (baseline, and 4/8/12 weeks). Body weight was measured at each visit and salt intake questionnaire was answered at baseline and 12 weeks. This analysis included 302 patients with sufficient home BP monitoring data (digital therapeutics: 156; control group: 146). The reduction in morning home SBP from baseline to 12 weeks was significantly greater in the digital therapeutics vs. control group for patients with baseline BMI ≥ 25 kg/m2 and higher salt intake group (self-reported salt intake score ≥ 14) (-5.1 mmHg, p < 0.01). Patients in the digital therapeutics group who experienced a reduction in BMI and an improvement in salt intake score during the 12-week study also had a significantly greater reduction in morning home SBP compared with patients in the control group (-7.2 mmHg, p < 0.01). The digital therapeutic intervention reduced home BP the most in unmedicated patients with hypertension with high baseline BMI and salt intake score. Those with improvements in both BMI and salt intake during the digital therapeutics intervention achieved the greatest reduction in home BP vs. control.Clinical trial registration: Japan Registry of Clinical Trials (jRCT2032190148).
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Abstract
Introduction Digital therapeutics (DT) emerged and has been expanding rapidly for pain management. However, the efficacy of such approaches demonstrates substantial heterogeneity. Machine learning (ML) approaches provide a great opportunity for personalizing the efficacy of DT. However, the ML model accuracy is mainly associated with reduced clinical interpretability. Moreover, classical ML models are not adapted for the longitudinal nature of the DT follow-up data, which may also include nonlinear fluctuations. Objectives This study presents an analytical framework for personalized pain management using piecewise mixed-effects model trees, considering the data dependencies, nonlinear trajectories, and boosting model interpretability. Methods We demonstrated the implementation of the model with posture biofeedback training data of 3610 users collected during 8 weeks. The users reported their pain levels and posture quality. We developed personalized models for nonlinear time-related fluctuations of pain levels, posture quality, and weekly training duration using age, gender, and body mass index as potential moderating factors. Results Pain levels and posture quality demonstrated strong improvement during the first 3 weeks of the training, followed by a sustained pattern. The age of the users moderated the time fluctuations in pain levels, whereas age and gender interactively moderated the trajectories in the posture quality. Train duration increased during the first 3 weeks only for older users, whereas all the users decreased the training duration during the next 5 weeks. Conclusions This analytical framework offers an opportunity for investigating the personalized efficacy of digital therapeutics for pain management, taking into account users' characteristics and boosting interpretability and can benefit from including more users' characteristics.
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Affiliation(s)
| | - Keren Pollak
- Integrative Pain Laboratory (iPainLab), School of Public Health, University of Haifa, Israel
| | - Pavel Goldstein
- Integrative Pain Laboratory (iPainLab), School of Public Health, University of Haifa, Israel
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Carrera A, Zoccarato F, Mazzeo M, Lettieri E, Toletti G, Bertoli S, Castelnuovo G, Fresa E. What drives patients' acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors. BMC Health Serv Res 2023; 23:145. [PMID: 36765410 PMCID: PMC9921481 DOI: 10.1186/s12913-023-09090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The rising incidence of chronic diseases among the population, further exacerbated by the phenomenon of aging, is a primary concern and a serious challenge for the healthcare systems worldwide. Among the wide realm of health digital technologies, the rise of Digital Therapeutics (DTx), which are medical devices able to deliver evidence-based treatments to manage and treat diseases, opens new opportunities. However, their diffusion and usage are still fragmented among countries. As the diffusion results from the adoption of technology from a social system and individual acceptance, this study aims to design and test a theoretical model that investigates the intention to use DTx, with a particular focus on the treatment of obesity, as a widespread and burdensome chronic condition. METHODS This research is built on 336 answers coming from a survey to test the proposed model, which consists of a combination of organizational mechanisms, derived from Institutional Theory, and rational factors, derived from the Technology Acceptance Model (TAM). The survey has been delivered to patients and former patients of Istituto Auxologico Italiano, a hospital with several locations in northern Italy, recognized as a center of excellence for the treatment of obesity. RESULTS The analyses of the answers, performed through the Structural Equation Modelling (SEM) technique, confirmed the influence of the Perceived Usefulness on Intention To Use, and of the Perceived Ease Of Use on the Perceived Usefulness, confirming the validity of the assumptions derived from the TAM. On the other hand, institutional factors were introduced as antecedents of the Perceived Usefulness, and the Perceived Ease Of Use. Results show that the Regulative Pillar influences both the TAM constructs, the Normative Pillar (peer influence) has a positive effect only on the Perceived Usefulness, and finally, the Cultural Pillar impacts the Perceived Ease Of Use. CONCLUSION This study allows filling the knowledge gap regarding the usage of the Institutional as a means to predict individuals' intentions. Moreover, managerial contributions are available as the results have been operationalized into practical advice to managers and healthcare professionals to foster the adoption, and thus the diffusion, of Digital Therapeutics.
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Affiliation(s)
| | - Francesca Zoccarato
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Margherita Mazzeo
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Emanuele Lettieri
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Giovanni Toletti
- grid.4643.50000 0004 1937 0327Polytechnic University of Milan, School of Management, Milan, Italy
| | - Simona Bertoli
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Gianluca Castelnuovo
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Milan, Italy ,grid.8142.f0000 0001 0941 3192Department of Psychology, Catholic University, Milan, Italy
| | - Emanuele Fresa
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Milan, Italy
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Thabrew H, Gega L. Editorial: Control alt delete - technology and children's mental health. Child Adolesc Ment Health 2023; 28:1-3. [PMID: 36642701 DOI: 10.1111/camh.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Indexed: 01/17/2023]
Abstract
With international contributions from Denmark, Peru, Italy, Turkey, Estonia, Russia, Canada, the USA, Australia and the UK, this special issue offers insights and evidence about the technology's ability to act as a force of good and a source of harm for young people's mental health. As we better understand the complex and bidirectional relationship between technology and mental health, we need to move beyond dichotomous narratives about it being good or bad; it is both, depending on how it is used. Collective responsibility across technology companies, researchers, public services and community organisations, parents and the young people themselves can make a difference in the way technology is used to protect and improve mental health.
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Affiliation(s)
- Hiran Thabrew
- Te Ara Haro, Centre for Infant, Child and Adolescent Mental Health, University of Auckland, Auckland, New Zealand
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
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Ono M, Iwasaki K. Comprehensive Analysis of Clinical Studies and Regulations of Therapeutic Applications in the United States and Japan. Ther Innov Regul Sci 2023; 57:86-99. [PMID: 36070067 PMCID: PMC9755089 DOI: 10.1007/s43441-022-00442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Digital therapeutics (DTx), the provision of treatment through mobile devices such as smartphones, have attracted great interest as a new medical modality. However, the number of authorized therapeutic applications in the US and Japan is low. Understanding the obstacles in obtaining regulatory authorizations will be the key in promoting timely development of therapeutic applications. Thus, we conducted a comprehensive analysis of the clinical study designs of therapeutic applications authorized in the US and Japan. METHODS Data on authorized therapeutic applications and the regulations involved were collated from the databases of the Food and Drug Administration (USA), Ministry of Health, Labour and Welfare (Japan), and Pharmaceuticals and Medical Devices Agency (Japan). RESULTS Most therapeutic applications authorized targeted neuropsychiatric disorders and used cognitive behavioral therapy (CBT)-based treatments. All the involved clinical trials were randomized-controlled studies. Various types of controls-such as standard care, sham application, digital control, and therapies delivered by healthcare providers-were used. Both subjective and objective indices were acceptable as the primary endpoints. Long-term efficacy was evaluated, and all adverse events were assessed comprehensively. The setting up of controls and the need to study long-term efficacy depend heavily on the applications functionality and the target disease characteristics. CONCLUSIONS This study reveals the points to be considered in planning clinical studies and regulatory strategies for authorizing therapeutic applications. Therapeutic applications can provide new therapy and have potential to solve unmet clinical needs. Our findings shed a light on efficient development and rapid commercialization of therapeutic applications.
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Affiliation(s)
- Mao Ono
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women’s Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo 162-8480 Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women’s Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo 162-8480 Japan ,Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, 169-8555 Japan ,Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, 162-8480 Japan ,Institute for Medical Regulatory Science, Waseda University, Tokyo, 162-8480 Japan
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Kwon M, Jung YC, Lee D, Ahn J. Mental Health Problems During COVID-19 and Attitudes Toward Digital Therapeutics. Psychiatry Investig 2023; 20:52-61. [PMID: 36721886 PMCID: PMC9890043 DOI: 10.30773/pi.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/23/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE We aimed to elucidate public mental health problems and associated factors during the coronavirus disease-2019 (COVID-19). Furthermore, we evaluated people's attitudes toward digital therapeutics during the pandemic. METHODS Data was collected online from participants, aged between 20-50 without any history of mental illness, from June 1st to June 30th 2021. The survey consisted of questions regarding demographics, changes during pandemic and attitude towards digital therapeutics, and mental health measures. RESULTS Among the total of 445 participants, 49.2% reported significant level of stress and 13.5% and 7.0% met the screening criteria for major depressive disorder and generalized anxiety disorder, respectively. Significant predictive factors for mental health problems were-younger age group, female sex, currently being treated for medical or surgical disease, change in the amount of time spent on mobile device or computer after pandemic, change in household income, and change in work environment due to pandemic. Furthermore, 35.1% of participants, considered psychiatric consultation, at least slightly, but were hesitant to receive it due to the fear of contacting COVID-19 at the clinics. Instead, 54.4% of them preferred using digital therapeutics as an alternative to visiting offline clinics. CONCLUSION We demonstrated that COVID-19 increased mental health problems along with access problems and identified their predictive factors. Digital therapeutics emerged as a viable solution to mental health problems and it was well-received by those in need of psychiatric consultation. Therefore, development and implementation of digital therapeutics should be considered to improve the mental health of people.
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Affiliation(s)
- Manjae Kwon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Chul Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Deokjong Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jaeun Ahn
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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Greywoode R, Szigethy E. Behavioral Digital Therapeutics in Gastrointestinal Conditions: Where Are We Now and Where Should We Go? Gastroenterol Clin North Am 2022; 51:741-752. [PMID: 36375993 DOI: 10.1016/j.gtc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Behavioral digital therapeutics represents a diverse range of health technology tools that can offer beneficial options for patients with gastrointestinal disorders, particularly with the shortage of mental health providers. Challenges to the uptake of behavioral digital interventions exist and can be addressed with mobile device applications, improved interoperability of technology platforms, and flexible integration into clinical practice.
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Affiliation(s)
- Ruby Greywoode
- Division of Gastroenterology, Einstein-Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467, USA
| | - Eva Szigethy
- University of Pittsburgh, 3708 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Silberman J, Sarlati S, Harris B, Bokhari W, Boushey H, Chesnutt A, Zhu P, Sitts K, Taylor TH, Willey VJ, Fuentes E, LeKrey M, Hou E, Kaur M, Niyonkuru C, Muscioni G, Bianchi MT, Bota DA, Lee RA. A digital approach to asthma self-management in adults: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2022; 122:106902. [PMID: 36049674 DOI: 10.1016/j.cct.2022.106902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 01/27/2023]
Abstract
Asthma self-management can improve symptom control, but adherence to established self-management behaviors is often poor. With adult asthma uncontrolled in over 60% of U.S. cases, there is a need for scalable, cost-effective tools to improve asthma outcomes. Here we describe a protocol for the Asthma Digital Study, a 24-month, decentralized, pragmatic, open-label, randomized controlled trial investigating the impact of a digital asthma self-management (DASM) program on asthma outcomes in adults. The program leverages consumer-grade devices with a smartphone app to provide "smart nudges," symptom logging, trigger tracking, and other features. Participants are recruited (target N = 900) from throughout the U.S., and randomized to a DASM or control arm (1:1). Co-primary outcomes at one year are a) asthma-associated costs for acute care and b) change from baseline in Asthma Control Test™ scores. Findings may inform decisions around adoption of digital tools for asthma self-management. Trial registration:clinicaltrials.gov identifier: NCT04609644. Registered: Oct 30, 2020.
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Affiliation(s)
| | - Siavash Sarlati
- Carelon Digital Platforms, Elevance Health, Palo Alto, CA, USA; Department of Emergency Medicine, School of Medicine, University of California, San Francisco, USA.
| | | | - Warris Bokhari
- Carelon Digital Platforms, Elevance Health, Palo Alto, CA, USA
| | - Homer Boushey
- School of Medicine, University of California, San Francisco, USA
| | | | | | - Kelly Sitts
- Carelon Digital Platforms, Elevance Health, Palo Alto, CA, USA
| | - Thomas H Taylor
- Department of Epidemiology, University of California, Irvine, USA
| | | | | | - Matthew LeKrey
- Carelon Digital Platforms, Elevance Health, Palo Alto, CA, USA
| | - Evan Hou
- Carelon Digital Platforms, Elevance Health, Palo Alto, CA, USA
| | - Manpreet Kaur
- Carelon Digital Platforms, Elevance Health, Palo Alto, CA, USA
| | | | - Guido Muscioni
- Carelon Digital Platforms, Elevance Health, Chicago, IL, USA
| | | | - Daniela A Bota
- UCI Center for Clinical Research and Department of Neurology, UC Irvine School of Medicine, Irvine, CA, USA
| | - Richard A Lee
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, UC Irvine School of Medicine, Irvine, CA, USA
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Beukes EW, Andersson G, Manchaiah V. Long-term efficacy of audiologist-guided Internet-based cognitive behaviour therapy for tinnitus in the United States: A repeated-measures design. Internet Interv 2022; 30:100583. [PMID: 36353148 PMCID: PMC9637888 DOI: 10.1016/j.invent.2022.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study investigated the long-term outcomes 1-year after undertaking an Internet-based cognitive behavioural therapy (ICBT) for tinnitus distress in a US population. Secondary aims were to identify the effects on additional difficulties associate with tinnitus and any unwanted events related to ICBT for tinnitus. METHODS A repeated-measures design with 4 time points was used. Participants previously undertaking two randomized ICBT efficacy trials for tinnitus in the US were invited to participate. Of the 200 invited, 132 (66 %) completed the 1-year follow-up questionnaire. The primary outcome was a change in tinnitus distress from baseline at one year post-intervention, as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for anxiety, depression, insomnia, hearing disability, hyperacusis, tinnitus cognitions and health-related quality of life. RESULTS Undertaking ICBT for tinnitus led to significant improvements 1-year post-intervention for tinnitus severity, with a large effect size (d = 1.06; CI: 0.80 to 1.32). Medium effects were found for anxiety (d = 0.54; CI: 0.29 to 0.79), depression (d = 0.46; CI: 0.21 to 0.70), insomnia (d = 0.47; CI: 0.22 to 0.72), and tinnitus cognitions (d = 0.43, CI: 0.18 to 0.68). Small effect sizes were found for hearing disability, hyperacusis and health-related quality of life. Adverse events related to the intervention were only reported by 1 participant. CONCLUSIONS The benefits of audiologist-guided ICBT for tinnitus and tinnitus-related difficulties were maintained 1-year post-intervention with very few adverse events reported. Ways of disseminate evidence-based easily accessible interventions to the general population with bothersome tinnitus should be sought.
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Affiliation(s)
- Eldré W. Beukes
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK,Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, CO, USA,Corresponding author at: Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Vinaya Manchaiah
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, CO, USA,Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA,UC Health Hearing and Balance, University of Colorado Hospital, Aurora, CO, USA,Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa,Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Kario K, Harada N, Okura A. The first software as medical device of evidence-based hypertension digital therapeutics for clinical practice. Hypertens Res 2022; 45:1899-1905. [PMID: 36207530 PMCID: PMC9540047 DOI: 10.1038/s41440-022-01016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022]
Abstract
In 2021, the open-label randomized HERB-Digital Hypertension 1 (HERB-DH1) trial showed for the first time that hypertension digital therapeutics (a hypertension treatment app) successfully reduced blood pressure (BP) in patients with hypertension. Patients in the digital therapeutics group who used the app and home BP monitoring (HBPM) showed significant and persistent decreases in office, home and ambulatory BP values compared with the control group (who were under physician management using HBPM and lifestyle modifications). The results of the pivotal study led to the first global approval of this app for the treatment of hypertension in Japan in 2022, including medical insurance reimbursement. As a result, this hypertension app is expected to become widely used in the clinical management of all stages of hypertension. The most important remaining research issues include the identification of patients likely to respond to this therapeutic approach and the development of clinical efficacy indices. In addition, guidelines for the appropriate use of hypertension apps in the treatment of hypertension are needed. Next steps include the development and research of digital tools to facilitate the behavioral modifications required to prevent hypertension. Home BP-guided digital approach to prevent the onset of hypertension and its consequences from prehypertension to severe hypertension. SaMD, software of medical device; CVD, cardiovascular disease![]()
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan.
| | - Noriko Harada
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ayako Okura
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan
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Zhang X, Luo Z, Yang M, Huang W, Yu P. Efficacy and safety of digital therapeutics-based cardiac rehabilitation in heart failure patients: a systematic review. ESC Heart Fail 2022; 9:3751-3760. [PMID: 36085358 PMCID: PMC9773765 DOI: 10.1002/ehf2.14145] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 01/19/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, it has become difficult to provide centre-based cardiac rehabilitation for heart failure patients. Digital therapeutics is a novel concept proposed in recent years that refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. However, little is known about the use of this technology in heart failure patients. This study aims to explore the safety and efficacy of digital therapeutics-based cardiac rehabilitation in heart failure patients and to provide new insights into a new cardiac rehabilitation model during the COVID-19 era. To identify technologies related to digital therapeutics, such as the use of medical applications, wearable devices, and the Internet, all relevant studies published on PubMed, EMBASE, Cochrane database, and China National Knowledge Internet were searched from the time the database was established until October 2021. The PEDro was used to assess the quality of included studies. We ultimately identified five studies, which included 1119 patients. The mean age was 66.37, the mean BMI was 25.9, and the NYHA classification ranged from I to III (I = 232, II = 157, III = 209). The mean 6-min walk distance was 397.7 m. The PEDro scores included in the study ranged from 4 to 8, with a mean of 5.8. Exercise training was performed in four studies, and psychological interventions were conducted in three studies. No death or serious adverse events were observed. Adherence was reported in three studies, and all exceeded 85%. The results of most studies showed that digital therapeutics-based cardiac rehabilitation significantly increases exercise capacity and quality of life in heart failure patients. Overall, although this study suggests that digital therapeutics-based cardiac rehabilitation may be a viable intervention for heart failure patients during the COVID-19 era, the efficacy of this new model in routine clinical practice needs to be further validated in a large clinical trial.
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Affiliation(s)
- Xiu Zhang
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Zeruxin Luo
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Mengxuan Yang
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Wei Huang
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Pengming Yu
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
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Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am 2022; 45:515-528. [PMID: 36055736 PMCID: PMC9352538 DOI: 10.1016/j.psc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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Kim S, Rhee SY, Lee S. Effectiveness of Information and Communications Technology-Based Interventions for Obesity and Metabolic Syndrome. J Obes Metab Syndr 2022; 31:201-207. [PMID: 36039021 PMCID: PMC9579473 DOI: 10.7570/jomes22027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/01/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
The rapid increase in the obese population is a problem indicates the need for measures to prevent and treat obesity. Since the early 2000s, worldwide digital health has focused on obesity management. Information and communication technology (ICT)-based obesity intervention can be an efficient method for treating obesity and metabolic syndrome, has no time limitations, and is an inexpensive and easily accessible treatment modality for both physicians and patients. Previous studies have confirmed the effects of ICT-based interventions for obesity and metabolic syndrome management for behavioral improvement in lifestyle modification. In addition, ICT-based interventions in obese and metabolic syndrome patients are recommended as part of a comprehensive strategy for weight loss and maintenance. The Committee of IT-convergence Treatment of Metabolic Syndrome was established by the Korean Society for the Study of Obesity in 2021, and had been gathering theoretical and clinical evidence in digital therapeutics fields and developing new methods for managing obesity and metabolic syndrome. As part of this effort, if the “obesity management prototype” is commercialized, it will be available for convenient treatment of individuals with obesity and metabolic syndrome.
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Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sungyoung Lee
- Department of Computer Science and Engineering, College of Software, Kyung Hee University, Seoul, Korea
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Keyser LE, McKinney JL, Pulliam SJ, Weinstein MM. A digital health program for treatment of urinary incontinence: retrospective review of real-world user data. Int Urogynecol J 2022. [PMID: 35969249 DOI: 10.1007/s00192-022-05321-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To determine the effectiveness of a prescription digital therapeutic (pDTx) in reducing urinary incontinence (UI) symptoms in real-world users. METHODS This is a retrospective cohort study of real-world data from users of a pDTx designed to guide pelvic floor muscle training(PFMT) between July 1, 2020-December 31, 2021. The primary outcome was UI symptom change as reported via in-app Urogenital Distress Inventory (UDI-6). Included subjects were female, ≥ 18 years with a diagnosis of stress, urgency, or mixed UI who completed the UDI-6 at baseline and 8 weeks. Demographic, symptom, and adherence data were summarized. Paired t-test and Wilcoxon signed rank test were used to analyze change in outcomes from baseline to 8 weeks across adherence and UI diagnosis groups. RESULTS Of 532 women with UI, 265 (50%) met criteria and were included in the analysis. Mean age was 51.2 ± 11.5 years (range 22-84, N = 265). Mean body mass index (BMI) was 27.3 ± 6.2 kg/m2 (range 15.2-46.9, N = 147). Most participants had stress UI (59%) followed by mixed UI (22%), urgency UI/OAB (11%), and unspecified UI (8%). UDI-6 scores improved by 13.90 ± 15.53 (p ≤ 0.001); 62% met or exceeded MCID. Device-reported PFMT adherence was 72% at 4 weeks and 66% at 8 weeks (100% = 14 uses/week). Participants in each diagnosis category reported significant improvement on UDI-6 score from baseline to 8 weeks. No association between UDI-6 score improvement and adherence category, age, BMI, or UI subtype was identified. CONCLUSIONS This study demonstrates effectiveness of a pDTx in reducing UI symptoms in a real-world setting. Users achieved statistically and clinically significant symptom improvement over an 8-week period.
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Nomura A, Tanigawa T, Kario K, Igarashi A. Cost-effectiveness of digital therapeutics for essential hypertension. Hypertens Res 2022. [PMID: 35726085 DOI: 10.1038/s41440-022-00952-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
Abstract
Hypertension increases the risk of cardiovascular and other diseases. Lifestyle modification is a significant component of nonpharmacological treatments for hypertension. We previously reported the clinical efficacy of digital therapeutics (DTx) in the HERB-DH1 trial. However, there is still a lack of cost-effectiveness assessments evaluating the impact of prescription DTx. This study aimed to analyze the cost-effectiveness of using prescription DTx in treating hypertension. We developed a monthly cycle Markov model and conducted Monte Carlo simulations using the HERB-DH1 trial data to investigate quality-adjusted life-years (QALYs) and the cost of DTx for hypertension plus guideline-based lifestyle modification consultation treatment as usual (TAU), comparing DTx + TAU and TAU-only groups with a lifetime horizon. The model inputs were obtained from the HERB-DH1 trial, published or publicly available data, and expert assumptions. The incremental cost-effectiveness ratio (ICER) per QALY was used as the benchmark for cost-effectiveness. We performed probabilistic sensitivity analyses (PSAs) using the Monte Carlo simulation with two million sets. The DTx + TAU strategy produced 18.778 QALYs and was associated with ¥3,924,075 ($34,122) expected costs, compared with 18.686 QALYs and ¥3,813,358 ($33,160) generated by the TAU-only strategy over a lifetime horizon, resulting in an ICER of ¥1,199,880 ($10,434)/QALY gained for DTx + TAU. The monthly cost and attrition rate of DTx for hypertension have a significant impact on ICERs. In the PSA, the probability of the DTx arm being a cost-effective option was 87.8% at a threshold value of ¥5 million ($43,478)/QALY gained. In conclusion, the DTx + TAU strategy was more cost-effective than the TAU-only strategy.
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Rassi-Cruz M, Valente F, Caniza MV. Digital therapeutics and the need for regulation: how to develop products that are innovative, patient-centric and safe. Diabetol Metab Syndr 2022; 14:48. [PMID: 35365189 PMCID: PMC8972652 DOI: 10.1186/s13098-022-00818-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/17/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Digital therapeutics are defined as therapeutic interventions that are driven by high quality software programs to prevent, manage or treat a medical disorder. These products provide great potential to improve patient outcomes, particularly for chronic disease sufferers, including people with Diabetes. MAIN TEXT As yet, regulatory pathways for these products are rather unclear across all jurisdictions, although somewhat more progress has been made in the US and UK. Since digital therapeutics use cutting-edge technology and a logic of continuous innovation, regulation used for medical devices may not be completely appropriate. However, these products could present risks to patients if not developed and used appropriately. In the article, we consider the importance of a regulation framework and the role of self-regulation by developers as a way of ensuring patient safety while promoting innovation. We particularly emphasize the inclusion of doctors and other medical professionals in the design of the products, not only as a way of ensuring safe and effective applications, but also to encourage their take-up by patients, who tend to have high levels of trust for their HCPs. CONCLUSION Developers of digital therapeutics have the duty to create products that are safe, ethical and effective, without waiting for government regulation. Further, by self-regulating, following principles such as those provided by the Digital Therapeutics Alliance, they can develop products that serve patients better, while continuing to innovate.
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Affiliation(s)
- Marcela Rassi-Cruz
- Endocrinologist and Medical Head of Axenya, Rua Leopoldo de Bulhões, 59, Vila Clementino,, 04022-020, São Paulo, SP, Brasil.
| | - Fernando Valente
- Endocrinology Division, Department of Internal Medicine, Faculdade de Medicina Do ABC, Santo André, São Paulo, Brazil
| | - Maria Vanina Caniza
- Global Chair of the Healthcare & Life Sciences Group, Baker & McKenzie, Cecilia Grierson 255, 6th Floor, C1107CPE, Buenos Aires, Argentina
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Kim SY, Moon JY, Shin J, Sim JY, Kim M, Jang J. Survey for Government Policies Regarding Strategies for the Commercialization and Globalization of Digital Therapeutics. Yonsei Med J 2022; 63:S56-S62. [PMID: 35040606 PMCID: PMC8790580 DOI: 10.3349/ymj.2022.63.s56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to build a direction for government policies regarding strategies for the commercialization of digital therapeutics in Korea, as well as its globalization. MATERIALS AND METHODS The study included 37 participants from the Korea Digital Health Industry Association (KODHIA). The data was based on a survey conducted in 2020 targeting employees of companies engaged in the digital health industry in Korea. Participants were asked about their involvement in product development of digital therapeutics and their opinion about the growing motivator for digital therapeutics in Korea and the global market. RESULTS According to our data, among subjects not involved in making digital therapeutics products, the main reason for not being involved was the lack of experts (73.9%) and difficulty in licensing (73.9%). Responses concerning the priority area in need of national support were R&D funding (43.2%), and the next was licensing guidance and simplifying regulations (24.3%). Possible difficulties of overseas market expansion were the unfamiliarity in digital therapeutics technology verification and licensing structures of foreign countries (73%), and concerns regarding the level of recognition of clinical trials and technology in Korea from overseas (70.3%). Overall, respondents were hesitant in starting a related business due to the lack of government support and the complexity of the regulation process. Moreover, concerns about global market entry were similar. Being unfamiliar with the novel process and worrying about the achievement despite existing challenges were the biggest drawback. CONCLUSION For the digital therapeutics industry to evolve domestically and internationally, government support and guidance are essential.
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Affiliation(s)
- Soo Young Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Jong Youn Moon
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
- Center for Public Healthcare, Gachon University Gil Medical Center, Incheon, Korea.
| | - Jaeyong Shin
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Jung Yeon Sim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Meelim Kim
- Health IT Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jieun Jang
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
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Vilardaga R, McClernon FJ. Regulatory oversight of behavioral digital therapeutics for addiction treatment: A commentary on Khadjesari et al. Addiction 2021; 116:3287-3289. [PMID: 34658104 DOI: 10.1111/add.15690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Aklin WM, Walton KM, Antkowiak P. Digital therapeutics for Substance Use Disorders: Research priorities and clinical validation. Drug Alcohol Depend 2021; 229:109120. [PMID: 34740068 DOI: 10.1016/j.drugalcdep.2021.109120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Will M Aklin
- National Institute on Drug Abuse, Division of Therapeutics and Medical Consequences, United States.
| | - Kevin M Walton
- National Institute on Drug Abuse, Division of Therapeutics and Medical Consequences, United States
| | - Patrick Antkowiak
- Food and Drug Administration, Center for Devices and Radiological Health, Office of Neurological and Physical Medicine Devices, United States
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Abstract
Diagnosis, prevention, management and treatment of acute and chronic medical conditions have improved with technological advancements in terms of scalability, efficacy, access, and personalized approach. Digital therapeutic applications (DTx) (Blue Star, Diabeo System, Livongo Diabetes Program, Tidepool etc.,) use web-based applications/cloud platforms to provide evidence-based, personalized, rapid point of care management of chronic, behavior-modifiable conditions, including diabetes mellitus (DM). DTx has improved patient compliance, therapeutic success and economic outcomes in DM management by enabling active patient engagement, lifestyle change, comprehensive medical care, and periodic monitoring of glycemic status. Addressing concerns along DTx data vulnerability, comparative efficacy with conventional treatments, ability to accommodate diverse population needs, and resolving ambiguous regulatory policies and reimbursement guidelines are critical for increasing access to DTx, and overcoming availability, accessibility, and affordability issues in the existing resource limited healthcare environment. In this commentary the authors explore the potential, prospects, and challenges of DTx in the management of Diabetes Mellitus.
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Affiliation(s)
| | - Kevin Yan
- Pharmalytics Group, Vancouver, Canada
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Kario K, Nomura A, Harada N, Okura A, Nakagawa K, Tanigawa T, Hida E. Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. Eur Heart J 2021; 42:4111-4122. [PMID: 34455443 PMCID: PMC8530534 DOI: 10.1093/eurheartj/ehab559] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/07/2021] [Accepted: 08/04/2021] [Indexed: 12/16/2022] Open
Abstract
Aims Digital therapeutics is a new approach to facilitate the non-pharmacological treatment of hypertension using software programmes such as smartphone applications and/or device algorithms. Based on promising findings from a small pilot trial, the HERB Digital Hypertension 1 (HERB-DH1) pivotal trial investigated the efficacy of digital therapeutics in patients with hypertension not receiving antihypertensive medication. Methods and results This prospective, open-label, randomized controlled study was performed at 12 sites in Japan. Patients with hypertension [office systolic blood pressure (SBP) 140 to <180 mmHg and 24 h SBP ≥130 mmHg] were randomly assigned 1:1 to the digital therapeutics group (HERB system + standard lifestyle modification) or control group (standard lifestyle modification alone). The primary efficacy endpoint was the mean change in 24 h ambulatory SBP from baseline to 12 weeks; key secondary efficacy endpoints were mean changes in office and home blood pressure (BP) from baseline to 12 weeks. All analyses were conducted in the full analysis set population. Between December 2019 and June 2020, 390 patients were randomly assigned to the digital therapeutics group (n = 199) or control (n = 191) group. Between-group differences in 24-h ambulatory, home, and office SBPs at 12 weeks were −2.4 (95% confidence interval −4.5 to −0.3), −4.3 (−6.7 to −1.9), and −3.6 (−6.2 to −1.0) mmHg, respectively. No major programme-related safety events occurred up to 24 weeks. Conclusion The HERB-DH1 pivotal study showed the superiority of digital therapeutics compared with standard lifestyle modification alone to reduce 24-h ambulatory, home, and office BPs in the absence of antihypertensive medications.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.,Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Biomedical Informatics, CureApp Institute, 4136-1 Azayakozawa, Nagakutra, Kitasaku-Gun, Karuizawa, Nagano 389-0111, Japan
| | - Noriko Harada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Ayako Okura
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Kiyose Nakagawa
- CureApp, Inc., . Kodenma-Cho YS building 4th floor, 12-5 Nihonbashi kodenma-Cho, Chuo-ku, Tokyo 103-0001, Japan
| | - Tomoyuki Tanigawa
- CureApp, Inc., . Kodenma-Cho YS building 4th floor, 12-5 Nihonbashi kodenma-Cho, Chuo-ku, Tokyo 103-0001, Japan
| | - Eisuke Hida
- Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita-Shi, Osaka 565-0871, Japan
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Heimann P, Lorenz N, Blum N, Schifferings C. [Experiences of digital health care applications (DIGA) manufacturers with the BfArM Fast-Track procedure]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1249-53. [PMID: 34542649 DOI: 10.1007/s00103-021-03422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Since October 2020, the first digital health applications (DiGA) have been listed with the Federal Institute for Drugs and Medical Devices (BfArM) and can be prescribed by physicians and psychotherapists in the statutory health insurance system. In this article, four of the first BfArM-listed DiGA manufacturers report on their experiences with the BfArM Fast-Track procedure for DiGA, which enables listing from the time of application in just three months.Regarding the DiGA Fast-Track procedure and the cooperation with the BfArM, overall positive experiences are reported. However, applicants need to consider some points before and during the application process as well as after the positive decision. Before submitting the application, it is advisable to conduct audits to ensure that all requirements are met. BfArM consultations should be used, especially to clarify questions regarding proof of positive supply effect. Manufacturers should be prepared for numerous queries and follow-up requests from BfArM and be able to respond quickly. In the case of ambiguities, direct contact should be made with the BfArM. Manufacturers should note that sales of their product will not automatically follow a positive decision, as the medical profession still needs to be informed more fundamentally about DiGA and the path from the prescription to the activation of DiGA is currently still cumbersome. Manufacturers should also be prepared for continued interaction with BfArM after listing.Overall, manufacturers are recommended to cooperate early, proactively, openly, and closely with the BfArM because they themselves are liable for the information they provide in the application and the BfArM does not check all of it in detail.
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Abstract
BACKGROUND AND OBJECTIVES Digital therapeutics are an emerging type of medical therapy and are defined as evidence-based therapeutic interventions for patients by means of qualified software programs to prevent, manage, or treat medical conditions. Today, digital therapeutics products are on the market or under development for a wide range of medical conditions such as diabetes, oncology treatment management, and neuropsychiatric disorders including anxiety disorder, depression, and substance use disorder. Digital therapeutics can be more flexible than other treatment methods to address patients' individual needs. METHODS AND RESULTS The advantages of digital therapeutics fall in line with market demand; thus, the digital therapeutics market is expanding globally, focusing on advanced medical markets. There are many digital therapeutics products such as Sleepio for insomnia, Daylight for anxiety, Livongo and Omada products for diabetes, pre-diabetes, hypertension, etc. None of these are cleared by the Food and Drug Administration (FDA), but all are commercially available through health insurance or employers. The EU, including Germany, and a number of Asian countries, including Korea, Japan, and China, are also introducing policies for the regulation of new fields and digital therapeutics. CONCLUSIONS The adoption of digital therapeutics is intricate and often involves various interests in numerous fields, decision-making processes, and individual or organizational value judgments. For digital therapeutics to be thoroughly introduced into real life, technical aspects must be supported, and an approach that considers users must be further investigated.
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Affiliation(s)
- Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
| | | | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
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Beukes EW, Andersson G, Fagelson MA, Manchaiah V. Dismantling internet-based cognitive behavioral therapy for tinnitus. The contribution of applied relaxation: A randomized controlled trial. Internet Interv 2021; 25:100402. [PMID: 34040997 PMCID: PMC8141772 DOI: 10.1016/j.invent.2021.100402] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. AIMS This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. METHODS A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken. RESULTS Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. CONCLUSION Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.
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Key Words
- Applied relaxation
- CBT, Cognitive Behavioral Therapy
- CONSORT, Consolidated Standards of Reporting Trials
- Cognitive behavioral therapy
- Digital therapeutics
- GAD-7, Generalized Anxiety Disorder
- HHIA-S, Hearing Handicap Inventory for Adults - Screening
- ICBT, Internet-based Cognitive Behavioral Therapy Intervention
- ISI, Insomnia Severity Index
- Internet intervention
- PHQ-9, Patient Health Questionnaire
- RCI, Reliable Change Index
- TFI, Tinnitus Functional Index
- Telehealth
- Tinnitus
- US, United States
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Affiliation(s)
- Eldré W. Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Vision and Hearing Sciences Research Group, School of Psychology and Sports Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Marc A. Fagelson
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, USA
- Audiological Rehabilitation Laboratory, Auditory Vestibular Research Enhancement Award Program, Veterans Affairs Medical Center, Mountain Home, TN, USA
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Raijada D, Wac K, Greisen E, Rantanen J, Genina N. Integration of personalized drug delivery systems into digital health. Adv Drug Deliv Rev 2021; 176:113857. [PMID: 34389172 DOI: 10.1016/j.addr.2021.113857] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
Personalized drug delivery systems (PDDS), implying the patient-tailored dose, dosage form, frequency of administration and drug release kinetics, and digital health platforms for diagnosis and treatment monitoring, patient adherence, and traceability of drug products, are emerging scientific areas. Both fields are advancing at a fast pace. However, despite the strong complementary nature of these disciplines, there are only a few successful examples of merging these areas. Therefore, it is important and timely to combine PDDS with an increasing number of high-end digital health solutions to create an interactive feedback loop between the actual needs of each patient and the drug products. This review provides an overview of advanced design solutions for new products such as interactive personalized treatment that would interconnect the pharmaceutical and digital worlds. Furthermore, we discuss the recent advancements in the pharmaceutical supply chain (PSC) management and related limitations of the current mass production model. We summarize the current state of the art and envision future directions and potential development areas.
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Affiliation(s)
- Dhara Raijada
- Department of Pharmacy, University of Copenhagen, Denmark
| | - Katarzyna Wac
- Department of Computer Science, University of Copenhagen, Denmark; Quality of Life Technologies Lab, Center for Informatics, University of Geneva, Switzerland
| | | | - Jukka Rantanen
- Department of Pharmacy, University of Copenhagen, Denmark
| | - Natalja Genina
- Department of Pharmacy, University of Copenhagen, Denmark.
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