Facilitators and barriers to using physical activity smartphone apps among Chinese patients with chronic diseases.
Sun Liu,Wang Yanling,Greene Brian,Xiao Qian,Jiao Chen,Ji Meihua,Wu Ying
BMC medical informatics and decision making
BACKGROUND:Smartphones and their applications (apps) impact society and health care. With the growth of smartphone users and app downloads in China, patients with chronic diseases have access to a self-management strategy for physical activity. Although studies report physical activity apps improve the physical activity of patients, data is limited concerning their use of these apps. Therefore, this study investigated the current usage, willingness to use, and barriers to using physical activity apps of Chinese patients with chronic diseases. METHODS:We designed a questionnaire to collect data from chronic disease patients in a tertiary hospital in Beijing, which was sent to 250 patients in four departments. RESULTS:Two hundred eighteen questionnaires were returned (87.2% response rate). Most (92.7%) respondents owned a smartphone, 34.9% had used a physical activity app, and 18.8% were current users. Additionally, 53.7% were willing to use a physical activity app designed for them. Respondents more likely to use physical activity apps were younger (i.e., ≤ 44 years), more educated, current smartphone users, and previous users of physical activity apps; moreover, they believed they needed exercise, their disease required exercise instruction and support, and their physical status needed monitored when exercising (p < 0.05). Main barriers to using apps reported were insufficient function, difficulty of use, extra cost, and security issues. CONCLUSIONS:Our results indicate sizeable smartphone ownership among Chinese patients with chronic diseases; moreover, over half of our participants report they would use a physical activity app designed for them. This information can be leveraged by healthcare workers managing patients with chronic diseases.
10.1186/s12911-017-0446-0
Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study.
JMIR mHealth and uHealth
BACKGROUND:Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. OBJECTIVE:This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. METHODS:The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. RESULTS:Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. CONCLUSIONS:A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting.
10.2196/mhealth.9988
Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey.
Ernsting Clemens,Dombrowski Stephan U,Oedekoven Monika,O Sullivan Julie L,Kanzler Melanie,Kuhlmey Adelheid,Gellert Paul
Journal of medical Internet research
BACKGROUND:Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. OBJECTIVE:The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. METHODS:A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. RESULTS:It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor's advice. CONCLUSIONS:Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user's motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions.
10.2196/jmir.6838
A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App.
JMIR formative research
BACKGROUND:The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. OBJECTIVE:The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. METHODS:The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. RESULTS:The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. CONCLUSIONS:The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia.
10.2196/25513
Managing Diabetes Using Mobiab: Long-Term Case Study of the Impact of a Mobile App on Self-management.
JMIR diabetes
BACKGROUND:This paper describes the development of a mobile app for diabetes mellitus (DM) control and self-management and presents the results of long-term usage of this system in the Czech Republic. DM is a chronic disease affecting large numbers of people worldwide, and this number is continuously increasing. There is massive potential to increase adherence to self-management of DM with the use of smartphones and digital therapeutics interventions. OBJECTIVE:This study aims to describe the process of development of a mobile app, called Mobiab, for DM management and to investigate how individual features are used and how the whole system benefits its long-term users. Using at least 1 year of daily records from users, we analyzed the impact of the app on self-management of DM. METHODS:We have developed a mobile app that serves as an alternative form to the classic paper-based protocol or diary. The development was based on cooperation with both clinicians and people with DM. The app consists of independent individual modules. Therefore, the user has the possibility to use only selected features that they find useful. Mobiab was available free of charge on Google Play Store from mid-2014 until 2019. No targeted recruitment was performed to attract users. RESULTS:More than 500 users from the Czech Republic downloaded and signed up for the mobile app. Approximately 80% of the users used Mobiab for less than 1 week. The rest of the users used it for a longer time and 8 of the users produced data that were suitable for long-term analysis. Additionally, one of the 8 users provided their medical records, which were compared with the gathered data, and the improvements in their glucose levels and overall metabolic stability were consistent with the way in which the mobile app was used. CONCLUSIONS:The results of this study showed that the usability of a DM-centered self-management smartphone mobile app and server-based systems could be satisfactory and promising. Nonetheless, some better ways of motivating people with diabetes toward participation in self-management are needed. Further studies involving a larger number of participants are warranted to assess the effect on long-term diabetes management.
10.2196/36675
Supporting Engagement, Adherence, and Behavior Change in Online Dietary Interventions.
Young Claire,Campolonghi Sara,Ponsonby Stephanie,Dawson Samantha L,O'Neil Adrienne,Kay-Lambkin Frances,McNaughton Sarah A,Berk Michael,Jacka Felice N
Journal of nutrition education and behavior
INTRODUCTION:Poor diet is a leading cause of death and disease globally. This epidemic requires effective and accessible interventions to stop the increasing number of diet-related deaths and the health and economic impacts of diet-related disease. Online interventions provide flexibility and accessibility. With the ubiquitous use of smartphones, they can be intertwined with daily activities such as shopping and eating. The aim of this review is to determine what features and behavior change techniques employed in online dietary interventions for adult populations promoting dietary behavior change. METHODS:The researchers conducted a systematic search of Cumulative Index of Nursing and Allied Health, Cochrane Library, Global Health, MEDLINE, PsychINFO, and psychological and behavioral sciences electronic bibliography databases, and specialist electronic health (e-health) journals from database inception to January, 2018. Studies were included if they were randomized controlled trials of online dietary interventions with active comparator conditions in adult populations, and with reported dietary change measures. A quality score was applied to each study calculated by a developed scoring system. The review analyzed intervention dietary change measures, attrition (nonuse and dropout), engagement (metrics and intensity of use), adherence (defined as compliance to the treatment protocol), behavior change techniques employed to achieve dietary change, and techniques employed in successful (those who achieved significant results in the targeted dietary behavior) vs unsuccessful interventions as reported by the studies. RESULTS:A total of 21 studies composed of a total of 7,455 adults and reporting on 19 different e-health interventions were included from 1,237 records. These studies targeted dietary change as measured by reduced energy intake (5) or changes in specific dietary components (15) and overall diet quality (4). Dietary change was a behavior target in general healthy populations (12) and for managing diseases such as obesity and cardiovascular disease (7), or for improving quality of life for those with chronic conditions (1). Improvements in dietary behavior were seen in 14 of the 19 interventions reported. DISCUSSION:The results suggest that online interventions can be successful in achieving dietary behavior change across a range of defined populations. However, disparate reporting of engagement and limited reporting of nonuse attrition rates limited the analysis of which behavior change techniques were most effective in achieving this change. IMPLICATIONS FOR RESEARCH AND PRACTICE:The results of this review support the potential of online and smartphone dietary interventions as a method to achieve change in diet in defined populations. However, further work needs to be done in examining how users engage with interventions, and thus which behavior change techniques are most effective.
10.1016/j.jneb.2019.03.006
Automatized follow-up and alert system for patients with chronic hypertension.
Urrea Claudio,Venegas Daniel
Health informatics journal
This article presents the development and implementation of a monitoring system for patients with chronic hypertension. Technological advances in wireless communication are increasingly used today to send and receive information through smartphones. This also applies to devices for measuring blood pressure, which can be efficiently integrated with smartphones. Telemedicine is used in a variety of health fields, and in the past 5 years, it has extended its reach to the online monitoring of patients. The objective of this study is to create an integrated system capable of conducting the follow-up, through mobile communication (smartphones), of patients with chronic diseases such as hypertension. An iHealth equipment certified by the Food and Drug Administration is used. The blood pressure values from users are uploaded via Internet and stored in an integral system for processing. The monitoring system developed not only informs users about their disease status but also sends them alerts generated during monitoring. This work uses the telecommunication technology existing through smartphones. The integrated system developed ensures the follow-up of the blood pressure of a large number of users. In addition, this system can be further applied to diseases such as diabetes and metabolic syndrome. The system developed was easy to use and efficient to monitor patients with chronic diseases such as high blood pressure.
10.1177/1460458219900446
Mobile Applications for Caregivers of Individuals with Chronic Conditions and/or Diseases: Quantitative Content Analysis.
International journal of medical informatics
BACKGROUND:Mobile health applications can help empowering caregivers and promote their wellbeing and their quality of life. OBJECTIVE:To analyze the technical and functional characteristics of mobile health applications designed for caregivers of individuals with chronic conditions and/or diseases. MATERIALS AND METHODS:Systematic search of mobile health applications for smartphones (apps) based on the PRISMA standard for systematic reviews on the App Store and Google Play store during May and June 2018. A second search was carried out on the Pubmed and Google Scholar database to determine whether the applications had been tested or evaluated with results published in scientific journals and then a third search was performed on the Spanish health apps catalogs to evaluate the quality and security of the selected apps. RESULTS:746 available health apps were identified and 43 were included in this paper. 67% (n = 29) of the apps were aimed exclusively at informal caregivers, 51% (n = 22) were designed to support caregivers and only 21% (n = 9) of them provided any sort of social or emotional support. The screening in Pubmed and Google Scholar determined that the apps analyzed lacked published papers and most of the apps (84%; n = 36) lacked approval from official agencies supporting their usage. DISCUSSION:The apps available on the market that meet the actual needs of caregivers are limited. Most of the apps were aimed at improving the care of the individual with a chronic illness. CONCLUSION:Despite the remarkable benefits of mHealth regarding the care of chronic diseases, a relatively poor contribution has been made to support caregivers. Customized apps, interventions assessing their effectiveness and adequate evidence are needed to understand the impact of this digital tool on caregivers' health.
10.1016/j.ijmedinf.2020.104310
The Impact of Digital Health on Smoking Cessation.
Interactive journal of medical research
BACKGROUND:Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients' quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation-relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. OBJECTIVE:This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. METHODS:A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. RESULTS:In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. CONCLUSIONS:mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources.
10.2196/41182
Applying a Social Determinants of Health Framework to Guide Digital Innovations That Reduce Disparities in Chronic Disease.
Psychosomatic medicine
ABSTRACT:Chronic diseases are among the top causes of global death, disability, and health care expenditure. Digital health interventions (e.g., patient support delivered via technologies such as smartphones, wearables, videoconferencing, social media, and virtual reality) may prevent and mitigate chronic disease by facilitating accessible, personalized care. Although these tools have promise to reach historically marginalized groups, who are disproportionately affected by chronic disease, evidence suggests that digital health interventions could unintentionally exacerbate health inequities. This commentary outlines opportunities to harness recent advancements in technology and research design to drive equitable digital health intervention development and implementation. We apply "calls to action" from the World Health Organization Commission on Social Determinants of Health conceptual framework to the development of new, and refinement of existing, digital health interventions that aim to prevent or treat chronic disease by targeting intermediary, social, and/or structural determinants of health. Three mirrored "calls to action" are thus proposed for digital health research: a) develop, implement, and evaluate multilevel, context-specific digital health interventions; b) engage in intersectoral partnerships to advance digital health equity and social equity more broadly; and c) include and empower historically marginalized groups to develop, implement, and access digital health interventions. Using these "action items," we review several technological and methodological innovations for designing, evaluating, and implementing digital health interventions that have greater potential to reduce health inequities. We also enumerate possible challenges to conducting this work, including leading interdisciplinary collaborations, diversifying the scientific workforce, building trustworthy community relationships, and evolving health care and digital infrastructures.
10.1097/PSY.0000000000001176
Lessons learned from inadequate implementation planning of team-based chronic disease management: implementation evaluation.
Sibbald Shannon L,Van Asseldonk Rachelle,Cao Peiwen L,Law Benson
BMC health services research
BACKGROUND:This study was a retrospective evaluation of an unsuccessfully implemented team-based, chronic disease management program, with an aim to understand more about implementation barriers. The program, the Chronic Disease Management Initiative (CDMI) was a new collaborative model of care for patients with COPD. It utilized customized health information and interactive tools, mainly smartphones, for ongoing disease management. The program's goal was to demonstrate that integrated team-based models of care could improve patient care, as well as reduce readmission rates and emergency department visits. The program planning for CDMI began in 2017, followed by the implementation and evaluation period in 2018. After a 10-month implementation period, the program was unable to enroll a sufficient number of patients to examine if there was an improvement in patient outcomes. METHODS:A retrospective case-study design using multiple data sources was used to gather feedback from participants involved in CDMI. Data collection occurred throughout planning and implementation and continued into early 2019. Semi-structured interviews were conducted, and transcripts were analyzed using NVivo 10 software. This was followed by content analysis. RESULTS:Analysis revealed four key themes as barriers to CDMI's implementation: 1) lack of a needs assessment with key stakeholders; 2) lack of buy-in from medical staff; 3) inadequate patient engagement and; 4) contextual barriers. Planners did not conduct a proper needs assessment, nor include patients in the study design. In addition, there was insufficient consideration for how CDMI should be integrated into the usual COPD care plan, leading to confusion in roles and responsibilities. Poor communication between the implementation team and healthcare providers implementing the program, led to a lack of buy-in and engagement. CONCLUSION:The key themes resonate with what is already known in the literature. This study supports the importance of using a theoretically grounded plan for implementation. Using a model only in the planning stages is insufficient even when an intervention is based on evidence to support higher quality care. It is imperative to consider practical and contextual factors of program implementation and their interactions. By detailing the 'failed implementation' of this intervention, we hope to share important lessons about the need to plan implementation processes early in program planning.
10.1186/s12913-021-06100-4
App Chronic Disease Checklist: Protocol to Evaluate Mobile Apps for Chronic Disease Self-Management.
Anderson Kevin,Burford Oksana,Emmerton Lynne
JMIR research protocols
BACKGROUND:The availability of mobile health apps for self-care continues to increase. While little evidence of their clinical impact has been published, there is general agreement among health authorities and authors that consumers' use of health apps assist in self-management and potentially clinical decision making. A consumer's sustained engagement with a health app is dependent on the usability and functionality of the app. While numerous studies have attempted to evaluate health apps, there is a paucity of published methods that adequately recognize client experiences in the academic evaluation of apps for chronic conditions. OBJECTIVE:This paper reports (1) a protocol to shortlist health apps for academic evaluation, (2) synthesis of a checklist to screen health apps for quality and reliability, and (3) a proposed method to theoretically evaluate usability of health apps, with a view towards identifying one or more apps suitable for clinical assessment. METHODS:A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was developed to guide the selection of the apps to be assessed. The screening checklist was thematically synthesized with reference to recurring constructs in published checklists and related materials for the assessment of health apps. The checklist was evaluated by the authors for face and construct validity. The proposed method for evaluation of health apps required the design of procedures for raters of apps, dummy data entry to test the apps, and analysis of raters' scores. RESULTS:The PRISMA flow diagram comprises 5 steps: filtering of duplicate apps; eliminating non-English apps; removing apps requiring purchase, filtering apps not updated within the past year; and separation of apps into their core functionality. The screening checklist to evaluate the selected apps was named the App Chronic Disease Checklist, and comprises 4 sections with 6 questions in each section. The validity check verified classification of, and ambiguity in, wording of questions within constructs. The proposed method to evaluate shortlisted and downloaded apps comprises instructions to attempt set-up of a dummy user profile, and dummy data entry to represent in-range and out-of-range clinical measures simulating a range of user behaviors. A minimum score of 80% by consensus (using the Intraclass Correlation Coefficient) between raters is proposed to identify apps suitable for clinical trials. CONCLUSIONS:The flow diagram allows researchers to shortlist health apps that are potentially suitable for formal evaluation. The evaluation checklist enables quantitative comparison of shortlisted apps based on constructs reported in the literature. The use of multiple raters, and comparison of their scores, is proposed to manage inherent subjectivity in assessing user experiences. Initial trial of the combined protocol is planned for apps pertaining to the self-monitoring of asthma; these results will be reported elsewhere.
10.2196/resprot.6194
Health monitors for chronic disease by gait analysis with mobile phones.
Juen Joshua,Cheng Qian,Prieto-Centurion Valentin,Krishnan Jerry A,Schatz Bruce
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
We have developed GaitTrack, a phone application to detect health status while the smartphone is carried normally. GaitTrack software monitors walking patterns, using only accelerometers embedded in phones to record spatiotemporal motion, without the need for sensors external to the phone. Our software transforms smartphones into health monitors, using eight parameters of phone motion transformed into body motion by the gait model. GaitTrack is designed to detect health status while the smartphone is carried during normal activities, namely, free-living walking. The current method for assessing free-living walking is medical accelerometers, so we present evidence that mobile phones running our software are more accurate. We then show our gait model is more accurate than medical pedometers for counting steps of patients with chronic disease. Our gait model was evaluated in a pilot study involving 30 patients with chronic lung disease. The six-minute walk test (6 MWT) is a major assessment for chronic heart and lung disease, including congestive heart failure and especially chronic obstructive pulmonary disease (COPD), affecting millions of persons. The 6 MWT consists of walking back and forth along a measured distance for 6 minutes. The gait model using linear regression performed with 94.13% accuracy in measuring walk distance, compared with the established standard of direct observation. We also evaluated a different statistical model using the same gait parameters to predict health status through lung function. This gait model has high accuracy when applied to demographic cohorts, for example, 89.22% accuracy testing the cohort of 12 female patients with ages 50-64 years.
10.1089/tmj.2014.0025
A systematic review of healthcare applications for smartphones.
BMC medical informatics and decision making
BACKGROUND:Advanced mobile communications and portable computation are now combined in handheld devices called "smartphones", which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. METHODS:In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. RESULTS:A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3), Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7); 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions (2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. CONCLUSIONS:Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also, smartphones can play a very important role in patient education, disease self-management, and remote monitoring of patients.
10.1186/1472-6947-12-67
The Prevalence of Smartphones and WeChat Use Among Older Adults With Chronic Disease in a Western China.
Computers, informatics, nursing : CIN
Telemedicine is a promising way to deliver patient education and health services, but access to information technology among potential patients is a prerequisite. This study surveyed the prevalence of smartphone use and the use of the Chinese social networking platform WeChat and Wi-Fi access in the homes of older adults in a western area of China. A convenience sample of 225 older adults with chronic diseases in two tertiary hospitals was interviewed regarding smartphone ownership, WeChat use, and access to Wi-Fi at home. Participant ability in performing the activities of daily living was also assessed. Logistic regressions were used to analyze the independently associated factors of smartphone ownership, WeChat use, and Wi-Fi access at home. The results show that the prevalence of smartphone use was 19.6%, only 8.9% of those surveyed used WeChat, but 39.6% had access to Wi-Fi at home. Education level was the only factor significantly associated with the three dependent variables. Ability in performing activities of daily living was positively correlated with access to Wi-Fi at home (odds ratio, 2.549; P = .011). It will be difficult to implement telemedicine through smartphones in such relatively poor areas of China. Better-educated older adults who are less dependent in performing activities of daily living are potential users of telemedicine.
10.1097/CIN.0000000000000638
Technological Innovations in Biobehavioral and Psychosomatic Medicine.
Psychosomatic medicine
ABSTRACT:The role of technological innovations in health care has increased over the past years and will continue to improve the diagnosis, monitoring, and treatment of various physical and mental disorders. In biobehavioral and psychosomatic medicine, the use of technology has also increased in both research and clinical contexts. The articles in the current special issue of Psychosomatic Medicine focus on technological solutions that have been applied to patient-monitoring/assessment (health-related behaviors and vital functioning) and treatment (ehealth and mhealth interventions). Although such solutions are promising and considered acceptable by patients and health care providers, important barriers have also been identified regarding the implementation of these technological advances. Topics addressed in this issue cover the following themes: the use of biological and behavioral sensors that are linked to user smartphones, technological innovations in clinical conditions (asthma, alcohol-associated liver disease, and chronic pain), the use of virtual humans in clinical settings, digital mental health interventions, and the importance of reducing health disparities in the development and implementation of technological innovation. These topics are critically relevant to the field of biobehavioral and psychosomatic medicine and provide future directions for research and clinical practice.
10.1097/PSY.0000000000001240
Mobile Technology-Based Interventions for Stroke Self-Management Support: Scoping Review.
JMIR mHealth and uHealth
BACKGROUND:There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, "self-management support" is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted. OBJECTIVE:The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management. METHODS:A scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis. RESULTS:A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong. CONCLUSIONS:On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale.
10.2196/46558
Deep Learning in mHealth for Cardiovascular Disease, Diabetes, and Cancer: Systematic Review.
JMIR mHealth and uHealth
BACKGROUND:Major chronic diseases such as cardiovascular disease (CVD), diabetes, and cancer impose a significant burden on people and health care systems around the globe. Recently, deep learning (DL) has shown great potential for the development of intelligent mobile health (mHealth) interventions for chronic diseases that could revolutionize the delivery of health care anytime, anywhere. OBJECTIVE:The aim of this study is to present a systematic review of studies that have used DL based on mHealth data for the diagnosis, prognosis, management, and treatment of major chronic diseases and advance our understanding of the progress made in this rapidly developing field. METHODS:A search was conducted on the bibliographic databases Scopus and PubMed to identify papers with a focus on the deployment of DL algorithms that used data captured from mobile devices (eg, smartphones, smartwatches, and other wearable devices) targeting CVD, diabetes, or cancer. The identified studies were synthesized according to the target disease, the number of enrolled participants and their age, and the study period as well as the DL algorithm used, the main DL outcome, the data set used, the features selected, and the achieved performance. RESULTS:In total, 20 studies were included in the review. A total of 35% (7/20) of DL studies targeted CVD, 45% (9/20) of studies targeted diabetes, and 20% (4/20) of studies targeted cancer. The most common DL outcome was the diagnosis of the patient's condition for the CVD studies, prediction of blood glucose levels for the studies in diabetes, and early detection of cancer. Most of the DL algorithms used were convolutional neural networks in studies on CVD and cancer and recurrent neural networks in studies on diabetes. The performance of DL was found overall to be satisfactory, reaching >84% accuracy in most studies. In comparison with classic machine learning approaches, DL was found to achieve better performance in almost all studies that reported such comparison outcomes. Most of the studies did not provide details on the explainability of DL outcomes. CONCLUSIONS:The use of DL can facilitate the diagnosis, management, and treatment of major chronic diseases by harnessing mHealth data. Prospective studies are now required to demonstrate the value of applied DL in real-life mHealth tools and interventions.
10.2196/32344
Smartphones and Apps to Control Glycosylated Hemoglobin (HbA1c) Level in Diabetes: A Systematic Review and Meta-Analysis.
Martos-Cabrera María Begoña,Velando-Soriano Almudena,Pradas-Hernández Laura,Suleiman-Martos Nora,Cañadas-De la Fuente Guillermo A,Albendín-García Luis,Gómez-Urquiza José L
Journal of clinical medicine
INTRODUCTION:Diabetes mellitus is a chronic endocrine-metabolic disease, the evolution of which is closely related to people´s self-control of glycemic levels through nutrition, exercise, and medicines. AIM:To determine whether smartphone apps can help persons with diabetes to improve their % levels of glycosylated hemoglobin. METHOD:A systematic review and meta-analysis were done. ProQuest, Pubmed/Medline, and Scopus databases were used. The search equation used was "(Prevention and Control) AND Diabetes Mellitus AND Smartphones". The inclusion criteria applied were clinical trials, conducted in 2014-2019. RESULTS:n = 18 studies were included in the review. The studies tried different applications to monitor glycemia and support patients to improve glycosylated hemoglobin (HbA1c) levels. More than half of the studies found statistically significant differences in HbA1c in the intervention group compared with the control group. Eleven studies were included in the meta-analysis and the study sample was n = 545 for the experimental group and n = 454 for the control group. The meta-analytic estimation of the HbA1c % level means differences between intervention and control group was statistically significant in favour of the intervention group with a mean difference of -0.37 (-0.58, -0.15. 95% confidence interval). CONCLUSION:Smartphone apps can help people with diabetes to improve their level of HbA1c, but the clinical impact is low.
10.3390/jcm9030693
Emerging Artificial Intelligence-Empowered mHealth: Scoping Review.
JMIR mHealth and uHealth
BACKGROUND:Artificial intelligence (AI) has revolutionized health care delivery in recent years. There is an increase in research for advanced AI techniques, such as deep learning, to build predictive models for the early detection of diseases. Such predictive models leverage mobile health (mHealth) data from wearable sensors and smartphones to discover novel ways for detecting and managing chronic diseases and mental health conditions. OBJECTIVE:Currently, little is known about the use of AI-powered mHealth (AIM) settings. Therefore, this scoping review aims to map current research on the emerging use of AIM for managing diseases and promoting health. Our objective is to synthesize research in AIM models that have increasingly been used for health care delivery in the last 2 years. METHODS:Using Arksey and O'Malley's 5-point framework for conducting scoping reviews, we reviewed AIM literature from the past 2 years in the fields of biomedical technology, AI, and information systems. We searched 3 databases, PubsOnline at INFORMS, e-journal archive at MIS Quarterly, and Association for Computing Machinery (ACM) Digital Library using keywords such as "mobile healthcare," "wearable medical sensors," "smartphones", and "AI." We included AIM articles and excluded technical articles focused only on AI models. We also used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) technique for identifying articles that represent a comprehensive view of current research in the AIM domain. RESULTS:We screened 108 articles focusing on developing AIM models for ensuring better health care delivery, detecting diseases early, and diagnosing chronic health conditions, and 37 articles were eligible for inclusion, with 31 of the 37 articles being published last year (76%). Of the included articles, 9 studied AI models to detect serious mental health issues, such as depression and suicidal tendencies, and chronic health conditions, such as sleep apnea and diabetes. Several articles discussed the application of AIM models for remote patient monitoring and disease management. The considered primary health concerns belonged to 3 categories: mental health, physical health, and health promotion and wellness. Moreover, 14 of the 37 articles used AIM applications to research physical health, representing 38% of the total studies. Finally, 28 out of the 37 (76%) studies used proprietary data sets rather than public data sets. We found a lack of research in addressing chronic mental health issues and a lack of publicly available data sets for AIM research. CONCLUSIONS:The application of AIM models for disease detection and management is a growing research domain. These models provide accurate predictions for enabling preventive care on a broader scale in the health care domain. Given the ever-increasing need for remote disease management during the pandemic, recent AI techniques, such as federated learning and explainable AI, can act as a catalyst for increasing the adoption of AIM and enabling secure data sharing across the health care industry.
10.2196/35053
Self-Guided Smartphone Application to Manage Chronic Musculoskeletal Pain: A Randomized, Controlled Pilot Trial.
International journal of environmental research and public health
OBJECTIVE:The goal of this study is to evaluate the feasibility and efficacy of an auricular point acupressure smartphone app (mAPA) to self-manage chronic musculoskeletal pain. METHODS:A prospective, longitudinal, randomized, controlled pilot trial was conducted using a three-group design (self-guided mAPA ( = 14); in-person mAPA ( = 12); and control ( = 11)). The primary outcomes included physical function and pain intensity. RESULTS:After a 4-week APA intervention, participants in the in-person mAPA group had improved physical function of 32% immediately post-intervention and 29% at the 1M follow-up. Participants in the self-guided mAPA group had higher improvement (42% at post-intervention and 48% at the 1M follow-up). Both mAPA groups had similar degrees of pain intensity relief at post-intervention (45% for in-person and 48% for the self-guided group) and the 1M follow-up (42% for in-person and 45% for the self-guided group). Over 50% of the participants in each group reached at least 30% reduced pain intensity at post-intervention, and this was sustained in the mAPA groups at the 1M follow-up. Approximately 80% of the participants in both mAPA groups were satisfied with the treatment outcomes and adhered to the suggested APA practice; however, participants in the self-guided group had higher duration and more frequency in APA use. The attrition rate was 16% at the 1M follow-up. No adverse effects of APA were reported, and participants found APA to be beneficial and the app to be valuable. CONCLUSIONS:The study findings indicate that participants effectively learned APA using a smartphone app, whether they were self-guided or received in-person training. They were able to self-administer APA to successfully manage their pain. Participants found APA to be valuable in their pain self-management and expressed satisfaction with the intervention using the app.
10.3390/ijerph192214875
The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review.
JMIR serious games
BACKGROUND:Chronic disease self-management is a public health issue of worldwide concern, and gamification is an emerging strategy to improve patients' participation in chronic disease self-management. Some studies have summarized designs for the gamification of chronic disease self-management from the perspective of eHealth technology, but they have not mentioned differences in design methods, functions, and evaluation methods of gamified designs for self-management in different chronic diseases. OBJECTIVE:This scoping review aims to synthesize the characteristics of realization forms, functions, and evaluation methods in chronic disease self-management gamification to improve self-management among the chronic disease population. METHODS:We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. As of January 7, 2023, we systematically searched 9 databases for relevant studies from January 2012 to December 2022. Related data were extracted based on the research questions. We calculated the frequencies, charted the quantitative data, and coded the extracted material for qualitative content analysis. RESULTS:We retrieved 16,221 records, of which 70 (0.43%) met the eligibility criteria. In the included research, the target populations for gamified designs for self-management of chronic diseases included patients with stroke, cancer, diabetes, chronic obstructive pulmonary disease, coronary heart disease, obesity, and hypertension. Almost all studies mentioned technical support for gamification (68/70, 97%), mainly in the form of active video games (58/70, 83%); however, less than half of the studies mentioned the theoretical basis for gamification (31/70, 44%). There were 37 concepts or theories relevant to gamification design, most of which were in the field of psychology or were cross-disciplinary (n=33, 89%). Gamification for the self-management of chronic diseases has been widely recognized, including for promoting physical exercise and rehabilitation training (48/99, 48%), increasing initiative for symptom management (18/99, 18%), providing psychological support (14/99, 14%), improving cognitive function (12/99, 12%), and improving medication adherence (7/99, 7%). A total of 39 studies mentioned the gamification effect; however, we did not find a unified evaluation standard. CONCLUSIONS:This scoping review focuses on gamification designs for chronic disease self-management and summarizes the realization forms and functions of gamification in self-management for different patient populations. With practice in a gamified internet-based environment, patients can not only master the knowledge and skills of self-management in fascinating scenarios but also benefit from gaming experience and make better health-related decisions in real life. It is worth noting that a comprehensive evaluation of the users as well as a personalized and targeted intervention should be developed before gamification.
10.2196/39019
Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis.
BMC public health
BACKGROUND:Chronic non-communicable diseases (CNCDs) are an urgent public health issue in China, especially among older adults. Hence, self-management is crucial for disease progression and treatment. Electronic health (e-health) literacy and self-efficacy positively correlate with self-management. However, we know little about their underlying mechanisms in older adults with CNCDs. OBJECTIVE:To explore the factors that influence chronic disease self-management (CDSM) and verify self-efficacy as the mediator between e-health literacy and self-management behavior in older patients with CNCDs. METHODS:This cross-sectional study included 289 older patients with CNCDs from Hunan province, China, between July and November 2021. E-health literacy, self-efficacy, social support, and CDSM data were collected through questionnaires. The influence of each factor on CDSM was explored with multiple linear regression analysis. Intermediary effects were computed via a structural equation model. RESULTS:The total CDSM score in the patients was 29.39 ± 9.60 and only 46 (15.92%) patients used smart healthcare devices. The regression analysis showed e-health literacy, self-efficacy, and social support were the factors that affected CDSM. Furthermore, the structural equation model revealed that self-efficacy directly affected CDSM (β = 0.45, P < 0.01), whereas e-health literacy affected it directly (β = 0.42, P < 0.01) and indirectly (β = 0.429, P < 0.01) through self-efficacy. CONCLUSIONS:This study revealed that self-management among older patients with CNCDs is at a low level, and few of them use smart healthcare devices. Self-efficacy plays a partial intermediary role between e-health literacy and self-management in older patients with CNCDs. Thus, efforts to improve their CDSM by targeting e-health literacy may be more effective when considering self-efficacy.
10.1186/s12889-022-14695-4
Characterising user engagement with mHealth for chronic disease self-management and impact on machine learning performance.
NPJ digital medicine
Mobile Health (mHealth) has the potential to be transformative in the management of chronic conditions. Machine learning can leverage self-reported data collected with apps to predict periods of increased health risk, alert users, and signpost interventions. Despite this, mHealth must balance the treatment burden of frequent self-reporting and predictive performance and safety. Here we report how user engagement with a widely used and clinically validated mHealth app, myCOPD (designed for the self-management of Chronic Obstructive Pulmonary Disease), directly impacts the performance of a machine learning model predicting an acute worsening of condition (i.e., exacerbations). We classify how users typically engage with myCOPD, finding that 60.3% of users engage frequently, however, less frequent users can show transitional engagement (18.4%), becoming more engaged immediately ( < 21 days) before exacerbating. Machine learning performed better for users who engaged the most, however, this performance decrease can be mostly offset for less frequent users who engage more near exacerbation. We conduct interviews and focus groups with myCOPD users, highlighting digital diaries and disease acuity as key factors for engagement. Users of mHealth can feel overburdened when self-reporting data necessary for predictive modelling and confidence of recognising exacerbations is a significant barrier to accurate self-reported data. We demonstrate that users of mHealth should be encouraged to engage when they notice changes to their condition (rather than clinically defined symptoms) to achieve data that is still predictive for machine learning, while reducing the likelihood of disengagement through desensitisation.
10.1038/s41746-024-01063-2
mHealth for the Self-management of Knee Osteoarthritis: Scoping Review.
Journal of medical Internet research
BACKGROUND:Educating patients on the self-management of knee osteoarthritis (OA) reportedly reduces pain, improves activities of daily living, and even reduces health care costs. OBJECTIVE:This scoping review will summarize the current evidence on mobile health (mHealth) and smartphone app-based disease self-management for patients with knee OA. METHODS:PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and CINAHL were systematically searched in May 2021 using the keywords "knee osteoarthritis," "mobile health," and "self-management." Studies that investigated patients with knee OA based on radiography or clinical diagnosis were included. The following criteria were applied to the mobile phone apps included in the search-derived studies: the ability to (1) record and manage symptoms, (2) provide patient education, and (3) guide and record activities of daily living. Studies eligible for inclusion in this scoping review were interventional trials or observational studies published in English. RESULTS:This scoping review included 8 reports, of which 3 were randomized controlled trials and 1 was a conference abstract. Most studies provided data on the outcomes of pain, physical function, and quality of life. CONCLUSIONS:An increasing number of reports are addressing the effectiveness of mHealth in patients with knee OA, and the data suggest that mHealth efficacy is similar to conventional management of health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.17504/protocols.io.buuxnwxn.
10.2196/38798
Smartphone app-based interventions targeting physical activity for weight management: A meta-analysis of randomized controlled trials.
International journal of nursing studies
BACKGROUND:Being overweight and obese are major public health challenges worldwide. Smartphone apps are an innovative platform to deliver physical activity modifications for weight management. This study aimed to explore the efficacy of smartphone app-based interventions targeting physical activity for obesity-related outcomes and compare the efficacy among behavioral change techniques. METHODS:Five online databases were searched for randomized controlled trials in September 30, 2021. Hedges' g was used to compute effect sizes. The random effect models were conducted for all analyses. RESULTS:In total, 12 trials were selected for qualitative and quantitative syntheses. Smartphone app-based interventions exerted small-to-moderate effects on body weight, body mass index, and body fat percentage. The meta-regression found that the older age of participants and a longer duration of the intervention increased the effect. Subgroup analyses found that the interventions were more effective on body weight among participants with a disease or disability, and on body mass index in participants who were obese or overweight. Apps with features such as reminders, self-reporting, and a health coach used as behavioral change techniques were more effective. CONCLUSION:Smartphone apps are an effective and feasible strategy for physical activity modification using behavioral change techniques. Smartphone app-based interventions can promote physical activity for weight management.
10.1016/j.ijnurstu.2022.104384
Can smartphone use affect chronic disease self-management among Chinese middle-aged and older adults? A moderated mediation model.
Frontiers in psychology
Introduction:Chronic disease self-management is influenced by many factors. Previous studies have linked patients' media use with chronic disease self-management, but the underlying mechanisms of this relationship are less understood. Objectives:The purpose of this study is to explore the mediating role of family health (FH) between frequency of smartphone use (FOSU) and self-management behaviors among middle-aged and older patients with chronic diseases (SBAMAOPWCD) through a moderated mediation model, and whether this indirect relationship is modified by the solitary status of middle-aged and older Chinese patients with chronic disease. Methods:Surveys were collected from 1,424 ( = 1,424; age > 45) middle-aged and older with one or more chronic conditions in China on self-reports of FOSU, FH and Chronic disease self-management behaviors were used to examine the moderated mediation model. Results:The results showed that the FOSU was significantly and positively associated with SBAMAOPWCD ( = 0.220, < 0.001; = 0.170, < 0.001; = 0.167, < 0.001; = 0.158, < 0.001); The Family health resources (FHR) dimension of FH and the Family external social supports (FESS) dimension mediated the relationship between the FOSU and SBAMAOPWCD ( = -0.0758, CI: -0.1402, -0.0236; = 0.0721, CI: 0.0141, 0.1458), Among them, the FHR dimension mediated mainly among FOSU, exercise and cognitive symptom management practices (CSMP; = -0.0344, CI: -0.0652, -0.0102; = -0.0401, CI: -0.0725, -0.0138), the FESS dimension of the FH mediated the relationship between the FOSU and communication with physicians (CWP; = 0.0376, CI: 0.0116, 0.0705); Solitary state played a moderating role in the relationship between FHR dimension and SBAMAOPWCD (live alone = -0.2395, CI: -0.4574, -0.0661; not live-alone = -0.0599, CI: -0.1164, -0.0172). In addition, solitary state played a moderating role in the relationship among FHR dimension and CSMP for middle-aged and older patients (live alone = -0.1095, CI: -0.1961, -0.0378; not live-alone = -0.0334, CI: -0.0633, -0.0102). Interestingly, the relationship between FESS dimension and SBAMAOPWCD was moderated only by the non-live alone population ( = 0.0676, CI: 0.0008, 0.1478), and not by the live-alone population ( = 0.1026, CI: -0.1061, 0.3278).Unexpectedly, we found that when their FHR were lower, they reported higher levels of chronic disease self-management, middle-aged and older patients with chronic diseases who live alone are more significant in this impact relationship. Conclusions:The study further deepens our understanding of the mechanisms linking frequency of smartphone use with chronic disease self-management behaviors, and it helps to develop interventions to improve chronic disease self-management behaviors in middle-aged and older adults.
10.3389/fpsyg.2022.1019335
Reliability, validity, and responsiveness of a smartphone-based manikin to support pain self-reporting.
Pain reports
Introduction:Many people worldwide suffer from chronic pain. Improving our knowledge on chronic pain prevalence and management requires methods to collect pain self-reports in large populations. Smartphone-based tools could aid data collection by allowing people to use their own device, but the measurement properties of such tools are largely unknown. Objectives:To assess the reliability, validity, and responsiveness of a smartphone-based manikin to support pain self-reporting. Methods:We recruited people with fibromyalgia, rheumatoid arthritis, and/or osteoarthritis and access to a smartphone and the internet. Data collection included the Global Pain Scale at baseline and follow-up, and 30 daily pain drawings completed on a 2-dimensional, gender-neutral manikin. After deriving participants' pain extent from their manikin drawings, we evaluated convergent and discriminative validity, test-retest reliability, and responsiveness and assessed findings against internationally agreed criteria for good measurement properties. Results:We recruited 131 people; 104 were included in the full sample, submitting 2185 unique pain drawings. Manikin-derived pain extent had excellent test-retest reliability (intraclass correlation coefficient, 0.94), moderate convergent validity (ρ, 0.46), and an ability to distinguish fibromyalgia and osteoarthritis from rheumatoid arthritis (F statistics, 30.41 and 14.36, respectively; < 0.001). Responsiveness was poor (ρ, 0.2; , 0.06) and did not meet the respective criterion for good measurement properties. Conclusion:Our findings suggest that smartphone-based manikins can be a reliable and valid method for pain self-reporting, but that further research is warranted to explore, enhance, and confirm the ability of such manikins to detect a change in pain over time.
10.1097/PR9.0000000000001131
Individual outcomes after tailored versus generic self-management strategies for persistent fatigue in youth with a fatigue syndrome or rheumatic condition: A multiple single-case study.
British journal of health psychology
OBJECTIVE:To examine individual outcomes after tailored lifestyle (PROfeel) or generic dietary advice as self-management intervention for persistent fatigue in adolescents and young adults with a chronic condition, to compare participants who did and did not benefit and to explore changes to factors in the biopsychosocial model of fatigue after PROfeel. METHOD:A multiple single-case AB-phase design was embedded in a randomized crossover trial (N = 45). Intensive longitudinal data (ILD) on outcomes 'fatigue severity', 'self-efficacy' and 'quality of life' (QoL) were collected through weekly smartphone measurement for 20 weeks. ILD on biopsychosocial factors were collected through experience sampling methodology for 28 days pre-post first intervention. Baseline characteristics were compared with t-tests and chi-square tests. Permutation distancing tests were used to assess change over time in all ILD. RESULTS:Regarding weekly measurements, nineteen participants (42.22%) showed small to large positive outcomes (d = .05 to 2.59), mostly after PROfeel. Eleven participants (24.44%) showed small to moderate negative outcomes (d = -.02 to -2.46), mostly after dietary advice. Fatigue severity improved most, followed by self-efficacy. Participants who benefitted showed higher QoL levels and lower fatigue and pain levels compared with others at baseline (all p < .02). When positive outcomes were observed after PROfeel, typically ≥1 biopsychosocial factor had been targeted successfully. CONCLUSION:Self-management advice has more potential when tailored to individual characteristics, including the biopsychosocial model of fatigue. PROfeel appears particularly useful as fatigue intervention for individuals with relatively less severe symptoms.
10.1111/bjhp.12722
Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study.
Interactive journal of medical research
BACKGROUND:Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients' experiences with these apps are underexplored. OBJECTIVE:This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app "My Bones." METHODS:Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. RESULTS:Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. CONCLUSIONS:Danish patients with osteoporosis are both motivated and capable of using digital health services. The app's usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services.
10.2196/53995
Design and rationale of the Comprehensive intelligent Hypertension managEment SyStem (CHESS) evaluation study: A cluster randomized controlled trial for hypertension management in primary care.
American heart journal
BACKGROUND:Hypertension management in China is suboptimal with high prevalence and low control rate due to various barriers, including lack of self-management awareness of patients and inadequate capacity of physicians. Digital therapeutic interventions including mobile health and computational device algorithms such as clinical decision support systems (CDSS) are scalable with the potential to improve blood pressure (BP) management and strengthen the healthcare system in resource-constrained areas, yet their effectiveness remains to be tested. The aim of this report is to describe the protocol of the Comprehensive intelligent Hypertension managEment SyStem (CHESS) evaluation study assessing the effect of a multifaceted hypertension management system for supporting patients and physicians on BP lowering in primary care settings. MATERIALS AND METHODS:The CHESS evaluation study is a parallel-group, cluster-randomized controlled trial conducted in primary care settings in China. Forty-one primary care sites from 3 counties of China are randomly assigned to either the usual care or the intervention group with the implementation of the CHESS system, more than 1,600 patients aged 35 to 80 years with uncontrolled hypertension and access to a smartphone by themselves or relatives are recruited into the study and followed up for 12 months. In the intervention group, participants receive patient-tailored reminders and alerts via messages or intelligent voice calls triggered by uploaded home blood pressure monitoring data and participants' characteristics, while physicians receive guideline-based prescription instructions according to updated individual data from each visit, and administrators receive auto-renewed feedback of hypertension management performance from the data analysis platform. The multiple components of the CHESS system can work synergistically and have undergone rigorous development and pilot evaluation using a theory-informed approach. The primary outcome is the mean change in 24-hour ambulatory systolic BP from baseline to 12 months. DISCUSSION:The CHESS trial will provide evidence and novel insight into the effectiveness and feasibility of an implementation strategy using a comprehensive digital BP management system for reducing hypertension burden in primary care settings. TRIAL REGISTRATION:https://www. CLINICALTRIALS:gov, NCT05605418.
10.1016/j.ahj.2024.03.018
Smartphone-delivered multicomponent lifestyle medicine intervention for improving mental health in a nonclinical population: a randomized controlled trial.
Frontiers in public health
Objective:To prevent the exacerbation of mental health burdens, a growing body of research has recommended a balanced approach that emphasizes both the delivery of mental health treatments to individuals with common mental disorders (CMDs) and the strengthening of protective factors for CMDs among nonclinical populations. This randomized controlled trial (RCT) evaluated the efficacy of a smartphone-delivered multicomponent lifestyle medicine (LM) intervention, Lifestyle Hub, for improving mental health among a nonclinical population of Chinese adults. Methods:A total of 106 participants with Patient Health Questionnaire-9 total score < 10 and Generalized Anxiety Disorder 7-Item Scale <8 were randomly assigned to either the Lifestyle Hub intervention group (LH, = 53) or the waitlist control group (WL, = 53). Lifestyle Hub is an 8-week smartphone-delivered multicomponent LM intervention developed based on the transtheoretical model. The intervention components included lifestyle psychoeducation, physical activity, diet and nutrition, stress management, sleep management, and motivation and goal-setting techniques. Assessments were conducted at baseline, immediate post-intervention, and 1-month follow-up (LH only). Results:The linear mixed effect model based on the intention-to-treat principle indicated that Lifestyle Hub significantly improved overall mental health, depressive symptoms, anxiety symptoms, stress, insomnia severity, overall health-promoting behaviors, dietary quality, and stress management compared to the WL group at immediate post-intervention ( = 0.13-0.56). No significant between-group differences were observed in terms of functional impairment, health-related quality of life, health responsibility, physical activity level, spiritual growth, and interpersonal relations. The intervention gains in the LH group were maintained at 1-month follow-up. The LH participants indicated that Lifestyle Hub was an acceptable intervention for improving mental health, although a significantly higher level of study attrition was observed in the LH group (20.8%) relative to the WL group (5.7%). Conclusion:Lifestyle Hub may serve as an efficacious and acceptable intervention for improving mental health in nonclinical adult populations. To extend the benefits of LM interventions at the population level, future studies are warranted to examine a stepped-care approach to delivering LM interventions.: This randomized controlled trial was pre-registered with ClinicalTrials.gov (NCT04295369).
10.3389/fpubh.2023.1231981
Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trials.
EClinicalMedicine
Background:Digital health interventions can be effective for blood pressure (BP) control, but a comparison of the effectiveness and application of these types of interventions has not yet been systematically evaluated in low- and middle-income countries (LMICs). This study aimed to compare the effectiveness of digital health interventions according to the World Health Organisation (WHO) classifications of patients in terms of BP control, lifestyle behaviour changes, and adherence to medication in patients with hypertension in LMICs. Methods:In this systematic review and meta-analysis, we searched the PubMed, Scopus, Web of Science, Embase, CINAHL, and Cochrane Library databases for randomised controlled trials (RCTs) published in English, comprised of adults (≥18 years old) with hypertension and the intervention consisted of digital health interventions according to WHO's classifications for patients in LMICs between January 1, 2009, and July 17, 2023. We excluded RCTs that considered patients with hypertension comorbidities such as diabetes and hypertension-mediated target organ damage (HMTOD). The references were downloaded into Mendeley Desktop and imported into the Rayyan web tool for deduplication and screening. The risk of bias was assessed using Cochrane Risk of Bias 2. Data extraction was done according to Cochrane's guidelines. The main outcome measures were mean systolic blood pressure (SBP) and BP control which were assessed using the random-effect DerSimonian-Laird and Mantel-Haenszel models. We presented the BP outcomes, lifestyle behaviour changes and medication adherence in forest plots as well as summarized them in tables. This study is registered with PROSPERO, CRD42023424227. Findings:We identified 9322 articles, of which 22 RCTs from 12 countries (n = 12,892 respondents) were included in the systematic review. The quality of the 22 studies was graded as high risk (n = 7), had some concerns (n = 3) and low risk of bias (n = 12). A total of 19 RCTs (n = 12,418 respondents) were included in the meta-analysis. Overall, digital health intervention had significant reductions in SBP [mean difference (MD) = -4.43 mmHg (95% CI -6.19 to -2.67), I = 92%] and BP control [odds ratio (OR) = 2.20 (95% CI 1.64-2.94), I = 78%], respectively, compared with usual care. A subgroup analysis revealed that short message service (SMS) interventions had the greatest statistically significant reduction of SBP [MD = -5.75 mm Hg (95% Cl -7.77 to -3.73), I = 86%] compared to mobile phone calls [MD = 3.08 mm Hg (-6.16 to 12.32), I = 87%] or smartphone apps interventions [MD = -4.06 mm Hg (-6.56 to -1.55), I = 79%], but the difference between groups was not statistically significant (p = 0.14). The meta-analysis showed that the interventions had a significant effect in supporting changes in lifestyle behaviours related to a low salt diet [standardised mean difference (SMD) = 1.25; (95% CI 0.64-1.87), I = 89%], physical activity [SMD = 1.30; (95% CI 0.23-2.37), I = 94%] and smoking reduction [risk difference (RR) = 0.03; (95% CI 0.01-0.05), I = 0%] compared to the control group. In addition, improvement in medication adherence was statistically significant and higher in the intervention group than in the control group [SMD = 1.59; (95% CI 0.51-2.67), I = 97%]. Interpretation:Our findings suggest that digital health interventions may be effective for BP control, changes in lifestyle behaviours, and improvements in medication adherence in LMICs. However, we observed high heterogeneity between included studies, and only two studies from Africa were included. The combination of digital health interventions with clinical management is crucial to achieving optimal clinical effectiveness in BP control, changes in lifestyle behaviours and improvements in medication adherence. Funding:None.
10.1016/j.eclinm.2024.102432
A Wearable Inertial Sensor Approach for Locomotion and Localization Recognition on Physical Activity.
Sensors (Basel, Switzerland)
Advancements in sensing technology have expanded the capabilities of both wearable devices and smartphones, which are now commonly equipped with inertial sensors such as accelerometers and gyroscopes. Initially, these sensors were used for device feature advancement, but now, they can be used for a variety of applications. Human activity recognition (HAR) is an interesting research area that can be used for many applications like health monitoring, sports, fitness, medical purposes, etc. In this research, we designed an advanced system that recognizes different human locomotion and localization activities. The data were collected from raw sensors that contain noise. In the first step, we detail our noise removal process, which employs a Chebyshev type 1 filter to clean the raw sensor data, and then the signal is segmented by utilizing Hamming windows. After that, features were extracted for different sensors. To select the best feature for the system, the recursive feature elimination method was used. We then used SMOTE data augmentation techniques to solve the imbalanced nature of the Extrasensory dataset. Finally, the augmented and balanced data were sent to a long short-term memory (LSTM) deep learning classifier for classification. The datasets used in this research were Real-World Har, Real-Life Har, and Extrasensory. The presented system achieved 89% for Real-Life Har, 85% for Real-World Har, and 95% for the Extrasensory dataset. The proposed system outperforms the available state-of-the-art methods.
10.3390/s24030735
Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity.
The Cochrane database of systematic reviews
BACKGROUND:Obesity is considered to be a risk factor for various diseases, and its incidence has tripled worldwide since 1975. In addition to potentially being at risk for adverse health outcomes, people with overweight or obesity are often stigmatised. Behaviour change interventions are increasingly delivered as mobile health (m-health) interventions, using smartphone apps and wearables. They are believed to support healthy behaviours at the individual level in a low-threshold manner. OBJECTIVES:To assess the effects of integrated smartphone applications for adolescents and adults with overweight or obesity. SEARCH METHODS:We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, and LILACS, as well as the trials registers ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform on 2 October 2023 (date of last search for all databases). We placed no restrictions on the language of publication. SELECTION CRITERIA:Participants were adolescents and adults with overweight or obesity. Eligible interventions were integrated smartphone apps using at least two behaviour change techniques. The intervention could target physical activity, cardiorespiratory fitness, weight loss, healthy diet, or self-efficacy. Comparators included no or minimal intervention (NMI), a different smartphone app, personal coaching, or usual care. Eligible studies were randomised controlled trials of any duration with a follow-up of at least three months. DATA COLLECTION AND ANALYSIS:We used standard Cochrane methodology and the RoB 2 tool. Important outcomes were physical activity, body mass index (BMI) and weight, health-related quality of life, self-efficacy, well-being, change in dietary behaviour, and adverse events. We focused on presenting studies with medium- (6 to < 12 months) and long-term (≥ 12 months) outcomes in our summary of findings table, following recommendations in the core outcome set for behavioural weight management interventions. MAIN RESULTS:We included 18 studies with 2703 participants. Interventions lasted from 2 to 24 months. The mean BMI in adults ranged from 27 to 50, and the median BMI z-score in adolescents ranged from 2.2 to 2.5. Smartphone app versus no or minimal intervention Thirteen studies compared a smartphone app versus NMI in adults; no studies were available for adolescents. The comparator comprised minimal health advice, handouts, food diaries, smartphone apps unrelated to weight loss, and waiting list. Measures of physical activity: at 12 months' follow-up, a smartphone app compared to NMI probably reduces moderate to vigorous physical activity (MVPA) slightly (mean difference (MD) -28.9 min/week (95% confidence interval (CI) -85.9 to 28; 1 study, 650 participants; moderate-certainty evidence)). We are very uncertain about the results of estimated energy expenditure and cardiorespiratory fitness at eight months' follow-up. A smartphone app compared with NMI probably results in little to no difference in changes in total activity time at 12 months' follow-up and leisure time physical activity at 24 months' follow-up. Anthropometric measures: a smartphone app compared with NMI may reduce BMI (MD of BMI change -2.6 kg/m, 95% CI -6 to 0.8; 2 studies, 146 participants; very low-certainty evidence) at six to eight months' follow-up, but the evidence is very uncertain. At 12 months' follow-up, a smartphone app probably resulted in little to no difference in BMI change (MD -0.1 kg/m, 95% CI -0.4 to 0.3; 1 study; 650 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in body weight change (MD -2.5 kg, 95% CI -6.8 to 1.7; 3 studies, 1044 participants; low-certainty evidence) at 12 months' follow-up. At 24 months' follow-up, a smartphone app probably resulted in little to no difference in body weight change (MD 0.7 kg, 95% CI -1.2 to 2.6; 1 study, 245 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in self-efficacy for a physical activity score at eight months' follow-up, but the results are very uncertain. A smartphone app probably results in little to no difference in quality of life and well-being at 12 months (moderate-certainty evidence) and in little to no difference in various measures used to inform dietary behaviour at 12 and 24 months' follow-up. We are very uncertain about adverse events, which were only reported narratively in two studies (very low-certainty evidence). Smartphone app versus another smartphone app Two studies compared different versions of the same app in adults, showing no or minimal differences in outcomes. One study in adults compared two different apps (calorie counting versus ketogenic diet) and suggested a slight reduction in body weight at six months in favour of the ketogenic diet app. No studies were available for adolescents. Smartphone app versus personal coaching Only one study compared a smartphone app with personal coaching in adults, presenting data at three months. Two studies compared these interventions in adolescents. A smartphone app resulted in little to no difference in BMI z-score compared to personal coaching at six months' follow-up (MD 0, 95% CI -0.2 to 0.2; 1 study; 107 participants). Smartphone app versus usual care Only one study compared an app with usual care in adults but only reported data at three months on participant satisfaction. No studies were available for adolescents. We identified 34 ongoing studies. AUTHORS' CONCLUSIONS:The available evidence is limited and does not demonstrate a clear benefit of smartphone applications as interventions for adolescents or adults with overweight or obesity. While the number of studies is growing, the evidence remains incomplete due to the high variability of the apps' features, content and components, which complicates direct comparisons and assessment of their effectiveness. Comparisons with either no or minimal intervention or personal coaching show minor effects, which are mostly not clinically significant. Minimal data for adolescents also warrants further research. Evidence is also scarce for low- and middle-income countries as well as for people with different socio-economic and cultural backgrounds. The 34 ongoing studies suggest sustained interest in the topic, with new evidence expected to emerge within the next two years. In practice, clinicians and healthcare practitioners should carefully consider the potential benefits, limitations, and evolving research when recommending smartphone apps to adolescents and adults with overweight or obesity.
10.1002/14651858.CD013591.pub2
Effectiveness of gamified exercise programs on the level of physical activity in adults with chronic diseases: a systematic review.
Disability and rehabilitation
PURPOSE:to assess the effects of supervised and unsupervised gamified exercise programs on physical activity level, sedentary behavior and quality of life in patients with non-communicable chronic diseases. MATERIALS AND METHODS:Six database were searched. Methodological quality of included studies, the quality of reporting interventions and the quality of the applications were assessed using the PEDro, TIDieR and MARS, respectively. RESULTS:Nine studies were included ( = 974; 60.2 ± 5.7 years). Three of them enrolled individuals with cancer, one with stroke, one with multiple sclerosis, one with COPD, two with Diabetes Mellitus, and one with knee and hip osteoarthritis. Gamification was performed via a smartphone application in three studies (MARS = 13.4 ± 9.75pts, ranging from 10.9 to 16.9pts). The intervention was supervised in six studies. The PEDro and TIDIeR scores were 5.5 ± 1.3 (ranging 0-8pts) and 16.11 ± 3.14 (ranging 10-20pts), respectively. Supervised gamified interventions increased the level of physical activity compared to usual supervised exercises. Quality of life was similar between groups. Unsupervised interventions were similar for all outcomes evaluated. CONCLUSIONS:Supervised gamified exercise programs seem to increase the level of physical activity compared to usual exercises in patients with chronic diseases. However, studies with better methodological qualities and subgroup analyzes are needed.
10.1080/09638288.2024.2323614
The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review.
JMIR medical informatics
BACKGROUND:Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. OBJECTIVE:This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. METHODS:A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. RESULTS:The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. CONCLUSIONS:This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.
10.2196/46699
Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review.
JMIR mHealth and uHealth
BACKGROUND:Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness. OBJECTIVE:This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns. METHODS:In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on. RESULTS:To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area. CONCLUSIONS:Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.
10.2196/45860
Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED).
BMC public health
BACKGROUND:The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour. METHODS:The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form. RESULTS:The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence. CONCLUSIONS:The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.
10.1186/s12889-024-18384-2
Smartphone app-based interventions on physical activity behaviors and psychological correlates in healthy young adults: A systematic review.
PloS one
BACKGROUND:The issue of low physical activity (PA) levels among the youth is a longstanding concern. Smartphone applications offer a promising avenue for delivering interventions that are both accessible and engaging. Up to now, there appears to be a gap in the literature, with no systematic reviews assessing the efficacy of smartphone apps in encouraging increased physical activity among healthy young adults. OBJECTIVE:To synthesize the effects of a smartphone app-based intervention on PA and PA-related psychological correlates in healthy young adults (18-35 years old). METHODS:A search was conducted on eighteen databases: PubMed, Medline, Web of Science, SPORTDiscus, Scopus, Academic Search Premier, Communication and Mass Media Complete, Article First, Biomed Central, BioOne, EBSCOHost, JSTOR, ProQuest, SAGE Reference Online, ScienceDirect, SpringerLink, Taylor&Francis, and Wiley Online. The search covered the period up until December 2023. This research included all randomized controlled trials (RCTs) that evaluated the effectiveness of smartphone app-based interventions on PA and PA related psychological outcomes in healthy young adults. The overall impact was determined by vote counting based on the direction of effect and aggregating p values. The quality of the evidence was evaluated using an 8-item scale. This study has been registered in the PROSPERO database with the identification number CRD42023390033. RESULTS:A total of 8403 articles were retrieved, and based on the predefined inclusion and exclusion criteria, seven articles were selected for inclusion. Among these articles, four high-quality RCTs were identified, and the results of vote counting and combining p values methods suggested that smartphone-based app interventions did not demonstrate significant effectiveness in improving PA and PA-related psychological outcomes. However, some improvements were observed. The analysis results, which were categorized into fitness apps and health apps based on the characteristics of the interventions, also failed to demonstrate significant intervention effects. CONCLUSION:The findings indicate that, currently, there are no significant effects of smartphone app interventions on improving PA and PA-related psychological outcomes in healthy young adults aged 18-35 years. It is important to note that these findings should be interpreted with caution due to the limited number of included studies. Future research should focus on employing high-quality study designs to determine the true effects of interventions and analyze various smartphone app interventions. These analyses should encompass different app characteristics (e.g., fitness app and health app), various combinations (e.g., fitness app alone and fitness app in combination with other interventions), diverse intervention goals (e.g., PA and PA along with other outcomes), and multiple intervention characteristics (e.g., frequency and duration).
10.1371/journal.pone.0301088
The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback.
Bartlett Ellis Rebecca J,Hill James H,Kerley K Denise,Sinha Arjun,Ganci Aaron,Russell Cynthia L
JMIR formative research
BACKGROUND:As many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. OBJECTIVE:The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. METHODS:A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants. RESULTS:A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging. CONCLUSIONS:It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases.
10.2196/13558
Smartphone-Based Application for Tele-follow-up of Patients with Endocrine Disorders in Context of a LMIC: A Compliance, Satisfaction, Clinical Safety and Outcome Assessment.
Yadav Sanjay Kumar,Jha Chandan Kumar,Mishra Saroj Kanta,Mishra Anjali
World journal of surgery
BACKGROUND:Remote video consultations are increasingly used in clinical practice, and a lot of data are emerging on its feasibility and acceptability. This study aims to bring out qualitative and quantitative data which will enhance our understanding of strengths and limitations of this media in the setting of a low- and middle-income country (LMIC). MATERIALS AND METHODS:This was a prospective study conducted from January 2017 to May 2018, at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India. A total of 107 patients were selected who chose remote follow-up care through social media (WhatsApp). Data were analyzed on feasibility, clinical safety, satisfaction and economic burden. RESULTS:A total of 107 postoperative patients were followed up using a social media tool. A total of 396 tele-sessions were held. The average number of tele-consultations per patient was 3.7 (range 2-6). Reasons for tele-follow-up included: confirmation of histology report (n = 92), medication dosage adjustments (n = 148), wound evaluation (n = 102), reporting of serum TSH and serum calcium levels (n = 296) and medical fitness certificate (n = 13). Wound evaluation through tele-follow-up was on par with the outpatient department (OPD) follow-up as no patient had to report to OPD for wound infection. Satisfaction level was excellent in 55% of patients and very good in 25%. 20% of the patients reported an average satisfaction level. If all of these 107 patients would have come to our OPD follow-up, they would have traveled 613.2 miles (908 km) per patient on an average, apart from losing work hours. Average cost and workdays saved per visit were $78 and 5.4 days, respectively. CONCLUSION:Video consultation using social media tools is clinically safe and cost effective. Economic benefits far outweigh the risk of missing an adverse event, especially in the setting of low- and middle-income countries.
10.1007/s00268-019-05212-7
Acceptability and practicability of self-management for patients with Parkinson's disease based on smartphone applications in China.
Hu J,Yuan D Z,Zhao Q Y,Wang X F,Zhang X T,Jiang Q H,Luo H R,Li J,Ran J H,Li J F
BMC medical informatics and decision making
BACKGROUND:China has had about 1.2 billion mobile-phone users, and this number continues to grow. However, mobile-health services (mHealth) are currently in the initial stage, and have not yet prevailed in China. Additionally, the prevalence of Parkinson's disease (PD) in China is 1700/100,000 (≥65 years). Indeed, these PD patients would benefit from mHealth to manage their disease. Therefore, we designed a study to determine attitudes toward smartphone applications (apps) for chronic condition self-management, and to discover the practicality of these apps among PD patients in China. METHODS:We selected 204 participants with PD between 52 and 87 years old and surveyed their attitudes concerning the use of smartphone apps for chronic condition management via questionnaires. RESULTS:Among the participants, 65.19% had smartphones. Among these smartphone users, 82.84% expressed a preference for using apps for PD management. This group tended to be younger and more frequent web users with higher education and better medication compliance, and they tended to have a longer PD course and worse conditions (P < 0.001, P = 0.001, P < 0.001, P = 0.041, P < 0.001, P = 0.013). Additionally, the willingness to apply apps for PD self-management was positively related to education (P < 0.001) and negatively related to age and PD course (P = 0.017, P < 0.001). CONCLUSION:In China, patients with PD have a generally positive attitude towards self-management through smartphone apps. Consequently, improving the coverage of smartphones with practical and handy apps is a promising strategy for PD self-management.
10.1186/s12911-020-01187-x
Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review.
JMIR mHealth and uHealth
BACKGROUND:Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA. OBJECTIVE:The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions. METHODS:A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion. RESULTS:The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app). CONCLUSIONS:SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results.
10.2196/19260
Comparative effect of eHealth interventions on hypertension management-related outcomes: A network meta-analysis.
International journal of nursing studies
BACKGROUND:Increasingly, health professionals and patients have begun to be involved in eHealth interventions to assist in the self-management of hypertension. Therefore, this study was aimed at comparing the effect of different types of eHealth interventions (phone calls, blood pressure telemonitoring, emails, web-site, smartphone-app, short message service (SMS) and more than two eHealth interventions) on reducing systolic and diastolic blood pressure, increasing adherence to medication treatment, improving physical activity compliance, controlling blood pressure, and improving quality of life (QoL). METHODS:A systematic search in MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to identify experimental studies addressing the effect of eHealth interventions on the self-management of hypertension. Comparative evaluation of the eHealth interventions effect were performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between eHealth interventions and control/non-intervention. RESULTS:Fifty-one studies were included in the analysis showing a moderate effect size for more than two types of eHealth interventions (-0.46; 95%CI: -0.64, -0.27, p < 0.001 and -0.29; 95%CI: -0.46, -0.13, p < 0.001), phone calls (-0.37; 95%CI: -0.57, -0.17, p < 0.001 and -0.29; 95%CI: -0.52, -0.07, p = 0.011) and smartphone-app (-0.26; 95%CI: -0.50, -0.01, p = 0.040 and -0.40; 95%CI: -0.70, -0.10, p = 0.010) on reducing both systolic and diastolic blood pressure, respectively. Additionally, i) smartphone-app improved medication adherence by 45%; ii) more than two types of eHealth interventions and emails improved physical activity compliance by 18% and 57% respectively; ii) more than two types of eHealth interventions, phone calls, blood pressure telemonitoring, website and SMS improved blood pressure control between 16% and 30%; and iv) blood pressure telemonitoring showed a week effect on QoL CONCLUSIONS: Our study reported eHealth to be a suitable intervention for the self-management of hypertension. Considering our results and the population's accessibility to eHealth devices, eHealth could be a useful and largely scalable tool for the self-management of hypertension. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42020187468.
10.1016/j.ijnurstu.2021.104085
A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial.
Huang Zhilian,Tan Eberta,Lum Elaine,Sloot Peter,Boehm Bernhard Otto,Car Josip
JMIR mHealth and uHealth
BACKGROUND:The efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations. OBJECTIVE:This study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes. METHODS:We block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients' electronic medical records. RESULTS:A total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication. CONCLUSIONS:Our feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.
10.2196/14914
Gaming for Adherence to Medication using Ehealth in Rheumatoid arthritis (GAMER) study: a randomised controlled trial.
RMD open
OBJECTIVE:To examine the effect on adherence to disease modifying anti-rheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) of a serious game that targeted implicit attitudes toward medication. METHODS:A multicentre randomised controlled trial (RCT) was performed with adults with RA that used DMARDs and possessed a smartphone/tablet. Control and intervention groups received care as usual. The intervention group played the serious game at will during 3 months. Game play data and online questionnaires Compliance Questionnaire on Rheumatology (CQR), Beliefs about Medicine Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI) were collected. Primary outcome was DMARD implementation adherence operationalised as the difference in proportion of non-adherent participants (<80% taking adherence) between intervention and control group after 3 months using a Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes. RESULTS:Of the 110 intervention participants that started the study, 87 participants (79%) installed the game and had a median playtime of 9.7 hours at 3 months. Overall, 186 participants completed the study. Adherence in intervention group (63%) and control group (54%) did not differ significantly (p=0.13) at 3 months. Neither were there differences oberved in CQR continuous score, beliefs about medication (BMQ) or clinical outcomes (HAQ and RADAI). CONCLUSION:A serious game aimed at reinterpreting attitudes toward medication failed to show an effect on adherence to DMARDs or clinical outcomes in patients with RA. The game was played frequently indicating that it can be an effective channel for reaching patients. TRIAL REGISTRATION NUMBER:NL7217.
10.1136/rmdopen-2022-002616
The Emerging Role of Mobile-Health Applications in the Management of Hypertension.
Thangada Neela D,Garg Neetika,Pandey Ambarish,Kumar Nilay
Current cardiology reports
PURPOSE OF REVIEW:Mobile-health technology, frequently referred to as m-health, encompasses smartphone, tablet, or personal computer use in the management of chronic disease. There has been a rise in the number of commercially available smartphone applications and website-based platforms which claim to help patients manage hypertension. Very little research has been performed confirming whether or not use of these applications results in improved blood pressure (BP) outcomes. In this paper, we review existing literature on m-health systems and how m-health can affect hypertension management. RECENT FINDINGS:M-health systems help patients manage hypertension in the following ways: (1) setting alarms and reminders for patients to take their medications, (2) linking patients' BP reports to their electronic medical record for their physicians to review, (3) providing feedback to patients about their BP trends, and (4) functioning as point-of-care BP sensors. M-health applications with alarms and reminders can increase medication compliance while applications that share ambulatory BP data with patients' physicians can foster improved patient-physician dialog. However, the most influential tool for achieving positive BP outcomes appears to be patient-directed feedback about BP trends. A large number of commercially available m-health applications may facilitate self-management of hypertension by enhancing medication adherence, maintaining a log of blood pressure measurements, and facilitating physician-patient communication. A small number of applications function as BP sensors, thereby transforming the smartphone into a medical device. Such BP sensors often generate unreliable recordings. Patients must be cautioned regarding the use of smartphones for BP measurement at least until these applications have been more extensively validated.
10.1007/s11886-018-1022-7
Machine Learning and Medication Adherence: Scoping Review.
JMIRx med
BACKGROUND:This is the first scoping review to focus broadly on the topics of machine learning and medication adherence. OBJECTIVE:This review aims to categorize, summarize, and analyze literature focused on using machine learning for actions related to medication adherence. METHODS:PubMed, Scopus, ACM Digital Library, IEEE, and Web of Science were searched to find works that meet the inclusion criteria. After full-text review, 43 works were included in the final analysis. Information of interest was systematically charted before inclusion in the final draft. Studies were placed into natural categories for additional analysis dependent upon the combination of actions related to medication adherence. The protocol for this scoping review was created using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS:Publications focused on predicting medication adherence have uncovered 20 strong predictors that were significant in two or more studies. A total of 13 studies that predicted medication adherence used either self-reported questionnaires or pharmacy claims data to determine medication adherence status. In addition, 13 studies that predicted medication adherence did so using either logistic regression, artificial neural networks, random forest, or support vector machines. Of the 15 studies that predicted medication adherence, 6 reported predictor accuracy, the lowest of which was 77.6%. Of 13 monitoring systems, 12 determined medication administration using medication container sensors or sensors in consumer electronics, like smartwatches or smartphones. A total of 11 monitoring systems used logistic regression, artificial neural networks, support vector machines, or random forest algorithms to determine medication administration. The 4 systems that monitored inhaler administration reported a classification accuracy of 93.75% or higher. The 2 systems that monitored medication status in patients with Parkinson disease reported a classification accuracy of 78% or higher. A total of 3 studies monitored medication administration using only smartwatch sensors and reported a classification accuracy of 78.6% or higher. Two systems that provided context-aware medication reminders helped patients to achieve an adherence level of 92% or higher. Two conversational artificial intelligence reminder systems significantly improved adherence rates when compared against traditional reminder systems. CONCLUSIONS:Creation of systems that accurately predict medication adherence across multiple data sets may be possible due to predictors remaining strong across multiple studies. Higher quality measures of adherence should be adopted when possible so that prediction algorithms are based on accurate information. Currently, medication adherence can be predicted with a good level of accuracy, potentially allowing for the development of interventions aimed at preventing nonadherence. Monitoring systems that track inhaler use currently classify inhaler-related actions with an excellent level of accuracy, allowing for tracking of adherence and potentially proper inhaler technique. Systems that monitor medication states in patients with Parkinson disease can currently achieve a good level of classification accuracy and have the potential to inform medication therapy changes in the future. Medication administration monitoring systems that only use motion sensors in smartwatches can currently achieve a good level of classification accuracy but only when differentiating between a small number of possible activities. Context-aware reminder systems can help patients achieve high levels of medication adherence but are also intrusive, which may not be acceptable to users. Conversational artificial intelligence reminder systems can significantly improve adherence.
10.2196/26993
Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension: A Randomized Clinical Trial.
Persell Stephen D,Peprah Yaw A,Lipiszko Dawid,Lee Ji Young,Li Jim J,Ciolino Jody D,Karmali Kunal N,Sato Hironori
JAMA network open
Importance:Mobile applications (apps) may help improve hypertension self-management. Objective:To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app. Design, Setting, and Participants:This was a 2-group, open, randomized clinical trial. Participants with uncontrolled hypertension were recruited in 2016 and 2017 and were followed up for 6 months. Data analysis was performed from April 2019 to December 2019. Interventions:Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor. Main Outcomes and Measures:The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors. Results:There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of -2.0 mm Hg (95% CI, -4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, -5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age. Conclusions and Relevance:Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted. Trial Registration:ClinicalTrials.gov Identifier: NCT03288142.
10.1001/jamanetworkopen.2020.0255
Smartphone-Based Technology in Diabetes Management.
Doupis John,Festas Georgios,Tsilivigos Christos,Efthymiou Vasiliki,Kokkinos Alexander
Diabetes therapy : research, treatment and education of diabetes and related disorders
Diabetes is a group of metabolic disorders characterized by elevated levels of blood glucose which leads over time to serious complications and significant morbidity and mortality worldwide. Self-management tasks in diabetes may be quite challenging because of lack of training, difficulties in sustaining lifestyle modifications, and limited access to specialized healthcare. Nowadays, the evolution of mobile technology provides a large number of health-related smartphone applications (apps), aiming to increase the self-management skills of the patient in chronic diseases, to facilitate the communication between the patient and healthcare providers, and to increase also the patient's compliance with the treatment. In the field of diabetes there are also many diabetes-related mobile apps mainly focusing on self-management of diabetes, lifestyle modification, and medication adherence motivation. The aim of this paper is to review the most important diabetes-related mobile smartphone applications, including only those supported by prospective randomized controlled trials.
10.1007/s13300-020-00768-3
Smartphone apps for improving medication adherence in hypertension: patients' perspectives.
Morrissey Eimear C,Casey Monica,Glynn Liam G,Walsh Jane C,Molloy Gerard J
Patient preference and adherence
PURPOSE:Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic conditions. It is important to investigate how patients feel about and engage with these technologies. The aim of this study was to explore patients' perspectives on smartphone apps to improve medication adherence in hypertension. METHODS:This was a qualitative study based in the West of Ireland. Twenty-four patients with hypertension were purposively sampled and engaged in focus groups. Thematic analysis on the data was carried out. RESULTS:Participants ranged in age from 50 to 83 years (M=65 years) with an equal split between men and women. Three major themes were identified in relation to patients' perspectives on smartphone apps to improve medication adherence in hypertension: "development of digital competence," "rules of engagement," and "sustainability" of these technologies. CONCLUSION:These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering in terms of their understanding of the condition and interactions with their general practitioners. However, the data also revealed that there are concerns about increasing health-related anxiety and doubts about the sustainability of this technology over time. This suggests that the current patient perspective of smartphone apps might be best characterized by "ambivalence."
10.2147/PPA.S145647
Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis.
JMIR mHealth and uHealth
BACKGROUND:Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. OBJECTIVE:The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. METHODS:This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. RESULTS:Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at -0.29 [-0.44, -0.15], P<.001; high-density lipoprotein SMD at -0.09 [-0.19, 0.00], P=.05; low-density lipoprotein SMD at -0.18 [-0.33, -0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at -0.37 [-1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at -0.06 [-0.20, 0.08], P=.43; systolic BP SMD at -0.03 [-0.18, 0.13], P=.74; Hemoglobin A blood sugar (HbA) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at -0.16 [-1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. CONCLUSIONS:Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA).
10.2196/21061
Artificial Intelligence-Based Chatbots for Promoting Health Behavioral Changes: Systematic Review.
Journal of medical Internet research
BACKGROUND:Artificial intelligence (AI)-based chatbots can offer personalized, engaging, and on-demand health promotion interventions. OBJECTIVE:The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. METHODS:A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS:Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. CONCLUSIONS:AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions.
10.2196/40789
The Association Between Smartphone App-Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis.
JMIR mHealth and uHealth
BACKGROUND:Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. OBJECTIVE:This systematic literature review evaluates the extent to which smartphone app-based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. METHODS:A systematic search of 7 databases was conducted in August 2021. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. The search strategy was developed using keywords from previous reviews and relevant literature. Trials involving adults, published after the year 2000, and in the English language were considered for inclusion. The random-effects meta-analysis method was used to account for the distribution of the effect across the studies. RESULTS:We identified 4638 articles, of which 227 were included for full-text screening. A total of 15 randomized controlled trials were included in the review. In total, 7415 patients with hypertension were included in the meta-analysis. The results indicate that app-based behavioral self-monitoring interventions had a small but significant effect in reducing systolic blood pressure (SBP), on average, by 1.64 mmHg (95% CI 2.73-0.55, n=7301; odds ratio [OR] 1.60, 95% CI 0.74-3.42, n=114) and in improving changes in medication adherence behavior (standardized mean difference [SMD] 0.78, 95% CI 0.22-1.34) compared to usual care or minimal intervention. The review found the intervention had a small effect on supporting improvements in healthy diet by changing habits related to high sodium food (SMD -0.44, 95% CI -0.79 to -0.08) and a trend, although insignificant, toward supporting smoking cessation, low alcohol consumption, and better physical activity behaviors. A subgroup analysis found that behavioral self-monitoring interventions combined with tailored advice resulted in higher and significant changes in both SBP and diastolic blood pressure (DBP) in comparison to those not providing tailored advice (SBP: -2.92 mmHg, 95% CI -3.94 to -1.90, n=3102 vs -0.72 mmHg, 95% CI -1.67 to 0.23, n=4199, χ=9.65, P=.002; DBP: -2.05 mmHg, 95% CI -3.10 to -1.01, n=968 vs 1.54 mmHg, 95% CI -0.53 to 3.61, n=400, χ=9.19, P=.002). CONCLUSIONS:Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has a modest but potentially clinically significant effect on blood pressure reduction. Future studies could use rigorous methods to explore its effects on supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision. TRIAL REGISTRATION:PROSPERO CRD42019136158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136158.
10.2196/34767
The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review.
Rathbone Amy Leigh,Prescott Julie
Journal of medical Internet research
BACKGROUND:The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient's mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. OBJECTIVE:The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. METHODS:A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. RESULTS:A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. CONCLUSIONS:The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions.
10.2196/jmir.7740
Smartphone Apps for Diabetes Medication Adherence: Systematic Review.
JMIR diabetes
BACKGROUND:Diabetes is one of the leading noncommunicable chronic diseases globally. In people with diabetes, blood glucose levels need to be monitored regularly and managed adequately through healthy lifestyles and medications. However, various factors contribute to poor medication adherence. Smartphone apps can improve medication adherence in people with diabetes, but it is not clear which app features are most beneficial. OBJECTIVE:This study aims to systematically review and evaluate high-quality apps for diabetes medication adherence, which are freely available to the public in Android and Apple app stores and present the technical features of the apps. METHODS:We systematically searched Apple App Store and Google Play for apps that assist in diabetes medication adherence, using predefined selection criteria. We assessed apps using the Mobile App Rating Scale (MARS) and calculated the mean app-specific score (MASS) by taking the average of app-specific scores on 6 dimensions, namely, awareness, knowledge, attitudes, intention to change, help-seeking, and behavior change rated on a 5-point scale (1=strongly disagree and 5=strongly agree). We used the mean of the app's performance on these 6 dimensions to calculate the MASS. Apps that achieved a total MASS mean quality score greater than 4 out of 5 were considered to be of high quality in our study. We formulated a task-technology fit matrix to evaluate the apps for diabetes medication adherence. RESULTS:We identified 8 high-quality apps (MASS score≥4) and presented the findings under 3 main categories: characteristics of the included apps, app features, and diabetes medication adherence. Our framework to evaluate smartphone apps in promoting diabetes medication adherence considered physiological factors influencing diabetes and app features. On evaluation, we observed that 25% of the apps promoted high adherence and another 25% of the apps promoted moderate adherence. Finally, we found that 50% of the apps provided low adherence to diabetes medication. CONCLUSIONS:Our findings show that almost half of the high-quality apps publicly available for free did not achieve high to moderate medication adherence. Our framework could have positive implications for the future design and development of apps for patients with diabetes. Additionally, apps need to be evaluated using a standardized framework, and only those promoting higher medication adherence should be prescribed for better health outcomes.
10.2196/33264
Association of a Smartphone Application With Medication Adherence and Blood Pressure Control: The MedISAFE-BP Randomized Clinical Trial.
Morawski Kyle,Ghazinouri Roya,Krumme Alexis,Lauffenburger Julie C,Lu Zhigang,Durfee Erin,Oley Leslie,Lee Jessica,Mohta Namita,Haff Nancy,Juusola Jessie L,Choudhry Niteesh K
JAMA internal medicine
Importance:Medication nonadherence accounts for up to half of uncontrolled hypertension. Smartphone applications (apps) that aim to improve adherence are widely available but have not been rigorously evaluated. Objective:To determine if the Medisafe smartphone app improves self-reported medication adherence and blood pressure control. Design, Setting, and Participants:This was a 2-arm, randomized clinical trial (Medication Adherence Improvement Support App For Engagement-Blood Pressure [MedISAFE-BP]). Participants were recruited through an online platform and were mailed a home blood pressure cuff to confirm eligibility and to provide follow-up measurements. Of 5577 participants who were screened, 412 completed consent, met inclusion criteria (confirmed uncontrolled hypertension, taking 1 to 3 antihypertensive medications), and were randomized in a ratio of 1:1 to intervention or control. Interventions:Intervention arm participants were instructed to download and use the Medisafe app, which includes reminder alerts, adherence reports, and optional peer support. Main Outcomes and Measures:Co-primary outcomes were change from baseline to 12 weeks in self-reported medication adherence, measured by the Morisky medication adherence scale (MMAS) (range, 0-8, with lower scores indicating lower adherence), and change in systolic blood pressure. Results:Participants (n = 411; 209 in the intervention group and 202 controls) had a mean age of 52.0 years and mean body mass index, calculated as weight in kilograms divided by height in meters squared, of 35.5; 247 (60%) were female, and 103 (25%) were black. After 12 weeks, the mean (SD) score on the MMAS improved by 0.4 (1.5) among intervention participants and remained unchanged among controls (between-group difference: 0.4; 95% CI, 0.1-0.7; P = .01). The mean (SD) systolic blood pressure at baseline was 151.4 (9.0) mm Hg and 151.3 (9.4) mm Hg, among intervention and control participants, respectively. After 12 weeks, the mean (SD) systolic blood pressure decreased by 10.6 (16.0) mm Hg among intervention participants and 10.1 (15.4) mm Hg among controls (between-group difference: -0.5; 95% CI, -3.7 to 2.7; P = .78). Conclusions and Relevance:Among individuals with poorly controlled hypertension, patients randomized to use a smartphone app had a small improvement in self-reported medication adherence but no change in systolic blood pressure compared with controls. Trial Registration:clinicaltrials.gov Identifier: NCT02727543.
10.1001/jamainternmed.2018.0447
Applications of Remote Patient Monitoring.
Primary care
Remote patient monitoring programs collect and analyze a variety of health-related data to detect clinical deterioration with the goal of early intervention. There are many program designs with various deployed devices, monitoring schemes, and escalation protocols. Although several factors are considered, the disease state plays a foundational role when designing a specific program. Remote patient monitoring is used both in chronic disease states and patients with acute self-limited conditions. These programs use health-related data to identify early deterioration and then successfully intervene to improve clinical outcomes and decrease costs of care.
10.1016/j.pop.2022.05.005
Remote Patient Monitoring: A Systematic Review.
Farias Frederico Arriaga Criscuoli de,Dagostini Carolina Matté,Bicca Yan de Assunção,Falavigna Vincenzo Fin,Falavigna Asdrubal
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patientphysician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.
10.1089/tmj.2019.0066
Challenges in Caring for People with Cardiovascular Disease through and beyond the COVID-19 Pandemic: The Advantages of Universal Access to Home Telemonitoring.
Healthcare (Basel, Switzerland)
(1) Background: Cardiovascular prevention was left in second place during the COVID-19 pandemic and the use of telemedicine turned out to be very useful. We aimed to evaluate the effectiveness of a telemedicine application for remote monitoring and treatment adjustments in terms of improving cardiovascular prevention. (2) Methods: A prospective study of 3439 patients evaluated between the 1st of March 2019 and the 1st of March 2022, in the pre-pandemic period by face-to-face visits and during the pandemic by teleconsultations or hybrid follow-up. We compared four periods: pre-pandemic-Pre-P (1 March 2019-1 March 2020), lockdown-Lock (1 March-1 September 2020), restrictive-pandemic-Restr-P (1 September 2020-1 March 2021), and relaxed-pandemic-Rel-P (1 March 2021-1 March 2022). (3) Results: The average values of total cholesterol (TC), LDL cholesterol, triglycerides, uric acid, and glucose had an increasing trend during Lock and Restr-P, and they decreased close to the baseline level during the Rel-P, with the exception of glucose which remained elevated in Rel-P. The number of patients with newly discovered DM increased significantly in the Rel-P, and 79.5% of them had mild/moderate forms of COVID-19. During Lock and Res-P, the percentage of obese, smoking, or hypertensive patients increased, but probably through the use of telemedicine, we managed to reduce it, although it remained slightly higher than the pre-pandemic level. Physical activity decreased in the first year of the pandemic, but in Rel-P people became more active than before the pandemic. (4) Conclusions: The use of telemedicine for cardiovascular prevention seems to yield favorable results, especially for secondary prevention in the very high-risk group and during the second year.
10.3390/healthcare11121727
Feasibility of the Remote Physical Activity Follow-Up Intervention after the Face-to-Face Program for Healthy Middle-Aged Adults: A Randomized Trial Using ICT and Mobile Technology.
International journal of environmental research and public health
Although the effectiveness of face-to-face and remote intervention for increasing and maintaining physical activity (PA) have been compared, the effect of combining the two forms of intervention is unknown. The purpose of this study was to examine the feasibility of the remote PA follow-up intervention after the face-to-face PA program on changing PA behaviors and some health outcomes in healthy middle-aged adults. As a secondary analysis, we also attempted a preliminary analysis of the difference in the number of behavior change interviews in the remote PA follow-up intervention. After the face-to-face intervention, 30 healthy subjects were randomly divided into four behavior change coaching interviews (BCI4 group) or three BCI (BCI3 group). The results of this study showed that body weight, body fat mass, and waist circumference were significantly reduced after face-to-face intervention, and were further reduced after remote PA follow-up intervention. However, the difference in the number of BCI affected only body fat mass. The remote PA follow-up intervention may have potential to maintain the effects of face-to-face intervention. In the future, it is necessary to refine the research design and conduct a full-scale intervention study.
10.3390/ijerph19084922
A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial.
Frontiers in digital health
Chronic pain is a debilitating condition that affects many older adults who often have limited access to non-pharmacological pain management strategies. One potentially effective and novel lifestyle medicine for chronic pain involves increasing physical activity through frequent movement across the day, thereby also decreasing the presence of extended sedentary bouts. The MORPH-II pilot randomized controlled refinement trial iterated on the MORPH trial, which was a first-of-its-kind group-mediated daylong physical activity (DPA) intervention for older adults with chronic pain rooted in social cognitive and self-determination theories and supported by an mHealth toolset designed to foster social connection and awareness of physical activity patterns. MORPH-II was delivered fully remotely videoconference software and supported by a technology kit comprising an iPad, activity monitor, and wireless weight scale. It was also implemented a refined coaching model designed to help participants better understand their own patterns of activity. A total of 44 participants were randomized to receive the 12-week group-mediated DPA intervention or to a low-contact control. Qualitative interviews suggest the program was well-received by participants and that participants developed an understanding of how patterns of physical activity related to their pain symptoms. Participants also highlighted several additional areas for refinement related to the coaching model and feedback provided within the mHealth app. Analyses of covariance, controlling for baseline values, revealed a small effect ( = 0.01) on pain intensity favoring the intervention condition, though both groups improved during the study period. There was a large effect favoring the intervention condition on ActivPAL-assessed average daily steps ( = 0.23) and postural shifts ( = 0.24). Control participants spent less time in short sedentary bouts ( = 0.09), and there was a small effect ( = 0.02) indicating intervention participants spent less time in extended sedentary bouts. Finally, relative to control, intervention participants demonstrated a moderate improvement in autonomy satisfaction ( = 0.05), relatedness frustration ( = 0.05), and competence frustration ( = 0.06), and a large magnitude improvement in competence satisfaction ( = 0.22). These findings indicate that the MORPH-II intervention was feasible and acceptable, and may positively impact steps, postural breaks, and several key domains of basic psychological needs detailed in self-determination theory.
10.3389/fdgth.2022.1040867
Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice.
Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses
PURPOSE:Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity. DESIGN AND METHODS:This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings. RESULTS:The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress. CLINICAL RELEVANCE:If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services. CONCLUSION:RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.
10.1097/RNJ.0000000000000435
Feasibility of a smartphone app for prescribed exercise tutoring in patients with stable coronary heart disease.
Digital health
Background:Digital health technologies have potential to address the challenges associated with traditional cardiac rehabilitation (CR). However, it is not complete enough for prescribed exercise guidance and remote monitoring. Objective:We aimed to evaluate the feasibility of a smartphone app for prescribed exercise tutoring by exercise videos combined with wearable devices to monitor heart rate in patients with stable coronary heart disease (CHD). Methods:The study is a quasi-experimental design study with a single group. A total of 31 patients were included with an average age of 56.2 years (SD 13.4). They participated in a 12-week remote digital CR program. We employed a wearable heart rate monitoring device connected with an app to monitor the patients' exercise intensity. The app can display the videos corresponding to an exercise prescription to guide the exercise. Cardiorespiratory endurance, blood pressure, blood glucose, cholesterol, blood uric acid, left ventricular ejection fraction and quality of life (QoL) were assessed at the beginning and end of the intervention. Compliance and safety events were recorded as well. Results:Completion rate reached 90.3%. Average daily effective exercise time was 39.4 min (SD 17.8), and 92.9% of the patients could exercise in the prescribed intensity for at least 20 min per day. Average effective exercise days per week were 4.6 days (SD 2.2), and 67.9% of the patients could exercise in the prescribed intensity for at least 3 days per week. Patients' peak VO ( = 0.041) and peak metabolic equivalents ( = 0.018) were significantly increased, low-density lipoprotein ( = 0.036) and diastolic blood pressure at rest ( = 0.044) were significantly decreased, and depression (GAD-7, = 0.014) and anxiety (PHQ-9, = 0.013) were significantly improved. Conclusions:It is feasible, safe, and helpful for stable CHD patients to use the app for prescribed exercise tutoring with videos combined with wearable devices to monitor heart rate. Trial Registration:ChiCTR1800019144.
10.1177/20552076231197424
Bio-acceptability of wearable sensors: a mechanistic study towards evaluating ionic leaching induced cellular inflammation.
Scientific reports
The recent need for remote health wellness monitoring has led to the extensive use of wearable sensors. Owing to their increased use, these sensors are required to exhibit both functionality and safety to the user. A major component in the fabrication of these sensors and their associated circuitry is the use of metallic/organic conductive inks. However, very less is known about the interfacial and molecular interactions of these inks with biological matter as they can result in an inflammatory reaction to the user. Significant efforts are thus needed to explore and improve the bio-acceptability of such conductive ink-based wearable sensors. The present study investigates the biocompatibility of encapsulated and non-encapsulated wearable electrochemical sensors used for sensing uric acid as a biomarker for wound healing fabricated using screen-printing technique. Ionic release of metallic ions was investigated first to understand the susceptibility of the conductive inks towards ionic leaching when in contact with a fluid. Time-lapse investigation using ICPS (inductive couple plasma spectroscopy) shows a high concentration (607.31 ppb) of leached silver (Ag) ions from the non-encapsulated sensors. The cell viability data suggests a 2.5-fold improvement in the sensor biocompatibility for an encapsulated sensor. While the carbon ink shows negligible effect on cell viability, the silver ink elicits significant decrease (< 50%) in cell viability at concentrations higher than 2 mg ml. The toxicity pathway of these sensors was further determined to be through the generation of reactive oxygen species resulting in over 20% apoptotic cell death. Our results show that the lower biocompatibility of the non-encapsulated sensor attributes to the higher leaching of Ag ions from the printed inks which elicits several different inflammatory pathways. This work highlights the importance biocompatibility evaluation of the material used in sensor fabrication to develop safe and sustainable sensors for long-term applications.
10.1038/s41598-022-13810-0
Recent advances in noninvasive flexible and wearable wireless biosensors.
Salim Ahmed,Lim Sungjoon
Biosensors & bioelectronics
Flexible and wearable biosensors have great potential to interface with skin and noninvasively extract biofluids for real time and continuous monitoring of physiological status. Soft electronics is the prime factor in these wearables, regardless of sensing mechanism and fabrication technology. Wireless connectivity would be a valuable addition to enhance wearable biosensor's scope for remote and resource limited settings. These skin-adaptable, user-friendly, battery-free (although not all), and noninvasive devices continuously and simultaneously monitor wearer well-being and transfer data wirelessly. Thus, they have a great potential to improve quality of life with timely diagnostics and hence early treatments. However, they remain in the early stages, with relatively conventional sensing modalities, battery requirements, soft electronics fabrication limitations, and practicable size restrictions to retain skin compatibility. We classify wearable biosensors by sensing functionality, such as skin temperature, pH, heart rate, sweat glucose, uric acid, sweat electrolyte, cerebrospinal shunt flow, and toxic chemicals, and discuss challenges and prospects for these biosensors.
10.1016/j.bios.2019.111422
[Remote monitoring of urinalysis parametres during treatment of patients with uric acid stones by citrate-containing compounds].
Prosiannikov M Yu,Shaderkin I A,Konstantinova O V,Anokhin N V,Voytko D A,Nikushina A A
Urologiia (Moscow, Russia : 1999)
INTRODUCTION:Oral dissolution therapy has been successfully used in urologic practice since 1950s. However, many doctors attempt to improve efficiency of this approach. Use of different medical personalized digital devices which are increasingly used in clinical practice, represent one of the solutions of this problem. AIM:Our aim was to assess efficiency of oral dissolution therapy with drug Blemaren in patients with uric acid stones using of portable urinary analyzer with system of remote monitoring. MATERIALS AND METHODS:A total of 12 patients with uric acid stones were followed. All of them had kidney stone with a density less than 500 HU according to CT-urography. Oral dissolution therapy was performed with the drug Blemaren for 8-9 weeks. All patients were advised to maintain urine pH of 6.5-7.0. With aim of dynamic monitoring of urine parameters, a portable urine analyzer "ETTA AMP-01" was given to all patients for 2 months. RESULTS:Complete dissolution was achieved in 10 (83.3%) patients. In one case (8.3%) oral dissolution therapy was complicated by acute pyelonephritis. A stenting was performed and dissolution therapy was continued with a positive effect. In another case (8.3%) partial dissolution was seen, however, extracorporeal shockwave lithotripsy was decided to perform. Doctor who remotely monitored different parameters of urinalysis (n=11) followed urine pH, density, leukocytes, erythrocytes, level of nitrite, which provided a more comprehensive assessment of patients current state. If necessary, the specialist contacted the patient and adjusted the therapy. CONCLUSION:The possibility of remote monitoring of urinalysis and simple communication with urologist allows to titrate drug dose more convenient compared to conventional approach when outpatient urologist controls pH diaries based on dip-stick test. Moreover, such approach gives an opportunity to quickly identify complications and correct the therapy in a timely manner.
[Detection and analysis of moving reaction boundary-based electrophoresis distance using smartphone images].
Se pu = Chinese journal of chromatography
Electrophoresis titration (ET) based on the moving reaction boundary (MRB) theory can detect the analyte contents in different samples by converting content signals into distance signals. However, this technique is only suitable for on-site qualitative testing, and accurate quantification relies on complex optical equipment and computers. Hence, applying this method to real-time point-of-care testing (POCT) is challenging. In this study, we developed a smartphone-based ET system based on a visual technique to achieve real-time quantitative detection. First, we developed a portable quantitative ET device that can connect to a smartphone; this device consisted of five components, namely, an ET chip, a power module, a microcontroller, a liquid crystal display screen, and a Bluetooth module. The device measured 10 cm×15 cm×2.5 cm, weighed 300 g, and was easy to hold. Thus, it is suitable for on-site testing with a run time of only 2-4 min. An assistant mobile software program was also developed to control the device and perform ET. The colored electrophoresis boundary can be captured using the smartphone camera, and quantitative detection results can be obtained in real time. Second, we proposed a quantitative algorithm based on ET channels. The software was used to recognize the boundary migration distance of three channels, a standard curve based on two given contents of the standards was established using the two-point method, and the content of the test sample was calculated. Human serum albumin (HSA) and uric acid (UA) were used as a model protein and biosample, respectively, to test the performance of the detection system. For HSA detection, different HSA solutions were mixed with a polyacrylamide gel (PAG) stock solution, phenolphthalein was added as an indicator, and sodium persulfate and tetramethyl ethylenediamine (TEMED) were used to promote polymerization to form a gel. For UA detection, agarose gel was filled into the ET channel, the UA sample, urate oxidase, and leucomalachite green were added into the anode cell and incubated for 20 min. ET was then performed. The fitting goodness () values of HSA and UA were 0.9959 and 0.9935, respectively, with a linear range of 0.5-35.0 g/L and a log-linear range of 100-4000 μmol/L. The limits of detection for HSA and UA were 0.05 g/L and 50 μmol/L, respectively, and the corresponding relative standard deviations (RSDs) were not greater than 2.87% and 3.21%, respectively. These results demonstrate that the detection system has good accuracy and sensitivity. Clinical samples collected from healthy volunteers were used as target blood samples, and the developed system was used to measure serum total protein and UA levels. Serum samples from five volunteers were selected, standard curves of total serum protein and UA were established, and the test results were compared with hospital standard testing results. The relative errors for serum total protein and UA were less than 6.03% and 6.21%, respectively, and the corresponding RSDs were less than 3.72% and 5.84%, respectively. These findings verify the accuracy and reliability of the proposed detection system. The smartphone-based ET detection system introduced in this paper presents several advantages. First, it enables the portable real-time detection of total serum protein and UA. Second, compared with traditional ET strategies based on colored boundaries, it does not rely on optical detection equipment or computers to obtain quantitative detection results; as such, it can reduce the complexity of the operation and provide portability and real-time metrics. Third, the detection of two biomarkers, serum total protein and UA, is achieved on the same device, thereby improving the multitarget detection potential of the ET method. These advantages render the developed method a promising detection platform for clinical applications and real-time POCT.
10.3724/SP.J.1123.2023.06001
Skin-Attachable Ink-Dispenser-Printed Paper Fluidic Sensor Patch for Colorimetric Sweat Analysis.
Advanced healthcare materials
In situ analysis of sweat biomarkers potentially provides noninvasive lifestyle monitoring and early diagnosis. Quantitative detection of sweat rate is crucial for thermoregulation and preventing heat injuries. Here, a skin-attachable paper fluidic patch is reported for in situ colorimetric sensing of multiple sweat markers (pH, glucose, lactate, and uric acid) with concurrent sweat rate tracking. Two sets of fluidic patterns-multiplexed detection zones and a longitudinal sweat rate channel-are directly printed by an automated ink dispenser from a specially developed ceramic-based ink. The ceramic ink thermal-cures into an impervious barrier, confining sweat within the channels. The ceramic-ink-printed boundary achieves higher pattern resolution, prevents fluid leakage, attains pattern thermal stability, and resistant to organic solvents. The cellulose matrix of the detection zones is modified with nanoparticles to improve the color homogeneity and sweat sensor sensitivity. The sweat rate channel is made moisture sensitive by incorporating a metal-salt-based dye. The change in saturation/color of the detection zones and/or channels upon sweat addition can be visually detected or quantified by a smartphone camera. A cost-effective way is provided to fabricate paper fluidic sensor patches, successfully demonstrating on-body multiplexed evaluation of sweat analytes. Such skin wearables offer on-site analysis, meaningful to an increasingly health-conscious population.
10.1002/adhm.202302173
Wearable intelligent sweat platform for SERS-AI diagnosis of gout.
Lab on a chip
For the past few years, sweat analysis for health monitoring has attracted increasing attention benefiting from wearable technology. In related research, the sensitive detection of uric acid (UA) in sweat with complex composition based on surface-enhanced Raman spectroscopy (SERS) for the diagnosis of gout is still a significant challenge. Herein, we report a visualized and intelligent wearable sweat platform for SERS detection of UA in sweat. In this wearable platform, the spiral channel consisted of colorimetric paper with Ag nanowires (AgNWs) that could capture sweat for SERS measurement. With the help of photos from a smartphone, the pH value and volume of sweat could be quantified intelligently based on the image recognition technique. To diagnose gout, SERS spectra of human sweat with UA are collected in this wearable intelligent platform and analyzed by artificial intelligence (AI) algorithms. The results indicate that the artificial neural network (ANN) algorithm exhibits good identification of gout with high accuracy at 97%. Our work demonstrates that SERS-AI in a wearable intelligent sweat platform could be a feasible strategy for diagnosis of gout, which expands research on sweat analysis for comfortable and noninvasive health monitoring.
10.1039/d3lc01094e
Laser-Induced Graphene-Based Wearable Epidermal Ion-Selective Sensors for Noninvasive Multiplexed Sweat Analysis.
Biosensors
Wearable sweat sensors are a rapidly rising research area owing to their convenience for personal healthcare and disease diagnosis in a real-time and noninvasive manner. However, the fast and scalable fabrication of flexible electrodes remains a major challenge. Here, we develop a wearable epidermal sensor for multiplexed sweat analysis based on the laser-induced graphene (LIG) technique. This simple and mask-free technique allows the direct manufacturing of graphene electrode patterns on commercial polyimide foils. The resulting LIG devices can simultaneously monitor the pH, Na, and K levels in sweat with the sensitivities of 51.5 mV/decade (pH), 45.4 mV/decade (Na), and 43.3 mV/decade (K), respectively. Good reproducibility, stability, and selectivity are also observed. On-body testing of the LIG-based sensor integrated with a flexible printed circuit board during stationary cycling demonstrates its capability for real-time sweat analysis. The concentrations of ions can be remotely and wirelessly transmitted to a custom-developed smartphone application during the period in which the sensor user performs physical activities. Owing to the unique advantages of LIG technique, including facile fabrication, mass production, and versatile, more physiological signals (glucose, uric acid, tyrosine, etc.) could be easily expanded into the LIG-based wearable sensors to reflect the health status or clinical needs of individuals.
10.3390/bios12060397
Nanozymatic magnetic nanomixers for enzyme immobilization and multiplexed detection of metabolic disease biomarkers.
Biosensors & bioelectronics
Nanozymes with enzyme-mimicking catalytic activity and unique functions have stimulated increasing interest in the biosensing field. Herein, we report a magnetic nanozyme (MNE) with integrated superior peroxidase-like activity and efficient mixing ability. This nanozymatic magnetic nanomixer is synthesized by depositing a Fe-doped polydopamine coating on the surface of well-aligned magnetic nanoparticles to form a rigid chain-like nanostructure. Polydopamine coating of the nanozymatic MNE allows for efficient immobilization of natural enzymes such as glucose oxidase, cholesterol oxidase or urate oxidase to produce a series of enzymes-immobilized MNE (MNE@enzymes) with intrinsic multienzyme cascade properties. These MNE@enzymes show synchronously rotating capability in spinning magnetic fields, which leads to an 80∼100% improvement in their overall catalytic efficiencies. In the on-chip detection of small molecular metabolites (i.e., glucose, cholesterol, and uric acid), the rotating MNE@enzymes lead to detection sensitivities 2.1∼4.3 times higher than those of the static ones. Importantly, the consistent performance of the rotating MNE@enzymes offers the possibility of integrating the detection of glucose, free cholesterol and uric acid into a single multiplexing microchip assay with smartphone readout, affording an improved sensitivity, good selectivity and reliability. The designed enzymes-loaded MNEs holds great promise in developing rapid and ultrasensitive measurements of diverse targets of healthcare concerns using portable devices.
10.1016/j.bios.2022.114795
Luminescent wearable biosensors based on gold nanocluster networks for "turn-on" detection of Uric acid, glucose and alcohol in sweat.
Zhou Ziping,Shu Tong,Sun Yafang,Si Hongxin,Peng Peiwen,Su Lei,Zhang Xueji
Biosensors & bioelectronics
From the difficulty of awareness of abnormal concentrations of biochemical indexes in people's daily life come wearable sensing technologies. Recently, luminescent wearable biosensors are emerging with simple fabrication, easy use, cost-effectivity and reliability. But several challenges should be taken up, such as availability of varied analytes, high sensitivity, stability of enzymes, photostability, low signal noises and recyclability of sensors. Here, the Luminescent Wearable Sweat Tape (LWST) biosensor is developed via embedding multi-component nanoprobes onto microwell-patterned paper substrates of hollowed-out double-side tapes. The nanoprobes consist of responsive luminophores, enzyme-loaded gold nanocluster (AuNCs) nano-networks, which are wrapped by the switch, MnO nanosheets. The responsive luminophores are constructed by 3 substitutable components: enzymes (uricase, GOx and alcohol dehydrogenase) for molecular target recognition, glutathione-protected AuNCs (yellow, red and green) for luminescent signal output and polycations PAH for integration. MnO NSs as the switch can quench the emission of the AuNCs but degraded by the reductive product of incorporated enzymes. Thus, targeting analysts (uric acid, glucose and alcohol) can be dose-dependently detected through "turn-on" luminescence approach. After incorporating the nanoprobes into hollow-out tapes, the formed LWST biosensors can detect uric acid, glucose and alcohol in sweat with the help of a smartphone. Subsequently, we primarily apply them into human daily life scenario, sampling from dine parties, and the positive relationships of analyte intakes and the increase of analytes in sweat are significant with individual difference.
10.1016/j.bios.2021.113530
Smartphone integrated handheld Long Range Surface Plasmon Resonance based fiber-optic biosensor with tunable SiO sensing matrix.
Jain Surbhi,Paliwal Ayushi,Gupta Vinay,Tomar Monika
Biosensors & bioelectronics
In the present work, a novel smartphone assisted fiber optic (FO)-Long range surface plasmon resonance (LRSPR) based biosensor is proposed. In the developed biosensor, the inbuilt color sensitive property of the digital camera present in the smartphone is used for the monitoring of blue and red color channel intensities. This will replace the most exploited diffraction gratings or narrow band filters used for analyzing the spectral data in reported smartphone based SPR sensors. The proposed technique helps in improving the sensitivity and reduces the chances of wrong detection. For the first time, SiO nanostructured film is employed as the dielectric sensing layer to excite the Long range surface plasmons (LRSPs) in the dielectric-metal-dielectric configuration. The proposed FO-LRSPR biosensor possess limit of detection of 0.02 mM and sensitivity of 0.9/mM and, for uric acid detection in the 0.1 mM-1 mM concentration range. The novel fabricated sensor which is found to be stable up to 24 weeks can be effectively utilized in health sector and environment monitoring and it possess the ability of point-of-care detection, even in rural and remote areas.
10.1016/j.bios.2021.113919
Smartphone-assisted robust enzymes@MOFs-based paper biosensor for point-of-care detection.
Kou Xiaoxue,Tong Linjing,Shen Yujian,Zhu Wangshu,Yin Li,Huang Siming,Zhu Fang,Chen Guosheng,Ouyang Gangfeng
Biosensors & bioelectronics
Portable devices featured with fast analysis and affordable methodologies for clinical diagnostics have stimulated the rapid development of point-of-care (POC) technologies, potentially lowering the mortality rate. Herein, we demonstrated a portable, robust, and user-friendly intelligent metal-organic frameworks (MOFs) paper device, called smartphone-assisted biomimetic MOFs nanoreactor colorimetric paper (SBMCP), for on-demand POC detection of endogenous biomolecules. The concept of this paper platform was analogous to the intracellular cascades signal transduction, wherein the single/multiple enzymes components trapped within a ZIF-8 exoskeleton allowed the sensitive and selective recognition of target analyte via the accessible micropores network of ZIF-8, and then transferred the recognition event to a visual color signal based on the cascade reaction. Meanwhile, the ZIF-8 exoskeleton also endowed the enzymes with significantly elevated stability. As a result, this robust and portable SBMCP sensor enabled the on-site analysis of different important disease-related biomolecules through modulating the enzyme cascades, combining with a custom-designed smartphone application for signal readout. In the SBMCP assay, no sophisticated instruments or professional skill of the user was required, only 5 μL sample volume was needed, and the whole analysis process could be achieved within a portable MOFs paper and pervasive smartphone, endowing this new assay with the merits of low-cost, time-saving and easy-to-use. We demonstrated this SBMCP sensor was capable of real-time colorimetric detection of glucose and uric acid in diabetes and gout events. It is believed that this portable biosensor platform proposed herein potentially represents promising alternatives for POC diagnosis, especially applicable in developing world and resource-limited settings.
10.1016/j.bios.2020.112095
Light-enhanced transparent hydrogel for uric acid and glucose detection by four different analytical platforms.
Analytica chimica acta
The lack of solid-phase media limits the portability of colorimetric sensing platforms. In this study, a series of transparent polyvinyl alcohol (PVA) hydrogels encapsulated antimony tin oxide nanoparticles (ATO NPs) and 3,3',5,5'-tetramethylbenzidine (TMB) were developed as the solid-phase sensing media for glucose and uric acid. Under the conditions of HO and UV light, the hydrogel presented a multicatalytic ability (photo Fenton-like and peroxidase-like activities), which accelerated the oxidation of TMB, turning the hydrogel from colorless to blue and finally enhancing the detection signal. The plasticity of the hydrogel allowed it to be designed into various shapes (membrane, microsphere etc.) to adapt multiple detection platforms (a liquid/solid-phase UV spectrophotometer, a NanoPhotometer, and smartphone spectroscopy). The hydrogel sensing media exhibited excellent tunability and enhanced the photocatalytic ability. The proposed material was successfully applied to detect glucose and uric acids in real samples by four detection platforms to evaluate its practicability.
10.1016/j.aca.2022.340717
Noninvasive and Individual-Centered Monitoring of Uric Acid for Precaution of Hyperuricemia via Optical Supramolecular Sensing.
Advanced science (Weinheim, Baden-Wurttemberg, Germany)
Characterized by an excessively increased uric acid (UA) level in serum, hyperuricemia induces gout and also poses a great threat to renal and cardiovascular systems. It is urgent and meaningful to perform early warning by noninvasive diagnosis, thus conducing to blockage of disease aggravation. Here, guanidinocalix[5]arene (GC5A) is successfully identified from the self-built macrocyclic library to specifically monitor UA from urine by the indicator displacement assay. UA is strongly bound to GC5A at micromolar-level, while simultaneously excluding fluorescein (Fl) from the GC5A·Fl complex in the "switch-on" mode. This method successfully differentiates patients with hyperuricemia from volunteers except for those with kidney dysfunction and targets a volunteer at high risk of hyperuricemia. In order to meet the trend from hospital-centered to individual-centered testing, visual detection of UA is studied through a smartphone equipped with a color-scanning feature, whose adaptability and feasibility are demonstrated in sensing UA from authentic urine, leading to a promising method in family-centered healthcare style. A high-throughput and visual detection method is provided here for alarming hyperuricemic by noninvasive diagnosis.
10.1002/advs.202104463
A facile, low-cost bimetallic iron-nickel MOF nanozyme-propelled ratiometric fluorescent sensor for highly sensitive and selective uric acid detection and its smartphone application.
Nanoscale
As a kind of well-known disease biomarker, uric acid (UA) is closely associated with normal metabolism and health. Despite versatile nanozymes facilitating the analysis of UA, most previous works could only generate single-signal outputs with unsatisfactory detection performance. Exploring a novel ratiometric fluorescent UA sensor with high sensitivity, reliability and portable sensing ability based on facile, low-cost nanozymes is still challenging. Herein, we report the first metal-organic-framework (MOF) nanozyme-originated ratiometric fluorescent UA sensor based on FeNi-MOF-NH propelled UA/uricase/-phenylenediamine tandem catalytic reaction. Different from previous reports, the peroxidase-like property and fluorescence of FeNi-MOF-NH were simultaneously employed. In the absence of UA, only the MOF's fluorescence at 430 nm (FI) can be observed, while the addition of UA will initiate UA/uricase catalytic reaction, and the generated HO could oxidize -phenylenediamine into highly fluorescent 2,3-diaminophenazine (DAP) (emission at 565 nm, FI) under the catalysis of the MOF nanozyme. Coincidently, MOF's fluorescence can be quenched by DAP the inner filter effect, resulting in a low FI value and high FI value, respectively. Therefore, HO and UA can be alternatively detected through monitoring the above contrary fluorescence changes. The limit of detection for UA is 24 nM, which is much lower than those in most previous works, and the lowest among nanozyme-based ratiometric fluorescent UA sensors reported to date. Moreover, the portable sensing of UA smartphone-based RGB analysis was facilely achieved by virtue of the above nanozyme-propelled tandem catalytic system, and MOF nanozyme-based molecular contrary logic pairs were further implemented accordingly.
10.1039/d3nr05028a
Smartphone-Based Electrochemical System for Biosensors and Biodetection.
Ji Daizong,Low Sze Shin,Zhang Diming,Liu Lei,Lu Yanli,Liu Qingjun
Methods in molecular biology (Clifton, N.J.)
With the advantages of high popularity, convenient operation, open-source operation systems, high resolution imaging, and excellent computing capabilities, smartphones have been widely used as the core of detection system for calculation, control, and real-time display. Hence, smartphones play an important role in electrochemical detection and optical detection. Smartphone-based electrochemical systems were combined with screen-printed electrode and interdigital electrodes for in situ detection. The electrodes were modified with biomaterials, chemical materials, and nanomaterials for biosensors and biodetection, such as 3-amino phenylboronic acid nanocomposites, graphene, gold nanoparticles, zinc oxide nanoparticles, carbon nanotubes, proteins, peptides, and antibodies. With the modified electrodes, the smartphone-based impedance system was used to detect acetone, bovine serum albumin, human serum albumin, and trinitrotoluene, while smartphone-based amperometric system was employed to monitor glucose, ascorbic acid, dopamine, uric acid, and levodopa. The smartphone-based electrochemical system for biosensors and biodetection has provided miniaturized and portable alternative for diagnosis, which is promising to find application in point-of-care testing (POCT).
10.1007/978-1-0716-1803-5_26
CuCoS nanozyme-based stimulus-responsive hydrogel kit for rapid point-of-care testing of uric acid.
Mikrochimica acta
An efficient analysis platform composed of nanozyme-based hydrogel kit and smartphone was constructed for on-site detection of uric acid (UA) in a rapid and realiable manner. CuCoS nanoparticles (CuCoS NPs) as a peroxidase mimic were successfully prepared and the peroxidase-like activity and catalytic mechanism were studied in detail. The hydrogen peroxide (HO) stimulus-responsive nanozyme-based hydrogel kit was manufactured by integrating agarose, CuCoS NPs, and 3,3',5,5'-tetramethylbenzidine (TMB) into the cap of centrifuge tube. HO generated via UA oxidation acts as stimulus signal, which triggers the oxidation of TMB to form blue product (oxTMB) under the catalysis of CuCoS NPs, resulting in the color response of the constructed kit. The color image of the kit was captured by a smartphone built-in camera and converted into color intensity using ImageJ software, thus achieving the quantitative determination of UA. The portable kit possesses high selectivity and was used to monitor UA in human serum with satisfactory results (recovery was in the range 95.8-107.3% and RSD was not greater than 4.6%). The established sensing platform is convenient and reliable, which provides a new strategy for point-of-care testing of UA and has a broad prospect in the fields of chemical sensing and biomedical.
10.1007/s00604-022-05381-8
Smartphone-based integrated voltammetry system for simultaneous detection of ascorbic acid, dopamine, and uric acid with graphene and gold nanoparticles modified screen-printed electrodes.
Ji Daizong,Liu Zixiang,Liu Lei,Low Sze Shin,Lu Yanli,Yu Xiongjie,Zhu Long,Li Candong,Liu Qingjun
Biosensors & bioelectronics
Ascorbic acid, dopamine, and uric acid are important electroactive biomolecules for health monitoring and they coexist in serum or urine. Their quantitative determination by electrochemistry could provide the accurate reference for diseases diagnosis and treatment. However, the traditional electrochemical workstations are too large for on-field inspection. Hence, the design of handheld electrochemical system for the detection of biomolecules is significant for point-of-care testing (POCT). In this paper, a smartphone-based integrated voltammetry system using modified electrode was developed for simultaneous detection of biomolecules. The system contained a disposable sensor, a coin-size detector, and a smartphone equipped with application program. Screen-printed electrodes were used as sensors for the detection, on which reduced graphene oxide and gold nanoparticles were electrochemically deposited by the system. The detector was used with voltammetric methods, in which excitation voltage was applied on the sensors and subsequent current responses were detected. The smartphone is the core component to communicate with the detector, calculate data, and plot voltammograms in real-time. Then, the system was applied to detect standard solutions of the biomolecules and their mixtures as examples. The results showed that the peak currents of each substance increased with higher concentration and the method allowed the discrimination of the different potentials of the studied species. Finally, the practical applications of the system were tested through detections of the biomolecules in artificial urine. The results exhibited that the system could be used to detect electrochemical activity of biomolecules with linear, high sensitivity, and specific responses in point-of-care testing.
10.1016/j.bios.2018.07.074
Design of Smartphone-Assisted Point-of-Care Platform for Colorimetric Sensing of Uric Acid via Visible Light-Induced Oxidase-Like Activity of Covalent Organic Framework.
Sensors (Basel, Switzerland)
Monitoring of uric acid (UA) levels in biological samples is of great significance for human health, while the development of a simple and effective method for the precise determination of UA content is still challenging. In the present study, a two-dimensional (2D) imine-linked crystalline pyridine-based covalent organic framework (TpBpy COF) was synthesized using 2,4,6-triformylphloroglucinol (Tp) and [2,2'-bipyridine]-5,5'-diamine (Bpy) as precursors via Schiff-base condensation reactions and was characterized with scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDS), Powder X-ray diffraction (PXRD), Fourier transform infrared (FT-IR) spectroscopy, and Brunauer-Emmett-Teller (BET) assays. The as-synthesized TpBpy COF exhibited excellent visible light-induced oxidase-like activity, ascribed to the generation of superoxide radicals (O) by photo-generated electron transfer. TpBpy COF could efficiently oxidase the colorless substrate 3,3',5,5'-tetramethylbenzydine (TMB) into blue oxidized TMB (oxTMB) under visible light irradiation. Based on the color fade of the TpBpy COF + TMB system by UA, a colorimetric procedure was developed for UA determination with a detection limit of 1.7 μmol L. Moreover, a smartphone-based sensing platform was also constructed for instrument-free and on-site detection of UA with a sensitive detection limit of 3.1 μmol L. The developed sensing system was adopted for UA determination in human urine and serum samples with satisfactory recoveries (96.6-107.8%), suggesting the potential practical application of the TpBpy COF-based sensor for UA detection in biological samples.
10.3390/s23083881
Photoacoustic-Based Miniature Device with Smartphone Readout for Point-of-Care Testing of Uric Acid.
Zhang Ya-Jie,Guo Lan,Yu Yong-Liang,Wang Jian-Hua
Analytical chemistry
Real-time and rapid detection of various biomarkers in body fluids has important significance for early disease diagnosis, efficient monitoring of treatment, and evaluation of prognosis. However, traditional detection methods not only require bulky and costly instruments but also are not suitable for the analysis of heterogeneous samples (e.g., serum and urine), limiting their applications in point-of-care testing (POCT). Herein, an integrated photoacoustic (PA) device with a smartphone as the acoustic signal readout has been constructed, greatly reducing the volume and cost of the instrument, and providing a potential miniature platform for POCT of clinical samples. By exploiting the electron transfer product of 3,3',5,5'-tetramethylbenzidine (TMB) (i.e., TMB) as the PA probe and hemin-graphene oxide (H-GO) complex as the peroxidase, quantitative analysis of uric acid was successfully performed by using only 30 μL of a sample solution. Due to the favorable stability of artificial enzymes, reaction reagents could be effectively embedded in agar gel to make a portable "test strip". Therefore, operators just need to drop clinical samples on the "test strip" for PA analysis, which is user friendly without requiring complex sample preparation steps. In addition, since the acoustic change mainly comes from the PA effect, it has a lower background signal than UV-vis and fluorescence analysis, greatly improving the analytical performance. The simplicity, low cost, and broad adaptability make this miniature PA device attractive for on-site detection, particularly in resource-limited settings.
10.1021/acs.analchem.0c03470
Sensitive colorimetric assay for uric acid and glucose detection based on multilayer-modified paper with smartphone as signal readout.
Wang Xu,Li Fang,Cai Ziqi,Liu Kaifan,Li Jing,Zhang Boyang,He Jianbo
Analytical and bioanalytical chemistry
In this work, a multilayer-modified paper-based colorimetric sensing platform with improved color uniformity and intensity was developed for the sensitive and selective determination of uric acid and glucose with smartphone as signal readout. In detail, chitosan, different kinds of chromogenic reagents, and horseradish peroxidase (HRP) combined with a specific oxidase, e.g., uricase or glucose oxidase (GOD), were immoblized onto the paper substrate to form a multilayer-modified test paper. Hydrogen peroxide produced by the oxidases (uricase or GOD) reacts with the substrates (uric acid or glucose), and could oxidize the co-immoblized chromogenic reagents to form colored products with HRP as catalyst. A simple strategy by placing the test paper on top of a light-emitting diode lamp was adopted to efficiently prevent influence from the external light. The color images were recorded by the smartphone camera, and then the gray values of the color images were calculated for quantitative analysis. The developed method provided a wide linear response from 0.01 to 1.0 mM for uric acid detection and from 0.02 to 4.0 mM for glucose detection, with a limit of detection (LOD) as low as 0.003 and 0.014 mM, respectively, which was much lower than for previously reported paper-based colorimetric assays. The proposed assays were successfully applied to uric acid and glucose detection in real serum samples. Furthermore, the enhanced analytical performance of the proposed method allowed the non-invasive detection of glucose levels in tear samples, which holds great potential for point-of-care analysis. Graphical abstract ᅟ.
10.1007/s00216-018-0939-4
Smartphone-based photochemical sensor for multiplex determination of glucose, uric acid, and total cholesterol in fingertip blood.
The Analyst
A smartphone-based photochemical biosensor capable of realizing multiplex detection of glucose, uric acid (UA), and total cholesterol (TC) is reported here for the first time. The system was composed of a photochemical dongle, a cloud-enabled smartphone, and disposable test strips. The dongle was controlled using a microcontroller unit and was designed to convert the reflected light's intensities into optoelectronic signals for analytes quantification. Only 30 μL of the fingertip blood is needed to complete accurate and reliable measurements within 2 minutes. A cloud-enabled smartphone is connected to the dongle Bluetooth to serve as a data receiver, and users can obtain the test results for proactive health management or remote diagnosis, while powering the dongle. We believe the proposed biosensor will contribute a lot to the point-of-care-testing and has promising prospects in contributing to the development of the Internet of Medical Things.
10.1039/d2an00764a
Smartphone based colorimetric approach for quantitative determination of uric acid using Image J.
Scientific reports
Recently, significant attention has been directed towards digital image colorimetry DIC using mobile applications or available software programs, which offer the advantage of analyzing samples without the need for sophisticated instruments. One such image processing program is Image J, widely used for obtaining quantitative information from scientific images. Image J could measure the color intensities by quantifying of the RGB (red-green-blue) gray levels across the images of colored substances. These values are correlated to the color intensities through conversion to CMY (cyan-magenta-yellow) values which are proportional to the color intensities. The objective of this study is to develop an innovative analytical method for the quantitative determination of uric acid using Image J for color quantification. Image J was utilized to analyze images captured by smart phone for successive concentrations of uric acid that were previously treated with phosphotungstate to develop a blue color. The proposed method has been applied for determination of uric acid in real urine using standard addition method and the results were compared with UV/VIS spectrophotometry as a reference method. In this research, we will also assess the effectiveness of quantitative analysis using Image J in comparison to a mobile application, namely RGB Color Detector.
10.1038/s41598-023-48962-0
Uric Acid Monitoring with a Smartphone as the Electrochemical Analyzer.
Guo Jinhong
Analytical chemistry
We report the world's first medical smartphone as an electrochemical analyzer, which is incorporated with an enzymatic test strip for rapid characterization of UA (uric acid) in peripheral whole blood. A disposable electrochemical uric acid test strip was connected to the electrochemical module integrated with the smartphone through a specific interface, a slot around the edge of smartphone. A 3 μL human finger whole blood drop is applied on the strip for UA evaluation and compared to the clinical biochemical analyzer with satisfactory agreement. The measured data was saved and uploaded into a personal health management center through the mobile Internet.
10.1021/acs.analchem.6b04345
Detection of Various Biomarkers and Enzymes via a Nanocluster-Based Fluorescence Turn-on Sensing Platform.
Zhao Yue,Liu Hou,Jiang Yingnan,Song Shanliang,Zhao Yueqi,Zhang Chuan,Xin Jingwei,Yang Bai,Lin Quan
Analytical chemistry
The profiling of disease-related biomarkers is an essential procedure for the accurate diagnosis and intervention of metabolic disorders. Therefore, the development of ultrasensitive and highly selective fluorogenic biosensors for diverse biomarkers is extremely desirable. There is still a considerable challenge to prepare nanocluster-based fluorescence turn-on probes capable of recognizing multiple biomolecules. We herein provide a novel nanocluster-based chemical information processing system (CIPS) for the programmable detection of various metabolites and enzymes. This CIPS consists of biocatalytic reactions between substrates and their respective oxidases to generate HO, which was then employed to synthesize bright fluorescent silver nanoclusters (Ag NCs). Utilizing this system, we are able to accurately probe a series of substrates/corresponding oxidases with high sensitivity and specificity, including glucose/glucose oxidase, uric acid/uric acid oxidase, sarcosine/sarcosine oxidase, choline/choline oxidase, xanthine/xanthine oxidase, and lactic acid/lactic acid oxidase. Furthermore, this metabolite profiling CIPS can be integrated with binary logic operations, which create an intelligent tool for the high-throughput screening of various diseases in vitro (e.g., diabetes, gout, prostate cancer, cardiovascular disease, and lactic acidosis).
10.1021/acs.analchem.8b04691
A Colorimetric Dermal Tattoo Biosensor Fabricated by Microneedle Patch for Multiplexed Detection of Health-Related Biomarkers.
Advanced science (Weinheim, Baden-Wurttemberg, Germany)
Detection of biomarkers associated with body conditions provides in-depth healthcare information and benefits to disease management, where the key challenge is to develop a minimally invasive platform with the ability to directly detect multiple biomarkers in body fluid. Dermal tattoo biosensor holds the potential to simultaneously detect multiple health-related biomarkers in skin interstitial fluid because of the features of minimal invasion, easy operation, and equipment-free result reading. Herein, a colorimetric dermal tattoo biosensor fabricated by a four-area segmented microneedle patch is developed for multiplexed detection of health-related biomarkers. The biosensor exhibits color changes in response to the change of biomarker concentration (i.e., pH, glucose, uric acid, and temperature), which can be directly read by naked eyes or captured by a camera for semi-quantitative measurement. It is demonstrated that the colorimetric dermal tattoo biosensor can simultaneously detect multiple biomarkers in vitro, ex vivo, and in vivo, and monitor the changes of the biomarker concentration for at least 4 days, showing its great potential for long-term health monitoring.
10.1002/advs.202103030
Carbon nanomaterials for sweat-based sensors: a review.
Mikrochimica acta
Sweat is easily accessible from the human skin's surface. It is secreted by the eccrine glands and contains a wealth of physiological information, including metabolites and electrolytes like glucose and Na ions. Sweat is a particularly useful biofluid because of its easy and non-invasive access, unlike other biofluids, like blood. On the other hand, nanomaterials have started to show promise operation as a competitive substitute for biosensors and molecular sensors throughout the last 10 years. Among the most synthetic nanomaterials that are studied, applied, and discussed, carbon nanomaterials are special. They are desirable candidates for sensor applications because of their many intrinsic electrical, magnetic, and optical characteristics; their chemical diversity and simplicity of manipulation; their biocompatibility; and their effectiveness as a chemically resistant platform. Carbon nanofibers (CNFs), carbon dots (CDs), carbon nanotubes (CNTs), and graphene have been intensively investigated as molecular sensors or as components that can be integrated into devices. In this review, we summarize recent advances in the use of carbon nanomaterials as sweat sensors and consider how they can be utilized to detect a diverse range of analytes in sweat, such as glucose, ions, lactate, cortisol, uric acid, and pH.
10.1007/s00604-023-06162-7
A nurse-led, rheumatologist-assisted telemedicine intervention for dose escalation of urate-lowering therapy in gout.
Phang Kee Fong,Santosa Amelia,Low Bernadette P L,Tan Pamela S H,Khong Zhi Wei,Lim Anita Y N,Teng Gim Gee,Tay Sen Hee
International journal of rheumatic diseases
AIMS:Urate-lowering therapy (ULT) is effective in gout, but suboptimal management with wide variability in dose escalation remains widespread. We protocolized dose escalation of ULT to improve gout management. The aim was to reduce time to achieve target serum urate (SU) <360 µmol/L. METHODS:Process improvement tools were used to identify underlying causes of prolonged time to target SU. We designed a nurse-led telemedicine intervention for dose escalation of ULT. Patients with gout with SU ≥360 µmol/L meeting indications for ULT at a single institution were recruited. Exclusion criteria were estimated glomerular filtration rate <30 mL/min, pregnancy, cognitive impairment and poor mobility. A nurse-led telemedicine clinic was set up to perform patient education, monitoring of adverse events and drug escalation. We partnered with primary healthcare centers for routine blood tests. RESULTS:From July 2016 to December 2017, 127 patients were recruited. Median time to target SU was 19.0 weeks (interquartile range [IQR] 11.0-31.0). Median dose of allopurinol was 300 mg/d (IQR 200-400) in normal renal function and lower in renal impairment. Median telemedicine calls required to achieve target SU was 2 (IQR 1-3). No patient was hospitalized for gout flares. Two patients had adverse drug reactions, one required cessation of allopurinol for rash with eosinophilia, the other had self-resolving ulcers and allopurinol was continued. Lower baseline SU and number of gout flares were associated with attainment of target SU. CONCLUSION:A nurse-led telemedicine for gout care is effective and safe. Our results affirm the utility of telemedicine in increasing access to care and lower healthcare utilization.
10.1111/1756-185X.13855
Universal Fully Integrated Wearable Sensor Arrays for the Multiple Electrolyte and Metabolite Monitoring in Raw Sweat, Saliva, or Urine.
Analytical chemistry
Fully integrated wearable sensors are capable of dynamically, directly, and independently tracking biomarkers in raw noninvasive biofluids without any other equipment or accessories by integrating the unique on-body monitoring feature with the special complete functional implementation attribute. Sweat, saliva, and urine are three important noninvasive biofluids, and changes in their biomarkers hold great potential for revealing physiological conditions. However, it is still a challenge to design single fully integrated wearable sensor arrays (FIWSAs) that are universally able to concurrently measure electrolytes and metabolites in three of the most common noninvasive biofluids including sweat, saliva, and urine. Here, we propose the first single universal FIWSAs for wirelessly, noninvasively, and simultaneously measuring various metabolites (i.e., uric acid) and electrolytes (i.e., Na and H) in raw sweat, saliva, or urine under subjects' exercise by integrating the specifically designed microfluidic, sensing, and electronic modules in a seamless manner. We evaluate its utility for noninvasive gout management in healthy subjects and in gout patients through a purine-rich meal challenge and with a medicine-treatment control, respectively. Noninvasive monitoring of multiple electrolytes and metabolites in a variety of raw noninvasive biofluids via such single universal FIWSAs may enrich the understanding of the biomarkers' levels in the body and would also facilitate self-health management.
10.1021/acs.analchem.3c00361
A nonrandomized controlled trial of individualized exercise prescription combined with remote exercise management in patients who are overweight or obese.
BMC sports science, medicine & rehabilitation
BACKGROUND:Between 2012 and 2020, the obesity rate increased among Chinese people aged 18 years and above, along with blood pressure, fasting blood glucose, serum total cholesterol, and triglycerides. PURPOSE:Our objective was to compare the effects of a combined intervention, including individualized exercise prescription plus remote management versus individualized exercise prescription only, on cardiovascular risk factors in patients who are overweight or obese, with the aim of establishing a more effective remote model of health management than self-management. METHODS:This nonrandomized controlled trial (ChiCTR2100046307) studied patients who are overweight or obese at model labor health management centers from January 2019 to December 2019, including 55 people in the experimental group and 34 in the control group. The relevant indexes of all the research objects from both experimental group and control group were examined. Participants in the experimental group were given individualized exercise prescription combined with remote exercise management over a period of 3 months. The control group was prescribed exercise only at time of enrollment and taught about exercise once, followed by voluntary exercise and self-management for 3 months. RESULT:After adjusting for baseline differences, the changes in weight (-2.72 ± 4.03 kg versus 0.32 ± 2.50 kg, P < 0.0001), body mass index (-0.99 ± 1.44 kg/m versus 0.11 ± 0.92 kg/m, P < 0.0001), waist circumference (-2.98 ± 6.29 cm versus 0.60 ± 5.33 cm, P < 0.0001), visceral fat area (-9.75 ± 19.68 cm versus -1.31 ± 12.37 cm, P = 0.028), body fat (- 2.65 ± 3.52 kg versus 0.54 ± 2.67 kg, P < 0.0001), body fat rate (-2.50 ± 3.32% versus 0.21 ± 3.30%, P < 0.0001), uric acid (-9.75 ± 19.68 µmol/L versus -1.31 ± 12.37 µmol/L, P = 0.028), serum total cholesterol (-0.11 ± 0.40 mmol/L versus -0.11 ± 0.59 mmol/L, P = 0.004), fasting insulin (- 2.36 ± 5.20 μU/mL versus 1.22 ± 7.34 μU/mL, P = 0.009), and homeostatic model assessment of insulin resistance (-0.62 ± 1.25 versus 0.14 ± 1.83, P = 0.022) were significantly better in the experimental group than in the control group after intervention. CONCLUSION:Individualized exercise prescription combined with remote management in patients who are obese or overweight facilitated weight and fat loss, lowered blood pressure and serum total cholesterol, improved glucose metabolism and insulin resistance, and reduced cardiovascular risk factors. The intervention was superior to conventional education in terms of weight loss, fat reduction, total cholesterol reduction, fasting insulin reduction, and amelioration of insulin resistance.
10.1186/s13102-022-00479-1
Development and usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy in gout.
BMC medical informatics and decision making
BACKGROUND:The aim of this study is to develop and assess usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy (ULT) among gout patients in a clinical setting. METHODS:The content of the tool was based on the Integrated Change (I-Change) model. This model combines various socio-cognitive theories and assumes behavioral change is a result of becoming aware of the necessity of change by integrating pre-motivational, motivational, and post-motivational factors. An expert group (five gout experts, three health services researchers, and one health behavior expert) was assembled that decided in three meetings on the tool's specific content (assessments and personalized feedback) using information from preparatory qualitative studies and literature reviews. Usability was tested by a think aloud approach and validated usability questionnaires. RESULTS:The I-Change Gout tool contains three consecutive sessions comprising 80 questions, 66 tailored textual feedback messages, and 40 tailored animated videos. Navigation through the sessions was determined by the patients' intention to adapt suboptimal ULT adherence. After the sessions, patients receive an overview of the personalized advices and plans to support ULT adherence. Usability testing among 20 gout patients that (ever) used ULT and seven healthcare professionals revealed an overall score for the tool of 8.4 ± 0.9 and 7.7 ± 1.0 (scale 1-10). Furthermore, participants reported a high intention to use and/or recommend the tool to others. Participants identified some issues for further improvement (e.g. redundant questions, technical issues, and text readability). If relevant, these were subsequently implemented in the I-Change Gout tool, to allow further testing among the following participants. CONCLUSION:This study provides initial support for the usability by patients and healthcare professionals of the I-Change Gout tool to support ULT adherence behavior.
10.1186/s12911-022-01833-6
Simultaneous monitoring of glucose and uric acid on a single test strip with dual channels.
Guo Jinhong,Ma Xing
Biosensors & bioelectronics
The conventional test strip has usually only one electrochemical reaction channel, which requires two times figure punctures for the self-management of patients suffering from both diabetes and gout. Considering the large number of such patients and for the sake of reducing their pains, we report an enzymatic test strip which can simultaneously monitor glucose and uric acid (UA) with only one fingertip blood droplet. The proposed test strip is composed of dual channels. The glucose in blood is detected in the 1st channel above on the substrate and the UA is characterized in the 2nd channel located at the bottom of the substrate. The proposed design intensively matches the requirement of those patients simultaneously suffering from diabetes and gout. We carried out comparative investigations on the proposed test strip and clinical biochemical analyser, which indicates a good agreement and proved the reliability and accuracy of the proposed test strip, as promising solution for the fast growth of family health management market.
10.1016/j.bios.2017.03.026
Effectiveness of an electronic patient-centred self-management tool for gout sufferers: a cluster randomised controlled trial protocol.
Day Richard O,Frensham Lauren J,Nguyen Amy D,Baysari Melissa T,Aung Eindra,Lau Annie Y S,Zwar Nicholas,Reath Jennifer,Laba Tracey,Li Ling,McLachlan Andrew,Runciman William B,Buchbinder Rachelle,Clay-Williams Robyn,Coiera Enrico,Braithwaite Jeffrey,McNeil H Patrick,Hunter David J,Pile Kevin D,Portek Ian,WIlliams Kenneth Mapson,Westbrook Johanna I
BMJ open
INTRODUCTION:Gout is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate-lowering therapy (ULT) is poor, with rates of less than 50% 1 year after initiation of ULT. Attempts to increase adherence in gout patients have been disappointing. We aim to evaluate the effectiveness of use of a personal, self-management, 'smartphone' application (app) to achieve target serum urate concentrations in people with gout. We hypothesise that personalised feedback of serum urate concentrations will improve adherence to ULT. METHODS AND ANALYSIS:Setting and designPrimary care. A prospective, cluster randomised (by general practitioner (GP) practices), controlled trial. PARTICIPANTS:GP practices will be randomised to either intervention or control clusters with their patients allocated to the same cluster. INTERVENTION:The intervention group will have access to the Healthy.me app tailored for the self-management of gout. The control group patients will have access to the same app modified to remove all functions except the Gout Attack Diary. PRIMARY AND SECONDARY OUTCOMES:The proportion of patients whose serum urate concentrations are less than or equal to 0.36 mmol/L after 6 months. Secondary outcomes will be proportions of patients achieving target urate concentrations at 12 months, ULT adherence rates, serum urate concentrations at 6 and 12 months, rates of attacks of gout, quality of life estimations and process and economic evaluations. The study is designed to detect a ≥30% improvement in the intervention group above the expected 50% achievement of target serum urate at 6 months in the control group: power 0.80, significance level 0.05, assumed 'dropout' rate 20%. ETHICS AND DISSEMINATION:This study has been approved by the University of New South Wales Human Research Ethics Committee. Study findings will be disseminated in international conferences and peer-reviewed journal. TRIAL REGISTRATION NUMBER:ACTRN12616000455460.
10.1136/bmjopen-2017-017281
Can Smartphone Notifications Help With Gout Management? A Feasibility Study.
The Journal of rheumatology
OBJECTIVE:This feasibility study aimed to assess the acceptability of using smartphone notifications to modify the medication beliefs of people with gout. We evaluated the feasibility and acceptability of a smartphone application using the Technology Acceptance Model. We explored adherence rate differences and outcomes between the intervention and control groups. METHODS:Fifty-two patients with gout who were prescribed allopurinol were randomly assigned to either active control (n = 24) or intervention group (n = 28). Over 3 months, both groups used the study app on their smartphones. The active control group received notifications about general health advice, whereas the intervention group received adherence-targeted notifications. The feasibility and acceptability of the smartphone app was measured through semistructured interviews. Adherence rate was assessed through serum urate levels and missed doses at 3 timepoints: baseline, 3 months (post intervention), and 6 months (follow-up). RESULTS:The smartphone app demonstrated high feasibility, with strong participant retention and compliance. The participants expressed high levels of satisfaction with the app's user-friendliness and content, highlighting its acceptability. Both groups showed a significant reduction in missed doses over time ( < 0.05), but no significant differences in serum urate levels were found between the groups. Patients who received adherence-targeted notifications reported finding it more convenient to take allopurinol and expressed higher overall treatment satisfaction throughout the study. CONCLUSION:Adherence-targeted notifications have the potential to be an effective and scalable approach to supporting medication adherence in patients with gout. Further research is needed with larger samples to refine the components of the intervention and explore its optimal implementation.
10.3899/jrheum.2023-0711
A WiFi scanner in conjunction with disposable multiplex paper assay for the quantitation of disease markers in blood plasma.
Hou Pengfei,Deng Rong,Guo Jiqiang,Chen Weiyi,Li Xiaochun,Yu Hua-Zhong
Analytical and bioanalytical chemistry
Herein we report a quantitative, multiplex assay for disease markers in plasma based on an integrated setup of a portable scanner and a disposable paper-based analytical device (PAD). The quantitative analysis relies on the digital colorimetric reading of the three-layer PAD with 30 assay sites for performing respective chromogenic reactions for plasma uric acid, glucose, and triglyceride, which are considered as important risk factors for cardiovascular diseases. A portable scanner with WiFi transmission capability was used to produce high-quality color images of the PADs and wirelessly transfer them to a smartphone or other mobile devices for data processing. The concentrations of biomarkers in both standard solutions and plasma samples can be directly obtained using a custom-designed smartphone app that is also capable of constructing calibration curves. The detection limits of uric acid, glucose, and triglyceride were determined to be 0.50 mg/dL, 0.84 mmol/L, and 14 mg/dL, respectively, which are below the normal limits and adequate for clinical validation. Owing to the distinct advantages-simple, portable, and cost-effective-this mobile assay protocol can be used for point-of-care (POC) settings or resource-limited situations, and potentially for the diagnosis and prevention of infectious diseases.
10.1007/s00216-021-03234-6
Glycemic Control of Type 2 Diabetes with the Chinese Metabolic Management Center and eKTANG.
Alternative therapies in health and medicine
Objective:Long-term management of patients with type 2 diabetes is a challenging clinical problem. The Metabolic Management Center (MMC) has been implemented in China to address metabolic diseases. This study aimed to evaluate the effectiveness of combining MMC with the eKTANG App, which is a fee-based blood glucose-monitoring platform, to improve outcomes for patients with diabetes. Methods:We recruited 240 patients with type 2 diabetes to our randomized controlled trial; the patients were randomly assigned into a control group (n = 120) and an intervention group (n = 120). Participants in the control group received MMC management; those in the intervention group received MMC + eKTANG management. Serum samples were taken at 0, 3, 6, and 12 months to test liver and kidney function, blood lipids, uric acid, and blood glucose-related indicators. An oral glucose tolerance test and behavior questionnaires were administered and complications related to type 2 diabetes were noted at 0, 6, and 12 months. Results:After up to 12 months of intervention with MMC + eKTANG, patients had improved mean (SEM) concentrations of hemoglobin A1c (6 months: control, 7.09% [1.32%] vs intervention, 7.19% [3.50%]; 9 months: control, 6.33% [0.31%] vs intervention, 6.50% [1.00%]; 12 months: control, 6.31% [2.30%] vs intervention, 6.01% [2.30%]), fasting plasma glucose (9 months: control, 7.20 [2.35] mmol/L vs intervention, 7.01 [0.56] mmol/L; 12 months: control, 6.98 [0.03] mmol/L vs intervention, 6.24 [2.03] mmol/L), and 2-hour postprandial plasma glucose (9 months: control, 9.85 [0.34] mmol/L vs intervention, 9.50 [0.23] mmol/L; 12 months: control, 9.55 [0.25] mmol/L vs intervention, 8.68 [0.87] mmol/L). The mean (SEM) concentrations of insulin and C-peptide measured during the oral glucose tolerance test also improved (measured as incremental area under the curve 0-180 min glucose; 6 months: control, 360.25 [2.30] mmol/L × min vs intervention, 352.24 [0.89] mmol/L × min; 12 months: control, 332.01 [2.32] mmol/L × min vs intervention, 300.32 [0.78] mmol/L × min). Moreover, the intervention ameliorated markers of lipid metabolism and liver and kidney function, and complications and behaviors related to diabetes. Conclusion:The MMC + eKTANG intervention combines the convenience and efficacy of the internet for delivering timely medical care and guidance to individuals with diabetes with valuable information for managing diabetes in daily life. This innovative approach incorporates a fee-based system to enhance patient motivation and initiative, leading to a novel and effective perspective on diabetes management beyond traditional hospital settings.
Micro-fabrication by wax spraying for rapid smartphone-based quantification of bio-markers.
Motalebizadeh Abbas,Asiaei Sasan
Analytical biochemistry
A cheap/rapid technique for the fabrication of μPADs is presented for point of care analysis. Hydrophobic channels were formed across the width of the paper by spraying hot pure wax. This biocompatible novel process yielded uniform 300 ± 5 μm hydrophilic microchannels on paper, without the use of the cleanroom, UV lamp, or organic solvents and was completed in a single step without the need for a hotplate. Hot wax is properly impregnated across paper thickness by spraying under optimized temperature and pressure. Our method is advantageous in the cost and ease of fabrication, process time (<1 min), the feasibility of mass-fabrication, readout, environmental considerations and multiplexing due to the embossed structure of remnant wax. The performance of the resulting μPAD was assessed on a multiplexed Uric acid and Nitride assay, bearing 95% of confidence level in the readout against standardized tests. A novel RGB processing app was developed for smart-phones to quantify colorimetric read-outs through a heuristic normalization equation that converts RGB to integer systems. This combinatorial sensor demonstrates a good linear range (up to 800 μM for Uric acid and 1250 μM for Nitride), low detection limit (100 μM for uric acid and 156 μM for nitride).
10.1016/j.ab.2020.113777
Microfluidic paper-based analytical device by using Pt nanoparticles as highly active peroxidase mimic for simultaneous detection of glucose and uric acid with use of a smartphone.
Zheng Jie,Zhu Min,Kong Jiao,Li Zimu,Jiang Jianming,Xi Yachao,Li Fang
Talanta
Herein, a simple microfluidic paper-based analytical device (μPAD) by using platinum nanoparticles (Pt NPs) as highly active peroxidase mimic for simultaneous determination of glucose and uric acid was fabricated. The μPAD consisted of one sample transportation layer, four paper-based detection chips, and two layers of hydrophobic polyethylene terephthalate (PET) films. The four detection chips were immobilized with various chromogenic reagents, Pt NPs, and specific oxidase (glucose oxidase or uricase). HO generated by specific enzymatic reactions could oxidize co-immobilized chromogenic reagents to produce colored products by using Pt NPs as efficient catalyst. The multi-layered structure of μPAD could effectively improve the color uniformity and color intensity. Total color intensity from each two detection chips modified with distinct chromogenic reagents were used for quantitative analysis of glucose and uric acid, respectively, resulting in significantly improved sensitivity. The linear range for glucose and uric acid detection was 0.01-5.0 mM and 0.01-2.5 mM, respectively. Satisfied results were obtained for glucose and uric acid detection in real serum samples. An easy-to-use smartphone APP was developed for convenient and intelligent detection. The developed μPAD integrated with smartphone as detector holds great applicability for simple and portable on-site analysis.
10.1016/j.talanta.2021.122954
Digital Quantification Method for Sensitive Point-of-Care Detection of Salivary Uric Acid Using Smartphone-Assisted μPADs.
ACS sensors
Uric acid (UA) is an important biomarker for many diseases. A sensitive point-of-care (POC) testing platform is designed for the digital quantification of salivary UA based on a colorimetric reaction on an easy-to-build smartphone-assisted microfluidic paper-based analytical device (SμPAD). UA levels are quantified according to the color intensity of Prussian blue on the SμPAD with the aid of a MATLAB code or a smartphone APP. A color correction method is specifically applied to exclude the light effect. Together with the engineering design of SμPADs, the background calibration function with the APP increases the UA sensitivity by 100-fold to reach 0.1 ppm with a linear range of 0.1-200 ppm. The assay time is less than 10 min. SμPADs demonstrate a correlation of 0.97 with a commercial UA kit for the detection of salivary UA in clinical samples. SμPADs provide a sensitive, fast, affordable, and reliable tool for the noninvasive POC quantification of salivary UA for early diagnosis of abnormal UA level-associated health conditions.
10.1021/acssensors.2c00854
Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review.
JMIR mHealth and uHealth
BACKGROUND:Health care professionals are increasingly using smartphones in clinical care. Smartphone use can affect patient quality of care and clinical outcomes. OBJECTIVE:This scoping review aimed to describe how physicians use smartphones and mobile apps in clinical settings. METHODS:We conducted a scoping review using the Joanna Briggs Institute methodology and reported the results according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We used the following databases in our literature search: MEDLINE, Embase, Cochrane Library, Web of Science, Google Scholar, and gray literature for studies published since 2010. An additional search was also performed by scanning the reference lists of included studies. A narrative synthesis approach was used. RESULTS:A total of 10 studies, published between 2016 and 2021, were included in this review. Of these studies, 8 used surveys and 2 used surveys with focus group study designs to explore smartphone use, its adoption, experience of using it, and views on the use of smartphones among physicians. There were studies with only general practitioners (n=3), studies with only specialists (n=3), and studies with both general practitioners and specialists (n=4). Physicians use smartphones and mobile apps for communication (n=9), clinical decision-making (n=7), drug compendium (n=7), medical education and training (n=7), maintaining health records (n=4), managing time (n=4), and monitoring patients (n=2) in clinical practice. The Medscape medical app was frequently used for information gathering. WhatsApp, a nonmedical app, was commonly used for physician-patient communication. The commonly reported barriers were lack of regulatory oversight, privacy concerns, and limited Wi-Fi or internet access. The commonly reported facilitator was convenience and having access to evidence-based medicine, clinical decision-making support, and a wide array of apps. CONCLUSIONS:Smartphones and mobile apps were used for communication, medical education and training, clinical decision-making, and drug compendia in most studies. Although the benefits of smartphones and mobile apps for physicians at work were promising, there were concerns about patient privacy and confidentiality. Legislation is urgently needed to protect the liability of health care professionals using smartphones.
10.2196/44765
Remote Management of Poststroke Patients With a Smartphone-Based Management System Integrated in Clinical Care: Prospective, Nonrandomized, Interventional Study.
Kim Do Yeon,Kwon Hee,Nam Ki-Woong,Lee Yongseok,Kwon Hyung-Min,Chung Young Seob
Journal of medical Internet research
BACKGROUND:Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases. OBJECTIVE:We developed a smartphone-based mHealth system and aimed to evaluate its effects on health behavior management and risk factor control in stroke patients. METHODS:With a multifaceted stroke aftercare management system that included exercise, medication, and educational materials, we performed a 12-week single-arm intervention among eligible poststroke patients in the stroke clinic from September to December 2016. The intervention consisted of (1) regular blood pressure (BP), blood glucose, and physical activity measurements; (2) stroke education; (3) an exercise program; (4) a medication program; and (5) feedback on reviewing of records by clinicians. Clinical assessments consisted of the stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences in the parameters over 12 weeks were investigated with repeated-measures analysis of variance. Changes in medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with a self-questionnaire using a 5-point Likert scale at visit 3. RESULTS:The study was approved by the Institutional Review Board in September 2016, and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 were included in our analyses. The mean stroke awareness score (baseline: 59.6 [SD 18.1]; 4 weeks: 67.6 [SD 16.0], P<.001; 12 weeks: 74.7 [SD 14.0], P<.001) and BDI score (baseline: 12.7 [SD 10.1]; 4 weeks: 11.2 [SD 10.2], P=.01; 12 weeks: 10.7 [SD 10.2], P<.001) showed gradual improvement; however, no significant differences were found in the mean EQ-5D score (baseline: 0.66 [SD 0.33]; 4 weeks: 0.69 [SD 0.34], P=.01; 12 weeks: 0.69 [SD 0.34], P<.001). Twenty-six patients who had uncontrolled BP at baseline had -13.92 mmHg (P=.001) and -6.19 mmHg (P<.001) reductions on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance was better at visit 2-3 (60.9% [SD 37.2%]) than at visit 1-2 (47.8% [SD 38.7%], P<.001). CONCLUSIONS:Awareness of stroke, depression, and BP was enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques have potential as new nonpharmacological secondary prevention methods because of their ubiquitous access, near real-time responsiveness, and comparatively lower cost.
10.2196/15377
A narrative synthesis systematic review of digital self-monitoring interventions for middle-aged and older adults.
Internet interventions
OBJECTIVE:Self-monitoring is crucial to raise awareness for own behaviors and emotions, and thus facilitate self-management. The composition of self-monitoring within interventions, however, varies and guidelines are currently unavailable. This review aimed to provide a comprehensive overview of technology-based self-monitoring interventions that intend to improve health in middle-aged and older adults (>45 years). METHODS:Five online databases were systematically searched and articles were independently screened. A narrative synthesis of 26 studies with 21 unique interventions was conducted. Primary focus lay on the composition of self-monitoring within interventions, including technology used, health-aspects monitored, and type of feedback provided. Secondly, the usability of/adherence to the self-monitoring treatment, intervention effects, and their sustainability were examined. FINDINGS:Studies concentrated on middle-aged adults (mean of 51 years). Mobile technologies seem necessary to ensure flexible self-monitoring in everyday life. Social health aspects were rarely monitored. Mechanisms and the sustainability of intervention effect are understudied. CONCLUSION:Digital self-monitoring technologies hold promise for future trials as they seem suitable to understand and support health-related self-management. Key elements including automatic and personal feedback following the blended care principle were highlighted and may guide study designs. Prospectively, research is especially needed to study sustained self-monitoring to support disease prevention and lasting lifestyle changes.
10.1016/j.invent.2019.100283
Use of mobile phones for behavior change communication to improve maternal, newborn and child health: a scoping review.
Journal of global health
BACKGROUND:Behavior change communication (BCC) to improve health and caring practices is an integral component of efforts to improve maternal, newborn and child health (MNCH). Mobile phones are widely available in low- and middle-income countries (LMIC), presenting new opportunities for BCC delivery. There is need for delivery science to determine how best to leverage mobile phone technology for BCC to improve MNCH practices. METHODS:We conducted a scoping review of studies and project reports documenting the feasibility, implementation or effectiveness of using mobile phones for BCC delivery related to MNCH in LMIC. Data were extracted and synthesized from three sources: i) systematic search of three electronic databases (PubMed, MedLine, Scopus); ii) grey literature search, including mHealth databases and websites of organizations implementing mHealth projects; iii) consultation with researchers and programme implementers. Records were screened using pre-determined inclusion criteria and those selected were categorized according to their primary intervention delivery approaches. We then performed a descriptive analysis of the evidence related to both effectiveness and implementation for each delivery approach. RESULTS:The systematic literature search identified 1374 unique records, 64 of which met inclusion criteria. The grey literature search added 32 records for a total of 96 papers in the scoping review. Content analysis of the search results identified four BCC delivery approaches: direct messaging, voice counseling, job aid applications and interactive media. Evidence for the effectiveness of these approaches is growing but remains limited for many MNCH outcomes. The four approaches differ in key implementation elements, including frequency, length and complexity of communication, and potential for personalization. These elements influence resource allocation and are likely to impact effectiveness for BCC targeting complex, habitual MNCH practices. CONCLUSIONS:This scoping review contributes to the evidence-base on the opportunities and limitations of using mobile phones for BCC delivery aiming to improve MNCH practices. The incorporation of mobile phone technology in BCC interventions should be guided by formative research to match both the content and delivery approach to the local context. We recommend five areas for further research, including both effectiveness and implementation studies on specific delivery approaches.
10.7189/jogh.09.020425
Use of Technology in the Management of Obesity: A Literature Review.
Shannon H Houser,Joseph Reena,Puro Neeraj,Darrell E
Perspectives in health information management
Technology is intended to assist with diagnosing, treating, and monitoring patients remotely. Little is known of its impact on health outcomes or how it is used for obesity management. This study reviewed the literature to identify the different types of technologies used for obesity management and their outcomes. A literature search strategy using PubMed, CINAHL, Scopus, Embase, and ABI/Inform was developed and then was vetted by two pairs of researchers. Twenty-three studies from 2010 to 2017 were identified as relevant. Mobile health, eHealth, and telehealth/telemedicine are among the most popular technologies used. Study outcome measurements include association between technology use and weight loss, changes in body mass index, dietary habits, physical activities, self-efficacy, and engagement. All studies reported positive findings between technology use and weight loss; 60 percent of the studies found statistically significant relationships. Knowledge gaps persist regarding opportunities for technology use in obesity management. Future research needs to include patient-level outcomes, cost-effectiveness, and user engagement to fully evaluate the feasibility of continued and expanded use of technology in obesity management.
A Systematic Review of Nutrition Recommendation Systems: With Focus on Technical Aspects.
Journal of biomedical physics & engineering
BACKGROUND:Nutrition informatics has become a novel approach for registered dietitians to practice in this field and make a profit for health care. Recommendation systems considered as an effective technology into aid users to adjust their eating behavior and achieve the goal of healthier food and diet. The purpose of this study is to review nutrition recommendation systems (NRS) and their characteristics for the first time. MATERIAL AND METHODS:The systematic review was conducted using a comprehensive selection of scientific databases as reference sources, allowing access to diverse publications in the field. The process of articles selection was based on the PRISMA strategy. We identified keywords from our initial research, MeSH database and expert's opinion. Databases of PubMed, Web of Sciences, Scopus, Embase, and IEEE were searched. After evaluating, they obtained records from databases by two independent reviewers and inclusion and exclusion criteria were applied to each retrieved work to select those of interest. Finally, 25 studies were included. RESULTS:Hybrid recommender systems and knowledge-based recommender systems with 40% and 32%, respectively, were the mostly recommender types used in NRS. In NRS, rule-based and ontology techniques were used frequently. The frequented platform that applied in NRS was a mobile application with 28%. CONCLUSION:If NRS was properly designed, implemented and finally evaluated, it could be used as an effective tool to improve nutrition and promote a healthy lifestyle. This study can help to inform specialists in the nutrition informatics domain, which was necessary to design and develop NRS.
10.31661/jbpe.v0i0.1248
The Effects of Smartphone Applications on Patients Self-care with Hypertension: A Systematic Review Study.
Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH
INTRODUCTION:High blood pressure or hypertension is one of the chronic diseases causing other serious diseases and syndromes. Active involvement of the patient in the management of the disease is crucial in improving self-care and clinical outcomes. Mobile technology is nowadays used widely to improve the self-care process in people with chronic diseases such as hypertension. AIM:The objective of this study was to provide an overview of the existing research evaluating the impact of mobile applications on the self-care of patients with hypertension. METHODS:The Scopus and PubMed databases were investigated using a comprehensive search strategy from the beginning of 2010 to 2019. All controlled clinical trial studies as well as quasi-experimental studies used mobile as a device for improving the self-care and conducted on patients with hypertension were included in the study. The studies were reviewed by two independent individuals. RESULTS:Out of 1032 studies found, 6 studies were finally reviewed after applying the inclusion criteria. Out of 6 studies reviewed, three studies confirmed the effect of using mobile applications on lowering blood pressure. Other studies reported a decline in blood pressure, while statistically significant were not shown. CONCLUSION:The results showed that mobile apps have positive potential on improving the self-care behavior of patients with hypertension, but the evidences presenting their impact are varied. Different reports for efficiency of mobile phone apps for the self-care modification was due to diverse condition of studies for mobile intervention on the patients with hypertension.
10.5455/aim.2019.27.263-267
Digital Medicine: A Primer on Measurement.
Coravos Andrea,Goldsack Jennifer C,Karlin Daniel R,Nebeker Camille,Perakslis Eric,Zimmerman Noah,Erb M Kelley
Digital biomarkers
Technology is changing how we practice medicine. Sensors and wearables are getting smaller and cheaper, and algorithms are becoming powerful enough to predict medical outcomes. Yet despite rapid advances, healthcare lags behind other industries in truly putting these technologies to use. A major barrier to entry is the cross-disciplinary approach required to create such tools, requiring knowledge from many people across many fields. We aim to drive the field forward by unpacking that barrier, providing a brief introduction to core concepts and terms that define digital medicine. Specifically, we contrast "clinical research" versus routine "clinical care," outlining the security, ethical, regulatory, and legal issues developers must consider as digital medicine products go to market. We classify types of digital measurements and how to use and validate these measures in different settings. To make this resource engaging and accessible, we have included illustrations and figures throughout that we hope readers will borrow from liberally. This primer is the first in a series that will accelerate the safe and effective advancement of the field of digital medicine.
10.1159/000500413
Using a Novel Smart-Device Application for Follow-up After Percutaneous Coronary Intervention.
Strauss Bradley H,Sud Maneesh,Arbel Yaron,Elbaz-Greener Gabby
The Canadian journal of cardiology
Smart-device applications offer a potential novel and accessible opportunity to follow-up patients undergoing percutaneous coronary intervention (PCI) and identify opportunities to improve care. To date, no studies have described patient follow-up through surveys administered with the use of smart-device applications. Through a large online personal health management record solution system (MyChart) and a complementary smart-device application, an electronic 26-item survey was administered to patients on their mobile device at 4 days, 1 month, 3 months, and 6 months after PCI at a single tertiary-care hospital from July 2017 to March 2018. Among the 112 participants, response rates at 4 days and 3-6 months after PCI were both 53%. Seventy-two percent of patients responded to at least 1 follow-up survey, and 25% patients responded at all 4 follow-up times. In responders, 68% had follow-up with cardiology/internal medicine at 30 days. At 3-6 months, 30% of patients reported persistent or recurrent symptoms, 19% had had a readmission for any cause, 54% were enrolled in cardiac rehabilitation, 25% were not on statin therapy, and 90% of patients who were working before PCI had returned to work. Post-PCI follow-up with the use of patient questionnaires through a smart-device application is feasible and a novel tool for improving quality of care.
10.1016/j.cjca.2019.11.019
Citizen Health Science: Foundations of a New Data Science Arena.
International journal of population data science
Citizen scientists with health interests have rapidly increased efforts to conduct their own health studies on themselves and in their communities, giving rise to a new transdisciplinary field of citizen health science. This science leverages long-standing traditions of single case or N-of-1 studies in psychology and also finds influential roots in the history of self-experimentation in health and medicine. These studies frequently incorporate new digital tools such as smartphone tracking and many other mobile health or "mHealth" devices. Citizen health scientists also tend to operate in social networks of people working to maintain or improve their health, increasing the complexity and richness of opportunities tied to this new platform. Population data scientists are well-positioned to seek new ways to derive scientific inferences from data generated in citizen health science projects. This paper provides an overview of citizen health science for population data scientists, including basic definitions, historical foundations, current challenges and opportunities, and future directions.
10.23889/ijpds.v4i1.1074
Persuasive technology for health and wellness: State-of-the-art and emerging trends.
Orji Rita,Moffatt Karyn
Health informatics journal
The evolving field of persuasive and behavior change technology is increasingly targeted at influencing behavior in the area of health and wellness. This paper provides an empirical review of 16 years (85 papers) of literature on persuasive technology for health and wellness to: (1.) answer important questions regarding the effectiveness of persuasive technology for health and wellness, (2.) summarize and highlight trends in the technology design, research methods, motivational strategies, theories, and health behaviors targeted by research to date, (3.) uncover pitfalls of existing persuasive technological interventions for health and wellness, and (4.) suggest directions for future research.
10.1177/1460458216650979
CRDC: a Chinese rheumatology research platform.
Li Mengtao,Tian Xinping,Zhang Wen,Leng Xiaomei,Zeng Xiaofeng
Clinical rheumatology
This review introduces the history of development, organizational structure, funding resources, data collection, and quality control of the Chinese Rheumatism Data Center (CRDC) and summarizes the collection of data. In 2009, Peking Union Medical College Hospital (PUMCH), together with several rheumatism centers, established the Chinese Systemic Lupus Erythematosus (SLE) Treatment and Research Group (CSTAR) to collect data on Chinese patients for the study of SLE disease characteristics. In 2011, CSTAR was extended with the formation of the CRDC at PUMCH with direction from the National Health and Family Planning Commission of the PRC. The CRDC currently includes 300 registration sites and 50 regional sites that have successively begun to collect data on 12 rheumatic diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic sclerosis, dermatomyositis, Takayasu arteritis, IgG4-related diseases, ANCA-associated vasculitis, gout, polyarteritis nodosa, unclassified systemic vasculitis, and Behcet disease. To date, 17,224 patients have been enrolled in the CRDC. Based on the SLE patients registered in the CRDC, papers investigating basic demographic characteristics and first symptom in Chinese SLE patients, risk factors of pulmonary hypertension, correlations between autoantibodies and clinical manifestations, and factors related to fetal loss have been published. The CRDC is a national registry that provides real-life data to improve clinical decision-making. At the same time, without additional work for the clinician, the CRDC is a powerful research database. The CRDC database provides sufficient information for Chinese clinical studies on rheumatology. Moreover, a mobile device application ensures convenient and efficient data collection without compromising data quality, thereby providing strong evidence-based data for the diagnosis and treatment of Chinese rheumatic patients.
10.1007/s10067-015-3003-1
mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies.
Nguyen Amy D,Frensham Lauren J,Wong Michael Xc,Meslin Sylvain Mm,Martin Paige,Lau Annie Ys,Baysari Melissa T,Day Richard O
JMIR mHealth and uHealth
BACKGROUND:Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. OBJECTIVE:The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. METHODS:Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. RESULTS:Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. CONCLUSIONS:These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app's presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients.
10.2196/mhealth.9811
A User-Centred Approach to Designing an eTool for Gout Management.
Fernon Anna,Nguyen Amy,Baysari Melissa,Day Richard
Studies in health technology and informatics
INTRODUCTION:Gout is a chronic inflammatory arthritis with increasing prevalence in Australia and rates of non-adherence to therapy higher than for any other chronic disease. Electronic health interventions can increase adherence to treatment for many chronic diseases. This study set out to involve end-user patients in the design of a gout self-management eTool. METHODS:Four semi-structured focus group sessions were held in July and August 2015 with 13 patients with gout (age range 39-79 years). Focus groups involved group discussions of potential eTool features and critiquing disease self-management websites and applications. Focus group sessions were audio-taped, transcribed and analysed by two independent researchers to identify useful eTool features and patient perspectives of using technology to manage their health. FINDINGS:Participants were open to using a supportive gout self-management eTool and identified a number of potentially helpful features, including educational material, serum uric acid monitoring and medication reminder alerts. DISCUSSION:Focus groups with patients with gout revealed a number of features that should be included in a gout self-management eTool. These results will inform the design and implementation of an eTool for patients with gout and may be broadly applicable to teams designing eTools for other chronic diseases.
How Can We Improve Disease Education in People with Gout?
Current rheumatology reports
PURPOSE OF REVIEW:Gout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts. RECENT FINDINGS:Nurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education. An interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.
10.1007/s11926-018-0720-x
Keeping Up with the Applications: Lessons Learned Evaluating Gout Apps.
Kieser Anel,Dalbeth Nicola,Serlachius Anna
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
In June 2017, we embarked on a study to test the efficacy of available smartphone applications (apps) for gout, a type of inflammatory arthritis, which is associated with severe joint inflammation causing significant joint pain. Several noteworthy challenges arose as we grappled with issues such as apps no longer being available (or functional), the poor quality and misinformation of apps, and the rapid and unforeseen updating (or complete lack of updating) of existing apps. These are critical issues that researchers and health professionals working in the rapidly developing digital health field must learn how to contend with. In this study, we offer some of our insights regarding issues that need to be considered when working in m-Health, especially when the research is being conducted in the health sector or with patients.
10.1089/tmj.2018.0091
eHealth-supported decentralized multi-disciplinary care for gout involving rheumatology, pharmacy, and dietetics: proof-of-concept study.
Howren Alyssa,Tsao Nicole W,Choi Hyon K,Shojania Kam,Kydd Alison,Friesen Russell,Avina-Zubieta J Antonio,De Vera Mary A
Clinical rheumatology
OBJECTIVE:To conduct quantitative and qualitative evaluation of an electronic health (eHealth)-supported decentralized multi-disciplinary care model for gout involving rheumatologists, pharmacist, and dietitian. METHODS:We conducted a 12-month proof-of-concept study. Gout patients with ≥ 1 flare in the past year and serum urate (SUA) ≥ 360 μmol/L within the previous 2 months were followed by participating community rheumatologists on an as-needed basis, received monthly telephone consults with a pharmacist, and one telephone consult with a dietitian. Healthcare professionals were not co-located but had shared access to the rheumatologists' electronic medical records (EMR) for remote communication and collaboration. In quantitative evaluation, the primary outcome was the proportion of patients with SUA < 360 μmol/L at 12 months. In qualitative evaluation, we conducted semi-structured interviews with a subset of patients and applied constructivist grounded theory to gather patients' perspectives. RESULTS:Overall, 35 gout patients (86% males, mean age 60.9 ± 14.9 years) participated. At 12 months, 72% of patients achieved target SUA < 360 μmol/L. Qualitative analysis of interviews with a subset of 12 patients resulted in two themes: (1) experiences with receiving care, including categories of improved knowledge about gout, receiving personalized support, and knowing someone cares, and (2) practical considerations, including categories of optimizing timing of care and coordination and accessibility. CONCLUSION:Our multi-method study shows that a decentralized, multi-disciplinary care for gout involving rheumatology, pharmacy, and dietetics with shared EMR access led to gout patients achieving target SUA. It was well-received by patients who perceived better education about gout and personalized care.Key Points• We demonstrated the feasibility and impact of an eHealth-supported, decentralized collaborative care model for gout involving rheumatology, pharmacy, and dietetics• Although prior multi-disciplinary models of care for gout have been reported, the novelty of our model is that healthcare providers are not co-located, lending to potential efficiencies and outreach to patients in rural areas.
10.1007/s10067-019-04809-6
Mobile applications to enhance self-management of gout.
Nguyen Amy D,Baysari Melissa T,Kannangara Diluk R W,Tariq Amina,Lau Annie Y S,Westbrook Johanna I,Day Richard O
International journal of medical informatics
BACKGROUND:Gout is an arthritic condition that is characterised by extremely painful, debilitating acute attacks and eventual joint and organ damage if not controlled. Despite the availability of very effective therapies that, if adhered to, will prevent acute attacks and long-term damage, the disorder is increasingly prevalent. There is an urgent need to improve self-management of gout. OBJECTIVES:Mobile health (mHealth) applications ('apps'), designed to facilitate management of chronic conditions, present novel opportunities for supporting patient self-management of gout. The aim of this review was to assess features of available gout management apps designed to assist consumers in managing their gout and their consistency with guidelines for gout management. METHODS:English-language, smart-device apps designed to assist self-management of gout were identified using search term "gout" and downloaded from Apple and Google Play app stores. To be included in the review, apps had to allow users to monitor their gout disease (e.g. serum uric acid (sUA) tracking, record acute attacks) and/or educate patients about gout. Investigators derived patient-focused recommendations for gout management from contemporary guidelines. Features of reviewed apps were independently assessed by two reviewers for their facilitation of these recommendations. RESULTS:The search identified 57 apps possibly relevant to gout management, of which six met the inclusion criteria. One app incorporated all recommendations for patient-focused gout management from guidelines including monitoring sUA, recording attacks and lifestyle advice. However, the majority of these elements were not functional within the app, and instead required users to manually complete printouts. CONCLUSIONS:Currently, only one app exists that includes all recommendations to facilitate patient self-management of gout, however some features can only be actioned manually. Given the lack of progress in achieving better patient outcomes and the promise of mHealth interventions to deliver significant gains, new or updated gout management apps are required to promote successful self-management of this chronic disease.
10.1016/j.ijmedinf.2016.06.021
Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial.
Serlachius Anna,Schache Kiralee,Kieser Anel,Arroll Bruce,Petrie Keith,Dalbeth Nicola
JMIR mHealth and uHealth
BACKGROUND:Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout. OBJECTIVE:Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions. METHODS:Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention. RESULTS:Participants rated the gout app as more engaging (mean difference -0.58, 95% CI -0.96 to -0.21) and more informative (mean difference -0.34, 95% CI -0.67 to -0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference -0.64, 95% CI -1.27 to -0.003) and higher knowledge/understanding of gout (mean difference -0.70, 95% CI -1.30 to -0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference -2.43, 95% CI -3.68 to -1.18), stronger beliefs regarding the severity of symptoms (mean difference -1.97, 95% CI -3.12 to -0.82), and a stronger emotional response to gout (mean difference -2.38, 95% CI -3.85 to -0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information. CONCLUSIONS:Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217.
10.2196/15021
Improving cirrhosis care: The potential for telemedicine and mobile health technologies.
Stotts Matthew Jonathon,Grischkan Justin Alexander,Khungar Vandana
World journal of gastroenterology
Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.
10.3748/wjg.v25.i29.3849