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van Beek JJW, Lehnick D, Pastore-Wapp M, Wapp S, Kamm CP, Nef T, Vanbellingen T. Tablet app-based dexterity training in multiple sclerosis (TAD-MS): a randomized controlled trial. Disabil Rehabil Assist Technol 2024; 19:889-899. [PMID: 36308305 DOI: 10.1080/17483107.2022.2131915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Mobile health applications (mHealth apps) may lead to health benefits. In recent years, the use of apps in multiple sclerosis (MS) has increased. Apps to train and improve dexterity in MS are scarce. This study investigated the effectiveness of a tablet app-based home-based training to improve dexterity in individuals with MS. MATERIALS AND METHODS In a randomized controlled trial, two standardized 4-week home-based interventions focussing on different aspects of dexterity and upper limb function were compared. Assessments were done at baseline, post-intervention and 12-week follow-up. The primary endpoint was the Arm Function in Multiple Sclerosis Questionnaire, a dexterity-related measure of patient-reported activities of daily living. Secondary endpoints were dexterous function, grip strength and health-related quality of life. RESULTS Forty-eight individuals were randomly assigned to a tablet app-based program (n = 26) or a control strengthening exercise program (n = 22). No significant differences were found for the primary endpoint (p = 0.35). Some significant differences in favour of the app-group were found in fine coordinated finger movements and strength. No significant differences were found at the 12-week follow-up for all endpoints. Adherence in both groups was above 90%. CONCLUSIONS App-based training was not superior compared to a control strengthening exercise program concerning the arm- and hand function from the participant's perspective. However, app-based training was found to be effective in improving specific dimensions (finger movements and strength), and can easily be applied at home. Therefore, individuals living with MS with impaired dexterity should consider app-based training. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT03369470.
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Affiliation(s)
- Judith J W van Beek
- Neurocenter, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Dirk Lehnick
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Cantonal Hospital Lucerne, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Simona Wapp
- Neurocenter, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christian P Kamm
- Neurocenter, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Cantonal Hospital Lucerne, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
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Tosun AT, Isiklar C, Yildirim M, Coskunsu DK. e-Health Literacy Status of Individuals with Multiple Sclerosis in Turkey. Telemed J E Health 2024; 30:e1166-e1171. [PMID: 37851986 DOI: 10.1089/tmj.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: This research aims to compare e-health literacy of technology users and nonusers in people with multiple sclerosis (MS) and to investigate whether there are correlations between age, duration of MS, gender, marital status, and e-health total scores. Methods: This descriptive study was carried out with a web-based questionnaire. The questionnaire was sent to 300 patients with MS who were registered at Istanbul University-Cerrahpasa Medical Faculty Neurology Department. Results: A total of 156 people (mean age: 35.33 ± 10.47 years) participated in the survey. Smartphone 98.1% (n = 153) was the mostly used device. Rate of using Google and recommended websites about MS was 94.25% (n = 145) and 73.9% (n = 113), respectively. e-Health literacy of both the tablet and recommended websites users significantly differed from that of nonusers (p = 0.007 for both). Participants' e-health literacy total score was found to weakly, but significantly, correlate with their age, marital status, and education level (rho: -0.161, p = 0.044; rho: 0.172, p = 0.032; rho: -0.192, p = 0.016, respectively). Conclusions: With developments in digital technologies, it is important to identify the access status of people with MS to improve daily clinical management and implement further motor and cognitive rehabilitation. Therefore, determining the health literacy of individuals with MS and providing education on this subject will reduce the information pollution.
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Affiliation(s)
- Anıl Tekeoglu Tosun
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
| | - Cagdas Isiklar
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merve Yildirim
- Department of Psychology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Dilber Karagozoglu Coskunsu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
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Vacchi L, Zirone E, Strina V, Cavaletti G, Ferrarese C. Mobile Applications to Support Multiple Sclerosis Communities: The Post-COVID-19 Scenario. Telemed J E Health 2024. [PMID: 38452336 DOI: 10.1089/tmj.2023.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Introduction: The increase in the use of mobile apps since the COVID-19 pandemic, even among people with multiple sclerosis (PwMS) and health care providers (HCPs), has enabled access to reliable information, symptoms monitoring and management, and social connections. The pandemic has undoubtedly contributed to the acceleration of the "digital revolution." But how far has it progressed for the MS communities? Methods: Italian Google Play and App Store were queried, selecting MS-specific apps in English or Italian language and usable by a wide public. Results: Fifty-four (n = 54) MS-specific apps were identified; most were PwMS-oriented (83%), free of charge (94%), and in English language (76%). The 45 PwMS-oriented apps focused on increasing MS knowledge (71%), tracking symptoms (33%), and promoting networking with peers or HCPs (38%). The 13 HCPs-oriented tools addressed education and updates on MS (62%), disease assessment and management (54%), and research (15%). Google Search tool was also queried to find non-MS-specific apps to fulfill some unmet domains (as sleep, pain, sexual or mental health). Twenty-four additional apps were listed to provide a valuable contribution. Conclusion: The "digital revolution" led to increasingly customized tools for PwMS, especially as m-health or social-networking apps. However, apps to support other specific MS-relevant domains, appealing HCPs-oriented apps, and specific mobile tools for MS caregivers are still lacking. The absence of data assessing the usability and quality of MS apps in ecologically contexts leads to not reliable conclusions about potential benefits. A strong dialogue between MS communities and the digital industry is encouraged to fill this gap.
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Affiliation(s)
- Laura Vacchi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
| | - Eleonora Zirone
- Department of Neuroscience and Mental Health, Neurophysiopathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Strina
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
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Russell RD, Black LJ, Purdue J, Daly A, Begley A. A collaborative approach to designing an online nutrition education program for people with multiple sclerosis. Disabil Rehabil 2024; 46:947-956. [PMID: 36908015 DOI: 10.1080/09638288.2023.2186499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE People with multiple sclerosis (pwMS) want disease-specific dietary advice to reduce the confusion around diet. This study used co-design principles to develop an online nutrition education program for pwMS. METHODS Mixed-methods (multiphase sequential design). Phase 1: online survey (n = 114 pwMS) to explore preferred content and characteristics of a nutrition program and develop a draft program. Phase 2: feedback on the draft program from stakeholders (two meetings; n = 10 pwMS and multiple sclerosis (MS) health professionals) and pwMS (two workshops; n = 6) to produce a full program prototype. Phase 3: cognitive interviews (n = 8 pwMS plus 1 spouse) to explore acceptability and ease of comprehension of one module of the program, analysed using deductive content analysis. RESULTS Preferred topics were included in the program, which were further developed with consumer feedback. Cognitive interviews produced four themes: (1) positive and targeted messaging to motivate behaviour change; (2) "not enough evidence" is not good enough; (3) expert advice builds in credibility; and (4) engaging and appropriate online design elements are crucial. CONCLUSIONS Positive language appears to improve motivation to make healthy dietary changes and engagement with evidence-based nutrition resources. To ensure acceptability, health professionals can use co-design to engage consumers when developing resources for pwMS.IMPLICATIONS FOR REHABILITATIONCo-designed nutrition education programs can help people achieve high-quality diets in line with recommendations, but very few programs exist for people with multiple sclerosis (MS), and none were co-designedThe participatory research in this study was instrumental in ensuring that important information regarding program acceptability was identifiedCo-design can ensure that the language is appropriate for the target audience, and positive language appeared to improve motivation in people with MS to engage with the online nutrition education programWhere practical and feasible, health professionals should collaborate with MS consumers when developing resources, and use positive, empowering language.
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Affiliation(s)
- Rebecca D Russell
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Justine Purdue
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Alison Daly
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Andrea Begley
- Curtin School of Population Health, Curtin University, Perth, Australia
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Polick CS, Darwish H, de Olivera LP, Watson A, Vissoci JRN, Calhoun PS, Ploutz-Snyder R, Connell CM, Braley TJ, Stoddard SA. Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.06.24302405. [PMID: 38370736 PMCID: PMC10871453 DOI: 10.1101/2024.02.06.24302405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Intro Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated. Aim To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience. Methods Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking. Results The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45). Conclusions This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.
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Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- VA Healthcare System, Durham, NC, USA
| | - Hala Darwish
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Ali Watson
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Patrick S Calhoun
- VA Healthcare System, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | | | | | - Tiffany J Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
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Üstündağ S, Yeşilbalkan ÖU, Kabay SC. The effect of a mobile education application (MobilMS) developed for multiple sclerosis patients in Turkey on symptom management and quality of life: A randomized controlled study. Mult Scler Relat Disord 2024; 81:105342. [PMID: 38091808 DOI: 10.1016/j.msard.2023.105342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system (CNS) and is caused by immune dysfunction. MS results in a variety of symptoms that affect physical, emotional, social, and cognitive functioning. Effective symptom management is a critical factor in improving the quality of life (QoL) of patients with MS. PURPOSE To determine the effects of a comprehensive mobile education application developed for Turkish patients with MS on symptom management and QoL. METHODS The study was conducted as a randomized controlled trial and included 63 patients with MS older than 18 years who had an Expanded Disability Status Scale score of ≤6 and were actively using smart phones (intervention group, n = 31; control group, n = 32). Data were collected using a patient information form, the Multiple Sclerosis-Related Symptom (MS-RS) checklist, the Multiple Sclerosis Quality of Life Scale (MSQoL-54), and the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ). The scales were administered three times: at baseline, first month, and third month. Patients with MS in the intervention group were followed up for three months using MobilMS. RESULTS In the intervention group, the mean rating of MobilMS was 8.74±1.29. Most patients indicated that MobilMS was an "informative and useful application". None of the patients in the study reported any side effects or difficulties when using MobilMS application. The mean MSQL-54 score of the intervention group was significantly higher compared to that of the control group at the first and third months (p = 0.001). The mean scores on the MS-RS checklist (p = 0.985), MS-TAQ subscale, Disease modifying therapies (DMT) barriers (p = 0.237), DMT side effects (p = 0.994), DMT coping strategies (p = 0.469), and Missing Doze Rate (MDR) (p = 0.765) were lower in the intervention group than in the control group, but these results were not statistically significant. CONCLUSION The results of the study showed that MobilMS was highly appreciated, accepted, and used by patients with MS. MobilMS has the potential to meet the requirements for a free and accessible symptom management tool for patients with MS. The innovative MobilMS-based education intervention for support and symptom management is recommended as part of supportive care for this patient population. It is hoped that this study will pave the way for future studies on the utility of mobile applications for symptom management in patients with MS.
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Affiliation(s)
- Sema Üstündağ
- Faculty of Health Sciences, Nursing Department, Kütahya Health Sciences University, Kütahya, Turkey.
| | | | - Sibel Canbaz Kabay
- Faculty of Medicine, Department of Neurology, Dokuz Eylül University, İzmir, Turkey
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Praha N, Sriyuktasuth A, Puwarawuttipanit W, Chuengsaman P, Kusakunniran W. Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study. J Med Internet Res 2023; 25:e48623. [PMID: 38051557 PMCID: PMC10731559 DOI: 10.2196/48623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further. OBJECTIVE This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD. METHODS This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses. RESULTS A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (β=.221; P=.002), higher perceived usefulness (β=.414; P<.001), unemployment (β=-.155; P=.03), and positive illness perception (β=-.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (β=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03). CONCLUSIONS This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD.
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Affiliation(s)
- Nattaya Praha
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | | | | | - Worapan Kusakunniran
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
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Guardado S, Mylonopoulou V, Rivera-Romero O, Patt N, Bansi J, Giunti G. An Exploratory Study on the Utility of Patient-Generated Health Data as a Tool for Health Care Professionals in Multiple Sclerosis Care. Methods Inf Med 2023; 62:165-173. [PMID: 37748719 PMCID: PMC10878743 DOI: 10.1055/s-0043-1775718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Patient-generated health data (PGHD) are data collected through technologies such as mobile devices and health apps. The integration of PGHD into health care workflows can support the care of chronic conditions such as multiple sclerosis (MS). Patients are often willing to share data with health care professionals (HCPs) in their care team; however, the benefits of PGHD can be limited if HCPs do not find it useful, leading patients to discontinue data tracking and sharing eventually. Therefore, understanding the usefulness of mobile health (mHealth) solutions, which provide PGHD and serve as enablers of the HCPs' involvement in participatory care, could motivate them to continue using these technologies. OBJECTIVE The objective of this study is to explore the perceived utility of different types of PGHD from mHealth solutions which could serve as tools for HCPs to support participatory care in MS. METHOD A mixed-methods approach was used, combining qualitative research and participatory design. This study includes three sequential phases: data collection, assessment of PGHD utility, and design of data visualizations. In the first phase, 16 HCPs were interviewed. The second and third phases were carried out through participatory workshops, where PGHD types were conceptualized in terms of utility. RESULTS The study found that HCPs are optimistic about PGHD in MS care. The most useful types of PGHD for HCPs in MS care are patients' habits, lifestyles, and fatigue-inducing activities. Although these subjective data seem more useful for HCPs, it is more challenging to visualize them in a useful and actionable way. CONCLUSION HCPs are optimistic about mHealth and PGHD as tools to further understand their patients' needs and support care in MS. HCPs from different disciplines have different perceptions of what types of PGHD are useful; however, subjective types of PGHD seem potentially more useful for MS care.
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Affiliation(s)
- Sharon Guardado
- Empirical Software Engineering (M3S) Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Vasiliki Mylonopoulou
- Division of Human-Computer Interaction, Department Of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Octavio Rivera-Romero
- Department of Electronic Technology, Universidad de Sevilla, Seville, Spain
- Instituto de Investigación en Informática, Universidad de Sevilla, Seville, Spain
- SABIEN Group, ITACA Institute, Universitat Politécnica de Valéncia, Valencia, Spain
| | - Nadine Patt
- Department of Neurology, Kliniken Valens, Rehabilitationszentrum Valens, Valens, Switzerland
| | - Jens Bansi
- Department of Neurology, Kliniken Valens, Rehabilitationszentrum Valens, Valens, Switzerland
| | - Guido Giunti
- Empirical Software Engineering (M3S) Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
- Health Sciences and Technology Unit, Faculty of Medicine, University of Oulu, Finland
- Applied Ergonomics and Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Abrahamsen C, Serritslev R, Myhre Jensen C. Information needs and preferences of patients with an ankle fracture: User involvement study creating an mHealth solution. PATIENT EDUCATION AND COUNSELING 2023; 116:107891. [PMID: 37591014 DOI: 10.1016/j.pec.2023.107891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE The aim of this study was to employ a user-driven participatory design (PD) approach to develop an mHealth solution that addresses patients' information needs after surgical or non-surgical treatment for an ankle fracture. METHODS Patients with an ankle fracture and health care professionals along the treatment pathway in both the hospital and municipality participated in four workshops (WS). RESULTS We found that patients with an ankle fracture need information on topics such as "a typical course," "bandages and assistive devices," "what can I feel," "what may I do," "what to usually worry about," "medicine," "tips and tricks," and "contact information." Moreover, patients requested diverse modes of dissemination, preferably a combination of text, timelines, pictures, animations, and videos. Alpha and beta testing of the digital platform was conducted, and content-related improvements were made. A readability analysis showed reading ease of 40.1 of 100, meaning that it should be easily understood by 15-16 year-olds. CONCLUSION Involving representatives of future users in creating this mHealth solution using PD demonstrates the benefits of creating a solution that aligns with users' needs. PRACTICE IMPLICATIONS The mHealth solution is now ready for implementation and large-scale evaluation in phase three of the overall PD study. An mHealth usability questionnaire will be employed to assess usability by future patients with surgically or non-surgically treated ankle fractures.
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Affiliation(s)
- Charlotte Abrahamsen
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding Hospital, Denmark; Department of Regional Health, University of Southern Denmark, Odense, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Serritslev
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding Hospital, Denmark
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Kutzinski M, Krause N, Riemann-Lorenz K, Meyer B, Heesen C. Acceptability of a digital health application to empower persons with multiple sclerosis with moderate to severe disability: single-arm prospective pilot study. BMC Neurol 2023; 23:382. [PMID: 37872471 PMCID: PMC10591383 DOI: 10.1186/s12883-023-03434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Many persons with multiple sclerosis (pwMS) desire to learn how health behaviour changes (e.g., dietary adjustments, physical activity, improvements in stress management) might help them manage their disease. Previous research has shown that certain health behaviour changes can improve quality of life (QoL), fatigue and other MS outcomes. Digital health applications may be well suited to deliver relevant health behavioural interventions because of their accessibility and flexibility. The digital health application "levidex" was designed to facilitate health behaviour change by offering evidence-based patient information and cognitive-behavioural therapy techniques to pwMS. By doing so, levidex aims to improve QoL and MS symptoms such as fatigue and mental health. OBJECTIVES A previous study reported on the development of levidex; this non-randomised pilot study examined the feasibility (practicability and acceptability) of levidex in pwMS with moderate to severe disability. Furthermore, the intervention's impact on empowerment, stress management, and relevant health behaviours (e.g., dietary behaviour, physical activity) was explored. METHODS levidex was originally developed for newly diagnosed pwMS in the first year after diagnosis and eventually modified to offer access to pwMS with moderate to severe disability. Participants (n = 43) with an Expanded Disability Status Scale between 3.5 and 7.5 and a disease duration of more than one year were eligible to participate. The intervention was used over a period of six months with measurement time points at baseline, month 3 and month 6. RESULTS Out of 38 participants who completed the six-month intervention period, 18 (47.4%) completed all 16 modules and 9 (23.7%) reached modules 13-16, the long-term maintenance part of levidex. Participants rated levidex positively in terms of practicability and acceptability and had only few points of criticism such as to include more physical exercise routine suggestions suitable for participants with severe impairment. Data on secondary endpoints showed no significant changes. CONCLUSION This pilot study provided evidence for the practicability and acceptability of levidex, a digital health application designed to facilitate health behaviour change in pwMS with moderate to severe disability. Adequately powered randomised controlled studies with longer follow-up periods are needed to clarify the benefit of levidex in pwMS with moderate to severe disability. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00032667 (14/09/2023); Retrospectively registered.
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Affiliation(s)
- Max Kutzinski
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Björn Meyer
- Research and Development Department, GAIA Group, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Daniel N, Bruns I, Casey B, Coote S, Daubmann A, Heesen C, Riemann-Lorenz K. "Activity Matters was great - I now realize: if I move, I'm fitter.": development and process evaluation of a web-based program for persons with multiple sclerosis. Disabil Rehabil 2023:1-10. [PMID: 37861220 DOI: 10.1080/09638288.2023.2269845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Research shows that persons with mild to moderate multiple sclerosis are less physically active than healthy controls even though they would benefit from it. This study focusses on the feasibility testing and process evaluation of the pilot study of Activity Matters, a twelve-week web-based program, from Ireland, to increase physical activity in this population. MATERIALS AND METHODS The intervention was adapted to local circumstances in Hamburg, Germany and consists of eleven modules incorporating behavior change techniques. After feasibility had been confirmed, 43 persons with multiple sclerosis participated in a pilot study with a pre-post, single-group intervention design. Qualitative data was collected with questionnaires and semi structured interviews. Physical activity level and stage of change was measured quantitatively. RESULTS Participants had a mean age of 49.5 years (SD 9.29) and an average Patient Determined Disease Step Score of 2.2 (SD 1.47). Thirty-six participants answered the follow-up questionnaire. On average 9.8 modules were processed within 13 weeks. Each tool for behavior change was perceived as helpful except the chat group. Physical activity levels increased significantly from pre- to post intervention (p-value 0.042, Cohen's d = 0.35). CONCLUSIONS The results indicate that Activity Matters is feasible and satisfactory and may change activity levels.
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Affiliation(s)
- N Daniel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - I Bruns
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - B Casey
- Healthy Eating Active Living Programme, Health and Wellbeing Division, HSE, Dublin, Ireland
| | - S Coote
- MS Society and Physical Activity for Health Group, Health Research Institute, Limerick, Ireland
| | - A Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - K Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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12
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Polick CS, Ploutz-Snyder R, Braley TJ, Connell CM, Stoddard SA. Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress. PLoS One 2023; 18:e0292233. [PMID: 37851620 PMCID: PMC10584096 DOI: 10.1371/journal.pone.0292233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive, autoimmune disease of the central nervous system that affects nearly one million Americans. Despite the existence of immunomodulatory therapies to slow physical and cognitive disability progression, interventions to ameliorate common symptoms of MS, including fatigue and pain, remain limited. Poor understanding of risk factors for these symptoms may contribute to treatment challenges. In recent years, childhood stress has been investigated as a risk factor for chronic autoimmune conditions including MS; yet remarkably few studies have investigated the relationship between childhood stressors and chronic MS symptoms. Our aim was to examine clusters of stressors and three key features of MS: fatigue, pain interference, and psychiatric morbidity. METHODS Cross-sectional data were collected from a sample of People with MS (PwMS) via a national web-based survey that assessed the presence and type of childhood stressors and MS clinical features. Hierarchical block regression was used to assess associations among emotional, physical, and environmental childhood stressors and three clinical features commonly experienced by PwMS. RESULTS N = 719 adults with MS (aged 21-85) completed the survey. Childhood emotional and physical stressors were significantly associated with overall presence of fatigue (p = 0.02; p<0.03) and pain interference (p<0.001; p<0.001) in adulthood, as well as the magnitude of both outcomes. Environmental stressors (p<0.001), in addition to emotional (p<0.001) and physical (p<0.001) stressors were significantly associated with psychiatric morbidity in PwMS. CONCLUSION Childhood stress may predict fatigue, psychiatric morbidity, and pain in adults with MS. Further research is needed to show cause and effect; however, if an association exists, strategies to mitigate the impact of childhood stress could offer new pathways to reduce the severity of these symptoms. Broadly, this work adds to the body of evidence supporting upstream preventive measures to help address the stress on children and families.
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Affiliation(s)
- Carri S. Polick
- School of Nursing, Duke University, Durham, NC, United States of America
- Durham VA Health Care System, Durham, NC, United States of America
| | - Robert Ploutz-Snyder
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Tiffany J. Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Cathleen M. Connell
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Sarah A. Stoddard
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
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13
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Titcomb TJ, Sherwood M, Ehlinger M, Saxby SM, Shemirani F, Eyck PT, Wahls TL, Snetselaar LG. Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial. Mult Scler Relat Disord 2023; 77:104858. [PMID: 37399671 PMCID: PMC11071624 DOI: 10.1016/j.msard.2023.104858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/22/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Wellness is a promising area of research in multiple sclerosis (MS); however, considerable questions remain regarding the efficacy of behavioral interventions to improve wellness and which delivery methods yield favorable results. OBJECTIVE To evaluate the efficacy of a wellness intervention consisting of diet, stress reduction techniques, sleep hygiene, and exercise, delivered via a 7-week web-based program with no tailored intervention support (e.g., counseling or resources) from the study team, on quality of life (QoL) and fatigue among people with MS. METHODS Individuals (n = 100) with self-reported physician's diagnosis of relapsing-remitting MS or clinically isolated syndrome were recruited to enroll in this randomized waitlist-control trial consisting of three timepoints at 0, 12, and 24 weeks. Participants were randomized to begin the intervention at baseline (INT; n = 51) or to a waitlist to begin the intervention after the 12-week timepoint (WLC; n = 49), and both groups were followed for 24 weeks. RESULTS At 12-weeks, 95 participants (46 INT and 49 WLC) completed the primary endpoint and 86 (42 INT and 44 WLC) completed the 24-week follow-up. Compared to baseline, the INT group had a significant increase in physical QoL (5.43 ± 1.85; P = 0.003) at 12-weeks which was maintained at 24-weeks. Physical QoL values in the WLC group did not significantly increase between weeks 12 and 24 (3.24 ± 2.03; P = 0.11); however, physical QoL values significantly improved compared to week 0 values (4.00 ± 1.87; P = 0.033). Neither group had significant changes in mental QoL. The INT group had a mean baseline to 12-week change of ‑5.06 ± 1.79 (P = 0.005) for MFIS and -0.68 ± 0.21 (P = 0.002) for FSS, both of which were maintained at 24-weeks. The 12- to 24-week changes for the WLC group were -4.50 ± 1.81 (P = 0.013) for MFIS and -0.44 ± 0.17 (P = 0.011) for FSS. At 12-weeks, the INT group had significantly greater reductions in fatigue compared to the WLC (P = 0.009 for both MFIS and FSS). There were no between-group mean differences for physical or mental QoL, but a significantly higher proportion of participants had clinically significant improvement in physical QoL in the INT group (50%) compared to the WLC group (22.5%) at 12-weeks (P = 0.006). The 12-week intervention effect was similar during the active intervention phase (i.e., baseline to 12 weeks for INT and 12 to 24 weeks for WLC) in each group. Course completion rates significantly differed between groups with 47.9% of the INT group and 18.8% of the WLC group completing the course (P = 0.01). CONCLUSION A wellness intervention delivered via a web-based program, without tailored support, resulted in significant improvements in fatigue compared to control. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05057676.
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Affiliation(s)
- Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
| | - Max Sherwood
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary Ehlinger
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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von Kalckreuth N, Feufel MA. Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany. JMIR Hum Factors 2023; 10:e45503. [PMID: 37585259 PMCID: PMC10468710 DOI: 10.2196/45503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/13/2023] [Accepted: 06/21/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances. OBJECTIVE This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies. METHODS A survey study was conducted to empirically validate our model, using a case vignette as cover story. Data were collected from 250 German participants and analyzed using a covariance-based structural equation model. RESULTS The model explains R2=79.3% of the variance in intention to use. The 3 main factors (social norms, attitude to privacy, and perceived control over personal data) influenced the intention to use mHealth apps, albeit partially indirectly. The intention to use mHealth apps is driven by the perceived benefits of the technology, trust in the provider, and social norms. Privacy concerns have no bearing on the intention to use. The attitude to privacy has a large inhibiting effect on perceived benefits, as well as on trust in the provider. Perceived control over personal data clearly dispels privacy concerns and supports the relationship of trust between the user and the provider. CONCLUSIONS Based on the privacy calculus, our domain-specific model explains the intention to use mHealth apps better than previous, more general models. The findings allow health care providers to improve their products and to increase usage by targeting specific user groups.
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Affiliation(s)
- Niklas von Kalckreuth
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
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15
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Moreno-Ligero M, Lucena-Anton D, Salazar A, Failde I, Moral-Munoz JA. mHealth Impact on Gait and Dynamic Balance Outcomes in Neurorehabilitation: Systematic Review and Meta-analysis. J Med Syst 2023; 47:75. [PMID: 37462759 PMCID: PMC10354142 DOI: 10.1007/s10916-023-01963-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
Gait and dynamic balance are two main goals in neurorehabilitation that mHealth systems could address. To analyze the impact of using mHealth systems on gait and dynamic balance outcomes in subjects with neurological disorders. Randomized controlled trials (RCT) published in PubMed, Web of Science, Scopus, and PEDro databases were searched up to April 2023. Studies including adults with neurological disorders, analyzing the effectiveness of mHealth systems on gait and dynamic balance compared with conventional therapy and/or not intervention, were included. The PEDro scale and the Cochrane Collaboration's 2.0 tool were used for the methodological quality and risk of bias assessment. The Review Manager 5.4 software was used to obtain meta-analyses. 13 RCT were included in the systematic review and 11 in the meta-analyses, involving 528 subjects. A total of 21 mobile applications were identified for gait and balance training, and to enhance physical activity behaviors. There were significant differences in gait parameters, speed by 0.10 s/m (95% confidence interval (CI)=0.07,0.13;p<0.001), cadence by 8.01 steps/min (95%CI=3.30,12.72;p<0.001), affected step length by 8.89 cm (95%CI=4.88,12.90;p<0.001), non-affected step length by 8.08 cm (5%CI=2.64,13.51;p=0.004), and in dynamic balance, Timed Up and Go by -7.15 s (95%CI=-9.30,-4.99;p<0.001), and mobility subscale of Posture Assessment Scale for Stroke by 1.71 points (95%CI=1.38,2.04;p<0.001). Our findings suggested the use of mHealth systems for improving gait in subjects with neurological disorders, but controversial results on dynamics balance recovery were obtained. However, the quality of evidence is insufficient to strongly recommend them, so further research is needed.
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Affiliation(s)
- Marta Moreno-Ligero
- Department of Biomedicine, Biotechnology and Public Health, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009, Cadiz, Spain
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009, Cadiz, Spain.
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), University of Cadiz, 11009, Cadiz, Spain.
| | - Alejandro Salazar
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), University of Cadiz, 11009, Cadiz, Spain
- Department of Statistics and Operational Research, School of Engineering, University of Cadiz, 11510, Puerto Real, Cadiz, Spain
| | - Inmaculada Failde
- Department of Biomedicine, Biotechnology and Public Health, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), University of Cadiz, 11009, Cadiz, Spain
| | - Jose A Moral-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), University of Cadiz, 11009, Cadiz, Spain
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16
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Howard Z, Win KT, Guan V. Mobile apps used for people living with multiple sclerosis: A scoping review. Mult Scler Relat Disord 2023; 73:104628. [PMID: 37003008 DOI: 10.1016/j.msard.2023.104628] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurodegenerative disorder. People living with MS (plwMS) require long-term, multidisciplinary care in both clinical and community settings. MS-specific mHealth interventions have advanced in the form of clinical treatments, rehabilitation, disease monitoring and self-management of disease. However, mHealth interventions for plwMS appear to have limited proof of clinical efficacy. As native mobile apps target specific mobile operating systems, they tend to have better interactive designs leveraging platform-specific guidelines. Thus, to improve such efficacy, it is pivotal to explore the design characteristics of native mobile apps used for plwMS. OBJECTIVES This study aimed to explore the design characteristics of native mobile apps used for adults living with MS in academic settings. METHODS A scoping review of studies was conducted. A literature search was performed through PubMed, CINAHL, MEDLINE and Cochrane Library. Per native mobile apps, characteristics, persuasive technology elements and evaluations were summarized. RESULTS A total of 14 native mobile apps were identified and 43% of the identified apps were used for data collection (n=6). Approximately 70% of the included apps involved users (plwMS) whilst developing (n=10). A total of three apps utilized embedded sensors. Videos or photos were used for physical activity interventions (n=2) and gamification principles were applied for cognitive and/or motor rehabilitation interventions (n=3). Behavior change theories were integrated into the design of the apps for fatigue management and physical activity. Regarding persuasive technology, the design principles of primary support were applied across all identified apps. The elements of dialogue support and social support were the least applied. The methods for evaluating the identified apps were varied. CONCLUSION The findings suggest that the identified apps were in the early stages of development and had a user-centered design. By applying the persuasive systems design model, interaction design qualities and features of the identified mobile apps in academic settings were systematically evaluated at a deeper level. Identifying the digital functionality and interface design of mobile apps for plwMS will help researchers to better understand interactive design and how to incorporate these concepts in mHealth interventions for improvement of clinical efficacy.
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Affiliation(s)
- Zahli Howard
- School of Indigenous, Medical and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Khin Than Win
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Vivienne Guan
- School of Indigenous, Medical and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.
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17
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Factors associated with the perceptions of eHealth technology of Chinese nurses and nursing students. Nurse Educ Pract 2023; 69:103605. [PMID: 37028224 DOI: 10.1016/j.nepr.2023.103605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/01/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
AIM The current study sought to assess the perceptions of eHealth technology of nurses and nursing students in China and to examine the association between these perceptions and demographic factors. BACKGROUND Despite the increasing use of eHealth technologies in China and across the globe, the perceptions of practicing and student nurses remain minimally explored. Findings from such an inquiry can potentially inform actions and policies to improve the uptake of eHealth technologies among Chinese nurses. DESIGN This was a cross-sectional study with a real-time online survey. METHODS A convenience sample of 1338 nurses and nursing students from Mainland China participated in the study. Their perceptions of eHealth technology were collected using the Chinese version of the Perceptions of eHealth Technology Scale. The Kruskal-Wallis test and multiple linear regression analysis were used to examine the relationship between demographic variables (age group, gender, occupation, education level, position and clinical experience) and perceptions of eHealth technology. All study procedures adhered to the STROBE guidelines. RESULTS Most participants were aged between 20 and 29 (55.8%). Nearly half (42.5%) were frontline clinical nursing staff, some were nursing students (36.2%), academic nursing staff (12.3%) and clinical nursing management staff (9.0%). Regardless of the differences in their demographic characteristics, the participants had higher mean scores in "Perception of eHealth applications" and lower mean scores in "Knowledge of eHealth technology". Participants with doctoral degree had a higher mean total score and higher sub-scale scores in knowledge of eHealth technology, perception of the advantages of eHealth technology and perception of eHealth applications; and the lowest scores in perception of the disadvantages of eHealth technology and perception of eHealth applications. Occupation, position and clinical experience were found to be the demographic characteristics associated with eHealth perceptions, before adjusting for age and gender. Education level was associated with eHealth perceptions regardless of adjustment. CONCLUSION Overall, participants had higher scores on perceptions of eHealth applications but lower scores on knowledge of eHealth technology. Considering the association between education and all subscales and overall scores, it may be essential to implement continuing professional education for nurses to improve their knowledge of eHealth applications. Encouragement to use available eHealth digital technologies may also be helpful to improve perceptions of eHealth.
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18
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Christ M, Schuh K, Bayas A. Large-scale cross-sectional online survey on patient-neurologist communication, burden of disease assessment and disease monitoring in people with multiple sclerosis. Front Neurol 2023; 13:1093352. [PMID: 36686532 PMCID: PMC9848394 DOI: 10.3389/fneur.2022.1093352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background Management of multiple sclerosis (MS) requires a high level of communication between health care professionals (HCPs) and people with MS (pwMS) including profound investigation and discussion of symptoms to identify therapeutic needs. For treatment decisions, monitoring of disease activity is important, in this respect self-monitoring devices and apps, as well as magnetic resonance imaging are important tools. Methods MS Perspectives is a cross-sectional online survey conducted in Germany which was designed to collect data, among others, on the communication between pwMS and HCPs regarding treatment goals, symptom assessment, usage of devices and apps to self-monitor health functions, as well as to identify patients' attitude toward the role of magnetic resonance imaging (MRI). Between December 2021 and February 2022, 4,555 pwMS completed the survey. Results In total, 63.7% of participants reported that treatment goals have been discussed with their HCPs. Symptoms worsening in the past 12 months independent of relapses was more often reported by pwMS than inquired by HCPs, according to patients' report. Devices or apps for health monitoring were used by less than half of participants. Frequency of MRI controls was much lower in participants with longer compared to shorter disease duration (47.5 vs. 86.3%). The proportion of patients with annual or semiannual scans was highest among pwMS receiving infusion therapy (93.5%), followed by oral medication (82.5%) and injectables (73.4%), and lowest for pwMS without immunotherapy (58.2%). Conclusion MS Perspectives identified a rather low patient involvement regarding treatment goals and symptom assessment in clinical practice. Regarding this and our findings for health self-monitoring and MRI usage, strategies for improving patient-HCP communication and disease monitoring may be considered.
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Affiliation(s)
- Monika Christ
- Department of Neurology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | - Antonios Bayas
- Department of Neurology, Faculty of Medicine, University of Augsburg, Augsburg, Germany,*Correspondence: Antonios Bayas ✉
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19
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Krause N, Riemann-Lorenz K, Rahn AC, Pöttgen J, Köpke S, Meyer B, Thale F, Temmes H, van de Loo M, Gold SM, Heesen C. 'That would have been the perfect thing after diagnosis': development of a digital lifestyle management application in multiple sclerosis. Ther Adv Neurol Disord 2022; 15:17562864221118729. [PMID: 36092248 PMCID: PMC9459469 DOI: 10.1177/17562864221118729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background A multiple sclerosis (MS) diagnosis urges decision-making on immunotherapies, while persons with MS (PwMS) need to develop a coping concept in parallel. At this stage, PwMS ask how they themselves may contribute to controlling the disease. Evidence suggests that maintaining a healthy lifestyle (e.g. physical activity and stress management) is a key factor for healthy aging and preserving activity, while data on MS are complex. Objectives Following the Medical Research Council framework, this study aimed to develop and investigate the feasibility of a new digital health application that conveys evidence-based patient information about lifestyle factors in MS and engages PwMS in relevant behaviour change techniques. Methods Based on a digital health application promoting lifestyle management in breast cancer survivors, an MS-specific adaptation ('levidex') was developed. Feasibility was tested with 15 PwMS and eight MS experts. Subsequently, a six-week pilot study with eight PwMS was conducted. All participants provided feedback on practicability and acceptability via a questionnaire and took part in a semi-structured telephone interview. Levidex was revised after each test phase. Results The final levidex tool includes 16 modules, 177 references and several other functions. Feasibility results showed that PwMS and MS experts perceived levidex as understandable (14 out of 15; 6 out of 8), trustworthy (15 out of 15; 8 out of 8), and relevant (10 out of 15; 8 out of 8). Interviews revealed potential for improvement regarding the length and complexity of some content. Piloting of the revised version confirmed good feasibility and high acceptance. Most participants felt inspired to initiate (7 out of 8) or had already implemented (5 out of 8) lifestyle changes after working with levidex. Conclusion Results suggest that levidex is feasible and well-accepted by PwMS and MS experts. It might be a useful tool to support PwMS in adapting to their diagnosis and initiating health-promoting lifestyle changes.
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Affiliation(s)
- Nicole Krause
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf,
Martinistraße 52, 20246 Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Nursing Research Unit, Institute for Social
Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Department of Neurology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of
Medicine, University of Cologne and University Hospital Cologne, Cologne,
Germany
| | - Björn Meyer
- Research and Development Department, GAIA
Group, Hamburg, Germany
| | - Frithjof Thale
- Research and Development Department, GAIA
Group, Hamburg, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society, Federal
Association, Hannover, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Society, Federal
Association, Hannover, Germany
| | - Stefan M. Gold
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Charité–Universitätsmedizin Berlin, Klinik für
Psychiatrie und Psychotherapie und Med. Klinik m.S. Psychosomatik, Berlin,
Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Department of Neurology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Aqib A, Lebouché B, Engler K, Schuster T. Feasibility of a Platform Trial Design for the Development of Mobile Health Applications: A Review. Telemed J E Health 2022; 29:501-509. [PMID: 35951018 DOI: 10.1089/tmj.2021.0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A novel adaptive trial design called platform trials (PTs) may offer an effective, efficient, and unbiased approach to evaluate different developer versions of mobile health (m-health) apps. However, the feasibility of their use for this purpose is yet to be explored. Objective: This literature review aims to explore the reported challenges associated with the adaptive PT design to assess its feasibility for the development of m-health apps. Methods: A descriptive literature review using two databases (MEDLINE and Embase) was conducted. Documents published in English between 1947 and September 20, 2020, were eligible for inclusion. Results: The titles and abstracts of 758 records were screened after which 179 full-text articles were assessed for eligibility. A total of 41 articles were included in the synthesis, all published after the year 2000. The synthesis yielded eight distinct categories of challenging issues with PTs relevant to their application in m-health app development, along with potential solutions. These categories are ethical issues (e.g., related to informed consent, equipoise, justice) (with 19 articles contributing content), biases (7 articles), temporal drift (4 articles), miscellaneous statistical issues (3 articles), logistical issues (e.g., cost and human resources, frequent amendments; 6 articles), sample size and power conflict (2 articles), generalizability of the results (2 articles), and operational challenges (1 article). Conclusion: Although PT designs are relatively new, they have promising feasibility for the seamless evaluation of interventions that undergo continuous development, including m-health apps; however, various challenges may hinder their successful implementation.
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Affiliation(s)
- Asma Aqib
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Department of Internal Medicine, University of Alabama, Montgomery, Alabama, USA
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, Canada.,Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Inequity in Access and Delivery of Virtual Care Interventions: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159411. [PMID: 35954768 PMCID: PMC9367842 DOI: 10.3390/ijerph19159411] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/27/2023]
Abstract
The objectives of this review were to map and summarize the existing evidence from a global perspective about inequity in access and delivery of virtual care interventions and to identify strategies that may be adopted by virtual care services to address these inequities. We searched MEDLINE, EMBASE, and CINAHL using both medical subject headings (MeSH) and free-text keywords for empirical studies exploring inequity in ambulatory services offered virtually. Forty-one studies were included, most of them cross-sectional in design. Included studies were extracted using a customized extraction tool, and descriptive analysis was performed. The review identified widespread differences in accessing and using virtual care interventions among cultural and ethnic minorities, older people, socioeconomically disadvantaged groups, people with limited digital and/or health literacy, and those with limited access to digital devices and good connectivity. Potential solutions addressing these barriers identified in the review included having digitally literate caregivers present during virtual care appointments, conducting virtual care appointments in culturally sensitive manner, and having a focus on enhancing patients’ digital literacy. We identified evidence-based practices for virtual care interventions to ensure equity in access and delivery for their virtual care patients.
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22
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Marrie RA, Kosowan L, Cutter G, Fox R, Salter A. Disparities in Telehealth Care in Multiple Sclerosis. Neurol Clin Pract 2022; 12:223-233. [DOI: 10.1212/cpj.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives:The COVID-19 pandemic has dramatically increased telehealth use. We assessed access to and use of telehealth care including videoconferencing, and usability of videoconferencing among persons with multiple sclerosis (MS).Methods:In Fall 2020, we surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants reported availability and receipt of MS care or education through telehealth. Participants who completed ≥1 live videoconferencing visit completed the Telehealth Usability Questionnaire (TUQ). We tested factors associated with access to and receipt of telehealth care using logistic regression. We tested factors associated with TUQ scores using quantile regression.Results:Of the 8434 participants to whom the survey was distributed, 6043 responded (71.6%); 5403 were eligible for analysis. Of the respondents, 4337 (80.6%) were women, and they had a mean (SD) age of 63.2 (10.0) years. Overall, 2889 (53.5%) reported access to MS care via telehealth, 2110 (39.1%) reported receipt of MS care via telehealth including 1523 (28%) via videoconference. Among participants who reported telehealth was available, older age was associated with decreased odds of having a telehealth video visit; higher income and being physically active were associated with increased odds. Older age and moderate to very severe visual symptoms were associated with lower perceived usability of telehealth.Conclusion:Older age, lower socioeconomic status and disease-related impairments are associated with less access to and use of telehealth services in people with MS. Barriers to telehealth should be addressed to avoid aggravating health care disparities when using digital medicine.
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23
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Bevens W, Weiland T, Gray K, Jelinek G, Neate S, Simpson-Yap S. Attrition Within Digital Health Interventions for People With Multiple Sclerosis: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e27735. [PMID: 35138262 PMCID: PMC8867299 DOI: 10.2196/27735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/06/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
Background Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition. Objective This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS—digital health interventions that were intended to support a program of engagement over a defined period—and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs). Methods We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators. Results There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively. Conclusions This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Tracey Weiland
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Carlton, Australia
| | - George Jelinek
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Sandra Neate
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Steve Simpson-Yap
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
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24
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UZDİL Z, TÜRKER PF, TERZİ M. Effects of nutrition education given to persons with multiple sclerosis and their families on diet quality and anthropometric and biochemical measurements. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e220153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
ABSTRACT Objective: In this study, it was aimed to investigate the effects of nutrition education given to persons with multiple sclerosis and their families on anthropometric and biochemical measurements and diet quality. Methods: Data from 51 persons with multiple sclerosis were analysed in this intervention study. The study was conducted with 3 groups. The education group consisted of only persons with multiple sclerosis, the family education group consisted of persons with multiple sclerosis and a family member living with them, and the control group consisted of persons with multiple sclerosis who had not received an education. Anthropometric and biochemical measurements and dietary quality assessments were made before (T1) and immediately after education (T2) and also 3 months after education (follow-up, T3). Results: The distribution of family education group diet quality scores showed a significant increase from “poor” to “needs improvement” at T3 compared to T1. The upper middle arm circumference measurements of the female control group were decreased at T2 and T3 [from 29.0 (23-34) cm to 28.0 (22-31) cm and to 27.5 (22-31) cm]. Women in family education group, levels of serum haemoglobin and haematocrit were higher than in control group at T2 and T3. Also, men in family education group, levels of alanine aminotransferase were lower than those in education group at follow up. Levels of total cholesterol and low-density lipoprotein cholesterol in education group were higher than those control group at T1, T2, and T3. Conclusion: This study indicates that nutrition education affects some biochemical and anthropometric measurements in persons with multiple sclerosis. Diet quality improved when receiving education together with families.
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25
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Keszler P, Maloni H, Miles Z, Jin S, Wallin M. Telemedicine and Multiple Sclerosis: A Survey of Health Care Providers Before and During the COVID-19 Pandemic. Int J MS Care 2022; 24:266-270. [PMID: 36545646 PMCID: PMC9749831 DOI: 10.7224/1537-2073.2021-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Telemedicine provides a gateway to specialty care that, otherwise, patients with multiple sclerosis (MS) could have difficulty accessing. Studies have shown that telemedicine provides a valid alternative to in-person visits. There are limited data on the strengths and limitations of telemedicine from the perspective of MS providers. METHODS After reviewing the literature and pilot testing questions about telemedicine in provider focus groups, a 34-question survey was created on the Qualtrics web platform. A stratified sample of MS providers throughout the United States was recruited to participate. The survey initiated in November 2019 and closed in November 2020. RESULTS Survey participants (N = 94) included neurologists (43.0%), advanced practice providers (28.0%), nurses (14.0%), mental health providers (7.0%), social workers (3.0%), rehabilitation providers (4.0%), and pharmacists (1.0%). Clinical video telemedicine (CVT) was the most commonly used platform, and 76.6% of respondents indicated that they used telemedicine to care for patients with MS. As a result of the COVID-19 pandemic, the rate of telemedicine use increased from 44.4% to 84.2%. Most health care providers (93.0%) were "very satisfied" or "somewhat satisfied" with their most recent telemedicine visit, and 94.4% of providers reported a desire to continue using telemedicine, although 84.6% found it difficult to perform a full examination. CONCLUSIONS There was a large uptick in the use of telemedicine when the COVID-19 pandemic forced clinics to cease in-person visits. Providers predominantly used CVT; store-and-forward telemedicine and remote patient monitoring have fewer technical issues than CVT and seem to be underused.
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Affiliation(s)
- Peter Keszler
- From the Department of Neurology, Johns Hopkins University, Baltimore, MD, USA (PK)
| | - Heidi Maloni
- Veteran's Administration Multiple Sclerosis Center of Excellence-East, Baltimore, MD, and Washington, DC, USA (HM, ZM, SJ, MW)
| | - Zipporah Miles
- Veteran's Administration Multiple Sclerosis Center of Excellence-East, Baltimore, MD, and Washington, DC, USA (HM, ZM, SJ, MW)
| | - Shan Jin
- Veteran's Administration Multiple Sclerosis Center of Excellence-East, Baltimore, MD, and Washington, DC, USA (HM, ZM, SJ, MW)
| | - Mitchell Wallin
- Veteran's Administration Multiple Sclerosis Center of Excellence-East, Baltimore, MD, and Washington, DC, USA (HM, ZM, SJ, MW),Department of Neurology, George Washington University, Washington, DC, USA (MW)
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26
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Thomas S, Pulman A, Dogan H, Jiang N, Passmore D, Pretty K, Fairbanks B, Davies Smith A, Thomas PW. Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study. JMIR Form Res 2021; 5:e19230. [PMID: 34889744 PMCID: PMC8704114 DOI: 10.2196/19230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/29/2020] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages. Methods Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue.
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Affiliation(s)
- Sarah Thomas
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Andy Pulman
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Huseyin Dogan
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Nan Jiang
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - David Passmore
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Keith Pretty
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Beth Fairbanks
- Department of Computing & Informatics, Faculty of Science & Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Angela Davies Smith
- Bristol & Avon Multiple Sclerosis Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Peter W Thomas
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
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27
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Lang M, Lemieux S, Hébert J, Sauvageau G, Zawati MH. Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review. J Med Internet Res 2021; 23:e26450. [PMID: 34762055 PMCID: PMC8663501 DOI: 10.2196/26450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/17/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. Objective This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. Methods This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O’Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. Results We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. Conclusions We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care.
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Affiliation(s)
- Michael Lang
- Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Sébastien Lemieux
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Josée Hébert
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,The Leucegene Project at Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada.,Division of Hematology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Guy Sauvageau
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Division of Hematology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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28
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Alexander S, Peryer G, Gray E, Barkhof F, Chataway J. Wearable technologies to measure clinical outcomes in multiple sclerosis: A scoping review. Mult Scler 2021; 27:1643-1656. [PMID: 32749928 PMCID: PMC8474332 DOI: 10.1177/1352458520946005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 11/15/2022]
Abstract
Wearable technology refers to any sensor worn on the person, making continuous and remote monitoring available to many people with chronic disease, including multiple sclerosis (MS). Daily monitoring seems an ideal solution either as an outcome measure or as an adjunct to support rater-based monitoring in both clinical and research settings. There has been an increase in solutions that are available, yet there is little consensus on the most appropriate solution to use in either MS research or clinical practice. We completed a scoping review (using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines) to summarise the wearable solutions available in MS, to identify those approaches that could potentially be utilised in clinical trials, by evaluating the following: scalability, cost, patient adaptability and accuracy. We identified 35 unique products that measure gait, cognition, upper limb function, activity, mood and fatigue, with most of these solutions being phone applications.
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Affiliation(s)
- Sarah Alexander
- Queen Square MS Centre and Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK
| | - Guy Peryer
- School of Health Sciences, University of East
Anglia, Norwich, UK
| | - Emma Gray
- The Multiple Sclerosis Society, London, UK
| | - Frederik Barkhof
- Queen Square MS Centre and Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK/Centre for Medical Image
Computing (CMIC), Department of Medical Physics and Biomedical Engineering,
University College London, London, UK/National Institute for Health Research
(NIHR), Biomedical Research Centre, University College London Hospitals
(UCLH), London, UK/Department of Radiology and Nuclear Medicine, VU
University Medical Centre, Amsterdam, The Netherlands
| | - Jeremy Chataway
- Queen Square MS Centre and Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK/National Institute for
Health Research (NIHR), Biomedical Research Centre, University College
London Hospitals (UCLH), London, UK/MRC CTU at UCL, Institute of Clinical
Trials and Methodology, University College London, London, UK
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29
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Detection of Health-Related Events and Behaviours from Wearable Sensor Lifestyle Data Using Symbolic Intelligence: A Proof-of-Concept Application in the Care of Multiple Sclerosis. SENSORS 2021; 21:s21186230. [PMID: 34577437 PMCID: PMC8470200 DOI: 10.3390/s21186230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
In this paper, we demonstrate the potential of a knowledge-driven framework to improve the efficiency and effectiveness of care through remote and intelligent assessment. More specifically, we present a rule-based approach to detect health related problems from wearable lifestyle sensor data that add clinical value to take informed decisions on follow-up and intervention. We use OWL 2 ontologies as the underlying knowledge representation formalism for modelling contextual information and high-level concepts and relations among them. The conceptual model of our framework is defined on top of existing modelling standards, such as SOSA and WADM, promoting the creation of interoperable knowledge graphs. On top of the symbolic knowledge graphs, we define a rule-based framework for infusing expert knowledge in the form of SHACL constraints and rules to recognise patterns, anomalies and situations of interest based on the predefined and stored rules and conditions. A dashboard visualizes both sensor data and detected events to facilitate clinical supervision and decision making. Preliminary results on the performance and scalability are presented, while a focus group of clinicians involved in an exploratory research study revealed their preferences and perspectives to shape future clinical research using the framework.
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30
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Haase R, Voigt I, Scholz M, Schlieter H, Benedict M, Susky M, Dillenseger A, Ziemssen T. Profiles of eHealth Adoption in Persons with Multiple Sclerosis and Their Caregivers. Brain Sci 2021; 11:brainsci11081087. [PMID: 34439706 PMCID: PMC8392753 DOI: 10.3390/brainsci11081087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023] Open
Abstract
(1) Background: Persons with multiple sclerosis (pwMS) are often characterized as ideal adopters of new digital healthcare trends, but it is worth thinking about whether and which pwMS will be targeted and served by a particular eHealth service like a patient portal. With our study, we wanted to explore needs and barriers for subgroups of pwMS and their caregivers when interacting with eHealth services in care and daily living. (2) Methods: This study comprises results from two surveys: one collecting data from pwMS and their relatives (as informal caregivers) and another one providing information on the opinions and attitudes of healthcare professionals (HCPs). Data were analyzed descriptively and via generalized linear models. (3) Results: 185 pwMS, 25 informal caregivers, and 24 HCPs in the field of MS participated. Nine out of ten pwMS used information technology on a daily base. Individual impairments like in vision and cognition resulted in individual needs like the desire to actively monitor their disease course or communicate with their physician in person. HCPs reported that a complete medication overview, additional medication information, overview of future visits and a reminder of medication intake would be very helpful eHealth features for pwMS, while they themselves preferred features organizing and enriching future visits. (4) Conclusions: A closer look at the various profiles of eHealth adoption in pwMS and their caregivers indicated that there is a broad and robust enthusiasm across several subgroups that does not exclude anyone in general, but constitutes specific areas of interest. For pwMS, the focus was on eHealth services that connect previously collected information and make them easily accessible and understandable.
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Affiliation(s)
- Rocco Haase
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany; (I.V.); (M.S.); (A.D.); (T.Z.)
- Correspondence:
| | - Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany; (I.V.); (M.S.); (A.D.); (T.Z.)
| | - Maria Scholz
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany; (I.V.); (M.S.); (A.D.); (T.Z.)
| | - Hannes Schlieter
- Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (H.S.); (M.B.); (M.S.)
| | - Martin Benedict
- Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (H.S.); (M.B.); (M.S.)
| | - Marcel Susky
- Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (H.S.); (M.B.); (M.S.)
| | - Anja Dillenseger
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany; (I.V.); (M.S.); (A.D.); (T.Z.)
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany; (I.V.); (M.S.); (A.D.); (T.Z.)
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31
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Gromisch ES, Turner AP, Haselkorn JK, Lo AC, Agresta T. Mobile health (mHealth) usage, barriers, and technological considerations in persons with multiple sclerosis: a literature review. JAMIA Open 2021; 4:ooaa067. [PMID: 34514349 PMCID: PMC8423420 DOI: 10.1093/jamiaopen/ooaa067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Persons with multiple sclerosis (MS) can face a number of potential healthcare-related barriers, for which mobile health (mHealth) technology can be potentially beneficial. This review aimed to understand the frequency, current uses, and potential barriers with mHealth usage among persons with MS. METHODS A query string was used to identify articles on PubMed, MEDLINE, CINAHL, and IEEE Xplore that were published in English between January 2010 and December 2019. Abstracts were reviewed and selected based on a priori inclusion and exclusion criteria. Fifty-nine peer-reviewed research studies related to the study questions are summarized. RESULTS The majority of persons with MS were reported as using smartphones, although rates of mHealth utilization varied widely. mHealth usage was grouped into 3 broad categories: (1) disability and symptom measurement; (2) interventions and symptom management; and (3) tracking and promoting adherence. While there have been an increasing number of mHealth options, certain limitations associated with MS (eg, poor dexterity, memory problems) may affect usage, although including persons with MS in the design process can address some of these issues. DISCUSSION Given the increased attention to mHealth in this population and the current need for telehealth and at home devices, it is important that persons with MS and healthcare providers are involved in the development of new mHealth tools to ensure that the end product meets their needs. Considerations for addressing the potential mHealth use barriers in persons with MS are discussed.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Aaron P Turner
- Multiple Sclerosis Center for Excellence West, Veterans Affairs, Seattle, Washington, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitative Medicine, University of Washington, Seattle, Washington, USA
| | - Jodie K Haselkorn
- Multiple Sclerosis Center for Excellence West, Veterans Affairs, Seattle, Washington, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitative Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Albert C Lo
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
| | - Thomas Agresta
- Department of Family Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Center for Quantitative Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
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Bevens W, Gray K, Neate SL, Nag N, Weiland TJ, Jelinek GA, Simpson-Yap S. Characteristics of mHealth app use in an international sample of people with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103092. [PMID: 34246024 DOI: 10.1016/j.msard.2021.103092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
The management of multiple sclerosis (MS) has progressed significantly with the emergence of mHealth technologies. Uptake of mHealth apps amongst people with MS, and clinical and demographic characteristics of mHealth adopters is unknown outside North America. Participants of the HOLISM study were queried about their mHealth apps use. We summarize mHealth app usage, and clinical and demographic characteristics of mHealth app adopters using descriptive statistics. Overall, 3.1% of respondents reported using an mHealth app, most of whom were located in Australasia and North America. This study provides insight regarding mHealth app usage within a large international cohort of people with MS.
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Affiliation(s)
- W Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - K Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Australia
| | - S L Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - T J Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - G A Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia
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Hsieh K, Fanning J, Frechette M, Sosnoff J. Usability of a Fall Risk mHealth App for People With Multiple Sclerosis: Mixed Methods Study. JMIR Hum Factors 2021; 8:e25604. [PMID: 33749609 PMCID: PMC8080269 DOI: 10.2196/25604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, neurodegenerative disease that causes a range of motor, sensory, and cognitive symptoms. Due to these symptoms, people with MS are at a high risk for falls, fall-related injuries, and reductions in quality of life. There is no cure for MS, and managing symptoms and disease progression is important to maintain a high quality of life. Mobile health (mHealth) apps are commonly used by people with MS to help manage their health. However, there are limited health apps for people with MS designed to evaluate fall risk. A fall risk app can increase access to fall risk assessments and improve self-management. When designing mHealth apps, a user-centered approach is critical for improving use and adoption. OBJECTIVE The purpose of this study is to undergo a user-centered approach to test and refine the usability of the app through an iterative design process. METHODS The fall risk app Steady-MS is an extension of Steady, a fall risk app for older adults. Steady-MS consists of 2 components: a 25-item questionnaire about demographics and MS symptoms and 5 standing balance tasks. Data from the questionnaire and balance tasks were inputted into an algorithm to compute a fall risk score. Two iterations of semistructured interviews (n=5 participants per iteration) were performed to evaluate usability. People with MS used Steady-MS on a smartphone, thinking out loud. Interviews were recorded, transcribed, and developed into codes and themes. People with MS also completed the System Usability Scale. RESULTS A total of 3 themes were identified: intuitive navigation, efficiency of use, and perceived value. Overall, the participants found Steady-MS efficient to use and useful to learn their fall risk score. There were challenges related to cognitive overload during the balance tasks. Modifications were made, and after the second iteration, people with MS reported that the app was intuitive and efficient. Average System Usability Scale scores were 95.5 in both iterations, representing excellent usability. CONCLUSIONS Steady-MS is the first mHealth app for people with MS to assess their overall risk of falling and is usable by a subset of people with MS. People with MS found Steady-MS to be usable and useful for understanding their risk of falling. When developing future mHealth apps for people with MS, it is important to prevent cognitive overload through simple and clear instructions and present scores that are understood and interpreted correctly through visuals and text. These findings underscore the importance of user-centered design and provide a foundation for the future development of tools to assess and prevent scalable falls for people with MS. Future steps include understanding the validity of the fall risk algorithm and evaluating the clinical utility of the app.
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Affiliation(s)
- Katherine Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Mikaela Frechette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jacob Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Physical Therapy and Rehabilitation Sciences, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
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Krause N, Riemann-Lorenz K, Steffen T, Rahn AC, Pöttgen J, Stellmann JP, Köpke S, Friede T, Icks A, Vomhof M, Temmes H, van de Loo M, Gold SM, Heesen C. Study protocol for a randomised controlled trial of a web-based behavioural lifestyle programme for emPOWERment in early Multiple Sclerosis (POWER@MS1). BMJ Open 2021; 11:e041720. [PMID: 33593774 PMCID: PMC7888332 DOI: 10.1136/bmjopen-2020-041720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system that mainly affects young adults. Uncertainty is a major psychological burden of the disease from diagnosis to prognosis, enhanced by the pressure to make early decisions on a diverse set of immunotherapies. Watchful waiting for 1-2 years while adapting goals and lifestyle habits to life with a chronic disease represents another reasonable option for persons with MS (PwMS). A behaviour change programme based on evidence-based patient information (EBPI) is not available in standard care. This randomised controlled trial (RCT) with an embedded process evaluation investigates the efficacy and cost-effectiveness of a web-based behavioural lifestyle programme to change lifestyle behaviour and reduce inflammatory disease activity in PwMS. METHODS AND ANALYSIS A web-based behavioural intervention will be evaluated in an RCT aiming to recruit 328 persons with clinically isolated syndrome, suspected MS or confirmed MS for less than 1 year, who have not yet started immunotherapy. Moreover, a mixed-methods process evaluation and a health economic evaluation will be carried out. Participants will be recruited in at least 16 MS centres across Germany and randomised to an intervention group with 12 months of access to EBPI about lifestyle factors in MS, combined with a complex behaviour change programme or to a control group (optimised standard care). The combined primary endpoint is the incidence of new T2 lesions on MRI or confirmed relapses. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Hamburg Chamber of Physicians (PV6015). Trial results will be communicated at scientific conferences and meetings and presented on relevant patient websites and in patient education seminars. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03968172); Pre-results.
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Affiliation(s)
- Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Steffen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Sascha Köpke
- University of Cologne, Faculty of Medicine and University Hospital Cologe, Institute of Nursing Science, Cologne, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Medical Department, Section Psychosomatic Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Electronic Health Interventions in the Case of Multiple Sclerosis: From Theory to Practice. Brain Sci 2021; 11:brainsci11020180. [PMID: 33540640 PMCID: PMC7913051 DOI: 10.3390/brainsci11020180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: eHealth interventions play a growing role in shaping the future healthcare system. The integration of eHealth interventions can enhance the efficiency and quality of patient management and optimize the course of treatment for chronically ill patients. In this integrative review, we discuss different types of interventions, standards and advantages of quality eHealth approaches especially for people with multiple sclerosis (pwMS). (2) Methods: The electronic databases PubMed, Cochrane and Web of Science were searched to identify potential articles for eHealth interventions in pwMS; based on 62 articles, we consider different ways of implementing health information technology with various designs. (3) Results: There already exist some eHealth interventions for single users with a single-use case, interventions with a social setting, as well as eHealth interventions that integrate various single and social interventions and even those that may be used additionally for complex use cases. A key determinant of consumer acceptance is a high-quality user-centric design for healthcare practitioners and pwMS. In pwMS, the different neurological disabilities should be considered, and particular attention must be paid to the course of the treatment and the safety processes of each treatment option. (4) Conclusion: Depending on the field of application and the respective users, interventions are designed for single, social, integrated or complex use. In order to be accepted by their target group, interventions must be beneficial and easy to use.
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Design considerations for a multiple sclerosis fatigue mobile app MS Energize: A pragmatic iterative approach using usability testing and resonance checks. Internet Interv 2021; 24:100371. [PMID: 33614414 PMCID: PMC7878181 DOI: 10.1016/j.invent.2021.100371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/21/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological condition affecting around 2.2 million people worldwide. The illness includes a range of symptoms, with fatigue considered to be one of the most disabling. This paper describes how a pragmatic and iterative approach, supported by usability and resonance testing, was used to build a minimum viable product of MS Energize-or MS Energise in UK English regions. MS Energise is a mobile application focused on self-management of fatigue for people with MS. The iterative approach included various stages of testing, during which user feedback including comments about interface, navigation and content, was sought to inform incremental app development and continual improvement. Usability testing was conducted with 11 people with longstanding multiple sclerosis in New Zealand and the United Kingdom, and focused on particular sections of the app as well as the accessibility of the app to users with MS. Two participants contributed to further resonance testing post-release to ensure the app was perceived as relevant and useful to the user. The usability testing and resonance testing phases suggested that user experience of MS Energise was mostly positive. Participants provided a number of suggestions for improvements to aspects of content and design; some of which we implemented during our app development process. Findings will also contribute to future planning and design iteration to enhance the user experience. The next step is further improvement of MS Energise prior to a trial of its clinical and cost effectiveness.
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Hsieh KL, Sosnoff JJ. Smartphone accelerometry to assess postural control in individuals with multiple sclerosis. Gait Posture 2021; 84:114-119. [PMID: 33307327 DOI: 10.1016/j.gaitpost.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are a major health concern for people with Multiple Sclerosis (pwMS), and impaired postural control is an important predictor of falls. Lab-based technology to measure posture is precise but expensive, and clinical tests may not capture underlying impairments. An alternative solution is to leverage smartphone accelerometry as it is affordable, ubiquitous, and portable. RESEARCH QUESTION Can smartphone accelerometry measure postural control compared to a force plate and research grade accelerometer in pwMS, and can smartphone accelerometry discriminate between assisted device and non-assisted device users? METHODS 27 pwMS (12 assisted device users, 15 non-assisted device users) stood on a force plate while holding a smartphone with an attached research grade accelerometer against their chest. Participants performed two, 30 s trials of: eyes open, eyes closed, semi-tandem, tandem, and single leg. Acceleration and center of pressure were extracted, and Root Mean Square (RMS) and 95 % confidence ellipse were calculated. Spearman's correlations were performed, and receiving operating characteristic (ROC) curves and the Area Under the Curve (AUC) were calculated. RESULTS There were moderate to high correlations between the smartphone and accelerometer for RMS (ρ = 0.85 - 1.0; p = 0.001 - <0.001) and 95 % area ellipse (ρ = 0.92 - 0.99; p = <0.001). There were weak to moderate correlations between the smartphone and force plate for RMS (ρ = 0.38 - 0.92; p = 0.06 - <0.001) and 95 % area ellipse (ρ = 0.69 - 0.90 p = 0.002 - <0.001). To discriminate between assisted device usage, ROC curves for smartphone outputs were constructed, the AUC was high and statistically significant (p < 0.001 - 0.02). SIGNIFICANCE There is potential to leverage smartphone accelerometery to measure postural control in pwMS. These finding provide preliminary results to support the development of a mobile health application to measure fall risk for pwMS.
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Affiliation(s)
- Katherine L Hsieh
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave, Urbana, IL 61801, USA; Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana-Champaign, 901 W. University Avenue, Suite 201 Urbana, IL 61801, USA; Department of Internal Medicine-Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC 27109, USA.
| | - Jacob J Sosnoff
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave, Urbana, IL 61801, USA; Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana-Champaign, 901 W. University Avenue, Suite 201 Urbana, IL 61801, USA
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Affiliation(s)
- Virginia Meca-Lallana
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario de la Princesa, Madrid, Spain
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Ziemssen T, Kern R, Voigt I, Haase R. Data Collection in Multiple Sclerosis: The MSDS Approach. Front Neurol 2020; 11:445. [PMID: 32612566 PMCID: PMC7308591 DOI: 10.3389/fneur.2020.00445] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/27/2020] [Indexed: 01/17/2023] Open
Abstract
Multiple sclerosis (MS) is a frequent chronic inflammatory disease of the central nervous system that affects patients over decades. As the monitoring and treatment of MS become more personalized and complex, the individual assessment and collection of different parameters ranging from clinical assessments via laboratory and imaging data to patient-reported data become increasingly important for innovative patient management in MS. These aspects predestine electronic data processing for use in MS documentation. Such technologies enable the rapid exchange of health information between patients, practitioners, and caregivers, regardless of time and location. In this perspective paper, we present our digital strategy from Dresden, where we are developing the Multiple Sclerosis Documentation System (MSDS) into an eHealth platform that can be used for multiple purposes. Various use cases are presented that implement this software platform and offer an important perspective for the innovative digital patient management in the future. A holistic patient management of the MS, electronically supported by clinical pathways, will have an important impact on other areas of patient care, such as neurorehabilitation.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Isabel Voigt
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
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van Beek JJW, van Wegen EEH, Rietberg MB, Nyffeler T, Bohlhalter S, Kamm CP, Nef T, Vanbellingen T. Feasibility of a Home-Based Tablet App for Dexterity Training in Multiple Sclerosis: Usability Study. JMIR Mhealth Uhealth 2020; 8:e18204. [PMID: 32515747 PMCID: PMC7312262 DOI: 10.2196/18204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Persons with multiple sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins, or writing, therefore impacting their health-related quality of life. Mobile health (mHealth) solutions, such as tablet apps, may be used to train impaired dexterous skills. The feasibility of a tablet app-based dexterity home-based intervention in MS (TAD-MS) has not been explored yet in persons with MS. OBJECTIVE The aim of this pilot study was to evaluate the feasibility and usability of home-based dexterity training with a tablet app in both persons with MS and healthy subjects. METHODS A total of 9 persons with MS, aged 35-71 years, with an Expanded Disability Status Scale score between 2 and 7.5, performed the TAD-MS for 4 weeks, five times a week, with each training session lasting approximately 30 minutes. Participants' impaired dexterity was measured by the Nine-Hole Peg Test. A total of 10 age-matched healthy subjects also tested and rated the usability of the app. Outcome measures were the adherence rate as well as usability measured by the System Usability Scale and a Custom User Engagement Questionnaire (CUEQ). RESULTS High feasibility of the tablet app-based dexterity training program was shown by a 97% adherence rate to the training protocol (ie, mean 19.4/20 sessions completed, SD 0.8). High system usability scores (ie, mean 85.39%, SD 11.67) and overall high scores given in the CUEQ (ie, mean 8.2/10, SD 1.4) further point to high usability of the app. Neither demographic variables nor dexterity levels affected the use of the app. CONCLUSIONS This pilot study is the first to demonstrate high feasibility and usability of a new tablet app-based dexterity home-based training program among both persons with MS and healthy individuals. Whether this kind of training improves dexterity will need to be evaluated in a randomized controlled trial.
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Affiliation(s)
- Judith Jantine Willemijn van Beek
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Erwin Everardus Henri van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Multiple Sclerosis Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Marc Berend Rietberg
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Multiple Sclerosis Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Thomas Nyffeler
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | | | - Christian Philipp Kamm
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Li J, Chang X. Improving mobile health apps usage: a quantitative study on mPower data of Parkinson's disease. INFORMATION TECHNOLOGY & PEOPLE 2020. [DOI: 10.1108/itp-07-2019-0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe emergence of mobile health (mHealth) products has created a capability of monitoring and managing the health of patients with chronic diseases. These mHealth technologies would not be beneficial unless they are adopted and used by their target users. This study identifies key factors affecting the usage of mHealth apps based on user usage data collected from an mHealth app.Design/methodology/approachUsing a dataset collected from an mHealth app named mPower, developed for patients with Parkinson's disease (PD), this paper investigated the effects of disease diagnosis, disease progression and mHealth app difficulty level on app usage, while controlling for user information. App usage is measured by five different activity counts of the app.FindingsThe results across five measures of mHealth app usage vary slightly. On average, previous professional diagnosis and high user performance scores encourage user participation and engagement, while disease progression hinders app usage.Research limitations/implicationsThe findings potentially provide insights into better design and promotion of mHealth products and improve the capability of health management of patients with chronic diseases.Originality/valueStudies on the mHealth app usage are critical but sparse because large-scale and reliable mHealth app usage data are limited. Unlike earlier works based solely on survey data, this research used a large user usage data collected from an mHealth app to study key factors affecting app usage. The methods presented in this study can serve as a pioneering work for the design and promotion of mHealth technologies.
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Babbage DR, van Kessel K, Drown J, Thomas S, Sezier A, Thomas P, Kersten P. MS Energize: Field trial of an app for self-management of fatigue for people with multiple sclerosis. Internet Interv 2019; 18:100291. [PMID: 31890637 PMCID: PMC6926294 DOI: 10.1016/j.invent.2019.100291] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/20/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022] Open
Abstract
Multiple sclerosis (MS) is a lifelong neurological condition affecting around 2.2 million people worldwide. There are a wide range of symptoms, with fatigue reported as one of the most troublesome. MS Energize-or MS Energise in UK English regions-is an iPhone app focused on self-management of fatigue for people with MS. Based on cognitive-behavioral therapy principles, the app covers MS fatigue, how to use energy effectively, how behavior, thoughts and emotions interact and impact on MS fatigue, as well as the potential effects of bodily and environmental factors. MS Energize provides education, interactive tasks, and supports application of the principles into a user's day-to-day life. We field tested the usability and perceived usefulness of MS Energize with 11 people with longstanding multiple sclerosis in New Zealand and the United Kingdom. Participants used the app over a period of five to six weeks after which they rated the usability of the app and participated in an in-depth qualitative interview. We developed four main themes through our thematic analysis. 1. Validation of participants' own experiences of living with MS fatigue. 2. The personal cost in engaging with such an intervention. 3. Reframing experiences and adding to knowledge. 4. That the app was generally a good idea. Field testers' feedback also identified usability issues that could be addressed. In particular, the amount of text-based content in the app contributed to the app itself being fatiguing. This field-testing process has highlighted the value of the app while also guiding our roadmap for further developments to enhance usability and usefulness. The next step is further refinement of components of MS Energize in preparation for a trial of its clinical and cost effectiveness.
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Affiliation(s)
- Duncan R. Babbage
- Auckland University of Technology, Centre for eHealth, New Zealand,Auckland University of Technology, Centre for Person Centred Research, New Zealand
| | - Kirsten van Kessel
- Auckland University of Technology, School of Public Health and Psychosocial Studies, New Zealand,Corresponding author at: Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Juliet Drown
- Auckland University of Technology, Centre for eHealth, New Zealand
| | - Sarah Thomas
- Bournemouth University, Bournemouth University Clinical Research Unit, United Kingdom
| | - Ann Sezier
- Auckland University of Technology, Centre for Person Centred Research, New Zealand
| | - Peter Thomas
- Bournemouth University, Bournemouth University Clinical Research Unit, United Kingdom
| | - Paula Kersten
- University of Brighton, School of Health Sciences, United Kingdom
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Gromisch ES, Turner AP, Leipertz SL, Beauvais J, Haselkorn JK. Who is not coming to clinic? A predictive model of excessive missed appointments in persons with multiple sclerosis. Mult Scler Relat Disord 2019; 38:101513. [PMID: 31756611 DOI: 10.1016/j.msard.2019.101513] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/26/2019] [Accepted: 11/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Missed appointments can have negative effects on several facets of healthcare, including disruption of services, worse patient health outcomes, and increased costs. The influence of demographic and clinical factors on missed appointments has been studied in a number of chronic conditions, but not yet in multiple sclerosis (MS). Engagement in healthcare services is a particular concern with this population, given the complexity of the condition. Furthermore, excessive missed appointments has emerged as a risk factor for suboptimal adherence to disease modifying therapies (DMTs), prompting further exploration into this issue and whether a tool could be developed to triage possible interventions for persons with MS on DMTs who are missing their appointments. As such, this study aimed to investigate the rate and factors associated with missed appointments among a large national sample of persons with MS and develop a predictive model of excessive missed appointments. METHODS Administrative data from 01/01/2013 to 12/31/2015 were extracted from the VA MS Center of Excellence Data Repository. Variables not related to excessive missed appointments, defined as missing more than 20% of scheduled appointments, in bivariate analyses (p > 0.20) were excluded. Remaining baseline co-occurring conditions, demographic, and healthcare utilization variables were entered into a logistic regression model, using a backward elimination criteria of p < 0.05. Calibration and discrimination of the model were assessed. An initial predictive score was generated based on the value of the variable and its β-value from the final model. RESULTS The number of missed appointments ranged from 0 to 84 over a two-year period. Over 59% missed at least one appointment, though only 4.28% had excessive missed appointments. Seven variables were retained in the model: adherence to DMTs, age, distance, histories of post-traumatic stress disorder, congestive heart failure, and chronic obstructive pulmonary disease, and emergency visits. Predictive scores ranged from -6.42 to 0.96 (M = -2.61, SD = 1.15). The final model had good discrimination, calibration, and fit. CONCLUSIONS By using this model and accompanying score, clinicians could have a good chance of predicting individuals who will miss more than 20% of their appointments and triaging interventions.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT 06112, United States; Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, United States; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT 06473, United States.
| | - Aaron P Turner
- Multiple Sclerosis Center of Excellence West, Veterans Affairs, 1660 South Columbian Way, Seattle, WA 98108, United States; Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, United States; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, United States
| | - Steven L Leipertz
- Multiple Sclerosis Center of Excellence West, Veterans Affairs, 1660 South Columbian Way, Seattle, WA 98108, United States
| | - John Beauvais
- Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
| | - Jodie K Haselkorn
- Multiple Sclerosis Center of Excellence West, Veterans Affairs, 1660 South Columbian Way, Seattle, WA 98108, United States; Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, United States; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, United States; Department of Epidemiology, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, United States
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Maillart E, Labauge P, Cohen M, Maarouf A, Vukusic S, Donzé C, Gallien P, De Sèze J, Bourre B, Moreau T, Louapre C, Mayran P, Bieuvelet S, Vallée M, Bertillot F, Klaeylé L, Argoud AL, Zinaï S, Tourbah A. MSCopilot, a new multiple sclerosis self-assessment digital solution: results of a comparative study versus standard tests. Eur J Neurol 2019; 27:429-436. [PMID: 31538396 DOI: 10.1111/ene.14091] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Assessing patients' disability in multiple sclerosis (MS) requires time-consuming batteries of hospital tests. MSCopilot is a software medical device for the self-assessment of patients with MS (PwMS), combining four tests: walking, dexterity, cognition and low contrast vision. The objective was to validate MSCopilot versus the Multiple Sclerosis Functional Composite (MSFC). METHODS This multicentre, open-label, randomized, controlled, crossover study enrolled 141 PwMS and 76 healthy controls (HCs). All participants performed MSCopilot and MSFC tests at day 0. To assess reproducibility, 46 PwMS performed the same tests at day 30 ± 3. The primary end-point was the validation of MSCopilot versus MSFC for the identification of PwMS against HCs, quantified using the area under the curve (AUC). The main secondary end-point was the correlation of MSCopilot z-scores with MSFC z-scores. RESULTS In all, 116 PwMS and 69 HCs were analysed. The primary end-point was achieved: MSCopilot performance was non-inferior to that of MSFC (AUC 0.92 and 0.89 respectively; P = 0.3). MSCopilot and MSFC discriminated PwMS and HCs with 81% and 76% sensitivity and 82% and 88% specificity respectively. Digital and standard test scores were highly correlated (r = 0.81; P < 0.001). The test-retest study demonstrated the good reproducibility of MSCopilot. CONCLUSION This study confirms the reliability of MSCopilot and its usability in clinical practice for the monitoring of MS-related disability.
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Affiliation(s)
- E Maillart
- Department of Neurology, Pitié Salpêtrière Hospital, Paris, France
| | - P Labauge
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - M Cohen
- Department of Neurology, Nice University Hospital, Nice, France
| | - A Maarouf
- CNRS, CRMBM, APHM, Aix-Marseille University, Marseille, France.,Pole de Neurosciences Cliniques, Marseille, France
| | - S Vukusic
- Department of Neurology, Hospices Civils de Lyon, Bron, France.,INSERM 1028 et CNRS UMR 5292, University Lyon 1, Lyon, France
| | - C Donzé
- Department of Physical and Rehabilitation Medicine, Groupe Hospitalier de l'Institut Catholique de Lille, Lille, France
| | - P Gallien
- Physical Rehabilitation Medicine, Pole Saint Helier, Rennes, France
| | - J De Sèze
- Department of Neurology, Hôpital Civil, Strasbourg University, Strasbourg, France
| | - B Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | - T Moreau
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - C Louapre
- Department of Neurology, Pitié Salpêtrière Hospital, Paris, France
| | | | - S Bieuvelet
- Ad Scientiam, Brain and Spine Institute (ICM), Pitié Salpêtrière Hospital, Paris, France
| | - M Vallée
- Ad Scientiam, Brain and Spine Institute (ICM), Pitié Salpêtrière Hospital, Paris, France
| | - F Bertillot
- Ad Scientiam, Brain and Spine Institute (ICM), Pitié Salpêtrière Hospital, Paris, France
| | - L Klaeylé
- Ad Scientiam, Brain and Spine Institute (ICM), Pitié Salpêtrière Hospital, Paris, France
| | - A-L Argoud
- Ad Scientiam, Brain and Spine Institute (ICM), Pitié Salpêtrière Hospital, Paris, France
| | - S Zinaï
- Ad Scientiam, Brain and Spine Institute (ICM), Pitié Salpêtrière Hospital, Paris, France
| | - A Tourbah
- Department of Neurology, Reims University Hospital, URCA, Reims, France.,LPN EA, 2027 Paris 8 University, Saint-Denis, France.,Service de Neurologie, Hôpitaux universitaires paris-Ile-de-France Ouest, APHP, Université Versailles-Saint Quentin en Yvelines, Paris Saclay, France
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Anastasiadou D, Folkvord F, Serrano-Troncoso E, Lupiañez-Villanueva F. Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder. JMIR Mhealth Uhealth 2019; 7:e12920. [PMID: 31199329 PMCID: PMC6592393 DOI: 10.2196/12920] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research, Barcelona, Spain
| | - Frans Folkvord
- Open Evidence Research, Barcelona, Spain.,School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain.,Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Francisco Lupiañez-Villanueva
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research, Barcelona, Spain
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46
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Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study. JMIR Form Res 2018; 2:e11977. [PMID: 30684408 PMCID: PMC6334710 DOI: 10.2196/11977] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.
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Affiliation(s)
| | - Mireille Menzel
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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