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Zhu D, Zhao J, Wang M, Cao B, Zhang W, Li Y, Zhang C, Han T. Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e53798. [PMID: 38696250 PMCID: PMC11099817 DOI: 10.2196/53798] [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: 10/19/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. OBJECTIVE This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. METHODS A systematic literature search was conducted using the keywords "Knee Osteoarthritis," "Behavior Therapy," and "Digitization" in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. RESULTS A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. CONCLUSIONS The results demonstrate that "goals and planning" and "repetition and substitution" are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting.
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Affiliation(s)
- Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Jianan Zhao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Mingxuan Wang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Bochen Cao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Yunlong Li
- Department of Design, Jiangxi Science and Technology Normal University, Shanghai, China
| | - Chenqi Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Han
- School of Design, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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Ariza-Vega P, Prieto-Moreno R, Mora-Traverso M, Molina-García P, Ashe MC, Martín-Matillas M. Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:1009-1018. [PMID: 36308295 DOI: 10.1080/17483107.2022.2138999] [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: 04/06/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. MATERIALS AND METHODS Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. RESULTS Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. CONCLUSIONS Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Molina-García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
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Leske M, Koczwara B, Blunt J, Morris J, Eakin E, Short CE, Daly A, Degner J, Beatty L. Co-designing Healthy Living after Cancer Online: an online nutrition, physical activity, and psychosocial intervention for post-treatment cancer survivors. J Cancer Surviv 2024; 18:606-616. [PMID: 36374435 PMCID: PMC9660094 DOI: 10.1007/s11764-022-01284-y] [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: 05/26/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of the present study was to co-design Healthy Living after Cancer Online (HLaC Online), an online intervention supporting cancer survivors to set and meet their healthy living goals. METHODS Adapted from an initial telephone-delivered Healthy Living after Cancer program, wireframes (PDF black and white mock-ups) of the proposed online program were presented in a series of focus groups and interviews to our stakeholder group, which consisted of cancer survivors, oncology healthcare professionals, and representatives from cancer support organisations. Stakeholders were prompted for feedback on the wireframe and given end-user scenarios to encourage deeper engagement with the co-design process. Transcriptions underwent thematic analysis to determine which features of the program needed change or expansion. RESULTS 27 participants took part in one of 8 focus groups or 10 interviews. Five themes were identified relating to (a) website design elements, (b) promoting and maintaining long-term engagement, (c) relatability and relevance, (d) navigating professional support, and (e) family and peer support. Recommended changes, such as simple activities and guidance videos, were integrated into the HLaC Online prototype. CONCLUSIONS Involving end-users in the co-design process ensured the intervention's relevance and specificity to the needs of cancer survivors. Next steps include feasibility testing the prototype, prior to commencing a national randomised control trial of HLaC Online. IMPLICATIONS FOR CANCER SURVIVORS HLaC Online aims to support cancer survivors to improve their quality of life by making healthy lifestyle changes in their physical activity, healthy eating, weight management, mental health, and fatigue management.
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Affiliation(s)
- Morgan Leske
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia.
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | | | | | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Jon Degner
- Cancer Voices South Australia, Kensington Park, SA, Australia
| | - Lisa Beatty
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
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Shin HD, Zaheer J, Torous J, Strudwick G. Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project. JMIR Res Protoc 2023; 12:e50643. [PMID: 37943582 PMCID: PMC10667981 DOI: 10.2196/50643] [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: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. OBJECTIVE The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). METHODS We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. RESULTS This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. CONCLUSIONS Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50643.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Ontario, Canada, Toronto, ON, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gillian Strudwick
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Shah N, Borrelli B, Kumar D. Perceptions about smartphone-based interventions to promote physical activity in inactive adults with knee pain - A qualitative study. Disabil Rehabil Assist Technol 2023:1-8. [PMID: 37873670 PMCID: PMC11039564 DOI: 10.1080/17483107.2023.2272854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Smartphone-based interventions offer a promising approach to address inactivity in people with knee osteoarthritis (OA). We explored perceptions towards smartphone-based interventions to improve physical activity, pain, and depressed mood in inactive people with knee pain. METHODS This qualitative study included six focus groups at Boston University with inactive people with knee pain (n = 35). A smartphone app, developed by our team, using constructs of Social Cognitive Theory, was used to obtain participant feedback. RESULTS Participants discussed wanting to use smartphone-based interventions for personalized exercise advice, for motivation (e.g., customized voice messages, virtual incentives), and to make exercise "less boring" (e.g., music, virtual gaming). Preferred app features included video tutorials on how to use the app, the ability to select information that can be viewed on the home screen, and the ability to interact with clinicians. Features that received mixed responses included daily pain tracking, daily exercise reminders, peer-interaction for accountability, and peer-competition for motivation. All participants discussed privacy and health data security concerns while using the app. CONCLUSIONS Using a co-design approach, we report preferences and concerns related to using smartphone-based physical activity interventions in inactive people with knee pain. This information may help improve acceptability of such interventions in this population.
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Affiliation(s)
- Nirali Shah
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, 02215, USA
| | - Belinda Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Ave, Boston, MA, 02118, USA
| | - Deepak Kumar
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, 02215, USA
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Litwin S, Sellen K. Designing a Sensory Kit to Improve the Environment for Children with Autism Spectrum Disorder in the Pediatric Emergency Department. J Autism Dev Disord 2023; 53:3369-3379. [PMID: 35834047 DOI: 10.1007/s10803-022-05651-7] [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] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Children with autism spectrum disorder (ASD) have more frequent use of healthcare services, including visits to the emergency department (ED). Medical care for children with ASD can be adversely affected by the highly stimulating environment of the ED. In this study, we gained insights from stakeholders with lived experience (parents of children with ASD, children with ASD, and ED healthcare providers) to create and implement a sensory equipment kit. The kit was evaluated and iteratively improved based on observations of children using the sensory equipment, satisfaction surveys from their parents, and interviews with healthcare providers in the ED. Findings from this study can be used to guide other EDs in creating their own ASD sensory kit.
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Affiliation(s)
- Sasha Litwin
- Division of Emergency Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Kate Sellen
- Faculty of Design, Ontario College of Art and Design University, 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
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Elliott MJ, Donald M, Farragher J, Verdin N, Love S, Manns K, Baragar B, Sparkes D, Fox D, Hemmelgarn BR. Priorities for peer support delivery among adults living with chronic kidney disease: a patient-oriented consensus workshop. CMAJ Open 2023; 11:E736-E744. [PMID: 37582622 PMCID: PMC10435241 DOI: 10.9778/cmajo.20220171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Peer support can address the informational and emotional needs of people living with chronic kidney disease (CKD) and enable self-management. We aimed to identify preferences and priorities for content, format and processes of peer support delivery for patients with non-dialysis CKD and their loved ones. METHODS Using a patient-oriented research approach, we conducted a half-day, virtual consensus workshop with stakeholder participants from across Canada, including patients, caregivers, peer mentors and clinicians. Using personas (fictional characters), participants discussed and voted on preferences for delivery of peer support across format, content and process categories. We analyzed transcripts from small- and large-group discussions inductively using content analysis. RESULTS Twenty-one stakeholders, including 9 patients and 4 caregivers, participated in the workshop. In the voting exercise on format, participants prioritized peer mentor matching, programming for both patients and caregivers, and flexible scheduling. For content, participants prioritized informational and emotional support focus, and for process, they prioritized leveraging kidney care programs and alternative sources (e.g., social media) for promotion and referral. Analysis of workshop transcripts complemented prioritization results and emphasized tailoring of peer support delivery to accommodate the diversity of people living with CKD and their support needs. This concept was elaborated in 3 themes, namely alignment of program features with needs, inclusive peer support options and multiple access points. INTERPRETATION We identified preferences for peer support delivery for people living with CKD and underscore the importance of tailored, flexible programming in this context. Findings could be used to develop, adapt or study CKD-focused peer support interventions.
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Affiliation(s)
- Meghan J Elliott
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta.
| | - Maoliosa Donald
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Janine Farragher
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Nancy Verdin
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Shannan Love
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Kate Manns
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Brigitte Baragar
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Dwight Sparkes
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Danielle Fox
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Brenda R Hemmelgarn
- Departments of Medicine (Elliott, Love, Manns) and Community Health Sciences (Elliott, Donald, Fox), University of Calgary, Calgary, Alta.; Department of Occupational Science and Occupational Therapy (Farragher), University of Toronto, Toronto, Ont.; Medicine Strategic Clinical Network (Verdin), Alberta Health Services; Patient and Community Engagement Research (PaCER) Program (Verdin), O'Brien Institute for Public Health, University of Calgary, Calgary, Alta.; Patient Partner (Verdin, Sparkes), Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC; Max Rady College of Medicine (Baragar), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
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Kwan YH, Ong ZQ, Choo DYX, Phang JK, Yoon S, Low LL. A Mobile Application to Improve Diabetes Self-Management Using Rapid Prototyping: Iterative Co-Design Approach in Asian Settings. Patient Prefer Adherence 2023; 17:1-11. [PMID: 36636285 PMCID: PMC9830050 DOI: 10.2147/ppa.s386456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diabetes is a global public health issue, causing burden on healthcare system and increasing risk of mortality. Mobile applications (apps) can be a promising approach to facilitate diabetes self-management. An increasingly utilized approach to facilitate engagement with mobile health (mHealth) technology is to involve potential users in the creation of the technology. OBJECTIVE The aim of this study was to use co-design for type 2 diabetes mellitus (T2DM) self-management mHealth development. METHODS Three rounds of iterative rapid prototyping panel sessions were conducted with a total of 9 T2DM participants in an Asian setting between Oct 2020 and April 2021. The participants were recruited through convenience sampling. For each round, feedback was gathered through qualitative interviews, and the feedback was used as a reference by the development team to develop and test a more refined version of the app in the next round. Transcribed semi-structured interview data was analyzed thematically using an inductive approach. RESULTS Participants' ages ranged from 40 to 69 years. Data saturation was reached, with no new themes emerging from the data. During the sessions, the participants expressed a variety of concerns and feedback on T2DM self-management using EMPOWER app and raised suggestions on the features of ideal T2DM self-management app. Important features include 1) reminders and notifications for medications, 2) Bluetooth integration with glucometers and blood pressure machines to minimize manual entry, 3) enlarged local food database including information on sugar content and recommendations for healthier options, 4) one touch for logging of routine medications and favorite foods, 5) export function for data sharing with physicians. Overall inputs concerned aspects such as user-friendliness of the app, customization possibilities, and educational content for the features in the mobile app. CONCLUSION In this study, we explored users' opinions on a T2DM self-management mobile app using co-design approach. This study adds to the growing body of literature on co-designing behavioral mHealth interventions and can potentially guide researchers in mobile app design for other chronic conditions.
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Affiliation(s)
- Yu Heng Kwan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Internal Medicine Residency, SingHealth, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Zhi Quan Ong
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Dawn Yee Xi Choo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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9
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Thiengwittayaporn S, Wattanapreechanon P, Sakon P, Peethong A, Ratisoontorn N, Charoenphandhu N, Charoensiriwath S. Development of a mobile application to improve exercise accuracy and quality of life in knee osteoarthritis patients: a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:729-738. [PMID: 34453570 PMCID: PMC8397851 DOI: 10.1007/s00402-021-04149-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Knee Osteoarthritis (OA) is a degenerative joint disease that needs consistent exercise and an accurate understanding of the condition for long-term maintenance. While the accessibility of outpatient care is essential for disease management, many patients lack the resources to receive adequate healthcare. To address this challenge, we developed a not-for-profit interactive mobile application that provides a disease-specific educational background and a structured exercise regimen to patients. MATERIAL AND METHODS "Rak Kao" (English translation: Love-Your-Knee) mobile application was designed to analyze the questionnaire data to assess the stage of knee OA and generate a personalized recommendation of treatment and exercise type using rule-based and Artificial Intelligence (AI) techniques. A single-blinded study was conducted with patients (n = 82) who were randomly assigned to the mobile application group (M-group) and the handout group (H-group). Patient groups were controlled for age, gender, BMI, onset of pain, grade of disease, education level, and occupation. Accuracy in performance of three prescribed knee exercises (catch-bend-down, stretch-touch-feet, and sit-stretch-hold) was evaluated. Clinical outcomes were evaluated before and after the 4-weeks program to assess the range of motion, symptoms, pain, physical activity, and quality of life via the KOOS and KSS scores. RESULTS Completion of the study led to significantly more overall exercise accuracy in the M-group (76.2%) than the H-group (52.5%). Activities of daily life, quality of life, ability to do sports and recreational activities were significantly more improved in the M-group than the H-group (p < .01). No difference in the range of motion between groups. Satisfaction of patients' experience was higher in the M-group than the H-group (p = .001) after the 4-week regimen. CONCLUSIONS With the better accuracy and outcomes for rehabilitation in the M-group than the H-group, we strongly recommend using our mobile application as a better alternative than handouts for exercises and information for patients with knee OA. TRIAL REGISTRATION ClinicalTrials.gov: NCT03666585.
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Affiliation(s)
- Satit Thiengwittayaporn
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Bangkok, 10300, Dusit, Thailand.
| | - Pichayut Wattanapreechanon
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Bangkok, 10300 Dusit Thailand
| | - Phraew Sakon
- Hematology and Oncology Department, Boston Children’s Hospital, Boston, MA USA
| | - Apatha Peethong
- Human Behavior Analytics Research Team (HBA), Data Science and Analytics Research Group (DSARG), National Electronics and Computer Technology Center (NECTEC), Khlong Nueng, Pathumthani, Khlong Luang Thailand
| | - Nantaporn Ratisoontorn
- Human Behavior Analytics Research Team (HBA), Data Science and Analytics Research Group (DSARG), National Electronics and Computer Technology Center (NECTEC), Khlong Nueng, Pathumthani, Khlong Luang Thailand
| | - Narattaphol Charoenphandhu
- Center of Calcium and Bone Research (COCAB), Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand ,Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand ,The Academy of Science, The Royal Society of Thailand, Bangkok, Dusit Thailand
| | - Supiya Charoensiriwath
- Human Behavior Analytics Research Team (HBA), Data Science and Analytics Research Group (DSARG), National Electronics and Computer Technology Center (NECTEC), Khlong Nueng, Pathumthani, Khlong Luang Thailand
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10
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Timmers T, van der Weegen W, Janssen L, Kremer J, Kool RB. Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics. JMIR Form Res 2022; 6:e39637. [PMID: 36326799 PMCID: PMC9672996 DOI: 10.2196/39637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients’ priorities. Objective In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app’s content. Conclusions In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app’s content from the patient’s perspective. Given the growing emphasis on patients’ self-management, it is crucial that the information they receive is not only relevant from a health care provider’s perspective but also aligns with what really matters to patients. Trial Registration Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295
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Affiliation(s)
- Thomas Timmers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Interactive Studios, Den Bosch, Netherlands
| | | | | | - Jan Kremer
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rudolf Bertijn Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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11
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Assessment of Mobile Health Applications for Management of Knee and/or Hip Osteoarthritis Using the Mobile Application Rating Scale. J Clin Rheumatol 2022:00124743-990000000-00058. [PMID: 36256541 DOI: 10.1097/rhu.0000000000001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mobile health applications (apps) can help individuals with knee and/or hip osteoarthritis (OA) learn about, monitor, and manage their condition. These apps have not been formally evaluated. OBJECTIVE The aim of this study was to evaluate the publicly available mobile health apps for individuals with knee and/or hip OA using a systematic review. METHODS We searched the Apple App Store, Android Google Play, and Amazon Appstore using the terms "arthritis," "osteoarthritis," "hip OA," "knee OA," "hip," "knee," "rehabilitation," "rehab," and "physical therapy" in December of 2021. Applications that met the inclusion/exclusion criteria were reviewed using the Mobile Application Rating Scale (MARS; 29 items across 6 sections, each rated at 1-5). RESULTS Among 1104 identified apps, 94 met the inclusion/exclusion criteria for MARS appraisal. Fourteen apps met the predetermined score thresholds for final summary. Of the 14 apps appraised, the total overall mean app score on the MARS ranged from 3.12 to 4.20 (mean, 3.51 ± 0.37). Although app features varied, common features were symptom tracking, exercise recommendations, education, goal setting, and improving well-being. Many apps allowed for sharing with health care providers and included some measures to protect privacy. Jointfully Osteoarthritis was the top-rated app in both the Apple App Store and Android Google Play. CONCLUSIONS The majority of the apps we identified for knee and/or hip OA did not meet predetermined score thresholds for final summary. Many failed to provide comprehensive education and deliver management plans and lacked scientific testing. Future research should focus on apps that fit the needs of health care providers and patients including quality information, structured exercise programs tailored to individual needs, secure communication methods, and health information protection.
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12
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Müller SD, Tsirozidis G, Mathiasen M, Nordenhof L, Jakobsen D, Mahler B. Eliciting Information Needs of Child Patients: Adapting the Kano Model to the Design of mHealth Applications. Methods Inf Med 2022; 61:123-138. [PMID: 36220108 DOI: 10.1055/s-0042-1749359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Health care services are increasingly being digitized, but extant literature shows that digital technologies and applications are often developed without careful consideration of user needs. Research is needed to identify and investigate best-in-class methods to support user-centered design of mHealth applications. OBJECTIVES The article investigates how the Kano model can be adapted and used for the purpose of eliciting child patients' information needs during the design phase of mHealth application development. The aim is to demonstrate its applicability for collecting and analyzing patient-centered data that are key to designing technology-supported solutions for health management. METHODS The article is based on a mixed-methods case study, which includes interviews with 21 patients aged 6 to 18. Structured interviews are analyzed based on prescriptions of the Kano model. Semi-structured interviews about child patients' information needs are analyzed thematically. RESULTS The results demonstrate several improvements to the Kano model that take into account the difficulties of effectively communicating with child patients. The combination of two types of interviews offers unique insights into the what, how, and why of patients' needs. Adaptation of the Kano model, simplification of response options, and participation of child patients' parents in interviews facilitate data collection. CONCLUSIONS The article shows how the Kano model can be adapted to provide an effective means of eliciting child patients' needs. Adapting the model by combining structured and semi-structured interviews makes it a powerful tool in designing mHealth applications.
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Affiliation(s)
- Sune Dueholm Müller
- Department of Informatics, University of Oslo, Ole-Johan Dahls Hus, Oslo, Norway
| | | | | | - Louise Nordenhof
- Department of Management, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Daniel Jakobsen
- Department of Management, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Birgitte Mahler
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
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13
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Wang SW, Chiou CC, Su CH, Wu CC, Tsai SC, Lin TK, Hsu CN. Measuring Mobile Phone Application Usability for Anticoagulation from the Perspective of Patients, Caregivers, and Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10136. [PMID: 36011765 PMCID: PMC9407822 DOI: 10.3390/ijerph191610136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Oral anticoagulants (OAC) are recommended for preventing stroke and systemic embolism in atrial fibrillation. Proper use is imperative for maximizing anticoagulation therapy's effectiveness and safety. In preparation for the implementation of a smartphone-based SmartMed app (application) aiming to promote patient self-management, medication adherence, and data collection for patients on anticoagulation therapy, its usability assessment can ensure the value of OAC app development and adoption. We evaluated the SmartMed app's usability using the System Usability Scale (SUS) and the app-specific domain of the Mobile App Rating Scale (MARS) for its perceived impact on taking OAC regularly. We recruited 25 OAC users and their home caregivers and 59 healthcare professionals, including pharmacists, nurses, and cardiac surgeons from one medical center and one regional hospital in Taiwan. All participants (n = 84) thought the SmartMed app was useful, with mean SUS and MARS scores of 81.49 (±14.42) and 4.65 (±0.49), respectively. Usability evaluation revealed that fewer experiences with smartphone apps and different healthcare professionals (pharmacists versus nurses or cardiac surgeons) were associated with lower SUS scores and perceived impact. Throughout the evaluation process, the SmartMed app's design was considered helpful from multiple stakeholders' perspectives. Further ongoing mobile technology supports are necessary to establish the SmartMed app's effectiveness.
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Affiliation(s)
- Shih-Wei Wang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chun-Chi Chiou
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chien-Hao Su
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Cheng-Chih Wu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Shu-Chen Tsai
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tsu-Kung Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Center for Mitochondrial Research and Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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14
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Alhussein G, Hadjileontiadis L. Digital Health Technologies for Long-term Self-management of Osteoporosis: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e32557. [PMID: 35451968 PMCID: PMC9073608 DOI: 10.2196/32557] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/18/2021] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Abstract
Background Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. Objective This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. Methods A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged ≥18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41%) studies of randomized controlled trials, whereas the 19 (59%) remaining studies were only included in the narrative synthesis as they did not provide enough data. Results In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g −1.09, 95% CI −1.68 to −0.45) and disability (Hedges g −0.77, 95% CI −1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95% CI −4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95% CI −1.84 to 2.17), physical activity (Hedges g 0.09, 95% CI −0.59 to 0.50), anxiety (Hedges g −0.29, 95% CI −6.11 to 5.53), fatigue (Hedges g −0.34, 95% CI −5.84 to 5.16), calcium (Hedges g −0.05, 95% CI −0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95% CI −4.05 to 4.26), and trabecular score (Hedges g 0.06, 95% CI −1.00 to 1.12). Conclusions Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed. Trial Registration PROSPERO 2021 CRD42021269399; https://tinyurl.com/2sw454a9
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Affiliation(s)
- Ghada Alhussein
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Prieto-Moreno R, Estévez-López F, Molina-Garcia P, Mora-Traverso M, Deschamps K, Claeys K, de Buyser J, Ariza-Vega P. ActiveHip+: A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic. Digit Health 2022; 8:20552076221139694. [PMID: 36420319 PMCID: PMC9677169 DOI: 10.1177/20552076221139694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/01/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Half of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. METHODS Sixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). RESULTS The ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. CONCLUSIONS The ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.
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Affiliation(s)
- Rafael Prieto-Moreno
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Pablo Molina-Garcia
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, KU Leuven, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Leuven, Flanders, Belgium
- Clinical Motion Analysis Laboratorium, University Hospitals Leuven, Campus Pellenberg, Leuven, Flanders, Belgium
- Division of Podiatry, Haute Ecole Leonard De Vinci, Institut D’Enseignement Supérieur Parnasse Deux-Alice, Bruxelles, Belgium
- Department of Podiatry, Artevelde University College, Gent, Belgium
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Leuven, Flanders, Belgium
| | - Janou de Buyser
- Department of Rehabilitation Sciences, KU Leuven, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Leuven, Flanders, Belgium
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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16
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Shewchuk B, Green LA, Barber T, Miller J, Teare S, Campbell-Scherer D, Mrklas KJ, Li LC, Marlett N, Wasylak T, Lopatina E, McCaughey D, Marshall DA. Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study. JMIR Form Res 2021; 5:e30495. [PMID: 34842526 PMCID: PMC8663438 DOI: 10.2196/30495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 02/06/2023] Open
Abstract
Background In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=−0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality.
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Affiliation(s)
- Brittany Shewchuk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.,Enhancing Alberta Primary Care Research Networks, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya Barber
- Enhancing Alberta Primary Care Research Networks, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jean Miller
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Sylvia Teare
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Office of Lifelong Learning and Physician Learning Program, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Kelly J Mrklas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Strategic Clinical Networks, System Innovation and Programs, Alberta Health Services, Calgary, AB, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Nancy Marlett
- Patient and Community Engagement Research Unit, O'Brien Institute for Public Health, Calgary, AB, Canada.,Community Rehabilitation and Disability Studies, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Elena Lopatina
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deirdre McCaughey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Marshall DA, Jin X, Pittman LB, Smith CJ. The use of patient-reported outcome measures in hip and knee arthroplasty in Alberta. J Patient Rep Outcomes 2021; 5:87. [PMID: 34636973 PMCID: PMC8511184 DOI: 10.1186/s41687-021-00362-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
PROMs are part of routine measurement for hip and knee replacement in Alberta, Canada. We provide an overview of how PROMs are implemented in routine care, and how we use PROMs data for decision-making at different levels within the health system. The Alberta Bone and Joint Health Institute (ABJHI) ran a randomized controlled trial to determine the effectiveness and cost-effectiveness of an evidence-based care pathway for hip and knee arthroplasty in 2004. The study included several PROMs questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index, Health Utility Index, Short Form 36 and the EQ-5D-3L. Subsequently, the focus shifted to spread and scale of the care pathway provincially. WOMAC and EQ-5D-3L and a patient experience survey were selected for provincial adoption – captured before surgery, three-months post-surgery, and 12-months post-surgery. These PROMs data were integrated into research and routine clinical practice at the micro, meso and macro levels. At the micro level, PROMs data are used at the individual patient and provider level for patients to provide input on their care and as a tool to communicate with their healthcare providers. We examined the relationship of appropriateness and patient reported outcomes in a prospective cohort study. We evaluated whether routinely collected PROMs could be integrated into a patient decision aid to better inform shared decision making. At the meso level, continuous quality improvement reports are provided routinely to individual health care providers, hospitals and clinics on their performance against the measurement framework and standard key performance indicators. At the macro level, PROMs data are used to evaluate system performance by comparing outcomes across different jurisdictions or over time and support health policy decision making. Combined with administrative databases, we have used simulation models to reflect transition through the continuum of care from disease onset through end-stage care regarding the burden of disease, healthcare resource requirements and associated healthcare costs. The addition of PROMs data in clinical repositories and analyses enables the system to identify and address issues of continuous quality improvement against a measurement framework of performance indicators and to explicitly recognize the trade-offs that are inherent in any resource-constrained system.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary Health Research Innovation Centre - 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Xuejing Jin
- Centre for Evidence-Based Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.,Alberta PROMs & EQ-5D Research & Support Unit, School of Public Health, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Lindsay B Pittman
- Alberta Bone and Joint Health Institute, Suite 316, 400 Crowfoot Crescent NW, Calgary, AB, T3G 5H6, Canada
| | - Christopher J Smith
- Alberta Bone and Joint Health Institute, Suite 316, 400 Crowfoot Crescent NW, Calgary, AB, T3G 5H6, Canada
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Martin L, Gillis C, Ljungqvist O. Preoperative nutrition care in Enhanced Recovery After Surgery programs: are we missing an opportunity? Curr Opin Clin Nutr Metab Care 2021; 24:453-463. [PMID: 34155154 DOI: 10.1097/mco.0000000000000779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW A key component of Enhanced Recovery After Surgery (ERAS) is the integration of nutrition care elements into the surgical pathway, recognizing that preoperative nutrition status affects outcomes of surgery and must be optimized for recovery. We reviewed the preoperative nutrition care recommendations included in ERAS Society guidelines for adults undergoing major surgery and their implementation. RECENT FINDINGS All ERAS Society guidelines reviewed recommend preoperative patient education to describe the procedures and expectations of surgery; however, only one guideline specifies inclusion of routine nutrition education before surgery. All guidelines included a recommendation for at least one of the following nutrition care elements: nutrition risk screening, nutrition assessment, and nutrition intervention. However, the impact of preoperative nutrition care could not be evaluated because it was rarely reported in recent literature for most surgical disciplines. A small number of studies reported on the preoperative nutrition care elements within their ERAS programs and found a positive impact of ERAS implementation on nutrition care practices, including increased rates of nutrition risk screening. SUMMARY There is an opportunity to improve the reporting of preoperative nutrition care elements within ERAS programs, which will enhance our understanding of how nutrition care elements influence patient outcomes and experiences.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Chelsia Gillis
- Department of Anesthesia, McGill University Health Center, Québec, Canada
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
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Saigle V, Miller J, Dumez V, Patrick K. Intégrer la voix des patients au JAMC. CMAJ 2021; 193:E1198-E1199. [PMID: 34344781 PMCID: PMC8354653 DOI: 10.1503/cmaj.211092-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Victoria Saigle
- Institut de recherche de l'Hôpital d'Ottawa (Saigle), Ottawa, Ont.; Programme PaCER [Patient and Community Engagement Research - Mobilisation des patients et de la communauté dans le cadre de la recherche] (Miller), Faculté de médecine, Université de Calgary, Calgary, Alb.; Directeur des partenariats communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Qc; Unité de soutien SRAP du Québec, Longueuil, Qc; Réseau Québécois COVID - Pandémie (Dumez); responsable, Mobilisation des patients, JAMC, rédactrice en chef par intérim, JAMC (Patrick)
| | - Jean Miller
- Institut de recherche de l'Hôpital d'Ottawa (Saigle), Ottawa, Ont.; Programme PaCER [Patient and Community Engagement Research - Mobilisation des patients et de la communauté dans le cadre de la recherche] (Miller), Faculté de médecine, Université de Calgary, Calgary, Alb.; Directeur des partenariats communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Qc; Unité de soutien SRAP du Québec, Longueuil, Qc; Réseau Québécois COVID - Pandémie (Dumez); responsable, Mobilisation des patients, JAMC, rédactrice en chef par intérim, JAMC (Patrick)
| | - Vincent Dumez
- Institut de recherche de l'Hôpital d'Ottawa (Saigle), Ottawa, Ont.; Programme PaCER [Patient and Community Engagement Research - Mobilisation des patients et de la communauté dans le cadre de la recherche] (Miller), Faculté de médecine, Université de Calgary, Calgary, Alb.; Directeur des partenariats communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Qc; Unité de soutien SRAP du Québec, Longueuil, Qc; Réseau Québécois COVID - Pandémie (Dumez); responsable, Mobilisation des patients, JAMC, rédactrice en chef par intérim, JAMC (Patrick)
| | - Kirsten Patrick
- Institut de recherche de l'Hôpital d'Ottawa (Saigle), Ottawa, Ont.; Programme PaCER [Patient and Community Engagement Research - Mobilisation des patients et de la communauté dans le cadre de la recherche] (Miller), Faculté de médecine, Université de Calgary, Calgary, Alb.; Directeur des partenariats communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Qc; Unité de soutien SRAP du Québec, Longueuil, Qc; Réseau Québécois COVID - Pandémie (Dumez); responsable, Mobilisation des patients, JAMC, rédactrice en chef par intérim, JAMC (Patrick)
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Ball E, Rivas C. Health Apps Require Co-development to Be Acceptable and Effective. Front Psychol 2021; 12:714453. [PMID: 34335428 PMCID: PMC8322940 DOI: 10.3389/fpsyg.2021.714453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, United Kingdom.,Women's Health Research Unit, Yvonne Carter Building, Queen Mary University of London, London, United Kingdom.,Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, United Kingdom
| | - Carol Rivas
- Social Research Institute, University College London, London, United Kingdom
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Affiliation(s)
- Victoria Saigle
- Ottawa Hospital Research Institute (Saigle), Ottawa, Ont.; Patient and Community Engagement Research (PaCER) Program (Miller), Faculty of Medicine, University of Calgary, Calgary, Alta.; Directeur des Partenariats Communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Que.; Unité de soutien SRAP du Québec, Longueil, Que.; Réseau Québécois COVID - Pandemie (Dumez); Lead, Patient involvement, CMAJ (Saigle); Interim Editor-in-Chief, CMAJ (Patrick)
| | - Jean Miller
- Ottawa Hospital Research Institute (Saigle), Ottawa, Ont.; Patient and Community Engagement Research (PaCER) Program (Miller), Faculty of Medicine, University of Calgary, Calgary, Alta.; Directeur des Partenariats Communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Que.; Unité de soutien SRAP du Québec, Longueil, Que.; Réseau Québécois COVID - Pandemie (Dumez); Lead, Patient involvement, CMAJ (Saigle); Interim Editor-in-Chief, CMAJ (Patrick)
| | - Vincent Dumez
- Ottawa Hospital Research Institute (Saigle), Ottawa, Ont.; Patient and Community Engagement Research (PaCER) Program (Miller), Faculty of Medicine, University of Calgary, Calgary, Alta.; Directeur des Partenariats Communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Que.; Unité de soutien SRAP du Québec, Longueil, Que.; Réseau Québécois COVID - Pandemie (Dumez); Lead, Patient involvement, CMAJ (Saigle); Interim Editor-in-Chief, CMAJ (Patrick)
| | - Kirsten Patrick
- Ottawa Hospital Research Institute (Saigle), Ottawa, Ont.; Patient and Community Engagement Research (PaCER) Program (Miller), Faculty of Medicine, University of Calgary, Calgary, Alta.; Directeur des Partenariats Communautaires (Dumez), Faculté de médecine, Université de Montréal; Centre d'excellence sur le partenariat avec les patients et le public (Dumez), Faculté de médecine, Université de Montréal, Centre de recherche du CHUM, Montréal, Que.; Unité de soutien SRAP du Québec, Longueil, Que.; Réseau Québécois COVID - Pandemie (Dumez); Lead, Patient involvement, CMAJ (Saigle); Interim Editor-in-Chief, CMAJ (Patrick)
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