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Szeto SG, Wan H, Alavinia M, Dukelow S, MacNeill H. Effect of mobile application types on stroke rehabilitation: a systematic review. J Neuroeng Rehabil 2023; 20:12. [PMID: 36694257 PMCID: PMC9872745 DOI: 10.1186/s12984-023-01124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Stroke is a significant contributor of worldwide disability and morbidity with substantial economic consequences. Rehabilitation is a vital component of stroke recovery, but inpatient stroke rehabilitation programs can struggle to meet the recommended hours of therapy per day outlined by the Canadian Stroke Best Practices and American Heart Association. Mobile applications (apps) are an emerging technology which may help bridge this deficit, however this area is understudied. The purpose of this study is to review the effect of mobile apps for stroke rehabilitation on stroke impairments and functional outcomes. Specifically, this paper will delve into the impact of varying mobile app types on stroke rehabilitation. METHODS This systematic review included 29 studies: 11 randomized control trials and 18 quasi-experimental studies. Data extrapolation mapped 5 mobile app types (therapy apps, education apps, rehab videos, reminders, and a combination of rehab videos with reminders) to stroke deficits (motor paresis, aphasia, neglect), adherence to exercise, activities of daily living (ADLs), quality of life, secondary stroke prevention, and depression and anxiety. RESULTS There were multiple studies supporting the use of therapy apps for motor paresis or aphasia, rehab videos for exercise adherence, and reminders for exercise adherence. For permutations involving other app types with stroke deficits or functional outcomes (adherence to exercise, ADLs, quality of life, secondary stroke prevention, depression and anxiety), the results were either non-significant or limited by a paucity of studies. CONCLUSION Mobile apps demonstrate potential to assist with stroke recovery and augment face to face rehabilitation, however, development of a mobile app should be carefully planned when targeting specific stroke deficits or functional outcomes. This study found that mobile app types which mimicked principles of effective face-to-face therapy (massed practice, task-specific practice, goal-oriented practice, multisensory stimulation, rhythmic cueing, feedback, social interaction, and constraint-induced therapy) and education (interactivity, feedback, repetition, practice exercises, social learning) had the greatest benefits. Protocol registration PROPSERO (ID CRD42021186534). Registered 21 February 2021.
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Affiliation(s)
- Stephen G. Szeto
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428UHN Toronto Rehab Institute, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Hoyee Wan
- grid.17063.330000 0001 2157 2938Division of Plastic, Reconstructive, and Aesthetic Surgery, University of Toronto, Toronto, Canada
| | - Mohammad Alavinia
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sean Dukelow
- grid.22072.350000 0004 1936 7697Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather MacNeill
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada ,grid.492573.e0000 0004 6477 6457Physical Medicine & Rehabilitation, Hennick Bridgepoint Hospital, Sinai Health System, Toronto, Canada
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2
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Babu V, Sylaja PN, Soman B, Varma RP, Manju MS, Geethu GL, Kumar BS. Medication-Adherence and Management of Risk Factors for Secondary Prevention of Stroke Using Smartphone-Based Application: Protocol for MAMORs-Randomized Controlled Trial. Ann Indian Acad Neurol 2022; 25:1153-1158. [PMID: 36911480 PMCID: PMC9996505 DOI: 10.4103/aian.aian_836_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 03/14/2023] Open
Abstract
Background In LMICs, the medication adherence and risk factor control are suboptimal in the post-stroke follow-up period. With shortage of physicians, smartphone-based interventions can help stroke survivors in secondary stroke prevention. Objectives We aim to validate a digital innovative technology-based intervention to improve the awareness, medication adherence, control of risk factors through timely intervention of physician among the stroke survivors. Methods MAMOR is a smartphone-based application to improve the stroke awareness by heath education materials, reminders to timely adherence of medication, alerts on control of risk factors, video files, and timely physician intervention. The study will involve development of the app using contextual research (Delphi qualitative method) followed by a randomized, single center, double arm-controlled trial with 1:1 assignment. The app will be evaluated over a period of 6 months with a target to enroll 192 participants. Process evaluation will be conducted. The sample size was calculated as 192, considering medication adherence of 43.8%, 20% increase in medication adherence by app, power of 80%, and 10% loss to follow-up. Results The primary outcome will be medication adherence, changes in the lifestyle and behavioral and control of vascular risk factors. The secondary outcome will include vascular events and functional outcome. Conclusion This study will be one among the few studies for secondary prevention of stroke through digital technology innovation in LMICs with resource constraints. The evidences generated from this study will provide translational evidence for other similar settings for stroke survivors.
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Affiliation(s)
- Veena Babu
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M S Manju
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - G L Geethu
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - B Suresh Kumar
- Computer Division, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
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Fruhwirth V, Berger L, Gattringer T, Fandler-Höfler S, Kneihsl M, Schwerdtfeger A, Weiss EM, Enzinger C, Pinter D. Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study. Front Neurol 2022; 12:791545. [PMID: 35069420 PMCID: PMC8766760 DOI: 10.3389/fneur.2021.791545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort. Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke. Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = -0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003). Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.
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Affiliation(s)
- Viktoria Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lisa Berger
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Neuropsychology - Neuroimaging, Institute of Psychology, University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Andreas Schwerdtfeger
- Department of Health Psychology, Institute of Psychology, University of Graz, Graz, Austria
| | - Elisabeth Margarete Weiss
- Department of Clinical Psychology, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria
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4
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O'Connor SR, Kee F, Thompson DR, Cupples ME, Donnelly M, Heron N. A review of the quality and content of mobile apps to support lifestyle modifications following a transient ischaemic attack or 'minor' stroke. Digit Health 2021; 7:20552076211065271. [PMID: 34950500 PMCID: PMC8689637 DOI: 10.1177/20552076211065271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/19/2021] [Indexed: 12/27/2022] Open
Abstract
Objective Secondary prevention is recommended to reduce cardiovascular risk after transient ischaemic attack (TIA) or ‘minor’ stroke. Mobile health interventions can provide accessible, cost-effective approaches to address modifiable risk factors, such as physical inactivity, hypertension and being overweight. The objective of this study was to evaluate the quality of apps for supporting lifestyle change following a TIA or ‘minor’ stroke. Methods Systematic searches of Google Play and the Apple Store were carried out to identify mobile apps released between 1 November 2019 and 1 October 2021. Keywords were used including stroke, TIA, lifestyle, prevention and recovery. Quality was assessed using the Mobile Application Rating Scale (MARS). Common components were identified with the Behaviour Change Technique (BCT) Taxonomy. Descriptive statistics were used to summarize the performance results for each app. Results Searches identified 2545 potential apps. Thirty remained after removing duplicates and screening titles and descriptions. Six were eligible after full review of their content. All apps included at least one BCT (range: 1–16 BCTs). The most frequent BCTs included ‘information about health consequences’ (n = 5/6), ‘verbal or visual communication from a credible source’ (n = 4/6) and ‘action planning’ (n = 4/6). The mean MARS score was 2.57/5 (SD: 0.51; range: 1.78–3.36). No apps were of ‘good’ overall quality (scoring more than 4/5). Conclusions This is the first review of mobile health interventions for this population. Only a small number of apps were available. None were targeted specifically at people with a TIA or ‘minor’ stroke. Overall quality was low. Further work is needed to develop and test accessible, user designed, and evidence-informed digital interventions in this population.
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Affiliation(s)
- Seán R O'Connor
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Neil Heron
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,School of Primary, Community and Social Care, Keele University, Staffordshire, UK
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5
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Hamaya R, Fukuda H, Takebayashi M, Mori M, Matsushima R, Nakano K, Miyake K, Tani Y, Yokokawa H. Effects of an mHealth App (Kencom) With Integrated Functions for Healthy Lifestyles on Physical Activity Levels and Cardiovascular Risk Biomarkers: Observational Study of 12,602 Users. J Med Internet Res 2021; 23:e21622. [PMID: 33900203 PMCID: PMC8111509 DOI: 10.2196/21622] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/24/2020] [Accepted: 03/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Mobile health (mHealth) apps are considered to be potentially powerful tools for improving lifestyles and preventing cardiovascular disease (CVD), although only few have undergone large, well-designed epidemiological research. “kencom” is a novel mHealth app with integrated functions for healthy lifestyles such as monitoring daily health/step data, providing tailored health information, or facilitating physical activity through group-based game events. The app is linked to large-scale Japanese insurance claims databases and annual health check-up databases, thus comprising a large longitudinal cohort. Objective We aimed to assess the effects of kencom on physical activity levels and CVD risk factors such as obesity, hypertension, dyslipidemia, and diabetes mellitus in a large population in Japan. Methods Daily step count, annual health check-up data, and insurance claim data of the kencom users were integrated within the kencom system. Step analysis was conducted by comparing the 1-year average daily step count before and after kencom registration. In the CVD risk analysis, changes in CVD biomarkers following kencom registration were evaluated among the users grouped into the quintile according to their change in step count. Results A total of 12,602 kencom users were included for the step analysis and 5473 for the CVD risk analysis. The participants were generally healthy and their mean age was 44.1 (SD 10.2) years. The daily step count significantly increased following kencom registration by a mean of 510 steps/day (P<.001). In particular, participation in “Arukatsu” events held twice a year within the app was associated with a remarkable increase in step counts. In the CVD risk analysis, the users of the highest quintile in daily step change had, compared with those of the lowest quartile, a significant reduction in weight (–0.92 kg, P<.001), low-density lipoprotein cholesterol (–2.78 mg/dL, P=.004), hemoglobin A1c (HbA1c; –0.04%, P=.004), and increase in high-density lipoprotein cholesterol (+1.91 mg/dL, P<.001) after adjustment of confounders. Conclusions The framework of kencom successfully integrated the Japanese health data from multiple data sources to generate a large, longitudinal data set. The use of the kencom app was significantly associated with enhanced physical activity, which might lead to weight loss and improvement in lipid profile.
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Affiliation(s)
- Rikuta Hamaya
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Department of Epidemiology, Harvard University, Boston, MA, United States
| | - Hiroshi Fukuda
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan.,Department of Advanced Preventive Medicine and Health Literacy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Masaki Takebayashi
- Graduate School of Health Science, Aomori University of Health and Welfare, Aomori, Japan
| | | | | | | | | | | | - Hirohide Yokokawa
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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6
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Mansour OY, Ramadan I, Elfatatry A, Hamdi M, Abudu A, Hassan T, Eldeeb H, Marouf H, Mogahed M, Farouk M, Abas M, Hamed M, Afify M, Abdallah T, Zaidat O. Using ESN-Smartphone Application to Maximize AIS Reperfusion Therapy in Alexandria Stroke Network: A Stroke Chain of Survival Organizational Model. Front Neurol 2021; 12:597717. [PMID: 33708169 PMCID: PMC7940834 DOI: 10.3389/fneur.2021.597717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background: In developing countries like Egypt, the clinical workflow of stroke management is poorly established due to the lack of awareness of the stroke patients concerning their need of therapeutic intervention and the poor identification of facilities equipped to treat stroke. Hence, establishing a stroke system of care in developing countries that can efficiently and rapidly triage patients to the appropriate reperfusion therapy center is imperative to improving stroke management and outcomes. Aims: To evaluate a pilot experience in stroke hospital identification and expediting decision-making in AIS treatment through the Alexandria stroke network and Egyptian Stroke Network (ESN)-app. Methods: Between 2017 and 2019, seven hospitals registered themselves on the AS-Network as pilot hospitals. The ESN-application was used to detect stroke type, tele-connect stroke teams and hospitals, track triage of patients to equipped facility in real time, and streamline stroke workflow. The quality of and time required for stroke management were compared between 84 patients with acute ischemic stroke (AIS) whose treatment involved the ESN-app and 276 patients whose treatment did not. Results: During this pilot study, 360 AIS cases received reperfusion therapy, 84 of which were indicated by the ESN-app. The use of the application was associated with the significant drop in time metrics for the reperfusion AIS-patients (door-in-door-out time; 56 ± 34 min vs. 96 ± 45 min, door-to-groin puncture time; 50 ± 7 min vs. 120 ± 25 min, door-to-needle time; 55 ± 12 min vs. 78 ± 16 min with p < 0.0001). Its use was also associated with higher rates of excellent outcomes at the 90-day follow-up (without ESN-app vs. with ESN-app, 67.9 vs. 47.1%, p = 0.001) but no difference in 90-day mortality or symptomatic intracerebral hemorrhage (without ESN-app vs. with ESN-app, 9.5 vs. 11.2% and 4.8 vs. 5.1%, p > 0.05). Conclusion: Our pilot experience demonstrated that the use of the ESN-app expedited the stroke treatment workflow and facilitated tele-connection between registered stroke facilities. Additionally, its use might be associated with achieving higher rates of excellent outcomes at 90 days, where a larger scale study is needed for more confirmation.
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Affiliation(s)
- Ossama Yassin Mansour
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Louran Comprehensive Stroke Center, Alexandria, Egypt.,Mabaret Elasafra Hospital, Alexandria, Egypt.,Shark el Madina Ministry of Health Hospital, Alexandria, Egypt.,Department of Neurology, Damanhur Medical National Institute, Damanhur, Egypt.,Elandalusia General Hospital, Alexandria, Egypt
| | - Ismail Ramadan
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Amer Elfatatry
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Mohamed Hamdi
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Ashraf Abudu
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Tamer Hassan
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Louran Comprehensive Stroke Center, Alexandria, Egypt
| | - Hany Eldeeb
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Mabaret Elasafra Hospital, Alexandria, Egypt
| | - Hazem Marouf
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Mabaret Elasafra Hospital, Alexandria, Egypt
| | | | - Mohamed Farouk
- Shark el Madina Ministry of Health Hospital, Alexandria, Egypt
| | - Mohamed Abas
- Department of Neurology, Damanhur Medical National Institute, Damanhur, Egypt
| | - Mervat Hamed
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Elandalusia General Hospital, Alexandria, Egypt
| | | | - Tamer Abdallah
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Louran Comprehensive Stroke Center, Alexandria, Egypt
| | - Osama Zaidat
- Bon Secours Mercy Health System, Neuroscience Institute, St. Vincent Hospital, Toledo, OH, United States
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Juengst SB, Terhorst L, Nabasny A, Wallace T, Weaver JA, Osborne CL, Burns SP, Wright B, Wen PS, Kew CLN, Morris J. Use of mHealth Technology for Patient-Reported Outcomes in Community-Dwelling Adults with Acquired Brain Injuries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2173. [PMID: 33672183 PMCID: PMC7926536 DOI: 10.3390/ijerph18042173] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
The purpose of our scoping review was to describe the current use of mHealth technology for long-term assessment of patient-reported outcomes in community-dwelling individuals with acquired brain injury (ABI). Following PRISMA guidelines, we conducted a scoping review of literature meeting these criteria: (1) civilians or military veterans, all ages; (2) self-reported or caregiver-reported outcomes assessed via mobile device in the community (not exclusively clinic/hospital); (3) published in English; (4) published in 2015-2019. We searched Ovid MEDLINE(R) < 1946 to 16 August 2019, MEDLINE InProcess, EPub, Embase, and PsycINFO databases for articles. Thirteen manuscripts representing 12 distinct studies were organized by type of ABI [traumatic brain injury (TBI) and stroke] to extract outcomes, mHealth technology used, design, and inclusion of ecological momentary assessment (EMA). Outcomes included post-concussive, depressive, and affective symptoms, fatigue, daily activities, stroke risk factors, and cognitive exertion. Overall, collecting patient-reported outcomes via mHealth was feasible and acceptable in the chronic ABI population. Studies consistently showed advantage for using EMA despite variability in EMA timing/schedules. To ensure best clinical measurement, research on post-ABI outcomes should consider EMA designs (versus single time-point assessments) that provide the best timing schedules for their respective aims and outcomes and that leverage mHealth for data collection.
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Affiliation(s)
- Shannon B. Juengst
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Andrew Nabasny
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | | | - Jennifer A. Weaver
- Department of Clinical Research & Leadership, George Washington University, Washington, DC 20006, USA;
| | - Candice L. Osborne
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
| | - Suzanne Perea Burns
- School of Occupational Therapy, Texas Woman’s University, Denton, TX 76204, USA;
| | - Brittany Wright
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | - Pey-Shan Wen
- Department of Occupational Therapy, Georgia State University, Atlanta, GA 30303, USA;
| | - Chung-Lin Novelle Kew
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | - John Morris
- Shepherd Center, Atlanta, GA 30309, USA; (T.W.); (J.M.)
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8
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Burns SP, Terblanche M, Perea J, Lillard H, DeLaPena C, Grinage N, MacKinen A, Cox EE. mHealth Intervention Applications for Adults Living With the Effects of Stroke: A Scoping Review. Arch Rehabil Res Clin Transl 2020; 3:100095. [PMID: 33778470 PMCID: PMC7984984 DOI: 10.1016/j.arrct.2020.100095] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To conduct a scoping review of mobile health (mHealth) application (app) interventions to support needs of adults living with the effects of stroke reported in the literature. Data Sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus were systematically searched for peer-reviewed publications. Articles were published between January 2007 and September 2020 and met predefined inclusion and exclusion criteria. Study Selection Articles included were written in English language, involved adults older than 18 years, and described an mHealth app specifically tested and/or developed as an intervention for someone with stroke to be used remotely and/or independently without constant provider supervision or assistance. Articles were excluded if they focused on acute management of stroke only, focused on primary prevention, were animal studies, were not an app for smartphone or tablet, and did not describe an empirical study. Data Extraction Two researchers independently screened titles and abstracts for inclusion. The full-text articles were then reviewed for eligibility by the research team. Data were extracted and verified by a third reviewer. Data Synthesis The search yielded 2123 studies and 49 were included for data extraction. The findings reveal that a global surge of studies on mHealth apps for people with stroke have emerged within the past 2 years. Most studies were developed for persons with stroke in the United States and the primary content foci included upper extremity function (31.5%); lower extremity function (5.3%); general exercise, physical activity, and/or functional mobility (23.7%); trunk control (5.3%); medical management and secondary prevention (26.3%); language and speech skills (20.5%); cognitive skills (7.9%); general disability and activities of daily living (5.3%); and home safety (2.6%). Of the included studies, a majority were preliminary in nature, with 36.7% being categorized as pilot or feasibility trials and 24.4% discussing initial design, development, and/or refinement. Conclusions Results from this study reveal that the number of apps specifically developed for people with stroke and described in the scientific literature are growing exponentially. The apps have widely varied content to meet the needs of persons with stroke; however, the studies are generally preliminary in nature, focusing on development, usability, and initial pilot testing. This review highlights the need for additional research and development of mHealth apps targeted for adults with stroke. Development should consider the various and complex needs of people living with the effects of chronic stroke, while large-scale trials are needed to build on the existing evidence.
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Affiliation(s)
- Suzanne P Burns
- School of Occupational Therapy, Texas Woman's University, Denton, Texas
| | | | | | | | - Catalina DeLaPena
- School of Occupational Therapy, Texas Woman's University, Denton, Texas
| | | | - Ashley MacKinen
- School of Occupational Therapy, Texas Woman's University, Denton, Texas
| | - Ella Elaine Cox
- Texas Woman's University Libraries, Texas Woman's University, Denton, Texas
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9
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Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, van Berlo S, Freene N. A smartphone app for sedentary behaviour change in cardiac rehabilitation and the effect on hospital admissions: the ToDo-CR randomised controlled trial study protocol. BMJ Open 2020; 10:e040479. [PMID: 33323435 PMCID: PMC7745513 DOI: 10.1136/bmjopen-2020-040479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is recommended for secondary prevention of cardiovascular disease and reducing the risk of repeat cardiac events. Physical activity is a core component of CR; however, studies show that participants remain largely sedentary. Sedentary behaviour is an independent risk factor for all-cause mortality. Strategies to encourage sedentary behaviour change are needed. This study will explore the effectiveness and costs of a smartphone application (Vire) and an individualised online behaviour change program (ToDo-CR) in reducing sedentary behaviour, all-cause hospital admissions and emergency department visits over 12 months after commencing CR. METHODS AND ANALYSIS A multicentre, assessor-blind parallel randomised controlled trial will be conducted with 144 participants (18+ years). Participants will be recruited from three phase-II CR centres. They will be assessed on admission to CR and randomly assigned (1:1) to one of two groups: CR plus the ToDo-CR 6-month programme or usual care CR. Both groups will be re-assessed at 6 months and 12 months for the primary outcome of all-cause hospital admissions and presentations to the emergency department. Accelerometer-measured changes in sedentary behaviour and physical activity will also be assessed. Logistic regression models will be used for the primary outcome of hospital admissions and emergency department visits. Methods for repeated measures analysis will be used for all other outcomes. A cost-effectiveness analysis will be conducted to evaluate the effects of the intervention on the rates of hospital admissions and emergency department visits within the 12 months post commencing CR. ETHICS AND DISSEMINATION This study received ethical approval from the Australian Capital Territory Health (2019.ETH.00162), Calvary Public Hospital Bruce (20-2019) and the University of Canberra (HREC-2325) Human Research Ethics Committees (HREC). Results will be disseminated through peer-reviewed academic journals. Results will be made available to participants on request. TRIAL REGISTRATION NUMBER ACTRN12619001223123.
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Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Theophile Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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10
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Use of mobile-stroke risk scale and lifestyle guidance promote healthy lifestyles and decrease stroke risk factors. Int J Nurs Sci 2020; 7:401-407. [PMID: 33195751 PMCID: PMC7644564 DOI: 10.1016/j.ijnss.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The purpose of this study was to determine the effectiveness of Mobile-Stroke Risk Scale and Life Style Guidance (M-SRSguide) in promoting a healthy lifestyle and reducing stroke risk factors in at-risk persons. Methods This research was an clinical trial with a pre-test and post-test control group design. The accessible population is persons at risk of stroke in the community (West and East Kalimantan Province, Indonesia). Thirty-two participants in the intervention group and 32 participants in the control group participated in this study. The sampling method was systematic random sampling. We allocate the sample into the intervention and control groups using a randomized block design. The intervention group used the M-SRSguide. The control group used manual book for a self-assessment of stroke risk. The measurement of a healthy lifestyle and the stroke risk factors was performed before and six months after the intervention. Results There are no significant differences in healthy lifestyle and stroke risk factors between the two groups after the intervention (P > 0.05). Analysis of healthy lifestyle behavior assessment items in the intervention group showed an increase in healthy diets, activity patterns, and stress control after the use of the M-SRSguide (P < 0.01). Conclusion The use of M-SRSguide is effective in promoting a healthy lifestyle.
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11
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Han H, Guo W, Lu Y, Wang M. Effect of mobile applications on blood pressure control and their development in China: a systematic review and meta-analysis. Public Health 2020; 185:356-363. [PMID: 32738577 DOI: 10.1016/j.puhe.2020.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mobile applications (apps) facilitate aspects of people's lives and are useful auxiliary tools for controlling risk factors for chronic diseases. This meta-analysis and systematic review aimed to explore the effect of app-assisted interventions on blood pressure (BP) control in Chinese adults and summarize the common functions of these apps. STUDY DESIGN This is a systematic review and meta-analysis. METHODS The search was conducted in four databases (PubMed, Embase, China National Knowledge Infrastructure database, and China Biology Medicine database). The identified articles were reviewed independently by two researchers. A random-effects model was used to compute the effect size. Studies were assessed for risk of bias and the transparency and quality of the apps. RESULTS Eighteen studies (n = 2965) were included in the final analysis. App-based interventions achieved additional decreases in BP levels (systolic BP [SBP]: -8.12 mmHg, 95% confidence interval [CI]: -11.47 to -4.77 mmHg, P < 0.001; diastolic BP [DBP]: -6.67 mmHg, 95% CI: -8.92 to -4.41 mmHg, P < 0.001). However, the results showed considerable heterogeneity (SBP: I2 = 97%, P < 0.001; DBP: I2 = 96%, P < 0.001). Four studies reported the BP control rate. The pooled results demonstrated a better control rate achieved via app-based interventions (risk ratio: 1.33; 95% CI: 1.18 to 1.49, P < 0.001) without heterogeneity (I2 = 0%). The transparency and replicability assessment revealed unsatisfying results, and only three studies reported more than half of the 16 items in the mHealth checklist. Few studies described the replicability, data security, and infrastructure of the apps used. We identified 16 app functions, with the top three functions being doctor-patient communication (16/16), health education (15/16), and personalized guidance (12/16). CONCLUSIONS We showed app-based interventions had a positive effect on BP management in Chinese adults. However, there was high heterogeneity among the included studies, which merits further exploration when more standardized research has been conducted. The functions of the apps varied widely, and further development of apps for BP management should abide by appropriate reporting guidelines.
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Affiliation(s)
- Heze Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifan Lu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; The Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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12
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Fruhwirth V, Enzinger C, Weiss E, Schwerdtfeger A, Gattringer T, Pinter D. [Use of smartphone apps in secondary stroke prevention]. Wien Med Wochenschr 2019; 170:41-54. [PMID: 31535230 DOI: 10.1007/s10354-019-00707-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 08/19/2019] [Indexed: 02/08/2023]
Abstract
Modifiable risk factors such as hypertension, obesity or smoking have been reported to explain up to 90% of risk for ischemic stroke. Treatment of these risk factors is known to decrease the risk of recurrent stroke events. We performed a computer-based literature research from June to August 2018 using the electronic database PubMed to investigate the effect of smartphone apps on risk factor control for secondary stroke prevention as well as feasibility and patient satisfaction with mobile health. Studies evaluating interventions by smartphone or tablet devices in stroke patients and reported results regarding risk factors, feasibility or patient satisfaction were considered (n = 10). Identified data showed significant improvement regarding the control of risk factors hypertension and diabetes as well as significant improvements of the lifestyle risk factors physical inactivity and obesity. Stroke patients perceive smartphone apps mostly as useful and are open-minded regarding mHealth, provided that these complement rather than replace personal medical care.
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Affiliation(s)
- Viktoria Fruhwirth
- Forschungseinheit für Neuronale Plastizität und Reparatur, Abteilung für Neurologie, Medizinische Universität Graz, 8036, Graz, Österreich
| | - Christian Enzinger
- Forschungseinheit für Neuronale Plastizität und Reparatur, Abteilung für Neurologie, Medizinische Universität Graz, 8036, Graz, Österreich.,Klinische Abteilung für Neuroradiologie, vaskuläre und interventionelle Radiologie, Abteilung für Radiologie, Medizinische Universität Graz, 8036, Graz, Österreich
| | - Elisabeth Weiss
- Abteilung für Biologische Psychologie, Institut für Psychologie, Universität Graz, 8010, Graz, Österreich
| | - Andreas Schwerdtfeger
- Abteilung für Gesundheitspsychologie, Institut für Psychologie, Universität Graz, 8010, Graz, Österreich
| | - Thomas Gattringer
- Forschungseinheit für Neuronale Plastizität und Reparatur, Abteilung für Neurologie, Medizinische Universität Graz, 8036, Graz, Österreich
| | - Daniela Pinter
- Forschungseinheit für Neuronale Plastizität und Reparatur, Abteilung für Neurologie, Medizinische Universität Graz, 8036, Graz, Österreich.
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Kim C, Prabhu AV, Hansberry DR, Agarwal N, Heron DE, Beriwal S. Digital Era of Mobile Communications and Smartphones: A Novel Analysis of Patient Comprehension of Cancer-Related Information Available Through Mobile Applications. Cancer Invest 2019; 37:127-133. [DOI: 10.1080/07357907.2019.1572760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christopher Kim
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Arpan V. Prabhu
- Department of Radiation Oncology, UAMS Winthrop P. Rockefeller Cancer Institute, Little Rock, Arkansas, USA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - David R. Hansberry
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dwight E. Heron
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Institute, Pittsburgh, Pennsylvania, USA
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El-Ghanem M, Gomez FE, Koul P, Nuoman R, Santarelli JG, Amuluru K, Gandhi CD, Cohen ER, Meyers P, Al-Mufti F. Mandatory Neuroendovascular Evolution: Meeting the New Demands. INTERVENTIONAL NEUROLOGY 2018; 8:69-81. [PMID: 32231697 DOI: 10.1159/000495075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/02/2018] [Indexed: 01/01/2023]
Abstract
Background Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time.
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Affiliation(s)
| | - Francisco E Gomez
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prateeka Koul
- Department of Internal Medicine, Stamford Hospital, Stamford, Connecticut, USA
| | - Rolla Nuoman
- Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Justin G Santarelli
- Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA
| | - Krishna Amuluru
- University of Pittsburgh Medical Center Hamot, Great Lakes Neurosurgery and Neurointervention, Erie, Pennsylvania, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA
| | - Eric R Cohen
- Department of Neurology and Neurosurgery, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Philip Meyers
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA
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Zhou X, Du M, Zhou L. Use of mobile applications in post-stroke rehabilitation: a systematic review. Top Stroke Rehabil 2018; 25:1-11. [PMID: 30209991 DOI: 10.1080/10749357.2018.1482446] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/19/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Information technology and mobile devices are potentially beneficial and useful in the management of patients who have had stroke, including recognition, translation, assessment, and rehabilitation. The objective of this study was to determine the effectiveness of mobile applications in the rehabilitation of stroke survivors. METHODS A literature search appraising the effectiveness of mobile applications in the rehabilitation of stroke survivors was performed on PubMed, Embase, Science Citation Index Expanded-SCIE, and EBSCO-CINAHL from their inception until May 28th, 2017. Two reviewers independently screened the literature according to eligibility criteria, evaluated study quality, and collected data from the articles included. RESULTS Of the 3574 articles screened, 12 studies met the eligibility criteria of the systematic review. Of these, 2 studies were randomized controlled trials and the remaining 10 were before-after studies, of which only 2 had control groups. The mobile applications encompassed 5 rehabilitation areas, 5 in physical function, 4 in language function, 2 in cognitive function, and 1 risk factor reduction. Of these 12 studies, 9 reported significant improvements in function, while in 3 studies the descriptive statistics indicated favorable changes after intervention. CONCLUSIONS Although the use of mobile applications in the rehabilitation of stroke survivors was effective, it is clear from this systematic review that more research is needed to verify their effectiveness.
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Affiliation(s)
- Xuan Zhou
- a Department of Clinical Nursing , School of Nursing, Second Military Medical University , Shanghai China
| | - Minxia Du
- a Department of Clinical Nursing , School of Nursing, Second Military Medical University , Shanghai China
- b Department of Surgical Nursing , School of Nursing, Xinxiang Medical University , Xinxiang Henan Province , China
| | - Lanshu Zhou
- a Department of Clinical Nursing , School of Nursing, Second Military Medical University , Shanghai China
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16
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Yi JY, Kim Y, Cho YM, Kim H. Self-management of Chronic Conditions Using mHealth Interventions in Korea: A Systematic Review. Healthc Inform Res 2018; 24:187-197. [PMID: 30109152 PMCID: PMC6085202 DOI: 10.4258/hir.2018.24.3.187] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives Population aging has increased the burden of chronic diseases globally. mHealth is often cited as a viable solution to enhance the management of chronic conditions. In this study, we conducted a systematic review of mHealth interventions for the self-management of chronic diseases in Korea, a highly-connected country with a high chronic care burden. Methods Five databases were searched for relevant empirical studies that employed randomized controlled trial (RCT) or quasi-experimental methods published in English or Korean from the years 2008 to 2018. The selected studies were reviewed according to the PRISMA guidelines. The selected studies were classified using the Individual and Family Self-Management Theory conceptual framework. Results Sixteen studies met the inclusion criteria, 9 of which were targeted towards diabetes management, and 7 of which were RCTs. Other target diseases included hypertension, stroke, asthma, and others. mHealth interventions were primarily delivered through smartphone applications, mobile phones connected to a monitoring device, and short message services (SMS). Various self-management processes were applied, including providing social influence and support, and facilitating self-monitoring and goal setting. Eleven studies showed mHealth interventions to be effective in improving self-management behaviors, biomarkers, or patient-reported outcome measures associated with chronic diseases. Conclusions While the number of identified studies was not large, none reported negative impacts of mHealth on selected outcomes. Future studies on mHealth should design interventions with a greater variety of targeted functions and should adopt more rigorous methodologies to strengthen the evidence for its effectiveness in chronic disease management.
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Affiliation(s)
- Jae Yoon Yi
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Yujin Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Yoon-Min Cho
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea.,Institute of Aging, Seoul National University College of Medicine, Seoul, Korea.,Institute of Health & Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
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Lynch EA, Jones TM, Simpson DB, Fini NA, Kuys SS, Borschmann K, Kramer S, Johnson L, Callisaya ML, Mahendran N, Janssen H, English C. Activity monitors for increasing physical activity in adult stroke survivors. Cochrane Database Syst Rev 2018; 7:CD012543. [PMID: 30051462 PMCID: PMC6513611 DOI: 10.1002/14651858.cd012543.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stroke is the third leading cause of disability worldwide. Physical activity is important for secondary stroke prevention and for promoting functional recovery. However, people with stroke are more inactive than healthy age-matched controls. Therefore, interventions to increase activity after stroke are vital to reduce stroke-related disability. OBJECTIVES To summarise the available evidence regarding the effectiveness of commercially available, wearable activity monitors and smartphone applications for increasing physical activity levels in people with stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, and the following clinical trial registers: WHO International Clinical Trials Registry Platform, Clinical Trials, EU Clinical Trial Register, ISRCTN Registry, Australian and New Zealand Clinical Trial Registry, and Stroke Trials Registry to 3 March 2018. We also searched reference lists, Web of Science forward tracking, and Google Scholar, and contacted trial authors to obtain further data if required. We did not restrict the search on language or publication status. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and randomised cross-over trials that included use of activity monitors versus no intervention, another type of intervention, or other activity monitor. Participants were aged 18 years or older with a diagnosis of stroke, in hospital or living in the community. Primary outcome measures were steps per day and time in moderate-to-vigorous intensity activity. Secondary outcomes were sedentary time, time spent in light intensity physical activity, walking duration, fatigue, mood, quality of life, community participation and adverse events. We excluded upper limb monitors that only measured upper limb activity. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology to analyse and interpret the data. At least two authors independently screened titles and abstracts for inclusion. We resolved disagreements by consulting a third review author. We extracted the following data from included studies into a standardised template: type of study, participant population, study setting, intervention and co-interventions, time-frame, and outcomes. We graded levels of bias as high, low, or unclear, and assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS We retrieved 28,098 references, from which we identified 29 potential articles. Four RCTs (in 11 reports) met the inclusion criteria.The sample sizes ranged from 27 to 135 (total 245 participants). Time poststroke varied from less than one week (n = 1), to one to three months (n = 2), or a median of 51 months (n = 1). Stroke severity ranged from a median of one to six on the National Institutes of Health Stroke Scale (NIHSS). Three studies were conducted in inpatient rehabilitation, and one was in a university laboratory. All studies compared use of activity monitor plus another intervention (e.g. a walking retraining programme or an inpatient rehabilitation programme) versus the other intervention alone. Three studies reported on the primary outcome of daily step counts.There was no clear effect for the use of activity monitors in conjunction with other interventions on step count in a community setting (mean difference (MD) -1930 steps, 95% confidence interval (CI) -4410 to 550; 1 RCT, 27 participants; very low-quality evidence), or in an inpatient rehabilitation setting (MD 1400 steps, 95% CI -40 to 2840; 2 RCTs, 83 participants; very low-quality evidence). No studies reported the primary outcome moderate-to-vigorous physical activity, but one did report time spent in moderate and vigorous intensity activity separately: this study reported that an activity monitor in addition to usual inpatient rehabilitation increased the time spent on moderate intensity physical activity by 4.4 minutes per day (95% CI 0.28 to 8.52; 1 RCT, 48 participants; low-quality evidence) compared with usual rehabilitation alone, but there was no clear effect for the use of an activity monitor plus usual rehabilitation for increasing time spent in vigorous intensity physical activity compared to usual rehabilitation (MD 2.6 minutes per day, 95% CI -0.8 to 6; 1 RCT, 48 participants; low-quality evidence). The overall risk of bias was low, apart from high-risk for blinding of participants and study personnel. None of the included studies reported any information relating to adverse effects. AUTHORS' CONCLUSIONS Only four small RCTs with 274 participants (three in inpatient rehabilitation and one in the community) have examined the efficacy of activity monitors for increasing physical activity after stroke. Although these studies showed activity monitors could be incorporated into practice, there is currently not enough evidence to support the use of activity monitors to increase physical activity after stroke.
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Affiliation(s)
- Elizabeth A Lynch
- The University of AdelaideAdelaide Nursing SchoolAdelaideSouth AustraliaAustralia
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Taryn M Jones
- Macquarie UniversityFaculty of Medicine and Health SciencesSydneyAustralia2109
| | - Dawn B Simpson
- University of TasmaniaMenzies Institute for Medical ResearchHobartAustralia
| | - Natalie A Fini
- The University of MelbournePhysiotherapy DepartmentLevel 7, Alan Gilbert BuildingMelbourneVICAustralia3010
- La Trobe UniversitySchool of Allied HealthMelbourneAustralia
| | - Suzanne S Kuys
- Australian Catholic UniversitySchool of PhysiotherapyBrisbaneQLDAustralia4114
| | - Karen Borschmann
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | | | - Niruthikha Mahendran
- University of CanberraDiscipline of Physiotherapy, Faculty of HealthCanberraAustralia2617
| | - Heidi Janssen
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- University of NewcastlePriority Research Centre for Stroke and Brain InjuryNewcastleAustralia
- Hunter New England HealthCommunity Aged Care and Hunter Stroke ServiceNew Lambton HeightsNSWAustralia2305
| | - Coralie English
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- University of NewcastlePriority Research Centre for Stroke and Brain InjuryNewcastleAustralia
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Coorey GM, Neubeck L, Mulley J, Redfern J. Effectiveness, acceptability and usefulness of mobile applications for cardiovascular disease self-management: Systematic review with meta-synthesis of quantitative and qualitative data. Eur J Prev Cardiol 2018; 25:505-521. [DOI: 10.1177/2047487317750913] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Mobile technologies are innovative, scalable approaches to reducing risk of cardiovascular disease but evidence related to effectiveness and acceptability remains limited. We aimed to explore the effectiveness, acceptability and usefulness of mobile applications (apps) for cardiovascular disease self-management and risk factor control. Design Systematic review with meta-synthesis of quantitative and qualitative data. Methods Comprehensive search of multiple databases (Medline, Embase, CINAHL, SCOPUS and Cochrane CENTRAL) and grey literature. Studies were included if the intervention was primarily an app aimed at improving at least two lifestyle behaviours in adults with cardiovascular disease. Meta-synthesis of quantitative and qualitative data was performed to review and evaluate findings. Results Ten studies of varying designs including 607 patients from five countries were included. Interventions targeted hypertension, heart failure, stroke and cardiac rehabilitation populations. Factors that improved among app users were rehospitalisation rates, disease-specific knowledge, quality of life, psychosocial well-being, blood pressure, body mass index, waist circumference, cholesterol and exercise capacity. Improved physical activity, medication adherence and smoking cessation were also characteristic of app users. Appealing app features included tracking healthy behaviours, self-monitoring, disease education and personalised, customisable content. Small samples, short duration and selection bias were noted limitations across some studies, as was the relatively low overall scientific quality of evidence. Conclusions Multiple behaviours and cardiovascular disease risk factors appear modifiable in the shorter term with use of mobile apps. Evidence for effectiveness requires larger, controlled studies of longer duration, with emphasis on process evaluation data to better understand important system- and patient-level characteristics.
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Affiliation(s)
- Genevieve M Coorey
- The George Institute for Global Health Australia, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, UK
- Sydney Nursing School, University of Sydney, Australia
| | - John Mulley
- The George Institute for Global Health Australia, Sydney, Australia
| | - Julie Redfern
- The George Institute for Global Health Australia, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
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Munich SA, Tan LA, Nogueira DM, Keigher KM, Chen M, Crowley RW, Conners JJ, Lopes DK. Mobile Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App. Neurointervention 2017; 12:69-76. [PMID: 28955508 PMCID: PMC5613047 DOI: 10.5469/neuroint.2017.12.2.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose The primary correlate to survival and preservation of neurologic function in patients suffering from an acute ischemic stroke is time from symptom onset to initiation of therapy and reperfusion. Communication and coordination among members of the stroke team are essential to maximizing efficiency and subsequently early reperfusion. In this work, we aim to describe our preliminary experience using the Join mobile application as a means to improve interdisciplinary team communication and efficiency. Materials and Methods We describe our pilot experience with the initiation of the Join mobile application between July 2015 and July 2016. With this application, a mobile beacon is transported with the patient on the ambulance. Transportation milestone timestamps and geographic coordinates are transmitted to the treating facility and instantly communicated to all treatment team members. The transport team / patient can be tracked en route to the treating facility. Results During our pilot study, 62 patients were triaged and managed using the Join application. Automated time-stamping of critical events, geographic tracking of patient transport and summary documents were obtained for all patients. Treatment team members had an overall favorable impression of the Join application and recommended its continued use. Conclusion The Join application is one of several components of a multi-institutional, interdisciplinary effort to improve the treatment of patients with acute ischemic stroke. The ability of the treatment team to track patient transport and communicate with the transporting team may improve reperfusion time and, therefore, improve neurologic outcomes.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Lee A Tan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Danilo M Nogueira
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Kiffon M Keigher
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - R Webster Crowley
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - James J Conners
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Demetrius K Lopes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Alotaibi NM, Sarzetto F, Guha D, Lu M, Bodo A, Gupta S, Dyer E, Howard P, da Costa L, Swartz RH, Boyle K, Nathens AB, Yang VXD. Impact of Smartphone Applications on Timing of Endovascular Therapy for Ischemic Stroke: A Preliminary Study. World Neurosurg 2017; 107:678-683. [PMID: 28823672 DOI: 10.1016/j.wneu.2017.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The metrics of imaging-to-puncture and imaging-to-reperfusion were recently found to be associated with the clinical outcomes of endovascular thrombectomy for acute ischemic stroke. However, measures for improving workflow within hospitals to achieve better timing results are largely unexplored for endovascular therapy. The aim of this study was to examine our experience with a novel smartphone application developed in house to improve our timing metrics for endovascular treatment. METHODS We developed an encrypted smartphone application connecting all stroke team members to expedite conversations and to provide synchronized real-time updates on the time window from stroke onset to imaging and to puncture. The effects of the application on the timing of endovascular therapy were evaluated with a secondary analysis of our single-center cohort. Our primary outcome was imaging-to-puncture time. We assessed the outcomes with nonparametric tests of statistical significance. RESULTS Forty-five patients met our criteria for analysis among 66 consecutive patients with acute ischemic stroke who received endovascular therapy at our institution. After the implementation of the smartphone application, imaging-to-puncture time was significantly reduced (preapplication median time, 127 minutes; postapplication time, 69 minutes; P < 0.001). Puncture-to-reperfusion time was not affected by the application use (42 minutes vs. 36 minutes). CONCLUSION The use of smartphone applications may reduce treatment times for endovascular therapy in acute ischemic stroke. Further studies are needed to confirm our findings.
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Affiliation(s)
- Naif M Alotaibi
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Francesca Sarzetto
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daipayan Guha
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Lu
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andre Bodo
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shaurya Gupta
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Erin Dyer
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter Howard
- Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard H Swartz
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Karl Boyle
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Avery B Nathens
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Victor X D Yang
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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21
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Singer J, Levine SR. Stroke and technology: prescribing mHealth apps for healthcare providers, patients and caregivers – a brief, selected review. FUTURE NEUROLOGY 2016. [DOI: 10.2217/fnl-2016-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jonathan Singer
- Neurology, Downstate Medical Center & Stroke Center, 450 Clarkson Avenue, MSC 1213, Brooklyn, NY 11203, USA
| | - Steven R Levine
- Neurology, Downstate Medical Center & Stroke Center, 450 Clarkson Avenue, MSC 1213, Brooklyn, NY 11203, USA
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22
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Park LG, Beatty A, Stafford Z, Whooley MA. Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease. Prog Cardiovasc Dis 2016; 58:639-50. [PMID: 27001245 PMCID: PMC4904827 DOI: 10.1016/j.pcad.2016.03.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 01/04/2023]
Abstract
Mobile health in the form of text messaging and mobile applications provides an innovative and effective approach to promote prevention and management of cardiovascular disease (CVD); however, the magnitude of these effects is unclear. Through a comprehensive search of databases from 2002-2016, we conducted a quantitative systematic review. The selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. A large majority of studies (22 of 28, 79%) demonstrated text messaging, mobile applications, and telemonitoring via mobile phones were effective in improving outcomes. Some key factors associated with successful interventions included personalized messages with tailored advice, greater engagement (2-way text messaging, higher frequency of messages), and use of multiple modalities. Overall, text messaging appears more effective than smartphone-based interventions. Incorporating principles of behavioral activation will help promote and sustain healthy lifestyle behaviors in patients with CVD that result in improved clinical outcomes.
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Affiliation(s)
- Linda G Park
- Department of Community Health Systems, University of California, San Francisco.
| | - Alexis Beatty
- Veterans Affairs Puget Sound Medical Center, Cardiology Section, Seattle, WA; University of Washington, Department of Medicine.
| | - Zoey Stafford
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA.
| | - Mary A Whooley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, Department of Medicine.
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