Leveraging Multi-Modal Sensing for Mobile Health: A Case Review in Chronic Pain

Investigating psychological mechanisms linking pain severity to depression symptoms in women cancer survivors at a cancer center with a rural catchment area

PURPOSE

Women cancer survivors, especially those in rural areas, with high levels of depression may be acutely susceptible to pain due to the ways they think, feel, and behave. The current study seeks to elucidate the relationship between symptoms of depression and pain severity in women cancer survivors, by examining the putative mediators involved in this relationship, specifically their self-efficacy for managing their health, how overwhelmed they were from life's responsibilities, and relational burden.

METHODS

Self-report data were collected from 183 cancer survivors of breast, cervical, ovarian, or endometrial/uterine cancer, who were between 6 months and 3 years post-active therapy.

RESULTS

Women cancer survivors with higher (vs. lower) symptoms of depression had more severe pain. Individual mediation analyses revealed that survivors with higher levels of depression felt more overwhelmed by life's responsibilities and had lower self-efficacy about managing their health, which was associated with greater pain severity. When all mediators were simultaneously entered into the same model, feeling overwhelmed by life's responsibilities significantly mediated the link between survivors' symptoms of depression and their pain severity.

CONCLUSIONS

The relationship between symptoms of depression and pain severity in women cancer survivors may be attributed in part to their self-efficacy and feeling overwhelmed by life's responsibilities. Early and frequent assessment of psychosocial factors involved in pain severity for women cancer survivors may be important for managing their pain throughout the phases of cancer survivorship.

Towards Secure and Intelligent Internet of Health Things: A Survey of Enabling Technologies and Applications

With the growth of computing and communication technologies, the information processing paradigm of the healthcare environment is evolving. The patient information is stored electronically, making it convenient to store and retrieve patient information remotely when needed. However, evolving the healthcare systems into smart healthcare environments comes with challenges and additional pressures. Internet of Things (IoT) connects things, such as computing devices, through wired or wireless mediums to form a network. There are numerous security vulnerabilities and risks in the existing IoT-based systems due to the lack of intrinsic security technologies. For example, patient medical data, data privacy, data sharing, and convenience are considered imperative for collecting and storing electronic health records (EHR). However, the traditional IoT-based EHR systems cannot deal with these paradigms because of inconsistent security policies and data access structures. Blockchain (BC) technology is a decentralized and distributed ledger that comes in handy in storing patient data and encountering data integrity and confidentiality challenges. Therefore, it is a viable solution for addressing existing IoT data security and privacy challenges. BC paves a tremendous path to revolutionize traditional IoT systems by enhancing data security, privacy, and transparency. The scientific community has shown a variety of healthcare applications based on artificial intelligence (AI) that improve health diagnosis and monitoring practices. Moreover, technology companies and startups are revolutionizing healthcare with AI and related technologies. This study illustrates the implication of integrated technologies based on BC, IoT, and AI to meet growing healthcare challenges. This research study examines the integration of BC technology with IoT and analyzes the advancements of these innovative paradigms in the healthcare sector. In addition, our research study presents a detailed survey on enabling technologies for the futuristic, intelligent, and secure internet of health things (IoHT). Furthermore, this study comprehensively studies the peculiarities of the IoHT environment and the security, performance, and progression of the enabling technologies. First, the research gaps are identified by mapping security and performance benefits inferred by the BC technologies. Secondly, practical issues related to the integration process of BC and IoT devices are discussed. Third, the healthcare applications integrating IoT, BC, and ML in healthcare environments are discussed. Finally, the research gaps, future directions, and limitations of the enabling technologies are discussed.

Methods for Facial Expression Recognition with Applications in Challenging Situations

In the last few years, a great deal of interesting research has been achieved on automatic facial emotion recognition (FER). FER has been used in a number of ways to make human-machine interactions better, including human center computing and the new trends of emotional artificial intelligence (EAI). Researchers in the EAI field aim to make computers better at predicting and analyzing the facial expressions and behavior of human under different scenarios and cases. Deep learning has had the greatest influence on such a field since neural networks have evolved significantly in recent years, and accordingly, different architectures are being developed to solve more and more difficult problems. This article will address the latest advances in computational intelligence-related automated emotion recognition using recent deep learning models. We show that both deep learning-based FER and models that use architecture-related methods, such as databases, can collaborate well in delivering highly accurate results.

Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches

Pain research traverses many disciplines and methodologies. Yet, despite our understanding and field-wide acceptance of the multifactorial essence of pain as a sensory perception, emotional experience, and biopsychosocial condition, pain scientists and practitioners often remain siloed within their domain expertise and associated techniques. The context in which the field finds itself today-with increasing reliance on digital technologies, an on-going pandemic, and continued disparities in pain care-requires new collaborations and different approaches to measuring pain. Here, we review the state-of-the-art in human pain research, summarizing emerging practices and cutting-edge techniques across multiple methods and technologies. For each, we outline foreseeable technosocial considerations, reflecting on implications for standards of care, pain management, research, and societal impact. Through overviewing alternative data sources and varied ways of measuring pain and by reflecting on the concerns, limitations, and challenges facing the field, we hope to create critical dialogues, inspire more collaborations, and foster new ideas for future pain research methods.

Feasibility and Acceptability of Mobile Phone-Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults

BACKGROUND

Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution.

OBJECTIVE

MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain.

METHODS

A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities.

RESULTS

In all, 90% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control (β_int=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more (β_int=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day (β_int=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday.

CONCLUSIONS

In the pilot study, MyBehaviorCBP's automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP's efficacy on a larger cohort and over a longer period of time.

Sensing Behavioral Change over Time

Personality traits describe individual differences in patterns of thinking, feeling, and behaving ("between-person" variability). But individuals also show changes in their own patterns over time ("within-person" variability). Existing approaches to measuring within-person variability typically rely on self-report methods that do not account for fine-grained behavior change patterns (e.g., hour-by-hour). In this paper, we use passive sensing data from mobile phones to examine the extent to which within-person variability in behavioral patterns can predict self-reported personality traits. Data were collected from 646 college students who participated in a self-tracking assignment for 14 days. To measure variability in behavior, we focused on 5 sensed behaviors (ambient audio amplitude, exposure to human voice, physical activity, phone usage, and location data) and computed 4 within-person variability features (simple standard deviation, circadian rhythm, regularity index, and flexible regularity index). We identified a number of significant correlations between the within-person variability features and the self-reported personality traits. Finally, we designed a model to predict the personality traits from the within-person variability features. Our results show that we can predict personality traits with good accuracy. The resulting predictions correlate with self-reported personality traits in the range of r = 0.32, MAE = 0.45 (for Openness in iOS users) to r = 0.69, MAE = 0.55 (for Extraversion in Android users). Our results suggest that within-person variability features from smartphone data has potential for passive personality assessment.

Keppi: A Tangible User Interface for Self-Reporting Pain

Motivated by the need to support those self-managing chronic pain, we report on the development and evaluation of a novel pressure-based tangible user interface (TUI) for the self-report of scalar values representing pain intensity. Our TUI consists of a conductive foam-based, force-sensitive resistor (FSR) covered in a soft rubber with embedded signal conditioning, an ARM Cortex-M0 microprocessor, and Bluetooth Low Energy (BLE). In-lab usability and feasibility studies with 28 participants found that individuals were able to use the device to make reliable reports with four degrees of freedom as well map squeeze pressure to pain level and visual feedback. Building on insights from these studies, we further redesigned the FSR into a wearable device with multiple form factors, including a necklace, bracelet, and keychain. A usability study with an additional 7 participants from our target population, elderly individuals with chronic pain, found high receptivity to the wearable design, which offered a number of participant-valued characteristics (e.g., discreetness) along with other design implications that serve to inform the continued refinement of tangible devices that support pain self-assessment.

Tracking Depression Dynamics in College Students Using Mobile Phone and Wearable Sensing

There are rising rates of depression on college campuses. Mental health services on our campuses are working at full stretch. In response researchers have proposed using mobile sensing for continuous mental health assessment. Existing work on understanding the relationship between mobile sensing and depression, however, focuses on generic behavioral features that do not map to major depressive disorder symptoms defined in the standard mental disorders diagnostic manual (DSM-5). We propose a new approach to predicting depression using passive sensing data from students' smartphones and wearables. We propose a set of symptom features that proxy the DSM-5 defined depression symptoms specifically designed for college students. We present results from a study of 83 undergraduate students at Dartmouth College across two 9-week terms during the winter and spring terms in 2016. We identify a number of important new associations between symptom features and student self reported PHQ-8 and PHQ-4 depression scores. The study captures depression dynamics of the students at the beginning and end of term using a pre-post PHQ-8 and week by week changes using a weekly administered PHQ-4. Importantly, we show that symptom features derived from phone and wearable sensors can predict whether or not a student is depressed on a week by week basis with 81.5% recall and 69.1% precision.