Pain Management Mobile Applications: A Systematic Review of Commercial and Research Efforts

Shared decision making is crucial in the pain domain. The subjective nature of pain demands solutions that can facilitate pain assessment and management. The aim of the current study is to review the current trends in both the commercial and the research domains in order to reveal the key issues and guidelines that could further help in the effective development of pain-focused apps. We searched for scientific publications and commercial apps in 22 databases and the two major app stores. Out of 3612 articles and 336 apps, 69 met the requirements for inclusion following the PRISMA guidelines. An analysis of their features (technological approach, design methodology, evaluation strategy, and others) identified critical points that have to be taken into consideration in future efforts. For example, commercial and research efforts target different types of pain, while no participatory design is followed in the majority of the cases examined. Moreover, the evaluation of the final apps remains a challenge that hinders their success. The examined domain is expected to experience a substantial increase. More research is needed towards the development of non-intrusive wearables and sensors for pain detection and assessment, along with artificial intelligence techniques and open data.

Digital Health Innovations in the Battle against COVID-19: A Global Perspective

The COVID-19 pandemic has unleashed unprecedented challenges upon the global population, demanding rapid and innovative solutions [...].

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

In the nine months leading up to COVID-19, our biomedical engineering research group was in the very early stages of development and in-home testing of HUGS, the Hand Use and Grasp Sensor (HUGS) system. HUGS was conceived as a tool to allay parents' anxiety by empowering them to monitor their infants' neuromotor development at home. System focus was on the evolving patterns of hand grasp and general upper extremity movement, over time, in the naturalistic environment of the home, through analysis of data captured from force-sensor-embedded toys and 3D video as the baby played. By the end of March, 2020, as the COVID-19 pandemic accelerated and global lockdown ensued, home visits were no longer possible and HUGS system testing ground to an abrupt halt. In the spring of 2021, still under lockdown, we were able to resume recruitment and in-home testing with HUGS-2, a system whose key requirement was that it be contactless. Participating families managed the set up and use of HUGS-2, supported by a detailed library of video materials and virtual interaction with the HUGS team for training and troubleshooting over Zoom. Like the positive/negative poles of experience reported by new parents under the isolation mandated to combat the pandemic, HUGS research was both impeded and accelerated by having to rely solely on distance interactions to support parents, troubleshoot equipment, and securely transmit data. The objective of this current report is to chronicle the evolution of HUGS. We describe a system whose design and development straddle the pre- and post-pandemic worlds of family-centered health technology design. We identify and classify the clinical approaches to infant screening that predominated in the pre-COVID-19 milieu and describe how these procedural frameworks relate to the family-centered conceptualization of HUGS. We describe how working exclusively through the proxy of parents revealed the family's priorities and goals for child interaction and surfaced HUGS design shortcomings that were not evident in researcher-managed, in-home testing prior to the pandemic.

A Method of Estimating Time-to-Recovery for a Disease Caused by a Contagious Pathogen Such as SARS-CoV-2 Using a Time Series of Aggregated Case Reports

During the outbreak of a disease caused by a pathogen with unknown characteristics, the uncertainty of its progression parameters can be reduced by devising methods that, based on rational assumptions, exploit available information to provide actionable insights. In this study, performed a few (~6) weeks into the outbreak of COVID-19 (caused by SARS-CoV-2), one of the most important disease parameters, the average time-to-recovery, was calculated using data publicly available on the internet (daily reported cases of confirmed infections, deaths, and recoveries), and fed into an algorithm that matches confirmed cases with deaths and recoveries. Unmatched cases were adjusted based on the matched cases calculation. The mean time-to-recovery, calculated from all globally reported cases, was found to be 18.01 days (SD 3.31 days) for the matched cases and 18.29 days (SD 2.73 days) taking into consideration the adjusted unmatched cases as well. The proposed method used limited data and provided experimental results in the same region as clinical studies published several months later. This indicates that the proposed method, combined with expert knowledge and informed calculated assumptions, could provide a meaningful calculated average time-to-recovery figure, which can be used as an evidence-based estimation to support containment and mitigation policy decisions, even at the very early stages of an outbreak.

The i-Walk Lightweight Assistive Rollator: First Evaluation Study

Robots can play a significant role as assistive devices for people with movement impairment and mild cognitive deficit. In this paper we present an overview of the lightweight i-Walk intelligent robotic rollator, which offers cognitive and mobility assistance to the elderly and to people with light to moderate mobility impairment. The utility, usability, safety and technical performance of the device is investigated through a clinical study, which took place at a rehabilitation center in Greece involving real patients with mild to moderate cognitive and mobility impairment. This first evaluation study comprised a set of scenarios in a number of pre-defined use cases, including physical rehabilitation exercises, as well as mobility and ambulation involved in typical daily living activities of the patients. The design and implementation of this study is discussed in detail, along with the obtained results, which include both an objective and a subjective evaluation of the system operation, based on a set of technical performance measures and a validated questionnaire for the analysis of qualitative data, respectively. The study shows that the technical modules performed satisfactory under real conditions, and that the users generally hold very positive views of the platform, considering it safe and reliable.

POS0064-PARE DESIGN OF AN INNOVATIVE MHEALTH SOLUTION FOR FIGHTING STIGMA ASSOCIATED WITH CHRONIC PAIN

Background:

Pain is associated with a plethora of diseases. The statistics reveal that chronic pain affects around 100 million people across Europe and is closely associated with high unemployment rates, depression, substance abuse & social exclusion. Stigma is a significant and persistent problem for those with chronic pain. Lack of public awareness & stigma associated with pain affect not only patients but also society.

Objectives:

The present research proposes a holistic solution to combat stigma using the latest technological developments. A mobile health application has been designed in order to serve the various stakeholders (patients, families, community) in the field under study. The objective of the final “StigmApp” solution is 4-fold:(i) to facilitate pain management, (ii) to aware the general public, (iii) to educate all different parties & (iv) to facilitate actions & research to combat stigma. Another innovative feature is that it delivers the required information to each party in a highly automated, personalized & digestible way making the whole experience enjoyable, while ensuring user engagement.

Methods:

A multidisciplinary team was formed at the beginning of the project in order to ensure the desired outcome. Two patient organizations from Cyprus & Greece, two behavioral scientists, three physicians, one psychologist, ten citizens, ten patients, two marketeers and two experts in mobile health applications participated. A participatory design methodology was followed in order to capture & address the whole user experience.

Results:

An iterative process was followed bringing & different end-users on board. The different parties evaluated and assessed all modules implemented providing appropriate feedback. It currently runs only on Android operating system and supports: (i) pain management (intense &points of pain, medications used, underlying diseases, life style, etc.),(ii) raise awareness & education (through information nuggets & bite-sized learning), (iii) “Share your story” option to inspire others, (iv) fund raising using crowd-funding techniques, (v) become a volunteer, (vi) organize an inspiring event, (vii) networking, (viii) automatic creation of infographics on how pain affects peoples’ lives. It has been awarded the first prize by BMP Innovation Grant.

Conclusion:

StigmApp has been designed to support the ecosystem around chronic pain regardless of the underlying disease. Our main concern is to raise awareness in order to fight stigma associated with pain & make life easier for patients & their families. The involvement of all different potential actors in the design guarantees a product/service that could meet their needs & can be applied in real life. In the next months the final solution will be piloted by a number of different end users in order to assess it under real life conditions.

References:

[1]Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review & meta-analysis of population studies. BMJ Open 2016 Jun 20;6(6):e010364. DOI:10.1136/bmjopen-2015-010364. PMID:27324708; PMCID: PMC4932255.

[2]Koumpouros Y, Georgoulas A. A systematic review of mhealth funded R&D activities in EU. Trends, technologies and obstacles, Informatics for Health&Social Care. 2020;45(2):168-187. DOI:10.1080/17538157.2019.1656208. Epub2019 Nov 19. PMID:31743060.

[3]Lalloo C, Jibb LA, Rivera J, Agarwal A, Stinson JN. There’s a Pain App for That: review of patient-targeted smartphone applications for pain management.Clin J Pain.2015;31(6):557–63. DOI:10.1097/AJP.0000000000000171.

[4]De Ruddere, Liesa, Craig, Kenneth D. Understanding stigma & chronic pain:a-state-of-the-art review,PAIN:August 2016-Volume 157-Issue 8-p1607-1610, doi:10.1097/j.pain.0000000000000512

Acknowledgements:

The project is funded by the Brain, Mind, and Pain, Patient-Centred Innovation Grant.

Many thanks to the two patient organizations Hellenic League Against Rheumatism & Cyprus League Against Rheumatism for their valuable contribution in the project.

Disclosure of Interests:

None declared.

PARE0031 AN MHEALTH TOOL FOR SHARED DECISION MAKING FOR PATIENTS WITH RHEUMATISM AND ARTHRITIS

Background:

Patient empowerment is a key element of patient-centred healthcare according to WHO. In the same direction, the Institute of Medicine in the United States supports actions to engage patients in their health care decision in a new patient-centered care model. Patient-centred care models have demonstrated better quality of care as well as potential long-term cost-efficiencies. However, nowadays, many patients are still struggling to become equal partners in care. Patients with chronic conditions, such as rheumatoid arthritis, are often referred to as the most under-used resource in the health system. Shared decision making is a collaborative process enabling a clinician and patient to participate jointly in making a health decision about the treatment having discussed the options, benefits and harms, while considering also the patient’s values and experiences.

Objectives:

The objective of the current research was to design a tool that will facilitate the shared decision making regarding the treatment approach, based on real life evidences from the patient. The focus of the application is on the pain assessment of patients suffering from rheumatism and arthritis. The proposed solution utilizes the latest technological innovations to support patients and clinicians on their decisions and assessment strategy on a more accurate base.

Methods:

The design process followed a user-centered approach by involving a multidisciplinary team of experts (an mHealth expert, a behavioural scientist, and two physicians). An iterative design process focused on the different end-users (patients and clinicians) and their actual needs on the topic concerned. In each phase, the experts involved the end-users to create a highly usable tool. The aim was to capture and address the whole user experience. An evaluation phase took place for three months.

Results:

The design team brought the users into every stage of the design process. Twenty patients and three physicians (one pathologist, one general surgeon and an expert in pharmacology and clinical pharmacology) participated and evaluated the modules implemented. The final solution consists of an application running on Android operating system in any smart phone. The final application supports the patient to enter all necessary information about: (i) the pain he/she is feeling, (ii) the medication he/she is receiving, and (iii) his/her life style.

Conclusion:

After a three months period of continuous use of the application from the participants during the evaluation phase, they reported very encouraging results. In terms of usage, the patients found it user friendly, easy to learn, easy to use, and easily accessible. They also consider it really useful in order to keep track of their progress and assess the treatment and medications they receive relevant to the pain they feel. The physicians involved in the evaluation of the application found it very useful and with significant potential for daily use by clinical staff to evaluate the therapies given to their patients. All users concluded that the developed app can help towards a more accurate and acceptable treatment based on shared decision, exploiting the collected evidences.

References:

[1]Angelmar R, Bermann BP. Patient empowerment and efficient health outcomes. Financing sustainable healthcare in Europe. 2007:139–162.

[2]Hargraves IG, Montori VM, Brito JP, et al. Purposeful SDM: A problem-based approach to caring for patients with shared decision making. Patient Education and Counseling. 102(10), 2019, p. 1786-1792.

[3]Légaré F, Stacey D, Brière N, et al. Healthcare providers’ intentions to engage in an interprofessional approach to shared decision-making in home care programs: a mixed methods study.J Interprof Care2013; 27: 214-222

[4]McWilliams DF, Walsh DA. Pain mechanisms in rheumatoid arthritis. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):94-101.

[5]National Research Council. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press, 2001.

[6]Hoffmann TC, Légaré F, Simmons MB, et al. Shared decision making: what do clinicians need to know and why should they bother? Med J Aust 2014; 201 (1): 35-39.

Disclosure of Interests:

None declared

Conceptualization of Hand-TaPS to measure the subjective experience of dynamic hand orthoses in promoting functional recovery at home after stroke

BACKGROUND

Dynamic exoskeleton orthoses provide assistance needed to complete movements that would otherwise be impossible after stroke. Beyond the demonstration of their effectiveness, the subjective experience of dynamic orthoses also needs to be considered.

OBJECTIVE

To support functional recovery after stroke through the development of Hand-TaPS (Task Practice after Stroke), an instrument to evaluate dynamic hand orthoses in home therapy.

METHODS

Dynamic hand orthosis subject matter experts (N = 14), professionals and consumers, considered the items of PYTHEIA, a valid and reliable instrument merging well-tested, assistive technology (AT) assessment items with those tuned to the greater complexity of emerging technologies. Experts reflected on how each item aligned with their personal experience of dynamic orthosis use. Interpretative Phenomenological Analysis guided identification of themes.

RESULTS

Four themes (5/20 items) appraised highly relevant for Hand-TaPS. The remaining eight themes (15/20 items) were deemed in need of modification.

CONCLUSIONS

Dynamic hand orthoses constitute a special case of AT; the assistance they provide targets therapy, not ADLs. Our work to develop Hand-TaPS provides a clear example of the theoretical difference between rehabilitative and assistive technology and underscores the importance of consideration of how a device is used in its assessment.

Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability

Technological advances in game-mediated robotics provide an opportunity to engage children with cerebral palsy (CP) and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24/7 in children's homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance of what we term assistive/rehabilitative (A/R) gamebots by their target populations. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A/R gamebots. We conducted in-depth interviews with 8 children with CP and their families who had trialed an exemplar A/R gamebot, PedBotHome, for 28 days in their homes. The goal was to understand how existing theories and instruments were either appropriate or inappropriate for measuring the subjective experience of A/R gamebots. Key findings were the importance of differentiating the use case of therapy from that of assistance in rehabilitative technology assessment, the need to incorporate the differing perspectives of children with CP and those of their parents into A/R gamebot evaluation, and the potential conflict between the goals of preserving the quality of the experience of game play for the child while also optimizing the intensity and duration of therapy provided during play.

The importance of patient engagement and the use of Social Media marketing in healthcare

BACKGROUND

The present research aims to identify the application of social media for marketing or communication purposes in healthcare. We studied the opinion of healthcare professionals, organizations and health consumers, trying to identify the current status, trends and beliefs. The research reveals that healthcare organizations have to move forward and engage with their customers. The health consumers are more mature than the health providers. The descriptive characteristics of the sample's responses collected during the survey are presented.

OBJECTIVE

The current research tries to identify the application of social media for marketing or communication purposes in healthcare in Greece. The scope of the paper is to investigate the status in Greece and compare it with other countries.

METHODS

We studied the opinion of healthcare professionals, organizations and health consumers, trying to identify the current status, trends and beliefs. We formed adequate questionnaires which were distributed to the different target groups, while for statistical analysis we performed tests (in order to investigate the dependence between certain respondents' categories) as well as one-way ANOVA analysis for inference purposes. In this context, the results can depict the (average) behavior, as well as the homogeneity of the corresponding general population.

RESULTS

The research conducted took into account the individualities of the Greek environment and revealed that both physicians and healthcare organizations have to move forward in order to engage with their customers. There is also a clear need to measure the effectiveness of any such media marketing effort. Most adopters are not yet-taking maximum advantage of the technology. Social networks are prevalent and several paradigms support their adoption for marketing purposes in the sensitive healthcare domain. Even though the expectations are ambitious, there is a lot of work to do in Greece in order to achieve the desired outcome. An important finding is that patients' attitudes are, in general, differentiated from those of healthcare professionals. Even though the results of the present paper can be generalized, according to the statistical analysis performed, further research would be warranted to cover all possible participants in the healthcare chain. It is clear that both physicians and healthcare organizations have to adopt social media marketing in their daily practice in order to meet the needs of their customers. The present paper advances the current state of knowledge, as there is not any prior study on this field in Greece.

Translation and validation of the assistive technology device predisposition assessment in Greek in order to assess satisfaction with use of the selected assistive device

PURPOSE

To examine the Assistive Technology Device Predisposition Assessment scale and provide evidence of validity and reliability of the Greek version.

METHODS

We translated and adapted the original instrument in Greek according to the most well-known guidelines recommendations. Field test studies were conducted in a rehabilitation hospital to validate the appropriateness of the final results. Ratings of the different items were statistically analyzed. We recruited 115 subjects who were administered the Form E of the original questionnaire.

RESULTS

The experimental analysis conducted revealed a three subscales structure: (i) Adaptability, (ii) Fit to Use, and (iii) Socializing. According to the results of our study the three subscales measure different constructs. Reliability measures (ICC = 0.981, Pearson's correlation = 0.963, Cronbach's α = 0.701) yielded high values. Test-retest outcome showed great stability.

CONCLUSIONS

This is the first study, at least to the knowledge of the authors, which focuses merely on measuring the satisfaction of the users from the used assistive device, while exploring the Assistive Technology Device Predisposition Assessment - Device Form in such depth. According to the results, it is a stable, valid and reliable instrument and applicable to the Greek population. Thus, it can be used to measure the satisfaction of patients with assistive devices. Implications for Rehabilitation The paper explores the cultural adaptability and applicability of ATD PA - Device Form. ATD PA - Device Form can be used to assess user satisfaction by the selected assistive device. ATD PA - Device Form is a valid and reliable instrument in measuring users' satisfaction in Greekreality.

Balanced scorecard: application in the General Panarcadian Hospital of Tripolis, Greece

PURPOSE

The purpose of this paper is to discuss the application of the balanced scorecard (BSC) in the Greek public health sector.

DESIGN/METHODOLOGY/APPROACH

The basic balanced scorecard theory has been adopted in the characteristics and individualities of the Greek public health system. The theoretical model developed was applied in the General Panarcadian Hospital of Tripolis (GPHT) in Greece. GPHT is a representative paradigm of a big regional Greek public hospital. It has about 300 beds and many clinics and specialties (internal medicine, cardiology, general surgery, intensive care unit, artificial kidney unit, etc.). Strategic management was performed for almost three years. The BSC model was formulated in an appropriate software program. The problems (both technical and managerial) faced during a three-year period along with the results of this management approach are presented in the current paper. The paper highlights some important gaps in the Greek public health system, while proposing actions to be taken.

FINDINGS

The BSC theory can be very successful under certain conditions.

ORIGINALITY/VALUE

Special attention is given to the peculiarities of the Greek public health situation. The paper presents for the first time a real life example of applying BSC in the Greek public health sector.