Mobile health technologies for the management of urinary incontinence: A systematic review of online stores in Brazil

BackgroundUrinary incontinence (UI) is a serious condition for which often times insufficient non-surgical treatment options are provided or sought. Mobile health (mHealth) applications (apps) offer potential to assist with the self-management of UI.ObjectiveTo perform a systematic review of available mHealth apps for UI in Brazil.MethodsA search for UI mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on June 4 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS).ResultsOf the 1111 mHealth apps found, 12 were eligible for inclusion. Four offered exclusively exercise programs, six offered exercise and educational content, and two offered tools to track patient-reported symptoms. The included apps scored poorly on the MARS quality scale, with a mean ± standard deviation score of 2.7 ± 0.6 on a 0–5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement.ConclusionAlthough there is growing interest in the development of mHealth technologies to support patients with UI, currently available tools in Brazil are of poor quality and limited functionality. Effective collaboration between industry and research is needed to develop new user-centered mHealth apps that can empower patients with UI.     

The efficacy of mobile health interventions used to manage acute or chronic pain: A systematic review

Chronic pain is a significant health issue that affects approximately 50 million adults in the United States. Traditional interventions are not always an effective treatment strategy for pain control. However, the wide adoption of smartphones and the rapid growth of health information technologies over the past decade have created opportunities to use mobile health (mHealth) applications (apps) for pain tracking and self‐management. In this PRISMA‐compliant systematic review, we assessed the current U.S.‐based research on pain‐related mHealth apps to describe the app components and determine the efficacy of these interventions for persons with acute or chronic pain. We conducted a comprehensive search of five databases based on methodological guidelines from the Joanna Briggs Institute. We included articles reporting original data on mHealth interventions with pain intensity as a primary or secondary outcome and excluded articles that utilized multimodal interventions. Of the original 4959 articles, only five studies met the eligibility criteria. Most of the interventions included feasibility or pilot studies, and all studies were published between 2015 and 2018. Two of the five studies used visual analog scales. Only two of the studies reported statistically significant pain intensity outcomes, and considerable heterogeneity between the studies limited our ability to generalize findings or conduct a meta‐analysis. Research investigating the components and efficacy of pain‐related mHealth apps as interventions is an emerging field. To better understand the potential clinical benefits of mHealth apps designed to manage pain, further research is needed.     

What makes a good health ‘app’? Identifying the strengths and limitations of existing mobile application evaluation tools

Research using mHealth apps has the potential to positively impact health care management and outcomes. However, choosing an appropriate mHealth app may be challenging for the health researcher. The author team used existing evaluation tools, checklists, and guidelines to assess selected mHealth apps to identify strengths, challenges, and potential gaps within existing evaluation tools. They identified specific evaluation tool components, questions, and items most effective in examining app content, usability, and features, including literacy demand and cultural appropriateness; technical information; practical aspects of app functionality; and evolving capabilities of mobile medical apps. Challenges included the subjective nature of the results, time required to complete the evaluation, lack of emphasis on evidence‐based content, and inadequate tool flexibility. Health researchers considering the integration of mobile apps into research will benefit from evaluation tools that assess both evidence‐based content and the ability of the mobile app to securely integrate with other digital technologies involved in patient care. Next steps will include the involvement of health care providers and professionals, including nurses a wide range of expertise, to develop an mHealth evaluation tool that focuses on identifying quality, evidence‐based mobile apps into patient outcomes research.     

mHealth applications to support caregiver needs and engagement during stroke recovery: A content review

Caregiving in stroke results in severe physical, psychological, and social impacts on the caregiver. Over the past few years, researchers have explored the use of mHealth technologies to support healthcare‐related activities due to their ability to provide real‐time care at any given place or time. The purpose of this content review is to investigate mHealth apps in supporting stroke caregiving engagement based on three aspects: motivation, value, and satisfaction. We searched app stores and repositories for apps related to stroke caregiving published up to September 2020. Extracted apps were reviewed and filtered using inclusion criteria, and then downloaded onto compatible devices to determine eligibility. Results were compared with evidence‐based frameworks to identify the ability of these apps in engaging and supporting the caregiver. Forty‐seven apps were included in this review that enabled caregivers to support their needs, such as adjustment to new roles and relationships, involvement in care and caring for oneself using several different functionalities. These functionalities include information resources, risk assessment, remote monitoring, data sharing, reminders and so on. However, no single app was identified that focuses on all aspects of stroke caregiving. We also identified several challenges faced by users through their reviews and the factors associated with value and satisfaction. Our findings can add to the knowledge of existing mHealth technologies and their functionalities to support stroke caregiving needs, and the importance of considering user engagement in the design. They can be used by developers and researchers looking to design better mHealth apps for stroke caregiving.     

Mobile health applications for the care of patients with breast cancer: A scoping review

ObjectivesIn recent years, the use of mobile health applications (mHealth apps) to deliver care for patients with breast cancer has increased exponentially. This study aimed to summarize the available evidence on developing mHealth apps to care for patients with breast cancer and identify the need for systematic efforts.MethodsA scoping review was performed according to Arksey and O’Malley’s framework, aiming to identify eligible research studies in PubMed, CINAHL, and Web of Science between January 2010 and December 2020. All identified studies were screened, extracted, and analyzed independently by two reviewers.ResultsA total of 676 studies were retrieved, and eight eligible studies were finally included. Four themes emerged: the involvement of patients and health professionals in the phases of design and development, patients’ preferences, the characteristics of patients, and the motivators to use mHealth apps. The results indicated promising prospects for using mHealth apps to care for patients with breast cancer and identified the need for systematic efforts to develop and validate relevant apps.ConclusionsThe attributes of patient characteristics, needs, and patient-reported outcomes data are vital components for developing mHealth apps for patients with breast cancer. Additionally, collaborative efforts, including patients, nurses, and other significant health professionals, should develop mHealth apps for breast cancer care. Additional research focusing on the design and development of mHealth apps for patients with breast cancer is warranted.     

An integrative review and theoretical examination of chronic illness mHealth studies using the Middle‐Range Theory of Self‐care of Chronic Illness

Self‐management, or self‐care, by individuals and/or families is a critical element in chronic illness management as more care shifts to the home setting. Mobile device‐enhanced health care, or mHealth, is being touted as a means to support self‐care. Previous mHealth reviews examined the effect of mHealth on patient outcomes, however, none used a theoretical lens to examine the interventions themselves. The aims of this integrative review were to examine recent (e.g., last 10 years) chronic illness mHealth empiric studies and (1) categorize self‐care behaviors engaged in the intervention according to the Middle‐Range Theory of Self‐care of Chronic Illness, and (2) conduct an analysis of gaps in self‐care theory domains and behaviors utilized. Methods included: (1) Best practice study identification, collection, and data extraction procedures and (2) realist synthesis techniques for within and across case analysis. From a pool of 652 records, 33 primarily North American clinical trials, published between 2010 and 2019 were examined. Most mHealth interventions used apps, clinician contact, and behavioral prompts with some wireless devices. Examination found self‐care maintenance behaviors were supported in most (n = 30) trials whereas self‐care monitoring (n = 12) and self‐care management behaviors (n = 8) were less so. Few trials (n = 2) targeted all three domains. Investigation of specific behaviors uncovered an overexamination of physical activity and diet behaviors and an underexamination of equally important behaviors. By examining chronic illness mHealth interventions using a theoretical lens we have categorized current interventions, conducted a gap analysis uncovering areas for future study, and made recommendations to move the science forward.     

慢性心力衰竭病人自我护理行为及影响因素的研究

[目的]描述慢性心力衰竭病人自我护理行为的现状,探讨自我护理行为的影响因素。[方法]采用描述性研究设计,采取便利抽样的方法,选取广州市某三级甲等医院心血管内科30例确诊为慢性心力衰竭的住院病人,调查病人的一般资料及自我护理行为状况。[结果]慢性心力衰竭病人的自我护理行为分值为76.83分±13.97分,年龄、文化程度对慢性心力衰竭病人的自我护理行为的影响有统计学意义(P<0.05)。[结论]慢性心力衰竭病人的自我护理行为总体处于中等水平,医务工作人员应该针对不同年龄及文化程度的病人,采取不同的教育方式及教育内容,以提高其自我护理能力。     

A standardized review of smartphone applications to promote balance for older adults

Background: Balance is one of the risk factors for falls in older adults. The use of smartphone applications (apps) related to health (mHealth) is increasing and, while there is potential for apps to be used as a self-managed balance intervention, many healthcare providers are concerned about the content and credibility of mHealth apps overall.

Purpose: This study evaluates the quality of balance promoting apps and identifies strengths and areas of concern to assist healthcare providers in recommending these resources.

Materials and methods: Balance apps for the general public, offered on the iPhone Operating System (iOS) and Android platforms, were evaluated using the Mobile Application Rating Scale (MARS).

Results: Five iOS apps met the inclusion criteria. The mean scores for each of the domains in MARS were: Engagement (3.32), Information (3.7), Functionality (3.8), and Esthetics (3.8). Overall, one app (UStabilize) received a rating of 4.43 in MARS five-point scale, which was considered “good”. Other apps in the review demonstrated acceptable quality.

Conclusions: The reviewed balance apps targeted to improve or maintain physical balance were of acceptable quality. Apps address many current issues older adults have to accessing rehabilitation services and, as such, may be particularly useful for this group. Future research should focus on assessing and comparing app efficacy. Development of balance apps for the Android platform is also necessary.

• Implications for Rehabilitation

• Given the availability and accessibility of various mHealth apps and the increasing mobile device usage among older adults, mobile apps are a promising avenue for delivering rehabilitation interventions, such as balance training, to older adults.

• Smartphone apps exist for balance training but overall confidence in health apps within the healthcare community is low and rigorous evaluation is required.

• A range of apps exist that demonstrate acceptable to good quality and stakeholders should work towards having these apps listed in credible mHealth clearinghouses.

     

Privacy versus Convenience: A Historical Perspective,Analysis of Risks,and an Informatics Call to Action

Background  The pace of technological change dwarfs the pace of social and policy change. This mismatch allows for individual harm from lack of recognition of changes in societal context. The value of privacy has not kept pace with changes in technology over time; individuals seem to discount how loss of privacy can lead to directed personal harm. Objective  The authors examined individuals sharing personal data with mobile health applications (mHealth apps) and compared the current digital context to the historical context of harm. The authors make recommendations to informatics professionals to support consumers who wish to use mHealth apps in a manner that balances convenience with personal privacy to reduce the risk of harm. Methods  A literature search focused by a historical perspective of risk of harm was performed throughout the development of this paper. Two case studies highlight questions a consumer might ask to assess the risk of harm posed by mobile health applications. Results  A historical review provides the context for the collective human experience of harm. We then encapsulate current perceptions and views of privacy and list potential risks created by insufficient attention to privacy management. Discussion  The results provide a historical context for individuals to view the risk of harm and shed light on potential emotional, reputational, economic, and physical harms that can result from naïve use of mHealth apps. We formulate implications for clinical informaticists. Conclusion  Concepts of both harm and privacy have changed substantially over the past 20 years. Technology provides methods to invade privacy and cause harm unimaginable a few decades ago. Only recently have the consequences become clearer. The current regulatory framework is extremely limited. Given the risks of harm and limited awareness, we call upon informatics professionals to support more privacy education and protections and increase mHealth transparency about data usage.     

Cluster randomized controlled trial testing the effectiveness of a self‐management intervention using the teach‐back method for people with heart failure

In this study, we examined the effectiveness of a self‐management intervention delivered to people with heart failure in Vietnam. It used teach‐back, a cyclical method of teaching content, checking comprehension, and re‐teaching to improve understanding. A single‐site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach‐back heart failure self‐management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self‐care, with understanding reinforced using teach‐back, a heart failure booklet, weighing scales, diary, and a follow‐up phone call 2 weeks post‐discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self‐care (maintenance, management and confidence), and all‐cause hospitalizations assessed at 1 and 3 months (end‐point). Upon completion of the study, the intervention group had significantly greater knowledge and self‐care maintenance than the control group. Other outcomes did not differ between the two groups. The teach‐back self‐management intervention demonstrated promising benefits in promoting self‐care for heart failure patients.     

Telehealth and mobile health interventions in adults with inflammatory bowel disease: A mixed‐methods systematic review

Inflammatory bowel disease (IBD) is a chronic illness that is comprised of two major disorders: Crohn's disease and ulcerative colitis. Adults with IBD have adopted telehealth and mobile health (mHealth) interventions to improve their self‐management skills and symptom‐monitoring. This systematic review aimed to evaluate the efficacy of telehealth and mHealth interventions and explore the benefits and challenges of these interventions in patients with IBD. This review used a convergent segregated approach to synthesize and integrate research findings, a methodology recommended by the Joanna Briggs Institute for mixed‐methods systematic reviews. Databases searched included PubMed, CINAHL, Embase, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. The search followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, which yielded sixteen quantitative and two qualitative articles. A narrative synthesis was performed to present the findings of quantitative and qualitative studies. Evidence from quantitative and qualitative studies was then integrated for a combined presentation. The results of quantitative analysis supported the efficacy of telehealth and mHealth interventions to improve patients' quality of life, medication adherence, disease activity, medication monitoring, disease‐related knowledge and cost savings. While some participants in qualitative studies reported certain challenges of telehealth and mHealth interventions, most of the participants conferred the benefits of the interventions, including improved disease‐related knowledge, communication between patients and providers, sense of reassurance, and appointment options. The evidence from quantitative and qualitative synthesis partially supported each other.     

Apps in therapy: occupational therapists’ use and opinions

To gather information on occupational therapy practitioners’ use and opinions of apps, an online survey was distributed to occupational therapy practitioners licensed in the state of Ohio. The survey sought information regarding clinical populations and skill areas for which apps are used, potential barriers to use of apps and preferred apps/app features. OTs working in medical and education-based settings and with clients of all ages responded to the survey. Over half (53%) reported not using apps in therapy, with “not having access to the technology at work” being the leading reason endorsed. Of practitioners who did report using apps, the majority used them with?≤25% of their case load and primarily used tablets to do so. Clinicians indicated that they use apps for a wide variety of reasons, including to promote skill building and to support the therapeutic process. Preferred features included the ability to grade difficulty up/down, multiple uses and accurate feedback. Recommendations from peers were the most commonly reported way respondents found new apps. The results suggest that occupational therapy practitioners employ clinical reasoning when implementing apps in therapy. Possible ways to improve access to apps for therapists who would like to implement them are discussed.

• Implications for Rehabilitation

• Many occupational therapy practitioners are using apps with at least a portion of their caseloads.

• Therapists select apps based on peer recommendations, most commonly selecting those which promote skill building and support the therapeutic process.

• More therapists might make use of apps if potential barriers were reduced or eliminated, including availability of technology in the clinical practice setting, therapist training and education, therapist input into app development and an enhanced evidence base.

     

慢性心衰患者自我护理能力的现状调查

目的 探讨慢性心衰患者自我护理能力的现状,为临床上提高慢性心衰患者自我护理能力提供相关的依据。方法 对97名慢性心衰患者采用自我护理能力测定量表(ESCA)进行调查评定,并对其相关因素进行简要分析。 结果 慢性心衰患者的自我护理能力处于中等水平,其中自理能力技能与健康知识的掌握处于中等水平,而自我责任感与自我概念处于高等水平。其中对于中低等自护能力水平的慢性心衰患者与高等自护水平的慢性心衰患者相比较,自护能力与健康知识维度得分差异有统计学意义。结论 慢性心衰患者的自我护理能力仍需不断提高,特别是自我护理技能与健康知识方面的提高,可从其影响因素进行针对性的护理,为今后的临床护理工作提供了相关依据。     

慢性心衰患者血清肌钙蛋白T、心肌酶和IL-6浓度变化的临床意义

目的通过检测血清中肌钙蛋白T、肌酸磷酸激酶（CK）以及肌酸磷酸激酶同工酶MB（CK-MB）以及细胞因子IL-6在慢性心衰患者中浓度变化的临床意义及与心功能的关系。方法收集50例充血性心力衰竭病人,30例正常人血浆,进行定量检测cTnT、CK、CK-MB三项指标,用ELISA方法检测IL-6的浓度。结果充血性心力衰竭（CHF）患者血清肌钙蛋白T及心肌酶检测结果显著高于对照组（P〈0.001）;CHF患者血清中IL-6的浓度显著高于对照组（P〈0.01）。心功能Ⅳ级组各项指标检测结果显著高于Ⅲ级组（P〈0.01）。结论 cTnT、CK、CK-MB三项指标以及细胞因子IL-6的联合检测,对心功能损伤及其严重程度的判断具有重要意义,并且具有较高的灵敏度和较强的特异性。     

Digital Technology and Mobile Health in Behavioral Migraine Therapy: a Narrative Review

Purpose of Review

This article reviews the recent research and development of electronic health (eHealth) and, in particular, mobile health (mHealth) strategies to deliver behavioral treatment for migraine. Prospects for future development and research of mobile health in migraine are suggested.

Recent Findings

Advances in digital technology and mobile technology have led to an era where electronic and mobile approaches are applied to several aspects of healthcare. Electronic behavioral interventions for migraine seem to be acceptable and feasible, but efficacy measures are uncertain. Clinical trials on mHealth-based classical behavioral therapies, such as relaxation, biofeedback, and cognitive behavioral therapy are missing in the literature. Within mHealth, headache diaries are the most researched and scientifically developed. Still, there is a gap between commercially available apps and scientifically validated and developed apps.

Summary

Digital technology and mobile health has not yet lived out its potential in behavioral migraine therapy. Application of proper usability and functionality designs towards the right market, together with appraisal of medical and technological recommendations, may facilitate rapid development of eHealth and mHealth, while also establishing scientific evidence.

     

B型利钠肽检测在慢性心力衰竭不同分级中的应用

目的探讨B型利钠肽(BNP)在慢性心力衰竭患者不同分级中的应用。方法选取慢性心衰患者246例,健康对照组30例,慢性心衰患者按美国纽约心脏病协会(NYHA)分级方案将心功能分为Ⅰ～Ⅳ级,分别测定各级患者和健康对照组BNP浓度,对受试者进行BNP工作特征曲线(ROC)分析,通过超声心动图检查计算各级患者左心室射血分数(LEVF%),并比较Ⅲ级、Ⅳ级心力衰竭患者治疗数周前后BNP浓度。结果 BNP诊断心力衰竭的诊断界值(cut off)为98.5pg/mL,诊断灵敏度为84.6%,特异性为94.5%;不同分级衰竭组BNP水平均明显高于健康对照组,差异有统计学意义(P<0.05);246例慢性心力衰竭患者BNP水平与左室射血分数LVEF%呈负相关,相关系数为-0.733(P<0.01);Ⅲ级、Ⅳ级患者治疗数周后BNP水平都有所下降,下降幅度接近30%。结论 BNP是诊断心力衰竭的最佳心肌标志物,可以作为评价心脏功能分级的一个客观指标,帮助指导临床治疗和预后判断都有重要价值。     

An approach to revising mHealth interventions for children and families: A case example in sickle cell disease

Frameworks for developing mHealth interventions that are informed by the end‐user and improve accessibility are necessary to ensure interventions meet the needs of the intended population and advance the science of health behavior change. The approach described in this paper addresses a gap in the mHealth development literature by describing a step‐by‐step method for evaluating and revising the mHealth interventions for health behavior change in child–parent dyads. Furthermore, this approach introduces the Website Analysis and MeasureMent Inventory framework as an initial coding structure for analyzing qualitative data to gauge appeal and enhance engagement of intervention for end‐users. This method uses specific considerations for child–parent dyads and details an example in the development and refinement of a mobile application for self‐management in children with sickle cell disease. This approach is translatable to populations of children with other chronic conditions and to other health behaviors.     

Willingness to use smartphone apps for lifestyle management among patients with schizophrenia

Mobile technology is a popular intervention mode for patients with schizophrenia because of its accessibility and functionality. We examined patients' willingness to use smartphone apps for lifestyle management and its effect on self-reported lifestyle habits. Five hundred fifty-five inpatients from various mental health institutions participated. Willingness to use smartphone apps was associated with age, education, income, device type, and body mass index. Positive opinions on smartphone app use were significantly associated with willingness to use apps, which was significantly associated with dietary and living habits. Thus, improving willingness to use apps can help patients improve their lifestyle, potentially preventing relapse.