%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65958 %T Impact of Tai Chi Therapy on Fatigue and Cognitive Function in Individuals With Chronic Fatigue Syndrome: Protocol for a Pilot Randomized Controlled Trial %A Wang,Bin %A Zhang,Xiaodong %A Lu,Ping %A Sun,Pingping %A He,Tianxiang %+ , Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Number 528, Zhangheng Road, Pudong New Area, Shanghai, 201203, China, 86 13310009629, hetianxiang@126.com %K Tai Chi %K chronic fatigue syndrome %K cognitive impairment %K ANT %K N-Back %K fatigue %K cognitive function %K cognitive %K protocol %K protocols %K randomized controlled trial %K RCT %K controlled trial %K controlled trials %K psychosomatic disorder %K cognition %K therapy %K efficacy %K safety %K CFS %K intervention %K data analysis %D 2025 %7 25.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic fatigue syndrome (CFS) is a psychosomatic disorder characterized by persistent fatigue, primarily involving physical and mental exhaustion, with greater emphasis on the latter. This leads to a deterioration in concentration and memory. These symptoms affect cognitive functions, including attention and memory, to varying degrees. Previous research has shown that Tai Chi can help reduce fatigue in individuals with CFS. However, the relationship between alleviating CFS-related fatigue through Tai Chi and its impact on cognitive functions remains unclear. The effects of Tai Chi on cognitive functions in individuals with CFS have not been clinically validated, and its efficacy and safety have yet to be examined through large-scale randomized controlled trials. Therefore, this protocol outlines a pilot randomized, parallel, single-blind clinical trial designed to evaluate the impact of Tai Chi therapy on fatigue and cognitive functions in individuals with CFS, using both subjective and objective assessments. Objective: This pilot study aims to explore the preliminary efficacy and safety of Tai Chi in reducing fatigue and improving cognitive function in patients with CFS, and to generate data to inform future large-scale trials. Methods: We will conduct a randomized, analyst-blinded, parallel-controlled trial with a 12-week intervention period and a 4-week follow-up. Enrolled patients will be randomly assigned to either the Tai Chi group (30 patients) or the health education group (30 patients). The Tai Chi group will receive the 24-style simplified Tai Chi intervention, while the control group will receive a health education intervention. Following the 12-week intervention, a 4-week follow-up will be conducted. The Tai Chi group will train 3 times per week, consisting of 2 in-person sessions at the Physical Education Center of Shanghai University of Traditional Chinese Medicine and 1 self-directed session guided online by an instructor. The primary outcome measure is the 20-item Multi-Dimensional Fatigue Inventory (MFI-20). The secondary outcome measures include the Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index (PSQI), Attention Network Test (ANT), working memory performance (N-Back task), and magnetic resonance imaging. Results: The research protocol and informed consent form were approved by the Shanghai Clinical Research Ethics Committee on March 18, 2024 (approval number SECCR2024-22-01). Participant recruitment began in April 2024. All interventions and concurrent data collection will be completed by October 2025, and the 4-week postintervention follow-up assessments will be finalized by the end of October 2025. Data management is still ongoing; therefore, data analysis has not yet been performed. Conclusions: As a pilot trial, the findings of this study will provide preliminary clinical evidence on the role of Tai Chi in improving cognitive function in patients with CFS and will serve as a foundation for designing future large-scale trials. Trial Registration: China Clinical Trials Registry ChiCTR2400082268; https://tinyurl.com/2tkr7j7x International Registered Report Identifier (IRRID): DERR1-10.2196/65958 %R 10.2196/65958 %U https://www.researchprotocols.org/2025/1/e65958 %U https://doi.org/10.2196/65958 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62786 %T The Added Value of Digital Body Chart Pain Surface Assessment as an Objective Biomarker: Multicohort Study %A Billot,Maxime %A Ounajim,Amine %A Moens,Maarten %A Goudman,Lisa %A Deneuville,Jean-Philippe %A Roulaud,Manuel %A Nivole,Kévin %A Many,Mathilde %A Baron,Sandrine %A Lorgeoux,Bertille %A Bouche,Bénédicte %A Lampert,Lucie %A David,Romain %A Rigoard,Philippe %+ PRISMATICS Lab, CHU de Poitiers, 2 Rue de la Milétrie, Poitiers, 86000, France, 33 05 49 44 32 24, maxime.billot@chu-poitiers.fr %K chronic pain %K neuropathic pain %K mechanical pain %K assessment tool %K digital body chart %K pain assessment %K pain treatment %K digital tool %K quality of life %K financial burdens %K machine learning %K pain management %K digital health biomarker %K pain typology %K neuropathic %K nociceptive %D 2025 %7 16.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although it has been well-documented that pain intensity alone is not sufficient to assess chronic pain, the objective pain surface encapsulated in a digital tool might present a major interest in the objective assessment of pain. Objective: This study aims to determine the potential added value of pain surface measurement by determining the correlation between pain surface and pain intensity in chronic pain patients. Methods: Two databases from observational prospective and retrospective longitudinal studies including patients with chronic pain were used in this research. Pain intensity was assessed by the Numeric Pain Rating Scale. Pain surface (cm²) and pain typology (neuropathic vs mechanical components) were measured by a specific pain mapping digital tool (PRISMap, Poitiers University Hospital). Patients were asked to draw their pain surface on a computerized tactile interface in a predetermined body (adapted from the patient’s BMI). A color code was used to represent pain intensity (very intense, intense, moderate, and low). Simple linear regression was used to assess the proportion of variance in pain surface explained by pain intensity. Results: The final analysis included 637 patients with chronic pain. The percentage of variance of the pain surface explained by pain intensity was 1.24% (R²=0.0124; 95% CI 0.11%-6.3%). In addition, 424 (66.6%) patients used more than 1 intensity or color, among whom 218 (34.2%) used 2 intensities or colors, 155 (24.3%) used 3 intensities or colors, and 51 (8%) used 4 intensities or colors. Conclusions: This study showed that pain intensity and pain surface provide complementary and distinct information that would help to improve pain assessment. Two-thirds of the cohort used 2 or more intensities to describe their pain. Combining pain intensity and pain surface should be strongly considered as a means of improving daily practice assessment of patients with chronic pain in primary and secondary care. Trial Registration: ClinicalTrials.gov NCT02964130; https://clinicaltrials.gov/study/NCT02964130?term=PREDIBACK&rank=2 %M 40239206 %R 10.2196/62786 %U https://www.jmir.org/2025/1/e62786 %U https://doi.org/10.2196/62786 %U http://www.ncbi.nlm.nih.gov/pubmed/40239206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70535 %T Unveiling the Potential of Large Language Models in Transforming Chronic Disease Management: Mixed Methods Systematic Review %A Li,Caixia %A Zhao,Yina %A Bai,Yang %A Zhao,Baoquan %A Tola,Yetunde Oluwafunmilayo %A Chan,Carmen WH %A Zhang,Meifen %A Fu,Xia %+ The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-sen University, No. 3025, Shennan Middle Road, Room 501, The Administrative Building, Shenzhen, 518033, China, 86 13829706026, fuxia5@mail.sysu.edu.cn %K artificial intelligence %K chronic disease %K health management %K large language model %K systematic review %D 2025 %7 16.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Chronic diseases are a major global health burden, accounting for nearly three-quarters of the deaths worldwide. Large language models (LLMs) are advanced artificial intelligence systems with transformative potential to optimize chronic disease management; however, robust evidence is lacking. Objective: This review aims to synthesize evidence on the feasibility, opportunities, and challenges of LLMs across the disease management spectrum, from prevention to screening, diagnosis, treatment, and long-term care. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, 11 databases (Cochrane Central Register of Controlled Trials, CINAHL, Embase, IEEE Xplore, MEDLINE via Ovid, ProQuest Health & Medicine Collection, ScienceDirect, Scopus, Web of Science Core Collection, China National Knowledge Internet, and SinoMed) were searched on April 17, 2024. Intervention and simulation studies that examined LLMs in the management of chronic diseases were included. The methodological quality of the included studies was evaluated using a rating rubric designed for simulation-based research and the risk of bias in nonrandomized studies of interventions tool for quasi-experimental studies. Narrative analysis with descriptive figures was used to synthesize the study findings. Random-effects meta-analyses were conducted to assess the pooled effect estimates of the feasibility of LLMs in chronic disease management. Results: A total of 20 studies examined general-purpose (n=17) and retrieval-augmented generation-enhanced LLMs (n=3) for the management of chronic diseases, including cancer, cardiovascular diseases, and metabolic disorders. LLMs demonstrated feasibility across the chronic disease management spectrum by generating relevant, comprehensible, and accurate health recommendations (pooled accurate rate 71%, 95% CI 0.59-0.83; I2=88.32%) with retrieval-augmented generation-enhanced LLMs having higher accuracy rates compared to general-purpose LLMs (odds ratio 2.89, 95% CI 1.83-4.58; I2=54.45%). LLMs facilitated equitable information access; increased patient awareness regarding ailments, preventive measures, and treatment options; and promoted self-management behaviors in lifestyle modification and symptom coping. Additionally, LLMs facilitate compassionate emotional support, social connections, and health care resources to improve the health outcomes of chronic diseases. However, LLMs face challenges in addressing privacy, language, and cultural issues; undertaking advanced tasks, including diagnosis, medication, and comorbidity management; and generating personalized regimens with real-time adjustments and multiple modalities. Conclusions: LLMs have demonstrated the potential to transform chronic disease management at the individual, social, and health care levels; however, their direct application in clinical settings is still in its infancy. A multifaceted approach that incorporates robust data security, domain-specific model fine-tuning, multimodal data integration, and wearables is crucial for the evolution of LLMs into invaluable adjuncts for health care professionals to transform chronic disease management. Trial Registration: PROSPERO CRD42024545412; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545412 %M 40239198 %R 10.2196/70535 %U https://www.jmir.org/2025/1/e70535 %U https://doi.org/10.2196/70535 %U http://www.ncbi.nlm.nih.gov/pubmed/40239198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53144 %T Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review %A Paneerselvam,Ganesh Sritheran %A Lua,Pei Lin %A Chooi,Wen Han %A Rehman,Inayat Ur %A Goh,Khang Wen %A Ming,Long Chiau %+ School of Pharmacy, Taylor's University, 1, Jln Taylors, Subang Jaya, 47500, Malaysia, 60 5629 5000, ganeshsritheran.Paneerselvam@taylors.edu.my %K mobile applications %K medication adherence %K chronic kidney disease %K health outcomes %K mobile health %K mhealth %K digital health %K kidney disease %K patient education %K medication monitoring %K e-medication %K electronic medication %D 2025 %7 16.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Chronic kidney disease (CKD) is a serious condition affecting millions of individuals worldwide. Adherence to medication regimens among patients with CKD is often suboptimal, leading to poor health outcomes. In recent years, mobile apps have gained popularity as a promising tool to improve medication adherence and self-management in various chronic diseases. Objective: This study aimed to evaluate the effectiveness of mobile apps to improve medication adherence among patients with CKD (including end-stage and renal replacement therapy). Methods: A systematic search was conducted using Scopus, Cochrane, PubMed, and EBSCOhost to include eligible articles that studied mobile apps to improve medication adherence among patients with CKD. The quality of the selected studies was evaluated using the Newcastle‒Ottawa Scale and the Cochrane risk-of-bias tool. Results: Out of 231 relevant articles, only 9 studies were selected for this systematic review. Based on Newcastle‒Ottawa Scale, 7 were deemed to be of high quality, while others were of fair quality. The Cochrane risk-of-bias tool indicated a low to moderate risk of bias across the included studies. Most of the included studies had a randomized controlled design. Of the 9 selected studies, 3 papers represented medication adherence by a coefficient of 10 variability of tacrolimus, 3 papers used adherence measurement scales to calculate the score for assessing medication adherence, 2 papers represented medication adherence by self-reporting, 2 papers represented medication adherence using electronic monitoring, and 1 represented medication adherence by pill count. The mobile apps were identified as Transplant Hero (Transplant Hero LLC), Perx (Perx Health), Smartphone Medication Adherence Saves Kidneys (developed by John McGillicuddy), Adhere4U (developed by Ahram Han), My Dialysis (developed by Benyamin Saadatifar), Kidney Love (developed by National Kidney foundation), and iCKD (developed by Dr Vivek Kumar). Of these apps, 3 focused on evaluating Transplant Hero, while the remaining investigated each of the other mentioned apps individually. The apps use various strategies to promote medication adherence, including reminders, gamification, patient education, and medication monitoring. A majority, 5 out of 9 mobile apps, had a statistically significant (P<.05) effect on medication adherence. There was strong evidence for a positive effect of interventions focusing on games and reminders combined with electronic medication tray monitoring and patient education. Conclusions: Mobile apps effectively improved medication adherence in patients with CKD, but low evidence and short intervention duration warrant caution. Future research should identify ideal features, provider costs, and user-friendly, secure apps. %M 40239197 %R 10.2196/53144 %U https://www.jmir.org/2025/1/e53144 %U https://doi.org/10.2196/53144 %U http://www.ncbi.nlm.nih.gov/pubmed/40239197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59632 %T AI Applications for Chronic Condition Self-Management: Scoping Review %A Hwang,Misun %A Zheng,Yaguang %A Cho,Youmin %A Jiang,Yun %+ , School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109, United States, 1 7347633705, jiangyu@umich.edu %K artificial intelligence %K chronic disease %K self-management %K generative AI %K emotional self-management %D 2025 %7 8.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) has potential in promoting and supporting self-management in patients with chronic conditions. However, the development and application of current AI technologies to meet patients’ needs and improve their performance in chronic condition self-management tasks remain poorly understood. It is crucial to gather comprehensive information to guide the development and selection of effective AI solutions tailored for self-management in patients with chronic conditions. Objective: This scoping review aimed to provide a comprehensive overview of AI applications for chronic condition self-management based on 3 essential self-management tasks, medical, behavioral, and emotional self-management, and to identify the current developmental stages and knowledge gaps of AI applications for chronic condition self-management. Methods: A literature review was conducted for studies published in English between January 2011 and October 2024. In total, 4 databases, including PubMed, Web of Science, CINAHL, and PsycINFO, were searched using combined terms related to self-management and AI. The inclusion criteria included studies focused on the adult population with any type of chronic condition and AI technologies supporting self-management. This review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: Of the 1873 articles retrieved from the search, 66 (3.5%) were eligible and included in this review. The most studied chronic condition was diabetes (20/66, 30%). Regarding self-management tasks, most studies aimed to support medical (45/66, 68%) or behavioral self-management (27/66, 41%), and fewer studies focused on emotional self-management (14/66, 21%). Conversational AI (21/66, 32%) and multiple machine learning algorithms (16/66, 24%) were the most used AI technologies. However, most AI technologies remained in the algorithm development (25/66, 38%) or early feasibility testing stages (25/66, 38%). Conclusions: A variety of AI technologies have been developed and applied in chronic condition self-management, primarily for medication, symptoms, and lifestyle self-management. Fewer AI technologies were developed for emotional self-management tasks, and most AIs remained in the early developmental stages. More research is needed to generate evidence for integrating AI into chronic condition self-management to obtain optimal health outcomes. %M 40198108 %R 10.2196/59632 %U https://www.jmir.org/2025/1/e59632 %U https://doi.org/10.2196/59632 %U http://www.ncbi.nlm.nih.gov/pubmed/40198108 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60587 %T Racial Disparities in Parkinson Disease Clinical Phenotype, Management, and Genetics: Protocol for a Prospective Observational Study %A Hall,Deborah A %A Shulman,Josh M %A Singleton,Andrew %A Bandres Ciga,Sara %A S Tosin,Michelle Hyczy %A Ouyang,Bichun %A Shulman,Lisa %+ Department of Neurological Sciences, Rush University, 1725 West Harrison St, Suite 755, Chicago, IL, 60612, United States, 1 312 563 2900, deborah_a_hall@rush.edu %K Parkinson disease %K racial disparities %K clinical protocol %K health disparities %K genetic risk factors %K quality of life %K quality of care %D 2025 %7 7.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) has been described and studied extensively in White populations, with little known about how the disease manifests and progresses in patients from the Black community. Studies investigating disease features in Black populations are uncommon, with some suggesting that the Black population with PD is more disabled and has greater disease severity and different clinical features compared with the White population with PD. These health disparities are likely to influence the quality of care for Black patients with PD. Objective: This study aimed to investigate the motor and nonmotor symptoms and quality of life in Black and White participants with PD in a case-case design. Methods: This is an observational, prospective, multicenter, case-case design study. Other aims will investigate the management of PD in Black individuals and the presence of shared or unique genetic risk factors among the Black PD population. A total of 400 Black and 200 White participants with PD will be recruited. Data will be collected at 7 US sites and entered into a Research Electronic Data Capture database. Linear multivariate regression analysis will be used, except for comparing PD management, which will be analyzed using the chi-square test or Fisher exact test. Bonferroni correction will be applied. This protocol also describes plans for educational programming for clinicians and patients at the end of the study in partnership with national PD organizations. Results: The Rush Institutional Review Board approved the project as the single-site institutional review board in February 2022, and it was funded by the National Institute of Neurological Disorders and Stroke in April 2022. Recruitment began in July 2022. At the time of submission of this manuscript, 131 participants had been recruited. Conclusions: To our knowledge, this is the largest study of PD phenotype and management in Black patients in the United States. The planned collaboration with the Global Parkinson’s Genetics Program and PD GENEration will enhance our understanding of genetic risk factors for PD in this understudied population. International Registered Report Identifier (IRRID): DERR1-10.2196/60587 %M 40193190 %R 10.2196/60587 %U https://www.researchprotocols.org/2025/1/e60587 %U https://doi.org/10.2196/60587 %U http://www.ncbi.nlm.nih.gov/pubmed/40193190 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e64618 %T Perspectives of Adolescents and Young Adults With Inflammatory Bowel Disease on a Biopsychosocial Transition Intervention: Qualitative Interview Study %A Allemang,Brooke %A Miatello,Ashleigh %A Browne,Mira %A Barwick,Melanie %A Maini,Pranshu %A Eszczuk,Joshua %A Pandit,Chetan %A Sadhra,Tandeep %A Forhan,Laura %A Bollegala,Natasha %A Fu,Nancy %A Lee,Kate %A Dekker,Emily %A Nistor,Irina %A Ahola Kohut,Sara %A Keefer,Laurie %A Griffiths,Anne Marie %A Walters,Thomas D %A Micsinszki,Samantha %A Mack,David R %A Lawrence,Sally %A Kroeker,Karen I %A de Guzman,Jacqueline %A Tausif,Aalia %A Tersigni,Claudia %A Anthony,Samantha J %A Benchimol,Eric I %K gastroenterology %K inflammatory bowel disease %K biopsychosocial %K patient-oriented research %K transition to adult care %K qualitative methods %K young adults %K qualitative %K adolescents %K patient perspectives %K Crohn's disease %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The transition from pediatric to adult health care marks a complex and pivotal process for adolescents and young adults with inflammatory bowel disease (IBD). This group requires support regarding disease self-management, skill development, and system navigation in preparation for transition. Evidence-based interventions are needed to promote optimal health and psychosocial outcomes for adolescents and young adults with IBD during this period. Objective: A qualitative study embedded within a randomized controlled trial was conducted to evaluate the perceived impact of a biopsychosocial transition intervention on the transition experiences of adolescents and young adults, their views on the intervention, and recommendations for future care. Methods: This patient-oriented research study used a qualitative descriptive design. Virtual semistructured interviews were held with 21 adolescents and young adults with IBD (16‐18 y) enrolled in the randomized controlled trial (intervention arm n=11 and control arm n=10). Interviews were audio-recorded, transcribed, and analyzed using an inductive approach to reflexive thematic analysis. Five members of a Youth Advisory Panel with lived experience of IBD collaborated throughout data analysis, interpretation, and the presentation of findings. Results: We constructed three themes through our analysis: (1) making meaning of transitions in care; (2) perceptions and impact of the biopsychosocial transition intervention; and (3) considerations for future transition care, including the importance of individualized support. Conclusions: Our findings illustrate the importance of relationships and the impact of a biopsychosocial intervention on adolescents’ and young adults’ confidence, knowledge, and self-management skills during transition. The results, which indicate the criticality of tailoring transition supports according to adolescents’ and young adults’ preferences and characteristics, will be used to refine the biopsychosocial intervention before it can be scaled and spread. %R 10.2196/64618 %U https://pediatrics.jmir.org/2025/1/e64618 %U https://doi.org/10.2196/64618 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e62978 %T Large-Scale Evaluation and Liver Disease Risk Prediction in Finland’s National Electronic Health Record System: Feasibility Study Using Real-World Data %A Männikkö,Viljami %A Tommola,Janne %A Tikkanen,Emmi %A Hätinen,Olli-Pekka %A Åberg,Fredrik %+ Atostek Oy, Hermiankatu 3 A, Tampere, 33720, Finland, 358 45 7834 70, viljami.mannikko@tuni.fi %K Kanta archive %K national patient data repository %K real world data %K risk prediction %K chronic liver disease %K mortality %K risk detection %K alcoholic liver %K prediction %K obesity %K overweight %K electronic health record %K wearables %K smartwatch %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Globally, the incidence and mortality of chronic liver disease are escalating. Early detection of liver disease remains a challenge, often occurring at symptomatic stages when preventative measures are less effective. The Chronic Liver Disease score (CLivD) is a predictive risk model developed using Finnish health care data, aiming to forecast an individual’s risk of developing chronic liver disease in subsequent years. The Kanta Service is a national electronic health record system in Finland that stores comprehensive health care data including patient medical histories, prescriptions, and laboratory results, to facilitate health care delivery and research. Objective: This study aimed to evaluate the feasibility of implementing an automatic CLivD score with the current Kanta platform and identify and suggest improvements for Kanta that would enable accurate automatic risk detection. Methods: In this study, a real-world data repository (Kanta) was used as a data source for “The ClivD score” risk calculation model. Our dataset consisted of 96,200 individuals’ whole medical history from Kanta. For real-world data use, we designed processes to handle missing input in the calculation process. Results: We found that Kanta currently lacks many CLivD risk model input parameters in the structured format required to calculate precise risk scores. However, the risk scores can be improved by using the unstructured text in patient reports and by approximating variables by using other health data–like diagnosis information. Using structured data, we were able to identify only 33 out of 51,275 individuals in the “low risk” category and 308 out of 51,275 individuals (<1%) in the “moderate risk” category. By adding diagnosis information approximation and free text use, we were able to identify 18,895 out of 51,275 (37%) individuals in the “low risk” category and 2125 out of 51,275 (4%) individuals in the “moderate risk” category. In both cases, we were not able to identify any individuals in the “high-risk” category because of the missing waist-hip ratio measurement. We evaluated 3 scenarios to improve the coverage of waist-hip ratio data in Kanta and these yielded the most substantial improvement in prediction accuracy. Conclusions: We conclude that the current structured Kanta data is not enough for precise risk calculation for CLivD or other diseases where obesity, smoking, and alcohol use are important risk factors. Our simulations show up to 14% improvement in risk detection when adding support for missing input variables. Kanta shows the potential for implementing nationwide automated risk detection models that could result in improved disease prevention and public health. %M 40172947 %R 10.2196/62978 %U https://medinform.jmir.org/2025/1/e62978 %U https://doi.org/10.2196/62978 %U http://www.ncbi.nlm.nih.gov/pubmed/40172947 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e57599 %T Accelerometry-Assessed Physical Activity and Circadian Rhythm to Detect Clinical Disability Status in Multiple Sclerosis: Cross-Sectional Study %A Bou Rjeily,Nicole %A Sanjayan,Muraleetharan %A Guha Niyogi,Pratim %A Dewey,Blake E %A Zambriczki Lee,Alexandra %A Hulett,Christy %A Dagher,Gabriella %A Hu,Chen %A Mazur,Rafal D %A Kenney,Elena M %A Brennan,Erin %A DuVal,Anna %A Calabresi,Peter A %A Zipunnikov,Vadim %A Fitzgerald,Kathryn C %A Mowry,Ellen M %K multiple sclerosis %K disability %K progressive %K physical activity %K circadian rhythm %K accelerometer %K ActiGraph %K accelerometry %D 2025 %7 31.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Tools for measuring clinical disability status in people with multiple sclerosis (MS) are limited. Accelerometry objectively assesses physical activity and circadian rhythmicity profiles in the real-world environment and may potentially distinguish levels of disability in MS. Objective: This study aims to determine if accelerometry can detect differences in physical activity and circadian rhythms between relapsing-remitting multiple sclerosis (RRMS) and progressive multiple sclerosis (PMS) and to assess the interplay within person between the 2 domains of physical activity (PA) and circadian rhythm (CR) in relation to MS type. Methods: This study represents an analysis of the baseline data from the prospective HEAL-MS (home-based evaluation of actigraphy to predict longitudinal function in multiple sclerosis) study. Participants were divided into 3 groups based on the Expanded Disability Status Scale (EDSS) criteria for sustained disability progression: RRMS-Stable, RRMS-Suspected progression, and PMS. Baseline visits occurred between January 2021 and March 2023. Clinical outcome measures were collected by masked examiners. Participants wore the GT9X Link ActiGraph on their nondominant wrists for 2 weeks. After adjusting for age, sex, and BMI, a logistic regression model was fitted to evaluate the association of each accelerometry metric with odds of PMS versus RRMS. We also evaluated the association of accelerometry metrics in differentiating the 2 RRMS subtypes. The Joint and Individual Variation Explained (JIVE) model was used to assess the codependencies between the PA and CR domains and their joint and individual association with MS subtype. Results: A total of 253 participants were included: 86 with RRMS-Stable, 82 with RRMS-Suspected progression, and 85 with PMS. Compared to RRMS, participants with PMS had lower total activity counts (β=−0.32, 95% CI −0.61 to −0.03), lower time spent in moderate to vigorous physical activity (β=−0.01, 95% CI −0.02 to −0.004), higher active-to-sedentary transition probability (β=5.68, 95% CI 1.86-9.5), lower amplitude (β=−0.0004, 95% CI −0.0008 to −0.0001), higher intradaily variability (β=4.64, 95% CI 1.45-7.84), and lower interdaily stability (β=−4.43, 95% CI −8.77 to −0.10). Using the JIVE model for PA and CR domains, PMS had higher first joint component (β=0.367, 95% CI 0.088-0.656), lower PA-1 component (β=−0.441, 95% CI −0.740 to −0.159), and lower PA-2 component (β=−0.415, 95% CI −0.717 to −0.126) compared to RRMS. No significant differences were detected between the 2 RRMS subtypes except for lower relative amplitude in those with suspected progression (β=−5.26, 95% CI −10.80 to −0.20). Conclusions: Accelerometry detected differences in physical activity patterns between RRMS and PMS. More advanced analytic techniques may help discern differences between the 2 RRMS subgroups. Longitudinal follow-up is underway to assess the potential for accelerometry to detect or predict disability progression. %R 10.2196/57599 %U https://mhealth.jmir.org/2025/1/e57599 %U https://doi.org/10.2196/57599 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62857 %T Ability of ChatGPT to Replace Doctors in Patient Education: Cross-Sectional Comparative Analysis of Inflammatory Bowel Disease %A Yan,Zelin %A Liu,Jingwen %A Fan,Yihong %A Lu,Shiyuan %A Xu,Dingting %A Yang,Yun %A Wang,Honggang %A Mao,Jie %A Tseng,Hou-Chiang %A Chang,Tao-Hsing %A Chen,Yan %+ Center of Inflammatory Bowel Diseases, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No 88, Jiefang Road, Hangzhou, 310000, China, 86 13757118653, chenyan72_72@zju.edu.cn %K AI-assisted %K patient education %K inflammatory bowel disease %K artificial intelligence %K ChatGPT %K patient communities %K social media %K disease management %K readability %K online health information %K conversational agents %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although large language models (LLMs) such as ChatGPT show promise for providing specialized information, their quality requires further evaluation. This is especially true considering that these models are trained on internet text and the quality of health-related information available online varies widely. Objective: The aim of this study was to evaluate the performance of ChatGPT in the context of patient education for individuals with chronic diseases, comparing it with that of industry experts to elucidate its strengths and limitations. Methods: This evaluation was conducted in September 2023 by analyzing the responses of ChatGPT and specialist doctors to questions posed by patients with inflammatory bowel disease (IBD). We compared their performance in terms of subjective accuracy, empathy, completeness, and overall quality, as well as readability to support objective analysis. Results: In a series of 1578 binary choice assessments, ChatGPT was preferred in 48.4% (95% CI 45.9%-50.9%) of instances. There were 12 instances where ChatGPT’s responses were unanimously preferred by all evaluators, compared with 17 instances for specialist doctors. In terms of overall quality, there was no significant difference between the responses of ChatGPT (3.98, 95% CI 3.93-4.02) and those of specialist doctors (3.95, 95% CI 3.90-4.00; t524=0.95, P=.34), both being considered “good.” Although differences in accuracy (t521=0.48, P=.63) and empathy (t511=2.19, P=.03) lacked statistical significance, the completeness of textual output (t509=9.27, P<.001) was a distinct advantage of the LLM (ChatGPT). In the sections of the questionnaire where patients and doctors responded together (Q223-Q242), ChatGPT demonstrated inferior performance (t36=2.91, P=.006). Regarding readability, no statistical difference was found between the responses of specialist doctors (median: 7th grade; Q1: 4th grade; Q3: 8th grade) and those of ChatGPT (median: 7th grade; Q1: 7th grade; Q3: 8th grade) according to the Mann-Whitney U test (P=.09). The overall quality of ChatGPT’s output exhibited strong correlations with other subdimensions (with empathy: r=0.842; with accuracy: r=0.839; with completeness: r=0.795), and there was also a high correlation between the subdimensions of accuracy and completeness (r=0.762). Conclusions: ChatGPT demonstrated more stable performance across various dimensions. Its output of health information content is more structurally sound, addressing the issue of variability in the information from individual specialist doctors. ChatGPT’s performance highlights its potential as an auxiliary tool for health information, despite limitations such as artificial intelligence hallucinations. It is recommended that patients be involved in the creation and evaluation of health information to enhance the quality and relevance of the information. %M 40163853 %R 10.2196/62857 %U https://www.jmir.org/2025/1/e62857 %U https://doi.org/10.2196/62857 %U http://www.ncbi.nlm.nih.gov/pubmed/40163853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63569 %T Perspectives on and Experiences With Remote Monitoring and Patient-Initiated Care Among Norwegian Patients With Axial Spondyloarthritis: Qualitative Study %A Hestevik,Christine Hillestad %A Varsi,Cecilie %A Østerås,Nina %A Tveter,Anne Therese %A Skandsen,Jon %A Eik,Hedda %+ Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Postboks 23 Vinderen, Oslo, 0319, Norway, 47 22451500, christine76@hotmail.no %K remote monitoring %K patient-initiated care %K patient-reported outcome measures %K chronic disease %K rheumatology %K axial spondyloarthritis %K joint disease %K spine %K medication %K therapy %K rheumatic %K patient care %K randomized controlled trial %K interventions %K decision-making %D 2025 %7 28.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory joint disease affecting the spine and sacroiliac joints, requiring frequent, lifelong monitoring and treatment. This involves regular symptom monitoring, assessing medication tolerance and side effects, and prompt therapy adjustments. Typically, patients with axSpA attend prescheduled hospital visits, but once stable disease has been attained, these seldom align with periods of high disease activity. Remote monitoring and patient-initiated care offer flexible, need-based, follow-up options. However, knowledge about how patients with axSpA perceive and experience these approaches is limited. To effectively implement these strategies in clinical practice, understanding patient perspectives is crucial. Objective: This study aims to explore how patients with axSpA perceive and experience remote monitoring and patient-initiated care. Methods: Our qualitative study was embedded in a randomized controlled trial. Participants were allocated to either usual care, remote monitoring, or patient-initiated care. The 2 intervention groups had no prescheduled visits and used a remote monitoring app, but only the remote monitoring group received monitoring by health care professionals. Semistructured interviews were conducted with 18 participants from the intervention groups to explore their experiences. The interviews were audio recorded, transcribed, anonymized, and analyzed using thematic analysis. Participants provided informed consent. Results: Eighteen patients (11 men and 7 women, aged 26-65 years) participated, 10 from the remote monitoring group and 8 from the patient-initiated care group. Transcripts were analyzed into four key themes: (1) “I don’t need to go to the hospital just to report I’m doing well.” When patients felt well, they perceived in-person consultations as less important. They acknowledged health care resource challenges and were willing to adapt but expressed concerns about rapid technological advancement, fearing it could exclude vulnerable groups. They emphasized the need for shared decision-making in determining follow-up strategies; (2) “It feels safer to meet healthcare personnel in person” highlighted participants’ preference for in-person interactions as a safety net for detecting changes or signs of disease. They felt more secure when communicating face-to-face with health care professionals; (3) Remote monitoring can promote a sense of freedom and self-efficacy. The app provided autonomy, enabling patients to monitor their health without disrupting daily routines and promoting their health competency; and (4) Practical challenges and limitations of technology affect sense of security. Concerns about app deactivation, digital privacy, and lack of personalized settings negatively affected confidence in technology and sense of security. Conclusions: Remote monitoring and patient-initiated care can adequately meet the needs of patients with axSpA with low disease activity, reducing unnecessary visits and enhancing self-efficacy. However, these approaches should not be one-size-fits-all. Care must adapt to evolving disease activity, circumstances, and preferences. Human interaction and support remain crucial, and future technological developments must address practical challenges to ensure user-friendly and reliable interfaces. %M 40153780 %R 10.2196/63569 %U https://www.jmir.org/2025/1/e63569 %U https://doi.org/10.2196/63569 %U http://www.ncbi.nlm.nih.gov/pubmed/40153780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59649 %T The Role of Machine Learning in Cognitive Impairment in Parkinson Disease: Systematic Review and Meta-Analysis %A Wu,Yanyun %A Cheng,Yangfan %A Xiao,Yi %A Shang,Huifang %A Ou,Ruwei %+ Department of Neurology, West China Hospital of Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China, 86 18980607525, ouruwei@aliyun.com %K Parkinson disease %K cognitive impairment %K machine learning %K systematic review %K meta-analysis %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease (PD) is a common neurodegenerative disease characterized by both motor and nonmotor symptoms. Cognitive impairment often occurs early in the disease and can persist throughout its progression, severely impacting patients’ quality of life. The utilization of machine learning (ML) has recently shown promise in identifying cognitive impairment in patients with PD. Objective: This study aims to summarize different ML models applied to cognitive impairment in patients with PD and to identify determinants for improving diagnosis and predictive power for early detection of cognitive impairment. Methods: PubMed, Cochrane, Embase, and Web of Science were searched for relevant articles on March 2, 2024. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Bivariate meta-analysis was used to estimate pooled sensitivity and specificity results, presented as odds ratio (OR) and 95% CI. A summary receiver operator characteristic (SROC) curve was used. Results: A total of 38 articles met the criteria, involving 8564 patients with PD and 1134 healthy controls. Overall, 120 models reported sensitivity and specificity, with mean values of 71.07% (SD 13.72%) and 77.01% (SD 14.31%), respectively. Predictors commonly used in ML models included clinical features, neuroimaging features, and other variables. No significant heterogeneity was observed in the bivariate meta-analysis, which included 12 studies. Using sensitivity as the metric, the combined sensitivity and specificity were 0.76 (95% CI 0.67-0.83) and 0.83 (95% CI 0.76-0.88), respectively. When specificity was used, the combined values were 0.77 (95% CI 0.65-0.86) and 0.76 (95% CI 0.63-0.85), respectively. The area under the curves of the SROC were 0.87 (95% CI 0.83-0.89) and 0.83 (95% CI 0.80-0.86) respectively. Conclusions: Our findings provide a comprehensive summary of various ML models and demonstrate the effectiveness of ML as a tool for diagnosing and predicting cognitive impairment in patients with PD. Trial Registration: PROSPERO CRD42023480196; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023480196 %M 40153789 %R 10.2196/59649 %U https://www.jmir.org/2025/1/e59649/ %U https://doi.org/10.2196/59649 %U http://www.ncbi.nlm.nih.gov/pubmed/40153789 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e67178 %T Predicting Clinical Outcomes at the Toronto General Hospital Transitional Pain Service via the Manage My Pain App: Machine Learning Approach %A Skoric,James %A Lomanowska,Anna M %A Janmohamed,Tahir %A Lumsden-Ruegg,Heather %A Katz,Joel %A Clarke,Hance %A Rahman,Quazi Abidur %K chronic pain %K transitional pain %K pain interference %K machine learning %K prediction model %K manage my pain %K pain app %K clinical outcome %K Toronto %K Canada %K transitional pain service %K pain service %K pain %K app %K application %K prognosis %K chronic pain management %K digital health %K digital health tool %K pain management %K machine learning methods %K machine learning %K prediction %K machine learning models %K logistic regression %D 2025 %7 28.3.2025 %9 %J JMIR Med Inform %G English %X Background: Chronic pain is a complex condition that affects more than a quarter of people worldwide. The development and progression of chronic pain are unique to each individual due to the contribution of interacting biological, psychological, and social factors. The subjective nature of the experience of chronic pain can make its clinical assessment and prognosis challenging. Personalized digital health apps, such as Manage My Pain (MMP), are popular pain self-tracking tools that can also be leveraged by clinicians to support patients. Recent advances in machine learning technologies open an opportunity to use data collected in pain apps to make predictions about a patient’s prognosis. Objective: This study applies machine learning methods using real-world user data from the MMP app to predict clinically significant improvements in pain-related outcomes among patients at the Toronto General Hospital Transitional Pain Service. Methods: Information entered into the MMP app by 160 Transitional Pain Service patients over a 1-month period, including profile information, pain records, daily reflections, and clinical questionnaire responses, was used to extract 245 relevant variables, referred to as features, for use in a machine learning model. The machine learning model was developed using logistic regression with recursive feature elimination to predict clinically significant improvements in pain-related pain interference, assessed by the PROMIS Pain Interference 8a v1.0 questionnaire. The model was tuned and the important features were selected using the 10-fold cross-validation method. Leave-one-out cross-validation was used to test the model’s performance. Results: The model predicted patient improvement in pain interference with 79% accuracy and an area under the receiver operating characteristic curve of 0.82. It showed balanced class accuracies between improved and nonimproved patients, with a sensitivity of 0.76 and a specificity of 0.82. Feature importance analysis indicated that all MMP app data, not just clinical questionnaire responses, were key to classifying patient improvement. Conclusions: This study demonstrates that data from a digital health app can be integrated with clinical questionnaire responses in a machine learning model to effectively predict which chronic pain patients will show clinically significant improvement. The findings emphasize the potential of machine learning methods in real-world clinical settings to improve personalized treatment plans and patient outcomes. %R 10.2196/67178 %U https://medinform.jmir.org/2025/1/e67178 %U https://doi.org/10.2196/67178 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63704 %T Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study %A Rookes,Tasmin Alanna %A Batla,Amit %A Armstrong,Megan %A Ambler,Gareth %A Walters,Kate %A Schrag,Anette %K Parkinson disease %K feasibility %K remote monitoring %K Parkinson %K acceptability %K reliability %K wearable devices %K wearable %K self-management %K quantitative assessments %K quantitative %K qualitative %K monitoring %K patient %D 2025 %7 25.3.2025 %9 %J JMIR Form Res %G English %X Background: Parkinson disease is a progressive neurodegenerative disorder with complex motor and nonmotor symptoms. To assess these, clinical assessments are completed, providing a snapshot of a person’s experience. Monitoring Parkinson disease using wearable devices can provide continuous and objective data and capture information on movement patterns in daily life. Objective: The aim of the study is to assess patient acceptability and technical reliability of 2 wearable devices used in clinical trials (ActivInsights and Axivity AX3). Methods: Participants in a feasibility study testing a self-management toolkit (PD-Care) optionally wore a wearable device for 1 week, providing feedback through an open- and closed-question survey conducted over the telephone about the acceptability of wearing the device. The closed questions used a Likert scale from 1 to 5 (with 1=strongly agree and 5=strongly disagree) asking whether (1) the device was comfortable to wear, (2) the device was easy to put on, (3) the device was easy to wear, (4) the device was embarrassing to wear, and (5) if they were happy to wear the device for longer than 7 days. Differences in acceptability between devices were analyzed using Mann-Whitney U tests and Wilcoxon matched pairs signed rank tests. These were followed by open-ended questions asking (1) How did you find wearing the device? (2) How did you find putting the device on? (3) Did you take it off and why? (4) What was your overall impression? (5) Did you prefer the wrist- or trunk-worn device and why (Axivity AX3 only)? Results: A total of 22 of 32 (69%) participants offered the device agreed to wear it. There were no significant differences in the demographic characteristics between those monitored and those who chose not to be. Acceptance with both devices was generally good. The ActivInsights device was more acceptable than the wrist- and trunk-worn Axivity AX3 devices, as more participants found it to be comfortable (n=15, 100% vs n=5, 71%; P=.02 and n=4, 57%; P=.004, respectively), easy to wear (n=15, 100% vs n=6, 86%; P=.048 and n=3, 43%; P=.004, respectively) and would wear for more than 7 days (n=13, 87% vs n=4, 57%; P=.02 and n=1, 14%; P<.001, respectively). The trunk-worn Axivity AX3 device had the lowest acceptance rates, but there were no statistical differences in acceptability between the wrist- and trunk-worn Axivity AX3 devices (all P>.05). There were issues with battery life and recording errors in 3 of 14 (21%) Axivity AX3 devices and upload failures in 3 of 15 (20%) ActivInsights devices. Conclusions: Acceptability of wearables for monitoring Parkinson was satisfactory, especially when wrist-worn, although a few participants experienced difficulties in correct use, and there were some errors with the data upload. Trial Registration: ISRCTN Registry ISRCTN92831552; https://www.isrctn.com/ISRCTN92831552 %R 10.2196/63704 %U https://formative.jmir.org/2025/1/e63704 %U https://doi.org/10.2196/63704 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57537 %T Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial %A Tandon,Puneeta %A Ismond,Kathleen P %A Purdy,Graeme %A Cruz,Christofer %A Etruw,Evelyn %A Suderman,Kirsten %A Hyde,Ashley %A Stickland,Michael %A Spence,John C %A Lien,Dale C %A Bhanji,Rahima %A Prado,Carla M %A Miguel-Cruz,Antonio %A Joy,Anil A %A Yaskina,Maryna %A McNeely,Margaret L %+ Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 8540 112 Street, Edmonton, AB, T6G2X8, Canada, 1 7804929844, ptandon@ualberta.ca %K eHealth %K patient-centered care %K adults %K geriatrics %K self-management %K web-based %K nutrition %K exercise rehabilitation %K wearable %K activity tracker %K quality of life %K physical health %K 2-minute step test %K patients with cancer %K chronic diseases %K COVID-19 %K randomized controlled trial %K acceptability %K effectiveness %K intervention %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation. Objective: This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion. Methods: A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist–led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle. Results: Of 216 participants, 202 (93.5%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4%; cancer: 126/202, 62.4%). Adherence exceeded a priori targets, with 82% (105/128) attending >75% of the program elements including postintervention tests. Participants rated the program as “quite a bit” or “very” useful, with similar ratings between Heal-Me Light (56/64, 88%) and Heal-Me Intensive (51/58, 88%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred. Conclusions: The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants. Trial Registration: Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106791 %M 40126542 %R 10.2196/57537 %U https://www.jmir.org/2025/1/e57537 %U https://doi.org/10.2196/57537 %U http://www.ncbi.nlm.nih.gov/pubmed/40126542 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56227 %T Behavioral Therapy–Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis %A Zhu,Beiyao %A Zhu,Dian %A Xue,Xiao'ao %A Yang,Hongyi %A Zhang,Shurong %+ Department of Sports Medicine, Huashan Hospital, Fudan University, No 12 Urumqi Middle Road, Jing'an District, Shanghai, 200040, China, 86 18901626266, zhangshurong@huashan.org.cn %K osteoarthritis %K digital intervention %K behavioral therapy %K treatment %K systematic review %K meta-analysis %K pain %K impairment %K quality of life %K socioeconomic burden %K psychotherapy-based digital intervention %K patient %K pain reduction %D 2025 %7 19.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving. Objective: The aim of this study was to analyze the efficacy of behavioral therapy–based digital interventions for patients with OA. Methods: This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy–based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases. Results: Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] –0.20, 95% CI –0.35 to –0.05). Six studies reported improvement in physical function (SMD –0.20, 95% CI –0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD –0.25, 95% CI –0.49 to 0.00) and physical function (SMD –0.26, 95% CI –0.54 to –0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD –0.14, 95% CI –0.27 to –0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD –0.28, 95% CI –0.54 to –0.01). Conclusions: Moderate- and low-quality evidence supported that behavioral therapy–based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes. Trial Registration: PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy %M 40106814 %R 10.2196/56227 %U https://www.jmir.org/2025/1/e56227 %U https://doi.org/10.2196/56227 %U http://www.ncbi.nlm.nih.gov/pubmed/40106814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53142 %T Digital Health Education for Chronic Lung Disease: Scoping Review %A Sun,Chao %A Dai,Huohuo %A M.J.J. van der Kleij,Rianne %A Li,Rong %A Wu,Hengchang %A Hallensleben,Cynthia %A Willems,Sofie H %A Chavannes,Niels H %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, The Netherlands, 31 0623826614, c.sun@lumc.nl %K digital health education %K digital health interventions %K chronic lung disease %K eHealth %K scoping review %D 2025 %7 18.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Chronic lung disease (CLD) is one of the most prevalent noncommunicable diseases globally, significantly burdening patients and increasing health care expenditures. Digital health education (DHE) is increasingly important in chronic disease prevention and management. However, DHE characteristics and impacts in CLD are rarely reported. Objective: This study aimed to provide an overview of the existing literature on DHE for CLD, with a focus on exploring the DHE mediums, content, mechanisms, and reported outcomes in patients with CLD. Methods: We searched PubMed, Web of Science, Embase, PsycINFO, and The Cochrane Library with the assistance of a librarian specialist. Articles were screened by the reviewer team with ASReview (Utrecht University) and EndNote X9 (Clarivate Analytics) based on predefined inclusion and exclusion criteria and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Quality assessment was conducted with the Critical Appraisal Skills Program tool. A descriptive analysis was used to summarize the study characteristics, DHE characteristics, and outcomes. Results: A total of 22 studies were included in this review with medium or high quality. They were published between 2000 and 2022, showing an increasing publication trend with the year, mostly in developed countries (16/22, 73%). Websites and mobile apps (10/22, 45%) were the most widely used DHE medium. Education on self-management skills of CLD was the primary topic (21/22, 95%), 4/22 (18%) of which mentioned DHE mechanisms. The majority of studies reported positive changes in CLD awareness (14/16, 88%), clinical outcomes (3/6, 50%), DHE feasibility, acceptability, and satisfaction (6/8, 75%), lifestyle outcomes (3/3, 100%), and psychosocial outcomes (7/8, 88%). Only 2 studies reported cost-effectiveness (2/22, 9%). Conclusions: Despite the heterogeneity of the study situation, some aspects can be concluded. DHE can improve disease awareness and clinical outcomes in patients with chronic lung disease, with good feasibility, acceptability, and satisfaction through different mediums and learning content. There is still relatively little research among people in low- and middle-income countries. Future research should consider the impact on cost-effectiveness, duration, frequency, and theoretical mechanisms of the DHE to maximize the potential impact. It should also be conducted in the context of health services research to better reflect the real world. %M 40101748 %R 10.2196/53142 %U https://www.jmir.org/2025/1/e53142 %U https://doi.org/10.2196/53142 %U http://www.ncbi.nlm.nih.gov/pubmed/40101748 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63153 %T Reliability of Average Daily Steps Measured Through a Consumer Smartwatch in Parkinson Disease Phenotypes, Stages, and Severities: Cross-Sectional Study %A Bianchini,Edoardo %A Rinaldi,Domiziana %A De Carolis,Lanfranco %A Galli,Silvia %A Alborghetti,Marika %A Hansen,Clint %A Suppa,Antonio %A Salvetti,Marco %A Pontieri,Francesco Ernesto %A Vuillerme,Nicolas %K gait %K Parkinson disease %K phenotype %K wearable sensors %K smartwatch %K step count %K reliability %K activity monitor %K digital health technology %K digital outcome measures %K wearable %K mHealth %K motor %K quality of life %K fall %K posture %K mobile health %D 2025 %7 18.3.2025 %9 %J JMIR Form Res %G English %X Background: Average daily steps (avDS) could be a valuable indicator of real-world ambulation in people with Parkinson disease (PD), and previous studies have reported the validity and reliability of this measure. Nonetheless, no study has considered disease phenotype, stage, and severity when assessing the reliability of consumer wrist-worn devices to estimate daily step count in unsupervised, free-living conditions in PD. Objective: This study aims to assess and compare the reliability of a consumer wrist-worn smartwatch (Garmin Vivosmart 4) in counting avDS in people with PD in unsupervised, free-living conditions among disease phenotypes, stages, and severity groups. Methods: A total of 104 people with PD were monitored through Garmin Vivosmart 4 for 5 consecutive days. Total daily steps were recorded and avDS were calculated. Participants were dichotomized into tremor dominant (TD; n=39) or postural instability and gait disorder (PIGD; n=65), presence (n=57) or absence (n=47) of tremor, and mild (n=65) or moderate (n=39) disease severity. Based on the modified Hoehn and Yahr scale (mHY), participants were further dichotomized into earlier (mHY 1‐2; n=68) or intermediate (mHY 2.5‐3; n=36) disease stages. Intraclass correlation coefficient (ICC; 3,k), standard error of measurement (SEM), and minimal detectable change (MDC) were used to evaluate the reliability of avDS for each subgroup. The threshold for acceptability was set at an ICC ≥0.8 with a lower bound of 95% CI ≥0.75. The 2-tailed Student t tests for independent groups and analysis of 83.4% CI overlap were used to compare ICC between each group pair. Results: Reliability of avDS measured through Garmin Vivosmart 4 for 5 consecutive days in unsupervised, free-living conditions was acceptable in the overall population with an ICC of 0.89 (95% CI 0.85‐0.92), SEM below 10%, and an MDC of 1580 steps per day (27% of criterion). In all investigated subgroups, the reliability of avDS was also acceptable (ICC range 0.84‐0.94). However, ICCs were significantly lower in participants with tremor (P=.03), with mild severity (P=.04), and earlier stage (P=.003). Moreover, SEM was below 10% in participants with PIGD phenotype, without tremor, moderate disease severity, and intermediate disease stage, with an MDC ranging from 1148 to 1687 steps per day (18%‐25% of criterion). Conversely, in participants with TD phenotype, tremor, mild disease severity, and earlier disease stage, SEM was >10% of the criterion and MDC values ranged from 1401 to 2263 steps per day (30%‐33% of the criterion). Conclusions: In mild-to-moderate PD, avDS measured through a consumer smartwatch in unsupervised, free-living conditions for 5 consecutive days are reliable irrespective of disease phenotype, stage, and severity. However, in individuals with TD phenotype, tremor, mild disease severity, and earlier disease stages, reliability could be lower. These findings could facilitate a broader and informed implementation of avDS as an index of ambulatory activity in PD. %R 10.2196/63153 %U https://formative.jmir.org/2025/1/e63153 %U https://doi.org/10.2196/63153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69100 %T Patients’ Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Systematic Review and Thematic Synthesis %A Main,Ashleigh %A McCartney,Haruno %A Ibrar,Maryam %A Muirhead,Fiona %A Mavroeidi,Alexandra %A Rai,Harleen Kaur %A Maguire,Roma %+ Department of Computer and Information Sciences, University of Strathclyde, Livingston Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 552 4400, ashleigh.main@strath.ac.uk %K chronic pain %K digital health %K digital tool %K digital health intervention %K mobile health %K mHealth %K eHealth %K self-management %K pain management %K person-centered %K patient experiences %K systematic review %K thematic synthesis %D 2025 %7 18.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Research regarding the effectiveness of digital health interventions (DHIs) for people living with chronic pain is widely documented, although it is often measured against changes in clinical outcomes. To gain a comprehensive understanding of the full impact of DHIs, it is vital to understand the experience of individuals who are using them. An exploration of qualitative data regarding the experience of people living with chronic pain engaging with DHIs could provide a more in-depth account of how individuals interact and engage with such tools, uncovering the overall impact DHIs can have on the lives of people living with chronic pain. Objective: This qualitative systematic review and thematic synthesis aimed to appraise and synthesize relevant qualitative evidence on patients’ experiences of engaging with DHIs for the self-management of chronic pain symptoms. Methods: A systematic literature search of qualitative and mixed methods studies published between 2013 and 2023 was conducted across 6 databases: MEDLINE, PubMed, Embase, CINAHL, PsycINFO, and Scopus. Eligible studies included adult patients aged ≥18 years with a chronic pain diagnosis (ie, >12 weeks) reporting on the experience of engaging in a DHI for the self-management of chronic pain. The Critical Appraisal Skills Program checklist for qualitative research was used to appraise each study. Following a 3-step inductive thematic synthesis approach, the researcher performed line-by-line coding of each eligible article to identify descriptive themes. Through iterative evaluation of the descriptive themes, analytical themes that facilitated a deeper understanding of the data were derived. Results: In total, 37 qualitative and mixed methods studies were included in the review. Thematic synthesis revealed three overarching themes encompassing five subthemes: (1) personal growth, with 2 subthemes (gaining new insights and renewed mindset); (2) active involvement, with 3 subthemes (motivation, improved access, and health care decision-making); and (3) connectedness and support. Conclusions: A positive experience with DHIs among people living with chronic pain is achieved through an improved understanding of their condition, greater self-awareness of how symptoms impact their lives, and an increase in motivation to play an active role in their health care. DHIs promote the confidence and independence of people living with chronic pain, as well as facilitate a sense of ongoing support between routine appointments. However, DHIs may disempower people living with chronic pain by placing too much focus on their pain and should be used as an adjunct to existing care as opposed to replacing in-person appointments. To appropriately meet the needs of people living with chronic pain, the content and features of DHIs should be personalized. Development of future DHIs should use a co-design approach involving key stakeholders to ensure the needs of people living with chronic pain are met. Trial Registration: PROSPERO CRD42023445100; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023445100 International Registered Report Identifier (IRRID): RR2-10.2196/52469 %M 40101209 %R 10.2196/69100 %U https://www.jmir.org/2025/1/e69100 %U https://doi.org/10.2196/69100 %U http://www.ncbi.nlm.nih.gov/pubmed/40101209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58266 %T App- and Wearable-Based Remote Monitoring for Patients With Myasthenia Gravis and Its Specialists: Feasibility and Usability Study %A Stein,Maike %A Stegherr,Regina %A Narayanaswami,Pushpa %A Legg,David %A Herdick,Meret %A Meisel,Andreas %A Gerischer,Lea %A Lehnerer,Sophie %K myasthenia gravis %K myasthenia %K remote monitoring %K PROMs %K digital platform %K wearables %K telemedicine %K spirometry %K app %K usability %K feasibility %K autoimmune disorder %K web-based portal %K activity tracker %K communication %K wearable data %K digital tool %K mobile phone %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Myasthenia gravis (MG) is rare, chronic autoimmune disorder of the neuromuscular junction that requires specialized care and often lifelong treatment, facing challenges due to its rarity and the limited availability of specialists. Telemedical solutions in specialized centers hold considerable promise in bridging this gap by increasing access to this care to a broader patient population in a timely manner. However, there is no research regarding interventional remote care solutions in the field of MG to date. Objective: This study aimed to assess the feasibility and usability among patients with MG and specialists of a telemedicine platform, tailored to patients with MG and designed to facilitate remote monitoring, treated in a specialized center. Methods: The telemedicine platform consisted of an app for patients and a web-based portal for physicians. Over a period of 3 months, 30 patients continuously monitored their vital parameters through external devices, including a digital spirometer and a wearable (activity tracker). Furthermore, patients completed 7 different patient-reported outcome measures (PROMs) through the app at predefined intervals. Specialists could review this monitoring data and adjust therapy as necessary. In addition, communication between patients and physicians was facilitated through a chat module. Feasibility was evaluated by total adherence rates for completing PROMs within the app, alongside the collection of spirometry and wearable data. Furthermore, user satisfaction was assessed among both patients with MG and physicians at the end of study. Results: Total adherence rates ranged from 74.3% (1830/2464) to 97.9% (327/334) across all data types, with the highest adherence observed for PROMs (1139/1179, 96.6%), followed by spirometry (293/334, 87.7%) and wearables (1830/2261, 80.9%). Notably, patients wore the wearable longer than required by protocol and conducted a higher number of spirometry measurements during the study than required per protocol (median 20 h/d [IQR 15-24] vs 14 h/d and median 49 [IQR 15-59] measurements vs 11 measurements, respectively). Technical issues and discomfort with wearables were factors affecting lower adherence in some patients. The System Usability Scale yielded a median score of 85 indicating “excellent usability.” In addition, results from a more detailed user evaluation questionnaire showed high levels of user satisfaction among both patients and health care professionals across diverse categories, including their experience of the care program, communication, and evaluation of the program. Conclusions: Remote monitoring of patients with MG through the telemedical platform demonstrated good feasibility and acceptability, as evidenced by above-average adherence rates and user satisfaction for both patients and physicians. The majority of patients wanted to continue using the app. These findings highlight the potential for user-friendly digital tools to enhance care for patients with MG, although addressing technical challenges and ensuring patient comfort with wearables are essential for optimal implementation. Further research involving larger cohorts and longer study duration is warranted to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029907; https://drks.de/search/en/trial/DRKS00029907 %R 10.2196/58266 %U https://formative.jmir.org/2025/1/e58266 %U https://doi.org/10.2196/58266 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58262 %T A Digital Program for Daily Life Management With Endometriosis: Pilot Cohort Study on Symptoms and Quality of Life Among Participants %A Breton,Zélia %A Stern,Emilie %A Pinault,Mathilde %A Lhuillery,Delphine %A Petit,Erick %A Panel,Pierre %A Alexaline,Maïa %+ Lyv Healthcare, 6 rue Edouard Nignon, Nantes, 44300, France, 33 650208680, maia@lyv.app %K digital program %K endometriosis %K integrative therapies %K quality of life %K nonpharmacological intervention %K daily life %K adenomyosis %K lesions %K women %K digital %K France %K case control %K digital health %K pilot study %K control group %K global symptom %K burden %K depression %K neuropathic pain %K chronic %K multidisciplinary %K web based %K mobile health %K mHealth %K intervention %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: After experiencing symptoms for an average of 7 years before diagnosis, patients with endometriosis are usually left with more questions than answers about managing their symptoms in the absence of a cure. To help women with endometriosis after their diagnosis, we developed a digital program combining user research, evidence-based medicine, and clinical expertise. Structured around cognitive behavioral therapy and the quality of life metrics from the Endometriosis Health Profile score, the program was designed to guide participants for 3 months. Objective: This cohort study was designed to measure the impact of a digital health program on the symptoms and quality of life levels of women with endometriosis. Methods: In total, 63% (92/146) of the participants were included in the pilot study, recruited either free of charge through employer health insurance or via individual direct access. A control group of 404 women with endometriosis who did not follow the program, recruited through social media and mailing campaigns, was sampled (n=149, 36.9%) according to initial pain levels to ensure a similar pain profile to participants. Questionnaires assessing quality of life and symptom levels were emailed to both groups at baseline and 3 months. Descriptive statistics and statistical tests were used to analyze intragroup and intergroup differences, with Cohen d measuring effect sizes for significant results. Results: Over 3 months, participants showed substantial improvements in global symptom burden, general pain level, anxiety, depression, dysmenorrhea, dysuria, chronic fatigue, neuropathic pain, and endo belly. These improvements were significantly different from the control group for global symptom burden (participants: mean –0.7, SD 1.6; controls: mean –0.3, SD 1.3; P=.048; small effect size), anxiety (participants: mean –1.1, SD 2.8; controls: mean 0.2, SD 2.5; P<.001; medium effect size), depression (participants: mean –0.9, SD 2.5; controls: mean 0.0, SD 3.1; P=.04; small effect size), neuropathic pain (participants: mean –1.0, SD 2.7; controls: mean –0.1, SD 2.6; P=.004; small effect size), and endo belly (participants: mean –0.9, SD 2.5; controls: mean –0.3, SD 2.4; P=.03; small effect size). Participants’ quality of life improved between baseline and 3 months and significantly differed from that of the control group for the core part of the Endometriosis Health Profile-5 (participants: mean –5.9, SD 21.0; controls: mean 1.0, SD 14.8; P=.03; small effect size) and the EQ-5D (participants: mean 0.1, SD 0.1; controls: mean –0.0, SD 0.1; P=.001; medium effect size). Perceived knowledge of endometriosis was significantly greater at 3 months among participants compared to the control group (P<.001). Conclusions: This study’s results suggest that a digital health program providing medical and scientific information about endometriosis and multidisciplinary self-management tools may be useful to reduce global symptom burden, anxiety, depression, neuropathic pain, and endo belly while improving knowledge on endometriosis and quality of life among participants. %M 39791286 %R 10.2196/58262 %U https://formative.jmir.org/2025/1/e58262 %U https://doi.org/10.2196/58262 %U http://www.ncbi.nlm.nih.gov/pubmed/39791286 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58582 %T The Utilization of Electronic Consultations (eConsults) to Address Emerging Questions Related to Long COVID-19 in Ontario, Canada: Mixed Methods Analysis %A Singh,Jatinderpreet %A Quon,Michael %A Goulet,Danica %A Keely,Erin %A Liddy,Clare %K COVID-19 %K long COVID %K eConsult %K consultation %K Canada %K mixed methods analysis %K diagnosis %K primary care %K electronic consultation %K COVID specialist %K specialist %K patient %K assessment %K COVID-19 vaccination %K vaccination %K symptom %K medical education %K web-based consultation %K teleconsultation %K web-based consultations %D 2025 %7 28.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Long COVID is an often debilitating condition affecting millions of people. Its diverse clinical presentations make effective diagnosis and management at the primary care level difficult, while specialist services for long COVID face extensive wait times. An electronic consultation (eConsult) program in Ontario developed a long COVID specialist group to allow primary care providers (PCPs) prompt access to specialist advice for patients with long COVID. Objective: This study aims to assess patterns of service use, response times, impact, and clinical content of eConsult cases submitted to an eConsult long COVID specialist group in Ontario. Methods: This study is a mixed methods analysis of eConsults submitted by PCPs to the long COVID specialist group of 2 eConsult services (Champlain eConsult BASE and Ontario eConsult) between June 1, 2021, and July 31, 2022. Data sources included the use data collected automatically by the services, responses to a mandatory closeout survey, and the content of PCP questions and specialist responses (Champlain eConsult BASE service only). Clinical questions or responses were analyzed using 2 validated taxonomies. Descriptive statistics were used for survey responses and use data. Results: A total of 40 PCPs submitted 47 eConsults through Champlain eConsult BASE and 197 PCPs submitted 228 cases through Ontario eConsult. The median specialist response time was 0.6 (IQR 0.19-2.36; mean 1.7, SD 2.29) days. The 5 most common symptoms of long COVID were fatigue (14/47, 30%), dyspnea (7/47, 15%), cough (6/47, 13%), altered sense of smell (ie, anosmia and parosmia; 6/47, 13%), and cognitive changes (6/47, 13%). The five main question categories asked by PCPs were: (1) management of chronic symptoms of COVID-19, (2) need for additional work-up or follow-up testing, (3) community resources to support or manage patients with long COVID, (4) diagnostic clarification, and (5) guidance regarding COVID-19 vaccination. Conclusions: The long COVID groups provided rapid access to a multispecialty service that facilitated the avoidance of unnecessary face-to-face referrals. An assessment of eConsults highlighted 5 common question types, providing insight into potential gaps in knowledge among PCPs that could help guide medical education and policy. %R 10.2196/58582 %U https://humanfactors.jmir.org/2025/1/e58582 %U https://doi.org/10.2196/58582 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e60683 %T Predictive Value of Frailty on Outcomes of Patients With Cirrhosis: Systematic Review and Meta-Analysis %A Tang,Wen-Zhen %A Zhu,Sheng-Rui %A Mo,Shu-Tian %A Xie,Yuan-Xi %A Tan,Zheng-Ke-Ke %A Teng,Yan-Juan %A Jia,Kui %K frailty %K cirrhosis %K diagnostic efficiency %K survival %K meta-analysis %K prognostic factor %K systematic review %D 2025 %7 27.2.2025 %9 %J JMIR Med Inform %G English %X Background: Frailty is one of the most common symptoms in patients with cirrhosis. Many researchers have identified it as a prognostic factor for patients with cirrhosis. However, no quantitative meta-analysis has evaluated the prognostic value of frailty in patients with cirrhosis. Objective: This systematic review and meta-analysis aimed to assess the prognostic significance of frailty in patients with cirrhosis. Methods: The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. We conducted a comprehensive search of the literature using databases such as PubMed, Cochrane Library, Embase, and Web of Science, as well as China National Knowledge Infrastructure, encompassing the period from inception to 22 December 2023. Data were extracted for frailty to predict adverse outcomes in patients with cirrhosis. RevMan (version 5.3) and R (version 4.2.2) were used to assess the extracted data. Results: A total of 26 studies with 9597 patients with cirrhosis were included. Compared with patients having low or no frailty, the frail group had a higher mortality rate (relative ratio, RR=2.07, 95% CI 1.82‐2.34, P<.001), higher readmission rate (RR=1.50, 95% CI 1.22‐1.84, P<.001), and lower quality of life (RR=5.78, 95% CI 2.25‐14.82, P<.001). The summary receiver operator characteristic (SROC) curve of frailty for mortality in patients with cirrhosis showed that the false positive rate (FPR) was 0.25 (95% CI 0.17-0.34), diagnostic odds ratio (DOR) was 4.17 (95% CI 2.93-5.93), sensitivity was 0.54 (95% CI 0.39-0.69), and specificity was 0.73 (95% CI 0.64-0.81). The SROC curve of readmission showed that the FPR, DOR, sensitivity, and specificity were 0.39 (95% CI 0.17-0.66), 1.38 (95% CI 0.64-2.93), 0.46 (95% CI 0.28-0.64), and 0.60 (95% CI 0.28-0.85), respectively. Conclusions: This meta-analysis demonstrated that frailty is a reliable prognostic predictor of outcomes in patients with cirrhosis. To enhance the prognosis of patients with cirrhosis, more studies on frailty screening are required. Trial Registration: PROSPERO CRD42024497698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=497698 %R 10.2196/60683 %U https://medinform.jmir.org/2025/1/e60683 %U https://doi.org/10.2196/60683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58543 %T Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review %A Chen,Yu-Ting %A Lehman,Michelle %A Van Denend,Toni %A Kish,Jacqueline %A Wu,Yue %A Preissner,Katharine %A Plow,Matthew %A Packer,Tanya L %+ School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 2nd Floor, 5850 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada, 1 902 494 7097, tanya.packer@dal.ca %K videoconference %K chronic disease management %K active participation %K intervention program %K self-management %K scoping review %K Taxonomy of Every Day Self-Management Strategies %K TEDSS %K Behavior Change Technique Taxonomy version 1 %K BCTTv1 %K behavior change %K mobile phone %D 2025 %7 26.2.2025 %9 Review %J J Med Internet Res %G English %X Background: A dramatic increase in the use of videoconferencing occurred as a response to the COVID-19 pandemic, including delivery of chronic disease management programs. With this increase, clients’ openness to and confidence in receiving any type of telehealth care has dramatically improved. However, the rapidity of the response was accomplished with little time to learn from existing knowledge and research. Objective: The purpose of this scoping review was to identify features, barriers, and facilitators of synchronous videoconference interventions that actively engage clients in the management of chronic conditions. Methods: Using scoping review methodology, MEDLINE, CINAHL, and 6 other databases were searched from 2003 onward. The included studies reported on structured, one-on-one, synchronous videoconferencing interventions that actively engaged adults in the management of their chronic conditions at home. Studies reporting assessment or routine care were excluded. Extracted text data were analyzed using thematic analysis and published taxonomies. Results: The 33 included articles reported on 25 distinct programs. Most programs targeted people with neurological conditions (10/25, 40%) or cancer (7/25, 28%). Analysis using the Taxonomy of Every Day Self-Management Strategies and the Behavior Change Technique Taxonomy version 1 identified common program content and behavior change strategies. However, distinct differences were evident based on whether program objectives were to improve physical activity or function (7/25, 28%) or mental health (7/25, 28%). Incorporating healthy behaviors was addressed in all programs designed to improve physical activity or function, whereas only 14% (1/7) of the programs targeting mental health covered content about healthy lifestyles. Managing emotional distress and social interaction were commonly discussed in programs with objectives of improving mental health (6/25, 24% and 4/25, 16%, respectively) but not in programs aiming at physical function (2/25, 8% and 0%, respectively). In total, 13 types of behavior change strategies were identified in the 25 programs. The top 3 types of strategies applied in programs intent on improving physical activity or function were feedback and monitoring, goals and planning, and social support, in contrast to shaping knowledge, regulation, and identity in programs with the goal of improving mental health. The findings suggest that chronic condition interventions continue to neglect evidence that exercise and strong relationships improve both physical and mental health. Videoconference interventions were seen as feasible and acceptable to clients. Challenges were mostly technology related: clients’ comfort, technology literacy, access to hardware and the internet, and technical breakdowns and issues. Only 15% (5/33) of the studies explicitly described compliance with health information or privacy protection regulations. Conclusions: Videoconferencing is a feasible and acceptable delivery format to engage clients in managing their conditions at home. Future program development could reduce siloed approaches by adding less used content and behavior change strategies. Addressing client privacy and technology issues should be priorities. %M 40009439 %R 10.2196/58543 %U https://www.jmir.org/2025/1/e58543 %U https://doi.org/10.2196/58543 %U http://www.ncbi.nlm.nih.gov/pubmed/40009439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64838 %T Harnessing Social Media Data to Understand Information Needs About Kidney Diseases and Emotional Experiences With Disease Management: Topic and Sentiment Analysis %A Hwang,Hee Jeong %A Kim,Nara %A You,Jeong Yun %A Ryu,Hye Ri %A Kim,Seo-Young %A Yoon Park,Jung Han %A Lee,Ki Won %+ Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 8th Fl., 1, Gwanak-ro, Seoul, 08826, Republic of Korea, 82 01099867464, kiwon@snu.ac.kr %K kidney diseases %K online health communities %K topic modeling %K sentiment analysis %K disease management %K patient support %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Kidney diseases encompass a variety of conditions, including chronic kidney disease, acute kidney injury, glomerulonephritis, and polycystic kidney disease. These diseases significantly impact patients’ quality of life and health care costs, often necessitating substantial lifestyle changes, especially regarding dietary management. However, patients frequently receive ambiguous or conflicting dietary advice from health care providers, leading them to seek information and support from online health communities. Objective: This study aimed to analyze social media data to better understand the experiences, challenges, and concerns of patients with kidney disease and their caregivers in South Korea. Specifically, it explored how online communities assist in disease management and examined the sentiment surrounding dietary management. Methods: Data were collected from KidneyCafe, a prominent South Korean online community for patients with kidney disease hosted on the Naver platform. A total of 124,211 posts from 10 disease-specific boards were analyzed using latent Dirichlet allocation for topic modeling and Bidirectional Encoder Representations From Transformers–based sentiment analysis. In addition, Efficiently Learning an Encoder That Classifies Token Replacements Accurately–based classification was used to further analyze posts related to disease management. Results: The analysis identified 6 main topics within the community: family health and support, medication and side effects, examination and diagnosis, disease management, surgery for dialysis, and costs and insurance. Sentiment analysis revealed that posts related to the medication and side effects and surgery for dialysis topics predominantly expressed negative sentiments. Both significant negative sentiments concerning worries about kidney transplantation among family members and positive sentiments regarding physical improvements after transplantation were expressed in posts about family health and support. For disease management, 7 key subtopics were identified, with inquiries about dietary management being the leading subtopic. Conclusions: The findings highlight the critical role of online communities in providing support and information for patients with kidney disease and their caregivers. The insights gained from this study can inform health care providers, policy makers, and support organizations to better address the needs of patients with kidney disease, particularly in areas related to dietary management and emotional support. %M 39998877 %R 10.2196/64838 %U https://www.jmir.org/2025/1/e64838 %U https://doi.org/10.2196/64838 %U http://www.ncbi.nlm.nih.gov/pubmed/39998877 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63763 %T Evaluating the Knowledge and Information-Seeking Behaviors of People Living With Multiple Sclerosis: Cross-Sectional Questionnaire Study %A Duguay,Véronique %A Comeau,Dominique %A Turgeon,Tiffany %A Bouhamdani,Nadia %A Belanger,Mathieu %A Weston,Lyle %A Johnson,Tammy %A Manzer,Nicole %A Giberson,Melissa %A Chamard-Witkowski,Ludivine %+ , Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, 50 De la Francophonie Street, Moncton, NB, E1A 7R1, Canada, 1 5062261627, veronique.duguay2@usherbrooke.ca %K multiple sclerosis %K chronic illness %K misinformation %K web-based searches %K education %K health information %K social media %K health literacy %K patient-doctor relationship %K health-related information %K information-seeking behavior %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has emerged as a primary source of health-related information for people living with multiple sclerosis (MS). However, given the abundance of misinformation found on the web, this behavior may pose a significant threat to internet users. Objective: This study aims to explore the knowledge and information-seeking behavior of people living with MS followed at a specialized MS clinic where education is a cornerstone of care. Methods: This cross-sectional survey–based study comprised 20 true or false statements, covering both scientific facts and popular misinformation about MS treatments. A “scientific fact score” and a “misinformation score” were calculated by attributing a scoring system to each point in the survey: +1 point was attributed to correct answers, –1 point was attributed to incorrect answers, and 0 point was attributed to “I don’t know.” Furthermore, the survey inquired about participants’ health-seeking behaviors. Results: The mean age of the 69 participants was 48.4 (SD 10.9) years, 78% (54/69) were female, 81% (56/69) were highly educated, 90% (62/69) were receiving a disease-modifying therapy, and 52% (30/58) had experimented with alternative therapies. The mean score for answering the scientific and misinformation questions correctly was 69% (SD 2.4%) and 22% (SD 4.5%), respectively (P<.001). Notably, when questioned about misinformation, answering correctly dropped significantly (P<.001), while indecision (P<.001) and answering incorrectly (P=.02) increased. Sociodemographic factors and medical questions were not significantly associated with scientific and misinformation scores (all P>.05); however, misinformation scores did significantly correlate with levels of education (P=.04). The main sources of health-related information were from expert-led MS websites (48/58, 82%) and health care professionals (34/58, 59%). Low-reliability sources were less used; however, word of mouth seemed to be prevalent (14/58, 24%), followed by Facebook (10/58, 17%). On average, people with MS reported having consulted 3 high- to moderate-quality sources and only 1 low-quality source. Conclusions: Education at the clinic and consulting primarily moderate- to high-quality sources did not safeguard against misinformation, indicating a need for more misinformation-geared education at the clinic. Notably, there is a need to proactively educate patients about misinformation commonly found on the web, and more importantly, create space for them to discuss the information without prejudice. As novel educational methods may be relatively more time-consuming, implementing change may be challenging. Furthermore, age, sex, education level, and health literacy might not safeguard against misinformation. Herein, we were unable to identify correlations associated with scores obtained on the questionnaire other than educational level. Although the educational level did seem to impact the misinformation score, this did not stop participants from experimenting with alternative therapies. Although studies are exploring novel ways to effectively deal with health misinformation on the web, more research is needed to fully understand this highly complex social phenomenon. %M 39998866 %R 10.2196/63763 %U https://www.jmir.org/2025/1/e63763 %U https://doi.org/10.2196/63763 %U http://www.ncbi.nlm.nih.gov/pubmed/39998866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59922 %T Virtual Reality Interventions and Chronic Pain: Scoping Review %A Ding,Michael E %A Traiba,Hajar %A Perez,Hector R %+ Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, United States, 1 7189205756, heperez@montefiore.org %K virtual reality %K chronic pain %K scoping review %K pain management %K efficacy %K anxiety disorders %K mood %K health condition %K health intervention %K adults %K aging %K therapeutic %K descriptive–analytical method %K monitoring %K US %K PRISMA %D 2025 %7 18.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Virtual reality (VR) interventions have demonstrated efficacy for more than a decade for mood and anxiety disorders and emerging evidence suggests they can reduce pain symptoms in both acute and chronic pain. More recently, these interventions have abounded within the commercial and academic sectors, immersing participants within a virtual environment to confer health benefits to users. VR immersion can facilitate the delivery of health interventions by isolating participants from distractors and stressors in a therapeutic environment. While recent studies of VR interventions have exploded, they are not uniform in approach or device type, limiting generalizability. Recent scoping reviews on VR and chronic pain have focused on specific diseases or limited inquiries to specific interventions or study types. Objective: We conducted a scoping review to generate new knowledge about the sum total of VR studies on chronic pain with specific emphasis on the methods and results of each study, including (1) the type of interventions, (2) outcomes chosen, (3) samples studied, and (4) data generated. Methods: A scoping review was performed on the literature on VR and chronic pain to describe themes associated with the literature to date and identify important gaps and unanswered questions to guide future research. CINAHL [EBSCO] (Cumulative Index to Nursing and Allied Health Literature) and PubMed were queried for the terms “virtual reality” and “pain,” providing studies of chronic pain adult participants using VR delivered through headset displays. We included English-language manuscripts that had at least one VR intervention arm with adults with chronic pain. For this analysis, we only included VR interventions that were immersive (ie, using headsets). Non–study reports, studies with no specific chronic pain component, those not involving adults, and those using VR as part of a comprehensive rehabilitation program were excluded. A descriptive analytical method was used to extract data, compare studies, and contextualize the presented outcomes. Articles were categorized into several themes including the type of intervention, outcomes chosen, participant characteristics, degree to which immersion was achieved, and adverse effect monitoring and reporting. Results: A total of 36 articles were included in our analysis. We summarize the literature using 5 themes: (1) heterogeneity of chronic pain types, (2) highly variable intervention types, (3) highly variable secondary and exploratory outcomes, (4) immersion was highly variable between studies and not systemically explored in many articles, and (5) side effect monitoring was limited. Conclusions: The literature on VR in chronic pain is highly variable and lacks theoretical rigor. While there is emerging evidence that supports VR use in a wide variety of health conditions including chronic pain, future research should focus on producing theoretically rigorous work that focuses on mechanisms and that systematically assesses side effects to generate robust generalizable knowledge. %M 39965778 %R 10.2196/59922 %U https://www.jmir.org/2025/1/e59922 %U https://doi.org/10.2196/59922 %U http://www.ncbi.nlm.nih.gov/pubmed/39965778 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e70282 %T Use of Clinical Public Databases in Hidradenitis Suppurativa Research %A Liu,Xu %A Guo,Linghong %A Jiang,Xian %+ Department of Dermatology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, China, 86 028 85423315, jiangxian@scu.edu.cn %K hidradenitis suppurativa %K clinical public databases %K disease progression %K patient data %K HS %D 2025 %7 18.2.2025 %9 Viewpoint %J Interact J Med Res %G English %X In this viewpoint, we argue that recent studies using clinical public databases have revolutionized our understanding of hidradenitis suppurativa (HS), a chronic inflammatory skin condition with significant impacts on patients’ quality of life. Our key messages are as follows: (1) these databases enable large-scale studies integrating genetic, epidemiological, and clinical data, providing crucial insights into HS’s genetic predispositions, comorbidities, and treatment outcomes; (2) findings highlight a strong genetic component, with mutations in the γ-secretase complex playing a key role in HS pathogenesis and shaping targeted therapies; (3) studies also reveal elevated risks for comorbidities like obesity, diabetes, cardiovascular disease, and systemic inflammation in patients with HS, with diet-driven inflammatory pathways potentially exacerbating disease severity; (4) while these databases offer unprecedented research opportunities, limitations such as data representativeness and quality must be considered; (5) nonetheless, their benefits outweigh potential drawbacks, allowing the identification of rare comorbidities, disease progression patterns, and personalized treatment strategies; and (6) increased funding for HS research is crucial to harness these databases’ full potential, develop targeted therapies, and ultimately improve patient outcomes. As HS’s impact is disproportionate to current research investments, we believe advocating for more resources and addressing database limitations will be key to advancing HS understanding and care. %M 39965202 %R 10.2196/70282 %U https://www.i-jmr.org/2025/1/e70282 %U https://doi.org/10.2196/70282 %U http://www.ncbi.nlm.nih.gov/pubmed/39965202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60246 %T Disease Awareness in Patients With Type 2 Diabetes: Analysis of Baseline Data From the SMART-Finder Observational Study %A Mueller,Christian %A Neusser,Thomas %A Thate-Waschke,Inga %A Nowicki,Julia %A Plominski,Tomasz %A Griesinger,Regine %A Kessner,Stefanie %A Martin,Stephan %K app-based documentation %K chronic kidney disease %K CKD %K disease awareness %K MyTherapy %K type 2 diabetes %K type 2 diabetes mellitus %K urine albumin-to-creatinine ratio screening %K patient %K observational study %K Germany %K quality of life %K treatment %K therapy %K physician-patient communication %D 2025 %7 18.2.2025 %9 %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a common comorbidity of type 2 diabetes mellitus (T2DM). Data on the determination of CKD-related biomarkers among patients with T2DM in a real-life setting within Germany are limited. Objective: We aimed to determine the prevalence of CKD and risk factors, availability of urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) values, treatment satisfaction, and quality of life among patients with T2DM in Germany. Methods: SMART-Finder is a retrospective and prospective, observational, digital, patient-centered cohort study being performed as part of the routine use of an adherence-supporting app. This baseline analysis’ observation period was from August to November 2023. Patients with T2DM in Germany who actively used the MyTherapy app; allowed push notifications; and documented use of diabetes medications, renin-angiotensin system inhibitors, finerenone, and/or blood glucose test strips were eligible for inclusion. Study materials (background information, electronic consent form, and laboratory and electronic questionnaires) were provided to eligible patients via app push notifications. Participants completed an electronic case report form that included questions on their blood pressure; their most recent UACR, eGFR, and glycated hemoglobin (HbA1c) values in the past 12 months; the EQ-5D-5L; and the Diabetes Treatment Satisfaction Questionnaire. The primary outcome was the proportion of patients with a UACR of ≥30 mg/g. Results: Of 9527 invited eligible patients, 101 completed the electronic case report form (male: n=61; female: n=40; age: mean 54.2, SD 11.4 y). Of these, 1 female patient and 5 male patients reported their UACR values; 3 (all male) had a UACR of ≥30 mg/g. The remaining 95 patients reported that their health care professionals had not provided UACR measurements. Only 9 (8.9%) patients were aware of their latest eGFR values (3 patients: 15‐44 mL/min/1.73 m2; 6 patients: 45‐89 mL/min/1.73 m2), 90 provided HbA1c values (80 patients: ≥6.0%), 46 had a systolic blood pressure of ≥130 mm Hg, and 83 reported former or current nephrotoxic medication intake. The mean EQ-5D-5L index score was 0.7 (SD 0.3; range –0.1 to 1.0; 50 patients). The mean Diabetes Treatment Satisfaction Questionnaire score was 28.8 (SD 6.8; range 9.0-36.0; 49 patients). Conclusions: Patients with T2DM who were using an adherence-supporting app in Germany lacked awareness of CKD-related biomarkers but had high knowledge of self-manageable biomarkers (eg, blood pressure, serum fasting glucose, and HbA1c values). Our results suggest that treating physicians either do not test for UACRs and eGFRs or do not inform patients about the results. Nonadherence to diagnostic testing guidelines and a lack of physician-patient communication put patients at risk. Another reason for this health literacy imbalance may be the focus on HbA1c instead of kidney comorbidity in patient education material. Future goals for diabetes management must include guideline-compliant testing of CKD-related biomarkers and open physician-patient communication. International Registered Report Identifier (IRRID): RR2-10.2196/44996 %R 10.2196/60246 %U https://formative.jmir.org/2025/1/e60246 %U https://doi.org/10.2196/60246 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e65358 %T Evaluation of a Game-Based Mechatronic Device for Rehabilitation of Hand-Arm Function in Children With Cerebral Palsy: Feasibility Randomized Controlled Trial %A Peramalaiah,Mrudula Kanakapura %A Parmar,Sanjay Tejraj %A Sepehri,Nariman %A Muthukumarana,Saman %A Kanitkar,Anuprita %A Hin,Cherry Kit-Fong %A Szturm,Tony Joseph %+ , SDM College of Physiotherapy, Shri Dharmasthala Manjunatheshwara University, Manjushree Nagar, Sattur, Dharwad, 580 009, India, 91 9845340450, sanjaytparmar777@gmail.com %K cerebral palsy %K computer game–assisted rehabilitation %K manual dexterity %K repetitive task practice %K robotic manipulandum %D 2025 %7 18.2.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Children with neurodevelopmental disorders, such as cerebral palsy (CP), often experience motor impairments in manual dexterity, which hinder daily tasks and social interactions. Traditional rehabilitation methods require repetitive task practice, which can be difficult for children to sustain due to low engagement. Game-based rehabilitation devices and robots offer a promising alternative by combining therapy with digital play, improving motivation and compliance. However, many systems fail to incorporate actual object manipulation, which is essential for motor learning through sensory feedback. To address this limitation, a low-cost, easy-to-use robotic manipulandum device (RMD) was developed. The RMD enables real-time object manipulation during gameplay while providing assistive force, allowing the practice of a wide range of manual dexterity skills beyond gross reaching. This system offers an engaging and effective rehabilitation approach to enhance hand function in children with CP. Objective: This study aimed to provide evidence for the feasibility and therapeutic value of the RMD game–based exercise program for children with CP. Methods: In total, 34 children with CP, aged 4 to 10 years, were randomly assigned to the experimental group (XG) or the control group (CG). The XG received a computer game–based exercise program using the RMD, focusing on object manipulation tasks, while the CG received task-specific training similar to constraint-induced movement therapy. Both groups received their respective therapy programs 3 times per week for 8 weeks. Semistructured interviews with parents and children, along with qualitative analysis, were conducted to evaluate their experiences with the exercise program. The following outcome measures were used: (1) the Peabody Developmental Motor Scale-2 (PDMS-2) grasping and visual-motor integration subtests and (2) the computer game–based upper extremity (CUE) assessment of manual dexterity. Results: No dropouts occurred during the 8-week program. Both groups showed significant improvements in the PDMS-2 subtests (P<.001) and the CUE assessment of manual dexterity, including success rates (tennis ball: P=.001; cone: P<.001; medicine ball: P=.001; and peanut ball: P<.001) and movement errors (tennis ball: P=.01; cone: P<.001; medicine ball: P=.04; and peanut ball: P<.001). The XG outperformed the CG, showing greater improvements in PDMS-2 grasping (P=.002) and visual-motor integration (P=.01). In the CUE assessment, the XG demonstrated higher success rates (medicine ball: P=.001 and peanut ball: P=.02) and fewer movement errors (cone: P<.001). Parents reported an increase in the children’s independence in daily tasks. Conclusions: This study demonstrates the feasibility, acceptability, and positive outcomes of the RMD game–based exercise program for improving hand function in children with CP. The findings support further research and development of computer game–assisted rehabilitation technologies. Trial Registration: Clinical Trials Registry - India CTRI/2021/07/034903; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc4ODU %M 39964707 %R 10.2196/65358 %U https://rehab.jmir.org/2025/1/e65358 %U https://doi.org/10.2196/65358 %U http://www.ncbi.nlm.nih.gov/pubmed/39964707 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e39950 %T Swasthya Pahal (Health for All) Using a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored Informatics Framework in Rural and Urban Areas of Chennai, Tamil Nadu: Protocol for a Quantitative Study %A Joshi,Ashish %A Surapaneni,Krishna Mohan %A Grover,Ashoo %A Kaur,Harpreet %A Saggu,Sofia Rani %A Oliveira,Doilyn %+ School of Public Health, University of Memphis, Robison Hall 3825 DeSoto Avenue, Memphis, TN, 38152-0001, United States, 1 4435706018, ashish1875@gmail.com %K interventions %K Swasthya Pahal %K acceptance %K health behavior %K NCDs risks %K self-management %K healthcare %K noncommunicable disease %D 2025 %7 6.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Noncommunicable diseases (NCDs) require a longer period of care, for which health care systems must acquire technologically advanced solutions to enhance patient care. Swasthya Pahal (health for all) is an innovative, interactive, multilingual, stand-alone, internet-enabled computer-based program that aims to improve the self-management of NCDs. Objective: This study aims to enhance the self-management of chronic NCDs (diabetes, hypertension, high cholesterol, and obesity) by determining the usefulness, acceptance, and effectiveness of the Swasthya Pahal program in hospital and community settings in both rural and urban areas of Chennai, Tamil Nadu. This objective can be met by generating risk factor profiles of individuals enrolled and enhancing their self-management of NCDs using a portable health information kiosk that uses the Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored (SMAART) model. Methods: A quantitative study will be conducted on a convenient sample of 2800 individuals from selected hospital and community settings in rural (n=1400) and urban areas (n=1400) in Chennai, Tamil Nadu. Data will be collected on sociodemographics, health behaviors, and clinical status, as well as knowledge, attitudes, and practices. Objective assessments such as weight, blood pressure, and random blood sugar levels will be measured. In addition, the usefulness, acceptance, and effectiveness of the Swasthya Pahal program will be determined. Results: Results will be summarized using descriptive analysis. Appropriate bivariate and multivariate regression analysis will be performed to determine the predictors of the outcome variables of usefulness, acceptance, and effectiveness of Swasthya Pahal in wider settings. All analyses will be performed using SAS (version 9.1; SAS Institute), and the results will be reported as 95% CI values and P<.05. Conclusions: The study proposes to enhance the self-management of NCDs in both rural and urban community settings through the implementation of the Swasthya Pahal program based on the SMAART informatics framework. The study aims to understand the implementation, acceptability, and usability of Swasthya Pahal among a diverse sample of people in urban and rural settings. International Registered Report Identifier (IRRID): PRR1-10.2196/39950 %M 39913916 %R 10.2196/39950 %U https://www.researchprotocols.org/2025/1/e39950 %U https://doi.org/10.2196/39950 %U http://www.ncbi.nlm.nih.gov/pubmed/39913916 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58612 %T Detecting Freezing of Gait in Parkinson Disease Using Multiple Wearable Sensors Sets During Various Walking Tasks Relative to Medication Conditions (DetectFoG): Protocol for a Prospective Cohort Study %A Cordillet,Sébastien %A Drapier,Sophie %A Leh,Frédérique %A Dumont,Audeline %A Bidet,Florian %A Bonan,Isabelle %A Jamal,Karim %+ Physical and Rehabilitation Medicine Department, Clinical Investigation Center INSERM 1414, University Hospital of Rennes, 2 Rue Henri Le Guilloux, Rennes, 35000, France, 33 0674113482, karim.jamal@univ-rennes.fr %K Parkinson %K detection %K freezing of gait %K sensor %K wearable %K freezing %K walk %K neurodegenerative %K movement %D 2025 %7 6.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Freezing of gait (FoG) is one of the most disabling symptoms of Parkinson disease (PD). Detecting and monitoring episodes of FoG are important in the medical follow-up of patients to assess disease progression and functional impact and to adjust treatment accordingly. Although several questionnaires exist, they lack objectivity. Using wearable sensors such as inertial measurement units (IMUs) to detect FoG episodes offers greater objectivity and accuracy. There is no consensus on the number and location of IMU, type of algorithm, and method of triggering and scoring the FoG episodes. Objective: The objective of this study is to investigate the use of multiple wearable sensors sets to detect FoG in patients with PD during various walking tasks under different medication conditions. Methods: This single-center, prospective cohort study (DetectFoG) will include 18 patients with PD. Patients will be fitted with 7 IMUs and will walk a freezing-provoking path under different tasks—“single task,” “dual motor task,” or “dual cognitive task”—and medical conditions corresponding to levodopa medication (“on” or “off”). Passages will be videotaped, and 2 movement disorder specialists will identify FoG episodes in the videos. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the most effective combination of wearable sensors for detecting FoG episodes will be studied. Results: The study is currently in the data collection phase, having commenced recruitment in February 2024. Once all data have been gathered, the data analysis will commence. As of August 2024, 3 patients have been recruited. It is anticipated that the results will be published by the end of 2025. Conclusions: Detecting FoG episodes in various medical and clinical settings would provide a more comprehensive understanding of this phenomenon. Furthermore, it would enable reliable and objective monitoring of the progression of this symptom based on treatments and the natural course of the disease. This could serve as an objective tool for monitoring patients and assessing the severity and frequency of FoG. Trial Registration: Clinicaltrials.gov NCT05822258; https://www.clinicaltrials.gov/study/NCT05822258 International Registered Report Identifier (IRRID): DERR1-10.2196/58612 %M 39913915 %R 10.2196/58612 %U https://www.researchprotocols.org/2025/1/e58612 %U https://doi.org/10.2196/58612 %U http://www.ncbi.nlm.nih.gov/pubmed/39913915 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65141 %T Effect of Medication Management at Home via Pharmacist-Led Home Televisits: Protocol for a Cluster Randomized Controlled Trial %A Hossain,Sheikh Rubana %A Samant,Akanksha N %A Balsamo,Briana C %A Hawley,Chelsea E %A Zanchelli,Michael C %A Zhu,Carolyn %A Venegas,Maria D %A Robertson,Marina %A McCullough,Megan B %A Beizer,Judith L %A Boockvar,Kenneth S %A Siu,Albert L %A Moo,Lauren R %A Hung,William W %+ James J Peters VA Medical Center, Geriatric Research Education and Clinical Center, 130 W Kingsbridge Road, 4A-17, Bronx, NY, 10468, United States, 1 7185849000 ext 3821, sheikh.Hossain@va.gov %K older adults %K medication management %K televisit %K polypharmacy %K adverse drug reaction %D 2025 %7 5.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults are more likely to have multiple chronic conditions, be prescribed multiple medications, and be more susceptible to adverse drug reactions (ADRs) to their medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimens. Complex medication regimens are potentially harmful to older adults. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as reviews of medication lists and the implementation of “brown bag” reconciliation, continue to be challenging, with limited success. Pharmacist-led interventions to improve appropriate medication use in older adults have demonstrated effectiveness in reducing ADRs. Video visits have the potential to provide direct visualization of medications in older adults’ homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist-led management of older adults’ medication regimens may improve appropriate medication use in older adults. Objective: The objective of this study is to examine the effect of pharmacist-led medication through home televisits compared to usual care on appropriate medication use, medication discrepancies, medication adherence, and ADRs. Methods: We will conduct a 2-site cluster randomized controlled trial (RCT). The intervention will be a pharmacist-led home televisit including medication reconciliation and assessment of actual medication use. The cluster RCT was iteratively adapted after a pilot test. The primary outcome of medication appropriateness of the intervention will be measured using the STOPP (Screening Tool of Older Persons’ Prescriptions) criteria for potentially inappropriate medications (PIMs) at 6 months. Medication lists obtained will be compared against electronic medical records (EMRs) by a clinician to establish discrepancies in medications. The clinician will review medications using the validated Medication Appropriateness Index (MAI). Results: This project has been peer-reviewed and selected for support by the Veterans Affairs (VA) Health Services Research Service. The pilot phase of the study was completed December 2021 with 20 veterans and was primarily informed by the Steinman model of the prescribing process adapted to include system- and provider-level factors. The last date of enrollment was August 6, 2021. We anticipate the completion of the ongoing trial in spring 2025. The first results are expected to be submitted for publication in 2025. Conclusions: The cluster RCT will provide evidence on medication management through televisits. If found effective in improving the use of medications, the intervention has the potential to impact older adults with multiple chronic conditions and polypharmacy. Trial Registration: ClinicalTrials.gov NCT04340570; https://clinicaltrials.gov/study/NCT04340570 International Registered Report Identifier (IRRID): PRR1-10.2196/65141 %M 39908544 %R 10.2196/65141 %U https://www.researchprotocols.org/2025/1/e65141 %U https://doi.org/10.2196/65141 %U http://www.ncbi.nlm.nih.gov/pubmed/39908544 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e57597 %T Determinants of Periodic Health Examination Uptake: Insights From a Jordanian Cross-Sectional Study %A Tayoun,Abdul Aziz %K periodic health examination %K PHE %K preventive health services %K routine health checkups %K Jordan %K cross-sectional study %D 2025 %7 5.2.2025 %9 %J JMIRx Med %G English %X Background: Routine periodic health examinations (PHEs) for adults who are asymptomatic are included in clinical preventive services. They aim to prevent morbidity and mortality by identifying modifiable risk factors and early signs of treatable diseases. PHEs are a standard procedure in primary health care worldwide, including in Jordan. The country is undergoing an epidemiological transition toward noncommunicable diseases, which are the leading causes of morbidity and mortality. The prevalence of smoking is among the highest in the world, with escalating rates of obesity and physical inactivity. Notably, hypertension and diabetes are the most prevalent diseases. Objective: This study aims to determine the extent to which individuals in Jordan participate in PHEs and to evaluate the various factors related to sociodemographics, health, knowledge, and behavior that influence this participation. Methods: This study used a cross-sectional design and includes 362 participants 18 years or older residing in Jordan. A convenience sampling method was used, and data were collected through a hybrid web-based and face-to-face questionnaire. The analysis involved the application of logistic regression through SPSS to investigate the relationship between various influencing factors and the uptake of PHEs. Results: Our study indicated that only 98 of the 362 (27.1%, 95% CI 22.8%-31.9%) participants underwent PHEs within the last 2 years. Noteworthy predictors of PHE uptake among Jordanians included recent visits to a primary health care facility within the previous year (adjusted odds ratio [AOR] 4.32, 95% CI 2.40‐7.76; P<.001), monthly income (P=.02; individuals with a monthly income of 1500‐2000 JD displayed more than five times the odds of undertaking PHEs than those with a monthly income <500 JD; AOR 5.74, 95% CI 1.32‐24.90; P=.02; those with a monthly income of more than 2000 JD exhibited even higher odds; AOR 9.81, 95% CI 1.73‐55.55; P=.02; a currency exchange rate of 1 JD=US $1.43 is applicable), and knowledge levels regarding PHEs and preventive health measures (AOR 1.23, 95% CI 1.03‐1.47; P=.007). These variables emerged as the strongest predictors in our analysis, shedding light on key factors influencing PHE uptake in the population. Contrary to other research, our study did not find any statistically significant association between gender (P=.33), smoking status (P=.76), marital status (P=.52), health status self-evaluation (P=.18), seasonal influenza vaccination (P=.07), combined health behavior factors (P=.34), and BMI (P=.76) and PHE uptake. Conclusions: PHE uptake is notably low in Jordan. Critical determinants of this uptake include recent visits to a primary health care facility within the previous year, monthly income, and knowledge levels regarding PHEs and preventive health services. To enhance PHE uptake, there is a critical need to integrate PHEs with primary health care services, increase awareness about PHEs, and offer free preventive services, particularly for those at high risk. %R 10.2196/57597 %U https://xmed.jmir.org/2025/1/e57597 %U https://doi.org/10.2196/57597 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e58615 %T Assessment of Reliability and Validity of Celiac Disease–Related YouTube Videos: Content Analysis %A Polat,Yunus Halil %A Cankurtaran,Rasim Eren %+ Department of Gastroenterology, Ankara Training and Research Hospital, bağlıca neighbourhood 1336 street no:7/7 Etimesgut, PO:06870, Ankara, 06870, Turkey, 90 5556801815, yunushpolat@gmail.com %K gastroenterology %K celiac %K YouTube %K internet-based information %K medical information %K health-related %K reliability %K validity %K quality %K videos %K celiac sprue %K sprue %K gluten enteropathy %K cross-sectional %D 2025 %7 4.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: YouTube is an increasingly used platform for medical information. However, the reliability and validity of health-related information on celiac disease (CD) on YouTube have not been determined. Objective: This study aimed to analyze the reliability and validity of CD-related YouTube videos. Methods: On November 15, 2023, a search was performed on YouTube using the keyword “celiac disease.” This search resulted in a selection of videos, which were then reviewed by 2 separate evaluators for content, origin, and specific features. The evaluators assessed the reliability and quality of these videos using a modified DISCERN (mDISCERN) score, the Journal of the American Medical Association (JAMA) benchmark criteria score, the usefulness score, video power index (VPI), and the Global Quality Scale (GQS) score. Results: In the analysis of 120 initially screened CD videos, 85 met the criteria for inclusion in the study after certain videos were excluded based on predefined criteria. While the duration of the videos uploaded by health care professionals was significantly longer than the other group (P=.009), it was concluded that the median scores for mDISCERN (4, IQR 4-5 vs 2, IQR 2-3; P<.001), GQS (4, IQR 4-5 vs 3, IQR 2-3; P<.001), JAMA (4, IQR 3-4 vs 2, IQR 2-3; P<.001), and usefulness (8, IQR 7-9 vs 6, IQR 3-6; P<.001) of the videos from this group were significantly higher than those from non–health care professionals. Video interaction parameters, including the median number of views, views per day, likes, dislikes, comments, and VPI, demonstrated no significant difference between the 2 groups. Conclusions: This study showed that YouTube videos about CD vary significantly in reliability and quality depending on their source. Increasing the production of reliable videos by health care professionals may help to improve patient education and make YouTube a more reliable resource. %M 39756057 %R 10.2196/58615 %U https://infodemiology.jmir.org/2025/1/e58615 %U https://doi.org/10.2196/58615 %U http://www.ncbi.nlm.nih.gov/pubmed/39756057 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58026 %T Effect of an Internet-Based Pilates Telerehabilitation Intervention in People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial %A Tacchino,Andrea %A Ponzio,Michela %A Confalonieri,Paolo %A Leocani,Letizia %A Inglese,Matilde %A Centonze,Diego %A Cocco,Eleonora %A Gallo,Paolo %A Paolicelli,Damiano %A Rovaris,Marco %A Sabattini,Loredana %A Tedeschi,Gioacchino %A Prosperini,Luca %A Patti,Francesco %A Sessa,Edoardo %A Pedrazzoli,Elisabetta %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713812, andrea.tacchino@aism.it %K exergame %K MS-FIT %K Pilates %K Kinect %K multiple sclerosis %K exercise %K physical activity %K leisure time physical activity %K Timed Up and Go %D 2025 %7 3.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) has been recommended in multiple sclerosis (MS) to maintain good physical fitness and mental health, reduce the severity of symptoms and risk of relapse, and improve quality of life. Pilates has been suggested as an ideal PA to manage physical, cognitive, and psychological symptoms of MS and a useful method to maintain and improve balance and gait. Objective: This paper presents the protocol for a study that aims to evaluate the efficacy on the physical domain (specifically balance and gait) of a home-based, self-managed PA intervention delivered through the MS-FIT exergame (HELAGLOBE Società a responsabilità limitata). In addition, measures of cognitive performance, quality of life, and well-being will be considered. Methods: This is a 2-arm, multicenter, randomized controlled trial with 3 assessment points (baseline, 12 weeks postintervention, and 6 weeks follow-up). People with MS with mild disability, low risk of falling, preserved cognitive functions, and low anxiety and depression are potential eligible participants. The experimental group (MS-FIT) will self-administer the MS-FIT exergame at home in addition to their leisure-time physical activities. MS-FIT is an internet- and Pilates-based tool that uses the Microsoft Kinect Sensor V2. Participants in the control group will only have access to their leisure-time physical activities. Participants in the MS-FIT group will train at home with MS-FIT for 12 weeks and will be required to perform the exercises for a total of 30 minutes/day for at least 3 days/week. The primary outcome is the Timed Up and Go, a test designed to assess walking. We will also administer additional tests for motor function (visual analog scale 0-10, Timed 25-Foot Walk, Ambulation Index, 2-minute walk test, Twelve Item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test), cognition (Brief International Cognitive Assessment for Multiple Sclerosis), fatigue (Modified Fatigue Impact Scale), quality of life (Multiple Sclerosis Quality of Life-54), well-being (Psychological Well-Being Scales), and PA (International Physical Activity Questionnaire and Minnesota Leisure Time Physical Activity Questionnaire). Acceptance and satisfaction with the intervention received (Client Satisfaction Questionnaire and an adapted version of the Tele-healthcare Satisfaction Questionnaire – Wearable Technology) and subjective impressions of changes in performance (Patients’ Global Impression of Change) will also be assessed. Results: Recruitment for the trial started on March 16, 2022, and the first participant was randomized the same day. Data analysis and results are expected to be published in 2025. Conclusions: Pilates has proven beneficial in several neurological diseases such as MS. With this study, we will provide evidence for the use in clinical practice of a digital tool for self-administered Pilates exercises at home as a complement to rehabilitation and for the continuity of care in MS. Trial Registration: ClinicalTrials.gov NCT04011579; https://tinyurl.com/2p9n4d2t International Registered Report Identifier (IRRID): DERR1-10.2196/58026 %M 39899835 %R 10.2196/58026 %U https://www.researchprotocols.org/2025/1/e58026 %U https://doi.org/10.2196/58026 %U http://www.ncbi.nlm.nih.gov/pubmed/39899835 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e43618 %T The Effects of Digital eHealth Versus Onsite 2-Day Group-Based Education in 255 Patients With Irritable Bowel Syndrome: Cohort Study %A Berentsen,Birgitte %A Thuen,Camilla %A Hillestad,Eline Margrete Randulff %A Steinsvik,Elisabeth Kjelsvik %A Hausken,Trygve %A Hatlebakk,Jan Gunnar %K irritable bowel syndrome %K IBS %K eHealth %K internet-guided %K patient education %K self-management %K self-reported %K patient behavior %K quality of life %K QOL %K anxiety %K depression %K gastrointestinal %K physiotherapist %K kinesiology %K cognitive behavioural therapy %K CBT %K Hospital Anxiety and Depression Scale %K HADS %K client satisfaction questionnaire %K CSQ %K Mann-Whitney U test %K nonparametric %K Wilcoxon test %K neurogastroenterology %D 2025 %7 3.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Irritable bowel syndrome (IBS) has a high worldwide prevalence and there are few effective treatment options. Patient education can influence patient behavior that subsequently may lead to changes in attitudes and skills necessary for maintenance or improvement in management of symptom severity and quality of life. However, as postdiagnostic patient education can be resource demanding, assessment of digital approaches and verification of their effectiveness is warranted. Objective: This cohort study aimed to investigate the effects of a digital web-based multidisciplinary eHealth program on the domains of symptom severity (Irritable Bowel Syndrome Symptom Severity Scale [IBS-SSS]), quality of life (irritable bowel syndrome quality of life [IBS-QOL]), anxiety and depression (Hospital Anxiety and Depression Scale), and a measure of general client satisfaction (client satisfaction questionnaire), compared with an onsite multidisciplinary 2-day group-based education program (“IBS-school”), in 2 cohorts of 255 patients with IBS. Methods: Patients diagnosed with IBS, aged 15-70 years, were enrolled after referral to the Section of Gastroenterology at Haukeland University Hospital, Norway. In total, 132 patients were recruited to the eHealth program and 123 to the IBS-school group for comparison. Data were self-reported and collected digitally at enrollment and after 3 months, between 2017 and 2019. Furthermore, 71 attending the eHealth program and 49 attending the IBS-school completed the questionnaires at 3 months. Intervention response was defined as a reduction of ≥50 points on the IBS-SSS. Results: Patients attending the eHealth program reported a significant reduction in IBS symptom severity 3 months after treatment (n=71), compared with patients attending the IBS-school (n=50). Overall, patients categorized as intervention responders in both programs showed a significant reduction in symptom severity at 3 months. Here, 41% (29/71) of patients attending the eHealth program reported a mean IBS-SSS reduction of 103 (SD 72.0) points (P<.001). In addition, these patients reported reduced anxiety (P>.001) and depression (P=.002) and enhanced quality of life (P=.03), especially the degrees of dysphoria, body image, food avoidance, health worry, interference with activity, relations, and social relations. Patients responding to the IBS-school intervention (18/50, 36%) reported a mean IBS-SSS reduction of 119 (SD 86.2) points (P<.001), and reduced depression scores (P=.046), but no difference in overall quality of life. Both groups reported the respective interventions as “good” quality health care programs, scoring them 23.5 (SD 4)—the eHealth program 23.5 (SD 4), and the IBS-school 24.2 (SD 4)—on the client satisfaction questionnaire. Conclusions: We conclude that the digital multidisciplinary eHealth program has a significant effect on IBS symptom severity in a portion of patients; it is useful as a tool in disease self-management and does not result in worse symptom scores than an onsite multidisciplinary 2-day group-based education program after 3 months. We believe these results indicate that a digital eHealth approach is preferable to an onsite multidisciplinary 2-day group-based education program covering the same topics. %R 10.2196/43618 %U https://humanfactors.jmir.org/2025/1/e43618 %U https://doi.org/10.2196/43618 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54147 %T Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control %A Manski-Nankervis,Jo-Anne %A Hunter,Barbara %A Lumsden,Natalie %A Laughlin,Adrian %A McMorrow,Rita %A Boyle,Douglas %A Chondros,Patty %A Jesudason,Shilpanjali %A Radford,Jan %A Prictor,Megan %A Emery,Jon %A Amores,Paul %A Tran-Duy,An %A Nelson,Craig %+ Primary Care and Family Medicine, Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore, 65 65138572, joanne.mn@ntu.edu.sg %K primary care %K general practice %K clinical decision support %K chronic kidney disease %K cardiovascular disease %K cardiovascular %K clinical decision %K decision support %K support %K kidney %K kidney disease %K electronic medical record %K risk %K risk reduction %K pharmacological %K pharmacological therapy %K medical records %K logistic model %D 2025 %7 3.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). Objective: This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). Methods: General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. Results: Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI –1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. Conclusions: FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19–related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. Trial Registration: ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119 %M 39899838 %R 10.2196/54147 %U https://formative.jmir.org/2025/1/e54147 %U https://doi.org/10.2196/54147 %U http://www.ncbi.nlm.nih.gov/pubmed/39899838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63063 %T Efficacy and Safety of Murivenna Anal Infiltration Compared to Diltiazem Topical Application in Chronic Anal Fissure: Protocol for a Prospective, Randomized, Open-Label Clinical Trial %A Shankar KM,Pratap %A Puthan Purayil,Indu %A Binitha,Palengara %A Rai,Amit Kumar %A Jameela,Sophia %A Ahmad,Azeem %A Bhogavalli,Chandra Sekhara Rao %A Srikanth,Narayanam %A Acharya,Rabinarayan %+ National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, D Block, Janakpuri Institutional Area, New Delhi, 110058, India, 91 9744824014, kmpvarma@gmail.com %K chronic anal fissure %K murivenna anal infiltration %K Ayurveda %K efficacy %K anal infiltration %K murivenna %K diltiazem %K app %K chronic %K study protocol %K randomized clinical trial %K proctologic condition %K proctologic %K pain %K quality of life %K well-being %K surgical intervention %K defecation %K cessation of bleeding %K treatment %D 2025 %7 3.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anal fissure is a common proctologic condition that causes significant pain and anguish to patients, significantly impacting their quality of life and well-being. There are various treatment options for anal fissure, ranging from pharmacological agents that reduce anal sphincter tone to surgical interventions for cases resistant to medical management. Ayurvedic treatments have shown potential for the therapeutic management of anal fissure. Objective: This clinical study aims to analyze the efficacy and safety of murivenna anal infiltration compared to diltiazem topical application in chronic anal fissure. Methods: This is an open-labeled, randomized, controlled parallel group clinical trial with a sample size of 66 participants to be randomized and allocated in a 1:1 ratio to 2 groups. The intervention group will be treated with murivenna anal infiltration, and the control group will be treated with topical application of diltiazem for a period of 4 weeks. The primary outcome will be the proportion of participants demonstrating complete healing after 4 weeks of treatment. The secondary outcomes will be the proportion of participants demonstrating complete healing after 7 days and 14 days of treatment, change in pain at or after defecation, cessation of bleeding, and any recurrence during the study period. Any adverse events will also be recorded during the trial period. Results: The project was funded in July 2023, and the study period is 24 months. Participant recruitment started in December 2023. As of August 2024, we have enrolled 50 participants. The data analysis will be complete by June 2025, and the results are expected to be published by August 2025. Conclusions: High recurrence rates, adverse effects, incomplete healing, and the negative impact on patients’ daily activities and quality of life underscore the need for alternative therapeutic options. Ayurveda offers potential for more sustainable relief with fewer adverse effects. Murivenna oil is a time-tested medicated oil effectively used by Ayurvedic physicians for various ulcers of traumatic and pathological origin. This study will provide scientific evidence on the efficacy and safety of murivenna anal infiltration; further, it can be incorporated into the cost-effective management of chronic anal fissure. Trial Registration: Clinical Trials Registry India CTRI/2023/09/057330; https://tinyurl.com/y4ut9e8p International Registered Report Identifier (IRRID): DERR1-10.2196/63063 %M 39899833 %R 10.2196/63063 %U https://www.researchprotocols.org/2025/1/e63063 %U https://doi.org/10.2196/63063 %U http://www.ncbi.nlm.nih.gov/pubmed/39899833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e50014 %T Barriers and Facilitators in Implementing a Telemonitoring Application for Patients With Chronic Kidney Disease and Health Professionals: Ancillary Implementation Study of the NeLLY (New Health e-Link in the Lyon Region) Stepped-Wedge Randomized Controlled Trial %A Delvallée,Marion %A Guerraoui,Abdallah %A Tchetgnia,Lucas %A Grangier,Jean-Pierre %A Amamra,Nassira %A Camarroque,Anne-Laure %A Haesebaert,Julie %A Caillette-Beaudoin,Agnès %+ Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, Lyon, 69008, France, 33 06 51 42 97 43, julie.haesebaert01@chu-lyon.fr %K telehealth %K telemonitoring %K chronic kidney disease %K implementation %K Consolidated Framework for Implementation Research %K Technology Acceptance Model %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of telemonitoring to manage renal function in patients with chronic kidney disease (CKD) is recommended by health authorities. However, despite these recommendations, the adoption of telemonitoring by both health care professionals and patients faces numerous challenges. Objective: This study aims to identify barriers and facilitators in the implementation of a telemonitoring program for patients with CKD, as perceived by health care professionals and patients, and to explore factors associated with the adoption of the program. This study serves as a process evaluation conducted alongside the cost-effectiveness NeLLY (New Health e-Link in the Lyon Region) trial. Methods: A mixed methods approach combining a quantitative questionnaire and semistructured interviews was conducted among nurses, nephrologists, and patients with stages 3 and 4 CKD across 10 renal care centers in France that have implemented telemonitoring. The Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) were used to design the questionnaires and interview guides. The dimensions investigated included ease of use, perceived usefulness, and intention to use (TAM), as well as characteristics of the intervention, local and general context, individual factors, and processes (CFIR). The adoption of telemonitoring was assessed based on the frequency with which patients connected to the telemonitoring device. Determinants of telemonitoring use were analyzed using nonparametric tests, specifically the Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. Thematic analysis was conducted on the transcriptions of semistructured interviews. Both quantitative and qualitative results, including data from patients and professionals, were integrated to provide a comprehensive understanding of the factors associated with the use of remote monitoring in CKD. Results: A total of 42 professionals and 128 patients with CKD responded to our questionnaire. Among these, 11 professionals and 13 patients participated in interviews. Nurses, who were responsible for patient follow-up, regularly used telemonitoring (8/13, 62%, at least once a month), while nephrologists, who were responsible for prescribing it, were primarily occasional users (5/8, 63%, using it less than once a month). Among professionals, the main obstacles identified were the heavy workload generated by telemonitoring, lack of training, and insufficient support for nurses. Among the 128 patients, 46 (35.9%) reported using the application at least once a week. The main barriers for patients were issues related to computer use, as well as the lack of feedback and communication with health care professionals. The main facilitators identified by both professionals and patients for using telemonitoring were the empowerment of patients in managing their health and the reduction of the burden associated with CKD. Conclusions: Improving adherence to telemonitoring in the context of CKD requires collaborative efforts from both professionals and patients. Our results provide insights that can inform the design of effective, theory-driven interventions aimed at improving telemonitoring adoption and usage. %M 39841992 %R 10.2196/50014 %U https://mhealth.jmir.org/2025/1/e50014 %U https://doi.org/10.2196/50014 %U http://www.ncbi.nlm.nih.gov/pubmed/39841992 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e59611 %T Integration of Conventional and Virtual Reality Approaches in Augmented Reality for Theory-Based Psychoeducational Intervention Design for Chronic Low Back Pain: Scoping Review %A Conen,Robin %A Mueller,Steffen %A Tibubos,Ana Nanette %+ Department of Nursing Science, Diagnostics in Healthcare and eHealth, Trier University, Max-Planck-Straße 6, Trier, 54296, Germany, 49 651 201 1904, conen@uni-trier.de %K augmented reality %K virtual reality %K chronic low back pain %K education %K pain management %K intervention %D 2025 %7 20.1.2025 %9 Review %J Interact J Med Res %G English %X Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one’s own body sensory perception and can combine conventional and VR approaches. Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP. Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories. Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended. Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed. %M 39832362 %R 10.2196/59611 %U https://www.i-jmr.org/2025/1/e59611 %U https://doi.org/10.2196/59611 %U http://www.ncbi.nlm.nih.gov/pubmed/39832362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53503 %T A New Smartphone-Based Cognitive Screening Battery for Multiple Sclerosis (icognition): Validation Study %A Denissen,Stijn %A Van Laethem,Delphine %A Baijot,Johan %A Costers,Lars %A Descamps,Annabel %A Van Remoortel,Ann %A Van Merhaegen-Wieleman,Annick %A D’hooghe,Marie %A D'Haeseleer,Miguel %A Smeets,Dirk %A Sima,Diana M %A Van Schependom,Jeroen %A Nagels,Guy %+ AIMS Lab, Center for Neurosciences, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 2 477 41 02, stijn.denissen@vub.be %K multiple sclerosis %K telemedicine %K cognition %K memory %K information processing speed %K mobile phone %D 2025 %7 20.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive deterioration is common in multiple sclerosis (MS) and requires regular follow-up. Currently, cognitive status is measured in clinical practice using paper-and-pencil tests, which are both time-consuming and costly. Remote monitoring of cognitive status could offer a solution because previous studies on telemedicine tools have proved its feasibility and acceptance among people with MS. However, existing smartphone-based apps include designs that are prone to motor interference and focus primarily on information processing speed, although memory is also commonly affected. Objective: This study aims to validate a smartphone-based cognitive screening battery, icognition, to detect deterioration in both memory and information processing speed. Methods: The icognition screening battery consists of 3 tests: the Symbol Test for information processing speed, the Dot Test for visuospatial short-term memory and learning, and the visual Backward Digit Span (vBDS) for working memory. These tests are based on validated paper-and-pencil tests: the Symbol Digit Modalities Test, the 10/36 Spatial Recall Test, and the auditory Backward Digit Span, respectively. To establish the validity of icognition, 101 people with MS and 82 healthy participants completed all tests. Of the 82 healthy participants, 20 (24%) repeated testing 2 to 3 weeks later. For each icognition test, validity was established by the correlation with its paper-and-pencil equivalent (concurrent validity), the correlation and intraclass correlation coefficient (ICC) between baseline and follow-up testing (test-retest reliability), the difference between people with MS and healthy participants, and the correlation with other clinical parameters such as the Expanded Disability Status Scale. Results: All icognition tests correlated well with their paper-and-pencil equivalents (Symbol Test: r=0.67; P<.001; Dot Test: r=0.31; P=.002; vBDS: r=0.69; P<.001), negatively correlated with the Expanded Disability Status Scale (Symbol Test: ρ=–0.34; P<.001; Dot Test: ρ=−0.32; P=.003; vBDS: ρ=−0.21; P=.04), and showed moderate test-retest reliability (Symbol Test: ICC=0.74; r=0.85; P<.001; Dot Test: ICC=0.71; r=0.74; P<.001; vBDS: ICC=0.72; r=0.83; P<.001). Test performance was comparable between people with MS and healthy participants for all cognitive tests, both in icognition (Symbol Test: U=4431; P=.42; Dot Test: U=3516; P=.32; vBDS: U=3708; P=.27) and the gold standard paper-and-pencil tests (Symbol Digit Modalities Test: U=4060.5, P=.82; 10/36 Spatial Recall Test: U=3934; P=.74; auditory Backward Digit Span: U=3824.5, P=.37). Conclusions: icognition is a valid tool to remotely screen cognitive performance in people with MS. It is planned to be included in a digital health platform that includes volumetric brain analysis and patient-reported outcome measures. Future research should establish the usability and psychometric properties of icognition in a remote setting. %M 39832354 %R 10.2196/53503 %U https://www.jmir.org/2025/1/e53503 %U https://doi.org/10.2196/53503 %U http://www.ncbi.nlm.nih.gov/pubmed/39832354 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 17 %N %P e49941 %T Using Community Engagement to Create a Telecoaching Intervention to Improve Self-Management in Adolescents and Young Adults With Cystic Fibrosis: Qualitative Study %A Duncan,Christina L %A Muther,Emily F %A Lindwall,Jennifer J %A Durkin,Kristine %A Ruvalcaba,Elizabeth %A Williamson,Eliza %A Ahrabi-Nejad,Corrine %A Bord,Evelyn %A Green,Angela %A Harrison,Megan L %A Polineni,Deepika %+ Department of Psychology, Oklahoma State University, 406 Psychology Building, Stillwater, OK, 74078, United States, 1 4057447495, Christina.Duncan12@okstate.edu %K cystic fibrosis %K telecoaching %K self-management %K community engagement %K community partner %K intervention development %D 2025 %7 20.1.2025 %9 Original Paper %J J Particip Med %G English %X Background: Adolescents and young adults (AYA) with cystic fibrosis (CF) are at risk for deviating from their daily treatment regimen due to significant time burden, complicated daily therapies, and life stressors. Developing patient-centric, effective, engaging, and practical behavioral interventions is vital to help sustain therapeutically meaningful self-management. Objective: This study aimed to devise and refine a patient-centered telecoaching intervention to foster self-management in AYA with CF using a combination of intervention development approaches, including an evidence- and theory-based approach (ie, applying existing theories and research evidence for behavior change) and a target population–centered approach (ie, intervention refinement based on the perspectives and actions of those individuals who will use it). Methods: AYA with CF, their caregivers, and health professionals from their CF care teams were recruited to take part in focus groups (or individual qualitative interviews) through a video call interface to (1) obtain perspectives on the overall structure and logistics of the intervention (ie, Step 1) and (2) refine the overall framework of the intervention and obtain feedback on feasibility, content, materials, and coach training (ie, Step 2). Qualitative data were analyzed using a reflexive thematic analysis process. Results were used to create and then modify the intervention structure and content in response to community partner input. Results: For Step 1, a total of 31 AYA and 20 clinicians took part in focus groups or interviews, resulting in 2 broad themes: (1) video call experience and (2) logistics and content of intervention. For Step 2, a total of 22 AYA, 18 clinicians, and 11 caregivers completed focus groups or interviews, yielding 3 major themes: (1) intervention structure, (2) intervention materials, and (3) session-specific feedback. Our Step 1 qualitative findings helped inform the structure (eg, telecoaching session frequency and duration) and approach of the telecoaching intervention. Step 2 qualitative results generally suggested that community partners perceived the feasibility and practicality of the proposed telecoaching intervention in promoting self-management in the face of complex treatment regimens. Extensive specific feedback was used to refine our telecoaching intervention before its efficacy testing in subsequent research. The diverse community partner input was critical in optimizing and tailoring our telecoaching intervention. Conclusions: This study documents the methods and results for engaging key community partners in creating an evidence-based behavioral intervention to promote self-management in AYA with CF. Incorporating the lived experiences and perspectives of community partners is essential when devising tailored and patient-centered interventions. %M 39832355 %R 10.2196/49941 %U https://jopm.jmir.org/2025/1/e49941 %U https://doi.org/10.2196/49941 %U http://www.ncbi.nlm.nih.gov/pubmed/39832355 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e55835 %T The Effect of Combining mHealth and Health Professional–Led Intervention for Improving Health-Related Outcomes in Chronic Diseases: Systematic Review and Meta-Analysis %A Kanai,Masashi %A Miki,Takahiro %A Sakoda,Toshiya %A Hagiwara,Yuta %+ PREVENT Inc, IKKO Shinsakae Building 9F, 1 Aoi, Higashi-ku, Aichi, 461-0004, Japan, 81 527157955, miki.takahiro@prevent.co.jp %K mHealth %K systematic reviews %K meta-analysis %K chronic diseases %K global health %K technology %K health care %K interventions %K chronic conditions %K health care professionals %K World Health Organization %K physical activity %K web-based %D 2025 %7 20.1.2025 %9 Review %J Interact J Med Res %G English %X Background: Chronic diseases such as diabetes and cardiovascular disease are global health challenges, affecting millions of people worldwide. Traditional health care often falls short in chronic disease management. This has led to the exploration of innovative solutions, such as mobile health (mHealth) technologies. mHealth, which leverages mobile and wireless technologies, has the potential to transform health care delivery by providing continuous, accessible, and personalized care. However, the effectiveness of mHealth, particularly when integrated with traditional health care interventions delivered by professionals, warrants comprehensive investigation. Understanding the combined impact of mHealth and professional-led interventions is critical to maximizing the potential of mHealth to improve patient outcomes and adherence. Objective: This study aims to investigate the effectiveness of combining mHealth and health professional–led intervention for improving health-related outcomes in chronic diseases Methods: This systematic review and meta-analysis focused on randomized controlled trials. We searched Web of Science, CENTRAL, MEDLINE, and CINAHL through July 17, 2023. The study targeted patients aged 18 years and older, experiencing at least 1 chronic condition. The interventions were a combination of mHealth and the use of a health care professional. The comparison groups consisted of participants receiving either general care and follow-up or those using mHealth devices without any health care professional involvement. The outcomes measured in this review included hemoglobin A1c (HbA1c), quality of life (QoL), and physical activity. Results: The study included 26 research papers, encompassing 7360 individuals. Meta-analysis was conducted for HbA1c, QoL, and physical activity. For HbA1c, short-term improvement was significant (standardized mean difference [SMD] –0.43; 95% CI –0.64 to –0.21; I2=69%) and medium term (SMD –0.49; 95% CI –0.49 to –0.09; I2=21%). However, in the long term, the improvement was not significant (SMD –0.23; 95% CI –0.49 to 0.03; I2=88%). For QoL, significant improvements were observed in the short term (SMD –0.23; 95% CI –0.42 to –0.05; I2=62%), and in the medium term (SMD –0.16; 95% CI –0.24 to –0.07; I2=0%). In the long term, however, the improvement was not significant (SMD –0.12; 95% CI –0.41 to 0.16; I2=71%). For physical activity, both subjective (questionnaire) and objective (number of steps) outcomes were analyzed. In the short term, subjective outcomes showed significant improvement (SMD 0.31; 95% CI 0.12-0.50; I2=0%), while objective outcomes did not (SMD 0.11; 95% CI –0.05 to 0.27; I2=0%). Medium- and long-term subjective outcomes showed no significant improvement. Meta-analysis for objective outcomes in the medium and long term was not possible due to insufficient studies. Conclusions: This study confirmed short- and medium-term benefits of mHealth combined with professional interventions for HbA1c, QoL, and short-term physical activity, supporting effective chronic disease management. %M 39832160 %R 10.2196/55835 %U https://www.i-jmr.org/2025/1/e55835 %U https://doi.org/10.2196/55835 %U http://www.ncbi.nlm.nih.gov/pubmed/39832160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60150 %T Digital Frequency Customized Relieving Sound for Chronic Subjective Tinnitus Management: Prospective Controlled Study %A Tang,Dongmei %A Peng,Yuzhu %A Gu,Dantong %A Wu,Yongzhen %A Li,Huawei %+ ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China, 86 13023299189, tang.dongm@163.com %K tinnitus %K digital frequency customized relieving sound %K unmodified music %K sound therapy %K prospective study %K mobile phone %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is a major health issue, but currently no tinnitus elimination treatments exist for chronic subjective tinnitus. Acoustic therapy, especially personalized acoustic therapy, plays an increasingly important role in tinnitus treatment. With the application of smartphones, personalized acoustic stimulation combined with smartphone apps will be more conducive to the individualized treatment and management of patients with tinnitus. Objective: The aim of this study was to evaluate the efficacy of a new personalized approach known as the digital frequency customized relieving sound (DFCRS) for tinnitus treatment and to explore the factors that may influence its therapeutic effect. Methods: Patients with subjective tinnitus were enrolled in this study from July 14, 2020, to May 24, 2021, in the tinnitus specialist clinic of Eye and ENT Hospital, Fudan University, Shanghai, China. In this nonrandomized concurrent controlled trial, a total of 107 participants were assigned to listen to personalized DFCRS through our developed app, while the other 77 participants who did not want to download and use the app were assigned to listen to unmodified music (UM). All the recruits were instructed to listen to DFCRS or UM for at least 2 hours a day and complete follow-up assessments at baseline, 1, 2, and 3 months. Multidimensional assessment scales, that is, Tinnitus Handicapped Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Fear of Tinnitus Questionnaire (FTQ), and Tinnitus Catastrophizing Scale (TCS) were used to evaluate the severity of tinnitus and the quality of life. Linear mixed models were used to test for changes in the THI scores across 3 months of acoustic treatment between group (DFCRS or UM treatment) and time. A multiclass logistic model was built with a stepwise function to determine the influence of the different covariates on the effects of acoustic treatment. Results: The results of the multidimensional assessment scales after 3 months of treatment showed that DFCRS-treated patients had significant tinnitus relief compared to those in the UM group. Linear mixed models revealed a significant reduction in the THI scores over time (P<.001), with the DFCRS group showing significantly greater improvement than the UM group (P<.001). At 3 months, 92.5% (99/107) of the patients undergoing DFCRS reported tinnitus relief or disappearance, and longer daily treatment time was associated with better outcomes (P=.007). Multiclass logistic regression confirmed that longer treatment time (odds ratio [OR] 13.07-64.78; P<.001) and more severe tinnitus at baseline (OR 10.46-83.71; P<.001) predicted better treatment response. All secondary outcomes (HADS, AIS, FTQ, TCS) showed significant improvements over time (P<.001). Conclusions: Our study suggests that DFCRS is a new promising and noninvasive therapy for chronic tinnitus, and it can be delivered through a mobile app to bring more convenience to patients with tinnitus. %M 39823588 %R 10.2196/60150 %U https://www.jmir.org/2025/1/e60150 %U https://doi.org/10.2196/60150 %U http://www.ncbi.nlm.nih.gov/pubmed/39823588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57363 %T Enhancing HIV Cognitive Abilities and Self-Management Through Information Technology–Assisted Interventions: Scoping Review %A Huang,Hao %A Xie,MeiLian %A Yang,Zhen %A Wang,AiPing %+ First Hospital of China Medical University, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, China, 86 1399889 0800, apwang@cmu.edu.cn %K digital media %K self-management %K HIV %K AIDS %K scoping review %K technology-assisted interventions %K information technology %K behaviors %K patient %K electronic database %K information systems %K smartphone %K app %K SMS text messaging %K effectiveness %K mobile phone %D 2025 %7 13.1.2025 %9 Review %J J Med Internet Res %G English %X Background: HIV/AIDS remains a significant global challenge, and with the rapid advancement of technology, there has been an increasing number of interventions aimed at improving HIV/AIDS cognition and self-management behaviors among patients. However, there is still a lack of detailed literature integrating relevant evidence. Objective: This study aims to comprehensively review existing research on interventions using modern information methods to improve HIV/AIDS cognition and enhance self-management behaviors among patients. It systematically reports the theoretical frameworks and specific intervention strategies used in current research, providing a comprehensive overview of the development status of relevant studies. We aim to compile existing evidence through this scoping review to identify potential avenues for future research. Methods: We followed the scoping review framework proposed by the Joanna Briggs Institute for the synthesis and reporting of evidence. Relevant literature was searched using electronic databases, including PubMed, Web of Science, Embase, CINAHL, and Cochrane Library. The time frame for inclusion was from 2018 to December 1, 2023. Inclusion criteria were (1) interventions using modern information technology or new digital media, (2) studies focusing on improving HIV awareness or self-management behaviors among people living with HIV, (3) intervention studies or evaluations of intervention effects, and (4) studies published within the last five years. Two reviewers (HH and MX) independently assessed each study at both the title and abstract screening stage and the full-text review stage, resolving any disagreements through discussion. Results: A total of 55 studies that met the inclusion criteria were included. The Information-Motivation-Behavioral Skills model, Social Cognitive Theory, Health Belief Model, Theory of Planned Behavior, and Information Systems Research Framework are among the most commonly used theoretical frameworks. Modern information technology interventions are mainly constructed using smartphone apps, SMS text messaging, internet-based platforms, audiovisual materials, and digital health education platforms, with smartphone apps and SMS text messaging being the most widely used intervention media. Conclusions: Modern information technology is becoming an important tool for health interventions among people living with HIV/AIDS. However, future research should focus on integrating theoretical framework guidance with intervention design, further exploring the diversity of intervention implementations, the applicability of different technological methods, their long-term effects, and how to more effectively combine traditional intervention strategies to maximize intervention outcomes. %M 39805101 %R 10.2196/57363 %U https://www.jmir.org/2025/1/e57363 %U https://doi.org/10.2196/57363 %U http://www.ncbi.nlm.nih.gov/pubmed/39805101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60689 %T The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study %A Bertram,Pia %A Oppelaar,Martinus C %A Bannier,Michiel AGE %A Reijers,Monique HE %A van der Vaart,Hester %A van der Meer,Renske %A Altenburg,Josje %A Conemans,Lennart %A Rottier,Bart L %A Nuijsink,Marianne %A van den Wijngaart,Lara S %A Merkus,Peter JFM %A Roukema,Jolt %+ Department of Pediatric Pulmonology, Amalia Children’s Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6526 GA, Netherlands, 31 243614430, marc.oppelaar@radboudumc.nl %K telemonitoring %K eHealth %K spirometry %K adherence %K pulmonary medicine %K home spirometers %K cystic fibrosis %K autosomal disease %K treatment %K remote monitoring %K survival analyses %K frequency %K digital health %K telehealth %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Home spirometers have been widely implemented in the treatment of people with cystic fibrosis (CF). Frequent spirometry measurements at home could lead to earlier detection of exacerbations. However, previous research indicates that the long-term use of home spirometry is not well maintained by people with CF. Objective: We aimed to gain insight into the long-term uptake of home spirometry in regular multicenter CF care. Methods: Home spirometers combined with a remote monitoring platform were introduced in the treatment of people with CF in 5 Dutch CF centers starting in April 2020. Usage data from April 2020 to December 2022 were analyzed retrospectively. Survival analyses were conducted to assess use consistency over time, and t tests were used to evaluate the impact of increased pulmonary symptoms on home spirometry frequency. The effect of the initiation of a new treatment, Elexacaftor/Tezacaftor/Ivacaftor, on use frequency over time was assessed in a subgroup of participants with repeated measures ANOVA. Results: During the observation period, a total of 604 people with CF were enrolled in the remote monitoring platform and 9930 home spirometry measurements were performed. After the initiation of home spirometry use, the number of users declined rapidly. One year after the initiation, 232 (54.2%) people with CF stopped using home spirometry. During the observation period, 67 (11.1%) users performed more than 20 measurements. Furthermore, the number of consistent home spirometry users decreased over time. After 600 days, only 1% of users had measured their lung function consistently every 31 days. Use frequency slightly increased during periods with increased pulmonary symptoms (ΔMean=0.45, t497.278=–4,197; P<.001) and showed an initial rise followed by a decrease after starting treatment with Elexacaftor/Tezacaftor/Ivacaftor (ΔMean=0.45, t497.278=–4,197; P<.001). Conclusions: Consistent uptake of home spirometry in people with CF is low but increases around periods of changing symptoms. A clear strategy for the organization of remote care seemed to improve the long-term uptake of home spirometry. Nevertheless, home spirometry and its intensity are not a goal on their own but should be used as a tool to reach individual goals within local contexts. %M 39788554 %R 10.2196/60689 %U https://www.jmir.org/2025/1/e60689 %U https://doi.org/10.2196/60689 %U http://www.ncbi.nlm.nih.gov/pubmed/39788554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58384 %T Effectiveness of Virtual Reality Training in Improving Outcomes for Dialysis Patients: Systematic Review and Meta-Analysis %A Kang,Xin %A Zhang,Yiping %A Sun,Chaonan %A Zhang,Jiaxin %A Che,Zhe %A Zang,Jinhui %A Zhang,Rongzhi %+ Department of Center for Hemodialysis, The Second Hospital of Dalian Medical University, 467, Zhongshan Road, Shahekou District, Liaoning Province, Dalian, 116000, China, 86 17709870601, zhangxinzhi169@163.com %K virtual reality %K VR %K training %K dialysis %K hemodialysis %K peritoneal dialysis %K chronic kidney disease %K rehabilitation %K quality of life %K meta-analysis %D 2025 %7 8.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Virtual reality (VR) training uses computer-generated simulations that enable users to engage with immersive virtual environments, simulating real-world activities or therapeutic exercises. This technology is increasingly recognized as a promising intervention to address the physical and psychological challenges faced by dialysis patients, who frequently experience diminished physical function, social isolation, and emotional distress associated with prolonged treatment regimens. Given the increasing prevalence of dialysis patients and the limitations of conventional rehabilitation approaches, VR presents a novel, interactive method that has the potential to enhance patient well-being and improve quality of life. Objective: This meta-analysis aimed to evaluate the effectiveness of VR training interventions for dialysis patients, with a focus on assessing their impact on motor abilities, psychological symptoms (specifically anxiety and depression), social functioning, and self-efficacy. This analysis also explores whether VR can offer comprehensive benefits to support both the physical and mental health of dialysis patients. Methods: The meta-analysis was conducted following Cochrane guidelines. Comprehensive searches were performed across major databases, including China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, China Biomedical Literature database, Cochrane library, Web of Science, PubMed, and Embase, encompassing all studies up to December 2023. Inclusion criteria targeted studies assessing VR’s impact on motor performance, psychological well-being, social functioning, and self-efficacy in dialysis patients. Two reviewers independently extracted data and assessed methodological quality using Cochrane’s risk of bias criteria, ensuring data synthesis reliability. Results: A total of 12 studies, involving 625 dialysis patients in total, met the inclusion criteria. The meta-analysis demonstrated that VR training led to significant improvements across multiple domains. VR interventions were associated with improved physical capacity, evidenced by higher scores in the 6-minute walk test (standardized mean difference [SD]=29.36, 95% CI 14.32-44.4, P<.001, I2=46%). VR training was associated with significant reductions in depression (SD=–6.30, 95% CI –7.14 to –5.47, P<.001, I2=96%) and anxiety (SD=–8.91, 95% CI –9.69 to –8.14, P<.001, I2=95%). In addition, VR interventions enhanced social functioning (SD=16.20, 95% CI 14.49-17.9, P<.001, I2=72%), and improved self-efficacy (SD=20.47, 95% CI 18.55-22.39, P<.001, I2=99%). However, VR training did not yield significant differences in gait speed, balance, or functional tests (Ten Sit-to-Stand Test, Five Sit-to-Stand Test, Sixty Sit-to-Stand Test, Timed Up and Go Test, and fatigue) compared with control groups. Conclusions: The findings suggest that VR training is a promising intervention for dialysis patients, providing benefits in physical endurance, social engagement, and psychological well-being. Despite these advantages, VR remains underused among peritoneal dialysis patients compared with hemodialysis patients. Further studies with larger sample sizes and more refined experimental designs are recommended to validate these results and support VR as a complementary tool in the holistic care of dialysis patients. %M 39773859 %R 10.2196/58384 %U https://www.jmir.org/2025/1/e58384 %U https://doi.org/10.2196/58384 %U http://www.ncbi.nlm.nih.gov/pubmed/39773859 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63494 %T ChatGPT’s Attitude, Knowledge, and Clinical Application in Geriatrics Practice and Education: Exploratory Observational Study %A Cheng,Huai Yong %+ Minneapolis VA Health Care System, 1 Veterans Dr., Minneapolis, MN, 55417, United States, 1 6124672051, wchengwcheng@gmail.com %K ChatGPT %K geriatrics attitude %K ageism %K geriatrics competence %K geriatric syndromes %K polypharmacy %K falls %K aging, older adults %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing use of ChatGPT in clinical practice and medical education necessitates the evaluation of its reliability, particularly in geriatrics. Objective: This study aimed to evaluate ChatGPT’s trustworthiness in geriatrics through 3 distinct approaches: evaluating ChatGPT’s geriatrics attitude, knowledge, and clinical application with 2 vignettes of geriatric syndromes (polypharmacy and falls). Methods: We used the validated University of California, Los Angeles, geriatrics attitude and knowledge instruments to evaluate ChatGPT’s geriatrics attitude and knowledge and compare its performance with that of medical students, residents, and geriatrics fellows from reported results in the literature. We also evaluated ChatGPT’s application to 2 vignettes of geriatric syndromes (polypharmacy and falls). Results: The mean total score on geriatrics attitude of ChatGPT was significantly lower than that of trainees (medical students, internal medicine residents, and geriatric medicine fellows; 2.7 vs 3.7 on a scale from 1-5; 1=strongly disagree; 5=strongly agree). The mean subscore on positive geriatrics attitude of ChatGPT was higher than that of the trainees (medical students, internal medicine residents, and neurologists; 4.1 vs 3.7 on a scale from 1 to 5 where a higher score means a more positive attitude toward older adults). The mean subscore on negative geriatrics attitude of ChatGPT was lower than that of the trainees and neurologists (1.8 vs 2.8 on a scale from 1 to 5 where a lower subscore means a less negative attitude toward aging). On the University of California, Los Angeles geriatrics knowledge test, ChatGPT outperformed all medical students, internal medicine residents, and geriatric medicine fellows from validated studies (14.7 vs 11.3 with a score range of –18 to +18 where +18 means that all questions were answered correctly). Regarding the polypharmacy vignette, ChatGPT not only demonstrated solid knowledge of potentially inappropriate medications but also accurately identified 7 common potentially inappropriate medications and 5 drug-drug and 3 drug-disease interactions. However, ChatGPT missed 5 drug-disease and 1 drug-drug interaction and produced 2 hallucinations. Regarding the fall vignette, ChatGPT answered 3 of 5 pretests correctly and 2 of 5 pretests partially correctly, identified 6 categories of fall risks, followed fall guidelines correctly, listed 6 key physical examinations, and recommended 6 categories of fall prevention methods. Conclusions: This study suggests that ChatGPT can be a valuable supplemental tool in geriatrics, offering reliable information with less age bias, robust geriatrics knowledge, and comprehensive recommendations for managing 2 common geriatric syndromes (polypharmacy and falls) that are consistent with evidence from guidelines, systematic reviews, and other types of studies. ChatGPT’s potential as an educational and clinical resource could significantly benefit trainees, health care providers, and laypeople. Further research using GPT-4o, larger geriatrics question sets, and more geriatric syndromes is needed to expand and confirm these findings before adopting ChatGPT widely for geriatrics education and practice. %M 39752214 %R 10.2196/63494 %U https://formative.jmir.org/2025/1/e63494 %U https://doi.org/10.2196/63494 %U http://www.ncbi.nlm.nih.gov/pubmed/39752214 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59179 %T Complete Lifestyle Medicine Intervention Program–Ontario: Implementation Protocol for a Rural Study %A Patel,Kush %A Allen,Lisa %A Boucher,Karine %A Fedele,Michelle %A Fong,Debbie %A Kumar,Sangeeta %A Lavigne,Deanna %A Marin-Couture,Elisa %A Partyka-Sitnik,Magdalena %A Rietze,Nicole %A Smith-Turchyn,Jenna %A Juneau,Mylene %A Rhéaume,Caroline %+ Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, 2325 Rue de l'Université, Québec, QC, G1V0A6, Canada, 1 418 575 1595, caroline.rheaume@fmed.ulaval.ca %K chronic disease %K nutrition, exercise %K sleep %K relationships %K stress reduction %K self-compassion %K risky substance use %K holistic medicine %K whole health %K implementation %K lifestyle medicine %K rural medicine %K web-based platform %K substance use %K feasibility %K wellness %K barriers %K opportunities %D 2024 %7 31.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use, limited social connections, and high stress contribute to the growing prevalence of chronic diseases. Lifestyle medicine, emphasizing therapeutic lifestyle changes for prevention and treatment, has demonstrated effectiveness but remains underutilized in clinical settings. The Complete Lifestyle Medicine Intervention Program–Ontario (CLIP-ON) was developed to educate the rural population of Northern Ontario in lifestyle medicine to improve health outcomes and engagement. Objective: This study evaluates the implementation and effectiveness of the CLIP-ON program for patients with chronic diseases in the Parry Sound area, focusing on lifestyle behaviors, health outcomes, enrollment, retention rates, and interdisciplinary team engagement. Methods: This observational cohort study guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) includes pre- and postintervention assessments from participants and health care providers. A hybrid type II mixed methods design evaluates the intervention’s effectiveness and implementation process in real-world settings through quantitative and qualitative data collection. CLIP-ON is tailored to the residents of the Parry Sound catchment area in Northern Ontario. Participants (≥18 years old) with chronic conditions such as prediabetes, type II diabetes, systemic hypertension, cardiovascular vascular disease, dyslipidemia, or high BMI (≥25) will be recruited through self-referral or provider referral. Approximately 10 participants per cohort will be enrolled in the CLIP-ON program, consisting of 22 weeks of weekly group sessions and monthly individual consultations with physicians, health coaches, kinesiologists, and registered dieticians either in person or through a web-based platform. CLIP-ON will cover the 6 pillars of lifestyle medicine through 14 group sessions followed by an 8-week supervised exercise program. Anthropometric and cardiometabolic variables will be measured before and after the program. Participants will be surveyed on lifestyle habits, wellness, perceived barriers, and program satisfaction at 3 and 6 months. Focus groups and dropout interviews with participants (n=10 per cohort) and providers (n=6 per cohort) will guide program adaptations. Quantitative and qualitative data collected at baseline and follow-up will assess the program’s implementation and identify barriers and opportunities for improvement. Results: This study was approved by the Laurentian University Research Ethics Board (6021397) on July 6, 2023. The first cohort was enrolled in late 2023 and is still under evaluation. The second cohort began in mid-2024, and data collection is currently underway. A mixed methods analysis will be used at enrollment, program completion (22 weeks), and follow-up (6 months after program completion). Focus groups assessing the program’s effectiveness and implementation will take place after the 22-week intervention. Data will be analyzed in early 2025. Conclusions: This protocol provides insights into the implementation of this lifestyle medicine program and its impact on participants’ health. The findings will guide future advancements and establish a scalable model for other communities. Trial Registration: ClinicalTrials.gov NCT06192251; https://clinicaltrials.gov/study/NCT06192251 International Registered Report Identifier (IRRID): DERR1-10.2196/59179 %M 39740215 %R 10.2196/59179 %U https://www.researchprotocols.org/2024/1/e59179 %U https://doi.org/10.2196/59179 %U http://www.ncbi.nlm.nih.gov/pubmed/39740215 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e60666 %T Examining the Spillover Economic Impacts of Caregiving Among Families of Children With Medical Complexity to Inform Inclusive Economic Models: Qualitative Study %A Keim-Malpass,Jessica %A Muir,K Jane %A Letzkus,Lisa C %A Scheer,Eleanore %A Valdez,Rupa S %+ Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, 1215 Lee Street, Charlottesville, VA, 22908, United States, 1 4349240000, jlk2t@virginia.edu %K caregiving %K children with medical complexity %K social network %K qualitative %K self-management %K care coordination %K economic evaluation %K spillover %K economic model %K care %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J J Particip Med %G English %X Background: Children with medical complexity represent a heterogeneous group of children with multiple chronic health care conditions. Caregivers of children with medical complexity experience a high intensity of caregiving that is often variable, extends across several networks of care, and often lasts for the entirety of the child’s life. The spillover, or indirect, economic impacts of caregiving are understudied in the context the family units of children with medical complexity. There have been recognized limitations to the sole use of quantitative methods when developing economic models of disease, because they lack direct caregiver voice and context of caregiving activities, and existing methods have been noted to be ableist. Objective: This study aimed to explore the economic spillover impacts of caregiving among families of children with medical complexity using their own words and perspectives, with the intent of expanding caregiver-centered perspectives when developing economic models. Methods: This study was a secondary analysis of a qualitative study that was conducted to examine family management practices among caregivers of children with medical complexity and their social networks. Caregivers of children with medical complexity were recruited through a pediatric complex care clinic at an academic medical center in the mid-Atlantic region, United States. This study used inductive qualitative descriptive methods and a template to define features of the person impacted and to define the economic construct as either a direct or indirect (spillover) cost. Results: A total of 20 caregivers were included in this study. Perspectives from the caregivers of children with medical complexity revealed several key themes: (1) time lost from employment, impacting the primary caregivers; (2) physical and mental health impacts, impacting the child themselves, siblings, and the primary caregivers; (3) impacts to leisure activities and self-care, impacting the child themselves, siblings, and the primary caregivers; and (4) impacts to the social network or social capital. Conclusions: The themes described can be operationalized into inclusive family-centered models that represent the impacts of caregiving in the context of the family units of children with medical complexity. The use of qualitative methods to expand our development of quantitative economic models can be adapted to other populations where caregivers are involved in care. Caregivers can and should have an active voice in preference-based assessments that are operationalized in economic contexts to make them more inclusive. International Registered Report Identifier (IRRID): RR2-10.2196/14810 %M 38758728 %R 10.2196/60666 %U https://jopm.jmir.org/2024/1/e60666 %U https://doi.org/10.2196/60666 %U http://www.ncbi.nlm.nih.gov/pubmed/38758728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53576 %T Current Implementation of Digital Health in Chronic Disease Management: Scoping Review %A Pong,Candelyn %A Tseng,Rachel Marjorie Wei Wen %A Tham,Yih Chung %A Lum,Elaine %+ Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore, 65 66017213, elaine_lum@duke-nus.edu.sg %K digital health %K telemedicine %K chronic disease %K noncommunicable disease %K implementation science %K evidence-based practice %K mobile phone %D 2024 %7 12.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated. Objective: This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors. Methods: We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data. Results: A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were “obtain and use patient or consumer feedback” (196/252, 77.8%); “audit and provide feedback” (106/252, 42.1%); and piloting before implementation or “stage implementation scale-up” (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs. Conclusions: This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them. %M 39666972 %R 10.2196/53576 %U https://www.jmir.org/2024/1/e53576 %U https://doi.org/10.2196/53576 %U http://www.ncbi.nlm.nih.gov/pubmed/39666972 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55925 %T Wearable Devices for Supporting Chronic Disease Self-Management: Scoping Review %A Gagnon,Marie-Pierre %A Ouellet,Steven %A Attisso,Eugène %A Supper,Wilfried %A Amil,Samira %A Rhéaume,Caroline %A Paquette,Jean-Sébastien %A Chabot,Christian %A Laferrière,Marie-Claude %A Sasseville,Maxime %+ Faculty of Nursing Sciences, Université Laval, 1050 Av. de la Médecine, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 407576, marie-pierre.gagnon@fsi.ulaval.ca %K chronic diseases %K self-care %K self-management %K empowerment %K mobile health %K mHealth %K wearable %K devices %K scoping %K review %K mobile phone %K PRISMA %D 2024 %7 9.12.2024 %9 Review %J Interact J Med Res %G English %X Background: People with chronic diseases can benefit from wearable devices in managing their health and encouraging healthy lifestyle habits. Wearables such as activity trackers or blood glucose monitoring devices can lead to positive health impacts, including improved physical activity adherence or better management of type 2 diabetes. Few literature reviews have focused on the intersection of various chronic diseases, the wearable devices used, and the outcomes evaluated in intervention studies, particularly in the context of primary health care. Objective: This study aims to identify and describe (1) the chronic diseases represented in intervention studies, (2) the types or combinations of wearables used, and (3) the health or health care outcomes assessed and measured. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, searching the MEDLINE and Web of Science databases for studies published between 2012 and 2022. Pairs of reviewers independently screened titles and abstracts, applied the selection criteria, and performed full-text screening. We included interventions using wearables that automatically collected and transmitted data to adult populations with at least one chronic disease. We excluded studies with participants with only a predisposition to develop a chronic disease, hospitalized patients, patients with acute diseases, patients with active cancer, and cancer survivors. We included randomized controlled trials and cohort, pretest-posttest, observational, mixed methods, and qualitative studies. Results: After the removal of 1987 duplicates, we screened 4540 titles and abstracts. Of the remaining 304 articles after exclusions, we excluded 215 (70.7%) full texts and included 89 (29.3%). Of these 89 texts, 10 (11%) were related to the same interventions as those in the included studies, resulting in 79 studies being included. We structured the results according to chronic disease clusters: (1) diabetes, (2) heart failure, (3) other cardiovascular conditions, (4) hypertension, (5) multimorbidity and other combinations of chronic conditions, (6) chronic obstructive pulmonary disease, (7) chronic pain, (8) musculoskeletal conditions, and (9) asthma. Diabetes was the most frequent health condition (18/79, 23% of the studies), and wearable activity trackers were the most used (42/79, 53% of the studies). In the 79 included studies, 74 clinical, 73 behavioral, 36 patient technology experience, 28 health care system, and 25 holistic or biopsychosocial outcomes were reported. Conclusions: This scoping review provides an overview of the wearable devices used in chronic disease self-management intervention studies, revealing disparities in both the range of chronic diseases studied and the variety of wearable devices used. These findings offer researchers valuable insights to further explore health care outcomes, validate the impact of concomitant device use, and expand their use to other chronic diseases. Trial Registration: Open Science Framework Registries (OSF) s4wfm; https://osf.io/s4wfm %M 39652850 %R 10.2196/55925 %U https://www.i-jmr.org/2024/1/e55925 %U https://doi.org/10.2196/55925 %U http://www.ncbi.nlm.nih.gov/pubmed/39652850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60240 %T Perceptions of Illness Control, Coherence, and Self-Efficacy Following a Web-Based Lifestyle Program for Multiple Sclerosis: A Qualitative Analysis of Semistructured Interviews %A Davenport,Rebekah %A Bevens,William %A Neate,Sandra %A Jelinek,Pia %A Yu,Maggie %A Jelinek,George %A Reece,Jeanette %+ Department of Psychiatry, IN STEP Children’s Mental Health Research Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 858 534 7792, wbevens@health.ucsd.edu %K illness perceptions %K personal control perceptions %K illness coherence %K self-efficacy %K lifestyle modification %K disease management %K multiple sclerosis %K MS %K qualitative %K health behavior %K thematic analysis %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence suggests that illness perceptions held by people living with multiple sclerosis (MS) impact affective distress and physical health outcomes. In a randomized controlled trial, we developed 2 MS Online Courses—the standard care course and the intervention course (IC). The IC was adapted from an evidence-based lifestyle program. Modifying lifestyle risk factors offers an opportunity to impact illness perceptions. Research on illness perceptions in people living with MS has focused predominately on quantitative methods. Objective: This study aimed to explore the experiences and health outcomes of randomized controlled trial participants, including individuals’ perceived changes in attitudes toward MS and their health (ie, illness perceptions). Methods: Qualitative responses provided by 38 participants (22 in the IC and 16 in the standard care course) were derived from semistructured interviews 1 month after completing the MS Online Course. The impact of course engagement and lifestyle modification on illness perceptions was explored using inductive thematic analysis. Results: Themes of changes in illness perceptions were most prominent in the IC arm. Qualitative responses from 22 people living with MS informed the development of three themes: “self-efficacy for disease management,” “personal control,” and “illness coherence.” Conclusions: Findings provide novel insights into the formation and modification of illness perceptions. Lifestyle modification may serve as a valuable adjunct to clinician-administered therapies, improving the sense of personal control over MS, illness coherence, and self-efficacy for disease management. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001605886; https://tinyurl.com/2vyve9p9 International Registered Report Identifier (IRRID): RR2-10.1186/s12883-023-03298-0 %M 39612211 %R 10.2196/60240 %U https://www.jmir.org/2024/1/e60240 %U https://doi.org/10.2196/60240 %U http://www.ncbi.nlm.nih.gov/pubmed/39612211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54641 %T Development and Validation of a Prediction Model Using Sella Magnetic Resonance Imaging–Based Radiomics and Clinical Parameters for the Diagnosis of Growth Hormone Deficiency and Idiopathic Short Stature: Cross-Sectional, Multicenter Study %A Song,Kyungchul %A Ko,Taehoon %A Chae,Hyun Wook %A Oh,Jun Suk %A Kim,Ho-Seong %A Shin,Hyun Joo %A Kim,Jeong-Ho %A Na,Ji-Hoon %A Park,Chae Jung %A Sohn,Beomseok %+ Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 1049045034, Beomseoksohn@gmail.com %K dwarfism %K pituitary %K idiopathic short stature %K child %K adolescent %K machine learning %K magnetic resonance imaging %K MRI %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Growth hormone deficiency (GHD) and idiopathic short stature (ISS) are the major etiologies of short stature in children. For the diagnosis of GHD and ISS, meticulous evaluations are required, including growth hormone provocation tests, which are invasive and burdensome for children. Additionally, sella magnetic resonance imaging (MRI) is necessary for assessing etiologies of GHD, which cannot evaluate hormonal secretion. Recently, radiomics has emerged as a revolutionary technique that uses mathematical algorithms to extract various features for the quantitative analysis of medical images. Objective: This study aimed to develop a machine learning–based model using sella MRI–based radiomics and clinical parameters to diagnose GHD and ISS. Methods: A total of 293 children with short stature who underwent sella MRI and growth hormone provocation tests were included in the training set, and 47 children who met the same inclusion criteria were enrolled in the test set from different hospitals for this study. A total of 186 radiomic features were extracted from the pituitary glands using a semiautomatic segmentation process for both the T2-weighted and contrast-enhanced T1-weighted image. The clinical parameters included auxological data, insulin-like growth factor-I, and bone age. The extreme gradient boosting algorithm was used to train the prediction models. Internal validation was conducted using 5-fold cross-validation on the training set, and external validation was conducted on the test set. Model performance was assessed by plotting the area under the receiver operating characteristic curve. The mean absolute Shapley values were computed to quantify the impact of each parameter. Results: The area under the receiver operating characteristic curves (95% CIs) of the clinical, radiomics, and combined models were 0.684 (0.590-0.778), 0.691 (0.620-0.762), and 0.830 (0.741-0.919), respectively, in the external validation. Among the clinical parameters, the major contributing factors to prediction were BMI SD score (SDS), chronological age–bone age, weight SDS, growth velocity, and insulin-like growth factor-I SDS in the clinical model. In the combined model, radiomic features including maximum probability from a T2-weighted image and run length nonuniformity normalized from a T2-weighted image added incremental value to the prediction (combined model vs clinical model, P=.03; combined model vs radiomics model, P=.02). The code for our model is available in a public repository on GitHub. Conclusions: Our model combining both radiomics and clinical parameters can accurately predict GHD from ISS, which was also proven in the external validation. These findings highlight the potential of machine learning–based models using radiomics and clinical parameters for diagnosing GHD and ISS. %M 39602803 %R 10.2196/54641 %U https://www.jmir.org/2024/1/e54641 %U https://doi.org/10.2196/54641 %U http://www.ncbi.nlm.nih.gov/pubmed/39602803 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58036 %T Benefits of Clinical Decision Support Systems for the Management of Noncommunicable Chronic Diseases: Targeted Literature Review %A Grechuta,Klaudia %A Shokouh,Pedram %A Alhussein,Ahmad %A Müller-Wieland,Dirk %A Meyerhoff,Juliane %A Gilbert,Jeremy %A Purushotham,Sneha %A Rolland,Catherine %+ Boehringer Ingelheim International GmbH, Binger Strasse 173, Ingelheim am Rhein, 55218, Germany, 49 15143151983, klaudia.grechuta@boehringer-ingelheim.com %K clinical decision support system %K digital health %K chronic disease management %K electronic health records %K noncommunicable diseases %K targeted literature review %K mobile phone %D 2024 %7 27.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Clinical decision support systems (CDSSs) are designed to assist in health care delivery by supporting medical practice with clinical knowledge, patient information, and other relevant types of health information. CDSSs are integral parts of health care technologies assisting in disease management, including diagnosis, treatment, and monitoring. While electronic medical records (EMRs) serve as data repositories, CDSSs are used to assist clinicians in providing personalized, context-specific recommendations derived by comparing individual patient data to evidence-based guidelines. Objective: This targeted literature review (TLR) aimed to identify characteristics and features of both stand-alone and EMR-integrated CDSSs that influence their outcomes and benefits based on published scientific literature. Methods: A TLR was conducted using the Embase, MEDLINE, and Cochrane databases to identify data on CDSSs published in a 10-year frame (2012-2022). Studies on computerized, guideline-based CDSSs used by health care practitioners with a focus on chronic disease areas and reporting outcomes for CDSS utilization were eligible for inclusion. Results: A total of 49 publications were included in the TLR. Studies predominantly reported on EMR-integrated CDSSs (ie, connected to an EMR database; n=32, 65%). The implementation of CDSSs varied globally, with substantial utilization in the United States and within the domain of cardio-renal-metabolic diseases. CDSSs were found to positively impact “quality assurance” (n=35, 69%) and provide “clinical benefits” (n=20, 41%), compared to usual care. Among CDSS features, treatment guidance and flagging were consistently reported as the most frequent elements for enhancing health care, followed by risk level estimation, diagnosis, education, and data export. The effectiveness of a CDSS was evaluated most frequently in primary care settings (n=34, 69%) across cardio-renal-metabolic disease areas (n=32, 65%), especially in diabetes (n=13, 26%). Studies reported CDSSs to be commonly used by a mixed group (n=27, 55%) of users including physicians, specialists, nurses or nurse practitioners, and allied health care professionals. Conclusions: Overall, both EMR-integrated and stand-alone CDSSs showed positive results, suggesting their benefits to health care providers and potential for successful adoption. Flagging and treatment recommendation features were commonly used in CDSSs to improve patient care; other features such as risk level estimation, diagnosis, education, and data export were tailored to specific requirements and collectively contributed to the effectiveness of health care delivery. While this TLR demonstrated that both stand-alone and EMR-integrated CDSSs were successful in achieving clinical outcomes, the heterogeneity of included studies reflects the evolving nature of this research area, underscoring the need for further longitudinal studies to elucidate aspects that may impact their adoption in real-world scenarios. %M 39602213 %R 10.2196/58036 %U https://www.i-jmr.org/2024/1/e58036 %U https://doi.org/10.2196/58036 %U http://www.ncbi.nlm.nih.gov/pubmed/39602213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54206 %T Long-Term Efficacy of an AI-Based Health Coaching Mobile App in Slowing the Progression of Nondialysis-Dependent Chronic Kidney Disease: Retrospective Cohort Study %A Ma,Jianwei %A Wang,Jiangyuan %A Ying,Jiapei %A Xie,Shasha %A Su,Qin %A Zhou,Tianmeng %A Han,Fuman %A Xu,Jiayan %A Zhu,Siyi %A Yuan,Chenyi %A Huang,Ziyuan %A Xu,Jingfang %A Chen,Xuyong %A Bian,Xueyan %+ Department of Nephrology, The First Affiliated Hospital of Ningbo University, The 5th floor of Building 6, Number 59 Liuting Street, Haishu District, Ningbo, 315000, China, 86 87085300, fyybianxueyan@nbu.edu.cn %K artificial intelligence %K chronic kidney disease %K eHealth care %K mobile app %K self-management %K kidney function %K telemedicine %K app %K health coaching %K CKD %K mobile phone %D 2024 %7 25.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic kidney disease (CKD) is a significant public health concern. Therefore, practical strategies for slowing CKD progression and improving patient outcomes are imperative. There is limited evidence to substantiate the efficacy of mobile app–based nursing systems for decelerating CKD progression. Objective: This study aimed to evaluate the long-term efficacy of the KidneyOnline intelligent care system in slowing the progression of nondialysis-dependent CKD. Methods: In this retrospective study, the KidneyOnline app was used for patients with CKD in China who were registered between January 2017 and April 2023. Patients were divided into 2 groups: an intervention group using the app’s nurse-led, patient-oriented management system and a conventional care group that did not use the app. Patients’ uploaded health data were processed via deep learning optical character recognition, and the artificial intelligence (AI) system provided personalized health care plans and interventions. Conversely, the conventional care group received suggestions from nephrologists during regular visits without AI. Monitoring extended for an average duration of 2.1 (SD 1.4) years. The study’s objective is to assess the app’s effectiveness in preserving kidney function. The primary outcome was the estimated glomerular filtration rate slope over the follow-up period, and secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and mean arterial pressure. Results: A total of 12,297 eligible patients were enrolled for the analysis. Among them, 808 patients were successfully matched using 1:1 propensity score matching, resulting in 404 (50%) patients in the KidneyOnline care system group and another 404 (50%) patients in the conventional care group. The estimated glomerular filtration rate slope in the KidneyOnline care group was significantly lower than that in the conventional care group (odds ratio –1.3, 95% CI –2.4 to –0.1 mL/min/1.73 m2 per year vs odds ratio –2.8, 95% CI –3.8 to –1.9 mL/min/1.73 m2 per year; P=.009). Subgroup analysis revealed that the effect of the KidneyOnline care group was more significant in male patients, patients older than 45 years, and patients with worse baseline kidney function, higher blood pressure, and heavier proteinuria. After 3 and 6 months, the mean arterial pressure in the KidneyOnline care group decreased to 85.6 (SD 9.2) and 83.6 (SD 10.5) mm Hg, respectively, compared to 94.9 (SD 10.6) and 95.2 (SD 11.6) mm Hg in the conventional care group (P<.001). The ACR in the KidneyOnline care group showed a more significant reduction after 3 and 6 months (736 vs 980 mg/g and 572 vs 840 mg/g; P=.07 and P=.03); however, there was no significant difference in ACR between the two groups at the end of the follow-up period (618 vs 639 mg/g; P=.90). Conclusions: The utilization of KidneyOnline, an AI-based, nurse-led, patient-centered care system, may be beneficial in slowing the progression of nondialysis-dependent CKD. %M 39402012 %R 10.2196/54206 %U https://www.jmir.org/2024/1/e54206 %U https://doi.org/10.2196/54206 %U http://www.ncbi.nlm.nih.gov/pubmed/39402012 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e60942 %T Whole-Body Cryotherapy Reduces Systemic Inflammation in Healthy Adults: Pilot Cohort Study %A Chun,Elizabeth %A Joseph,Richard %A Pojednic,Rachele %+ Stanford Lifestyle Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 6178337372, rpojedni@stanford.edu %K cold therapy %K C-reactive protein %K fasting glucose %K HbA1c %K inflammation %K lipid metabolism %K whole-body cryotherapy %K cryotherapy %K retrospective %K reactive protein %K biomarker %K adult %K systemic inflammation %D 2024 %7 22.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease–related inflammation. In addition, the long-term durability of W-BC effect is unknown. Objective: This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides. Methods: Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at –110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw. Results: The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (–0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (–0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and <5.7%) and was not clinically significant. There was no association between W-BC and LDL cholesterol, HDL cholesterol, or triglycerides (P>.10), although LDL trended lower over the time period examined (P=.07). Conclusions: These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose. %M 39576692 %R 10.2196/60942 %U https://www.i-jmr.org/2024/1/e60942 %U https://doi.org/10.2196/60942 %U http://www.ncbi.nlm.nih.gov/pubmed/39576692 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57771 %T German Version of the Telehealth Usability Questionnaire and Derived Short Questionnaires for Usability and Perceived Usefulness in Health Care Assessment in Telehealth and Digital Therapeutics: Instrument Validation Study %A Zimmermann,Jannik %A Morf,Harriet %A Scharf,Florian %A Knitza,Johannes %A Moeller,Heidi %A Muehlensiepen,Felix %A Nathrath,Michaela %A Orlemann,Till %A Voelker,Thomas %A Deckers,Merlin %+ Palliative Care Team for Children Kassel, Mönchebergstr. 41-43, Kassel, 34125, Germany, 49 56198017558, merlin.deckers@kleine-riesen-nordhessen.de %K mHealth %K mobile health %K telehealth %K usability %K questionnaire validation %K technology acceptance model %K validity %K questionnaire translation %K Net Promoter Scale %K NPS %K usefulness %K autoimmune chronic diseases %K questionnaire %K German %K digital therapeutics %K therapeutics %K feasibility %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the “Telehealth Usability Questionnaire” (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients—“Telehealth Usability and Perceived Usefulness Short Questionnaire for patients” (TUUSQ). Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. Results: The analysis revealed that a parsimonious factor structure with 2 factors (“perceived usefulness in health care” and “usability”) is sufficient to describe the patient’s perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors “perceived usefulness in health care” and “usability” in patients. Trial Registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546 %M 39571151 %R 10.2196/57771 %U https://humanfactors.jmir.org/2024/1/e57771 %U https://doi.org/10.2196/57771 %U http://www.ncbi.nlm.nih.gov/pubmed/39571151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60966 %T Telemonitoring of Active Inflammatory Bowel Disease Using the App TECCU: Short-Term Results of a Multicenter Trial of GETECCU %A Aguas,Mariam %A Del Hoyo,Javier %A Vicente,Raquel %A Barreiro-de Acosta,Manuel %A Melcarne,Luigi %A Hernandez-Camba,Alejandro %A Madero,Lucía %A Arroyo,María Teresa %A Sicilia,Beatriz %A Chaparro,María %A Martin-Arranz,María Dolores %A Pajares,Ramón %A Mesonero,Francisco %A Mañosa,Miriam %A Martinez,Pilar %A Chacón,Silvia %A Tosca,Joan %A Marín,Sandra %A Sanroman,Luciano %A Calvo,Marta %A Monfort,David %A Saiz,Empar %A Zabana,Yamile %A Guerra,Ivan %A Varela,Pilar %A Baydal,Virginia %A Faubel,Raquel %A Corsino,Pilar %A Porto-Silva,Sol %A Brunet,Eduard %A González,Melodi %A Gutiérrez,Ana %A Nos,Pilar %+ Gastroenterology Department, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell, nº 106, Valencia, 46026, Spain, 34 34 96 124 4000, delhoyo_jav@gva.es %K clinical trial %K telemonitoring %K inflammatory bowel disease %K Crohn disease %K ulcerative colitis %K quality of life %K socioeconomical and psychological end points %K health outcomes %K remission time %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemonitoring for inflammatory bowel disease (IBD) has not consistently demonstrated superiority over standard care; however, noninferiority may be an acceptable outcome if remote care proves to be more efficient. Objective: This study aims to compare the remission time and quality of life of patients with active IBD managed through standard care versus the TECCU (Telemonitoring of Crohn Disease and Ulcerative Colitis) app. Methods: A 2-arm, randomized, multicenter trial with a noninferiority design was conducted across 24 hospitals in Spain. The study included adult patients with IBD who were starting immunosuppressive or biological therapy. Participants were randomized into 2 groups: the telemonitoring group (G_TECCU) and the standard care group (G_Control). The follow-up schedule for the telemonitoring group (G_TECCU) was based on contacts via the TECCU app, while the control group (G_Control) adhered to standard clinical practice, which included in-person visits and telephone calls. In both groups, treatment adjustments were made based on the progression of disease activity and medication adherence, assessed using specific indices and biological markers at each check-up. The primary outcome was the duration of remission after 12 weeks, while secondary outcomes included quality of life, medication adherence, adverse events, and patient satisfaction. Results: Of the 169 patients enrolled, 158 were randomized and 150 were analyzed per protocol: telemonitoring (n=71) and control (n=79). After 12 weeks, the time in clinical remission was not inferior in the telemonitoring group (mean 4.20, SD 3.73 weeks) compared with the control group (mean 4.32, SD 3.28 weeks), with a mean difference between arms of –0.12 weeks (95% CI –1.25 to 1.01; noninferiority P=.02). The mean reduction in C-reactive protein values was –15.40 mg/L (SD 90.15 mg/L; P=.19) in the G_TECCU group and –13.16 mg/L (SD 54.61 mg/L; P=.05) in the G_Control group, with no significant differences between the 2 arms (P=.73). Similarly, the mean improvement in fecal calprotectin levels was 832.3 mg/L (SD 1825.0 mg/L; P=.003) in the G_TECCU group and 1073.5 mg/L (SD 3105.7 mg/L; P=.03) in the G_Control group; however, the differences were not statistically significant (P=.96). Quality of life improved in both groups, with a mean increase in the 9-item Inflammatory Bowel Disease Questionnaire score of 13.44 points (SD 19.1 points; P<.001) in the G_TECCU group and 18.23 points (SD 22.9 points; P=.001) in the G_Control group. Additionally, the proportion of patients who adhered to their medication significantly increased from 35% (25/71) to 68% (48/71) in the G_TECCU group (P=.001) and from 46% (36/79) to 73% (58/79) in the G_Control group (P=.001). The satisfaction rate remained stable at around 90%, although noninferiority was not demonstrated for the secondary outcomes. Conclusions: Telemonitoring patients with active IBD is not inferior to standard care for achieving and maintaining short-term remission. The TECCU app may serve as a viable alternative follow-up tool, pending confirmation of improved health outcomes and cost-effectiveness over the long-term. Trial Registration: ClinicalTrials.gov NCT06031038; https://clinicaltrials.gov/ct2/show/NCT06031038 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9639 %M 39189160 %R 10.2196/60966 %U https://www.jmir.org/2024/1/e60966 %U https://doi.org/10.2196/60966 %U http://www.ncbi.nlm.nih.gov/pubmed/39189160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50959 %T Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study %A Zhou,Zhiheng %A Jin,Danian %A He,Jinghua %A Zhou,Shengqing %A Wu,Jiang %A Wang,Shuangxi %A Zhang,Yang %A Feng,Tianyuan %+ Pingshan Hospital of Southern Medical University, No. 16 Renmin Road, Pingshan District, Shenzhen, 518118, China, 86 13828493963, zhihengz@163.com %K information platform %K active health %K chronic disease management %K effectiveness %K community %K digital health %K health literacy %K cardio-cerebrovascular disease %K China %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents’ self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the “i Active Health” applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents’ risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents’ health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients’ BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. %M 39556830 %R 10.2196/50959 %U https://www.jmir.org/2024/1/e50959 %U https://doi.org/10.2196/50959 %U http://www.ncbi.nlm.nih.gov/pubmed/39556830 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e60049 %T Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study %A Chien,Shih-Ying %+ Department of Industrial Design, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C., Taoyuan, 333, Taiwan, 886 3 2118800 ext 5669, shihying@mail.cgu.edu.tw %K digital health %K chronic obstructive pulmonary disease %K COPD %K usability %K telerehabilitation %K mobile health app %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. Objective: This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. Methods: This study used a mixed methods approach involving two key stakeholders—patients with chronic obstructive pulmonary disease and HCPs—across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Results: The research indicated a notable difference in app usability perceptions: 66% (8/12) of HCPs found tasks “very easy,” compared to only 22% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non–native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Conclusions: Most HCPs (11/12, 91%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care. %M 39546767 %R 10.2196/60049 %U https://humanfactors.jmir.org/2024/1/e60049 %U https://doi.org/10.2196/60049 %U http://www.ncbi.nlm.nih.gov/pubmed/39546767 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56649 %T Phenotype-Genotype Correlation in Morquio A Syndrome: Protocol for a Meta-Analysis %A Diaz-Ordoñez,Lorena %A Duque-Cordoba,Paola Andrea %A Nieva-Posso,Daniel Andrés %A Saldarriaga,Wilmar %A Gutierrez-Medina,Juan David %A Pachajoa,Harry %+ Department of Basic Medical Sciences, Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Universidad Icesi, St 18 122-135, Cali, 760031, Colombia, 57 5552334 ext 8542, lldiaz@icesi.edu.co %K Morquio A syndrome %K genotype-phenotype associations %K rare diseases %K scoping review %K Mucopolysaccharidosis type IV %K meta-analysis %K genotype %K GALNS gene %K N-acetylgalactosamine-6-sulfatase %K pathophysiology %K laboratories %K mutations %D 2024 %7 14.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mucopolysaccharidosis type IVA (MPS IVA), also known as Morquio A syndrome, is a rare lysosomal storage disease characterized by autosomal recessive inheritance of mutations in the N-acetylgalactosamine-6-sulfatase (GALNS) gene. This leads to a deficiency of the GALNS enzyme, causing the accumulation of glycosaminoglycans in tissues. Morquio A syndrome primarily affects the skeletal system and joints but can also impact various organs, resulting in symptoms such as hearing and vision loss, respiratory issues, spinal cord compression, heart diseases, and hepatomegaly. The genotype-phenotype relationship is diverse, with studies highlighting variants associated with classic, nonclassic, or intermediate phenotypes. Understanding these genetic factors is crucial for predicting disease prognosis and tailoring effective treatment strategies for individuals with Morquio A syndrome. Objective: The aim of this meta-analysis is to comprehend the relationship between the severity of the phenotype and the genotype of patients with MPS IVA, considering factors such as the type of variant and its location in the different domains of the protein. Methods: This meta-analysis will include articles featuring participants of all genders and age groups who have a molecular diagnosis of MPS IVA and a description of the phenotype. Literature published in English, Spanish, and Portuguese will be considered. Exclusion criteria will encompass studies lacking full-text availability and those involving patients with an MPS IVA diagnosis but without phenotype information. The databases to be searched include PubMed, MEDLINE, ScienceDirect, and Scopus. The screening of literature, paper selection, and data extraction will involve 2 independent reviewers, who will conduct the process blindly. In the event of disagreements between the 2 reviewers at any stage, resolution will be sought through discussion or with the involvement of an additional reviewer. The final selection of manuscripts will be based on consensus. The results of the review will be presented using descriptive statistics, and the information will be organized in either diagrammatic or tabular formats, following the guidelines provided by the Joanna Briggs Institute. Genotype-phenotype relationships will be analyzed using IBM SPSS Statistics, using chi-square tests, Fisher exact tests, and regression analysis to interpret the data. Results: A literature search conducted in January 2024 produced 760 results. The review is expected to be completed by the end of 2024. Conclusions: This meta-analysis will gather and analyze information on the phenotype-genotype relationship in patients diagnosed with MPS IVA. The data collection and resulting analyses will make a substantial contribution to understanding the underlying mechanism of the disease, enabling the prediction of the syndrome’s progression and severity. International Registered Report Identifier (IRRID): DERR1-10.2196/56649 %M 39541578 %R 10.2196/56649 %U https://www.researchprotocols.org/2024/1/e56649 %U https://doi.org/10.2196/56649 %U http://www.ncbi.nlm.nih.gov/pubmed/39541578 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57873 %T An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study %A Merry,Kohle %A MacPherson,Megan M %A Whittaker,Jackie L %A Napier,Christopher %A Holsti,Liisa %A Scott,Alex %+ Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 (604) 822 8225, kohle.merry@hiphealth.ca %K exercise therapy %K physical therapy modalities %K rehabilitation %K tendons %K tendinopathy %K mobile health %K mHealth %K mobile phone %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective: This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods: The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results: By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions: Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies. %M 39536312 %R 10.2196/57873 %U https://humanfactors.jmir.org/2024/1/e57873 %U https://doi.org/10.2196/57873 %U http://www.ncbi.nlm.nih.gov/pubmed/39536312 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55667 %T Clinical Acceptability of a Quality Improvement Program for Reducing Cardiovascular Disease Risk in People With Chronic Kidney Disease in Australian General Practice: Qualitative Study %A McBride,Caroline %A Hunter,Barbara %A Lumsden,Natalie %A Somasundaram,Kaleswari %A McMorrow,Rita %A Boyle,Douglas %A Emery,Jon %A Nelson,Craig %A Manski-Nankervis,Jo-Anne %K clinical decision support %K general practice %K GP %K primary care %K family medicine %K general medicine %K family physician %K implementation science %K chronic kidney disease %K CKD %K nephrology %K nephrologist %K chronic disease %K cardiovascular risk %K cardiology %K quality improvement %K EHR %K electronic health record %K clinical software %D 2024 %7 13.11.2024 %9 %J JMIR Hum Factors %G English %X Background: Future Health Today (FHT) is a technology program that integrates with general practice clinical software to provide point of care (PoC) clinical decision support and a quality improvement dashboard. This qualitative study looks at the use of FHT in the context of cardiovascular disease risk in chronic kidney disease (CKD). Objective: This study aims to explore factors influencing clinical implementation of the FHT module focusing on cardiovascular risk in CKD, from the perspectives of participating general practitioner staff. Methods: Practices in Victoria were recruited to participate in a pragmatic cluster randomized controlled trial using FHT, of which 19 practices were randomly assigned to use FHT’s cardiovascular risk in CKD program. A total of 13 semistructured interviews were undertaken with a nominated general practitioner (n=7) or practice nurse (n=6) from 10 participating practices. Interview questions focused on the clinical usefulness of the tool and its place in clinical workflows. Qualitative data were coded by 2 researchers and analyzed using framework analysis and Clinical Performance Feedback Intervention Theory. Results: All 13 interviewees had used the FHT PoC tool, and feedback was largely positive. Overall, clinicians described engaging with the tool as a “prompt” or “reminder” system. Themes reflected that the tool’s goals and clinical content were aligned with clinician’s existing priorities and knowledge, and the tool’s design facilitated easy integration into existing workflows. The main barrier to implementation identified by 2 clinicians was notification fatigue. A total of 7 interviewees had used the FHT dashboard tool. The main barriers to use were its limited integration into clinical workflows, such that some participants did not know of its existence; clinicians’ competing clinical priorities; and limited time to learn and use the tool. Conclusions: This study identified many facilitators for the successful use of the FHT PoC program, in the context of cardiovascular risk in CKD, and barriers to the use of the dashboard program. This work will be used to inform the wider implementation of FHT, as well as the development of future modules of FHT for other risk or disease states. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119&is %R 10.2196/55667 %U https://humanfactors.jmir.org/2024/1/e55667 %U https://doi.org/10.2196/55667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51900 %T Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review %A Deinboll,Anne %A Moe,Cathrine Fredriksen %A Ludvigsen,Mette Spliid %+ Faculty of Nursing and Health Sciences, Nord University, Pb 614, Mo i Rana, 8607, Norway, 47 75129709, anne.deinboll@nord.no %K eHealth %K electronic health records %K hemodialysis %K patient participation %K renal dialysis %K renal insufficiency %K chronic %K mobile phone %D 2024 %7 11.11.2024 %9 Review %J J Med Internet Res %G English %X Background: eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. Objective: This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. Methods: This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. Conclusions: This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients’ limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. International Registered Report Identifier (IRRID): RR2-10.2196/38615 %M 39527788 %R 10.2196/51900 %U https://www.jmir.org/2024/1/e51900 %U https://doi.org/10.2196/51900 %U http://www.ncbi.nlm.nih.gov/pubmed/39527788 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60787 %T Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review %A Wang,Tzu %A Huang,Yen-Ming %A Chan,Hsun-Yu %+ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S Rd, Zhongzheng Dist, Taipei City, 100025, Taiwan, 886 33668784, yenming927@ntu.edu.tw %K Asia %K adherence %K application %K feature %K medication %K mobile %D 2024 %7 8.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included “Asia,” “chronic disease,” “app,” “application,” “survey,” “experiment,” “questionnaire,” “group,” “medical adherence,” “medication adherence,” “case-control,” “cohort study,” “randomized controlled trial,” “clinical trial,” “observational study,” “qualitative research,” “mixed methods,” and “analysis,” combined using logical operators “OR” and “AND.” The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. %M 39514859 %R 10.2196/60787 %U https://www.jmir.org/2024/1/e60787 %U https://doi.org/10.2196/60787 %U http://www.ncbi.nlm.nih.gov/pubmed/39514859 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59897 %T Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach %A Berger,Mathilde %A Deblock-Bellamy,Anne %A Chèze,Laurence %A Robert,Thomas %A Desrosiers,Julie J %A Christe,Guillaume %A Bertrand,Anne Martine %+ Department of Occupational Therapy, University of Applied Sciences and Arts Western Switzerland (HETSL | HES-SO), Chemin des Abeilles 14, Lausanne, 1010, Switzerland, 41 (0)216510330, mathilde.berger@hetsl.ch %K chronic low back pain %K needs %K self-management %K physical activity %K mobile health %K mHealth %K user-centered design %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. %M 39509701 %R 10.2196/59897 %U https://humanfactors.jmir.org/2024/1/e59897 %U https://doi.org/10.2196/59897 %U http://www.ncbi.nlm.nih.gov/pubmed/39509701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62877 %T Noninvasive, Multimodal Inflammatory Biomarker Discovery for Systemic Inflammation (NOVA Study): Protocol for a Cross-Sectional Study %A Shim,Jinjoo %A Muraru,Sinziana %A Dobrota,Rucsandra %A Fleisch,Elgar %A Distler,Oliver %A Barata,Filipe %+ Centre for Digital Health Interventions, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8006, Switzerland, 41 765457890, jshim@ethz.ch %K systemic inflammation %K chronic inflammation %K inflammatory biomarkers %K biofluids %K serum %K urine %K sweat %K saliva %K exhaled breath %K stool %K C-reactive protein %K interleukin %K IL-1β %K IL-6 %K IL-8 %K IL-10 %K tumor necrosis factor %K TNF-α %K fractional exhaled nitric oxide %K calprotectin %K core body temperature %K noninvasive biomarker %K multimodal biomarker %K remote monitoring %K surrogate biomarker %K rheumatology %K chronic inflammatory disease %D 2024 %7 5.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prolonged systemic inflammation is recognized as a major contributor to the development of various chronic inflammatory diseases. Daily measurements of inflammatory biomarkers can significantly improve disease monitoring of systemic inflammation, thus contributing to reducing the burden on patients and the health care system. There exists, however, no scalable, cost-efficient, and noninvasive biomarker for remote assessment of systemic inflammation. To this end, we propose a novel, multimodal, and noninvasive approach for measuring inflammatory biomarkers. Objective: This study aimed to evaluate the relationship between the levels of inflammatory biomarkers in serum (gold standard) and those measured noninvasively in urine, sweat, saliva, exhaled breath, stool, and core body temperature in patients with systemic inflammation. Methods: This study is a single-center, cross-sectional study and includes a total of 20 participants (10 patients with systemic inflammation and 10 control patients). Eligible participants provide serum, urine, sweat, saliva, exhaled breath, and stool samples for biomarker analyses. Core body temperature is measured using a sensor. The primary end point is the level of C-reactive protein (CRP). The secondary end points are interleukin (IL)–1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α levels. The tertiary end points are fractional exhaled nitric oxide, calprotectin, and core body temperature. Samples will be collected in 2 batches, enabling preliminary analysis of the first batch (patients 1-5 from each group). The full analysis will include both batches. CRP and cytokine levels will be measured using enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay. For statistical analysis, the Shapiro-Wilk test will be used to evaluate the normality of the distribution in each variable. We will perform the 2-tailed t test or Wilcoxon rank sum test to compare the levels of inflammatory biomarkers between patients with systemic inflammations and control patients. Pearson and Spearman correlation coefficients will assess the relationship between inflammatory biomarkers from noninvasive methods and serum biomarkers. Using all-subset regression analysis, we will determine the combination of noninvasive methods yielding the highest predictive accuracy for serum CRP levels. Participants’ preferences for sampling methods will be assessed through a questionnaire. Results: The study received ethics approval from the independent research ethics committee of Canton Zurich on October 28, 2022. A total of 20 participants participated in the study measurements. Data collection started on February 22, 2023, and was completed on September 22, 2023. Participants were on average 52.8 (SD 14.4; range 24-82) years of age, and 70% (14/20) of them were women. The analysis results reporting findings are expected to be published in 2025. Conclusions: This study aims to evaluate the feasibility of noninvasive, multimodal assessment of inflammatory biomarkers in patients with systemic inflammation. Promising results could lead to the creation of noninvasive and potentially digital biomarkers for systemic inflammation, enabling continuous monitoring and early diagnosis of inflammatory activity in a remote setting. International Registered Report Identifier (IRRID): DERR1-10.2196/62877 %M 39499914 %R 10.2196/62877 %U https://www.researchprotocols.org/2024/1/e62877 %U https://doi.org/10.2196/62877 %U http://www.ncbi.nlm.nih.gov/pubmed/39499914 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58711 %T Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study %A Jordan,Arne %A Nothacker,Julia %A Paucke,Valentina %A Hager,Klaus Heinz %A Hueber,Susann %A Karimzadeh,Arian %A Kötter,Thomas %A Löffler,Christin %A Müller,Beate Sigrid %A Tajdar,Daniel %A Lühmann,Dagmar %A Scherer,Martin %A Schäfer,Ingmar %+ Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany, 49 40 7410 52760, in.schaefer@uke.de %K climate change %K online survey %K open internet data %K climate %K environment %K rising temperature %K heatexposure %K chronic disease management %K epidemiology %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients’ issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. Objective: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. Methods: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Results: Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=–0.25, 95% CI –0.49 to –0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=–0.39, 95% CI –0.54 to –0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Conclusions: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. Trial Registration: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163 %M 39496153 %R 10.2196/58711 %U https://publichealth.jmir.org/2024/1/e58711 %U https://doi.org/10.2196/58711 %U http://www.ncbi.nlm.nih.gov/pubmed/39496153 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57359 %T Sex-Specific Trends in the Prevalence of Osteoarthritis and Rheumatoid Arthritis From 2005 to 2021 in South Korea: Nationwide Cross-Sectional Study %A Park,Seoyoung %A Son,Yejun %A Lee,Hyeri %A Lee,Hayeon %A Lee,Jinseok %A Kang,Jiseung %A Smith,Lee %A Rahmati,Masoud %A Dragioti,Elena %A Tully,Mark A %A Fond,Guillaume %A Boyer,Laurent %A Lee,Jun Hyuk %A Pizzol,Damiano %A Park,Jaeyu %A Woo,Selin %A Yon,Dong Keon %+ Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, 23 Kyungheedae–ro, Dongdaemun–gu, Seoul, 02447, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K epidemiology %K osteoarthritis %K rheumatoid arthritis %K South Korea %K trend %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Osteoarthritis and rheumatoid arthritis (RA) are prevalent chronic joint disorders, with prevalence rates varying by sex. However, few studies have comprehensively documented the factors contributing to the sex-specific prevalence of osteoarthritis and RA, including sociological factors and the impact of the COVID-19 pandemic. Objective: This study aims to identify long-term trends in the sex-specific prevalence of osteoarthritis and RA from 2005 to 2021 while examining the factors that serve as vulnerabilities specific to each sex within the context of the COVID-19 pandemic. Methods: Data were collected from a nationally representative sample of 110,225 individuals through the Korea National Health and Nutrition Examination Survey from 2005 to 2021. The study included patients aged 19 years and older diagnosed with osteoarthritis or RA in South Korea. Data were analyzed using weighted trends to accurately represent the sample population, with a 95% CI. Weighted logistic and regression models were used to identify vulnerable groups at risk of osteoarthritis or RA during the pandemic to assess sex-specific trends. Results: In total, 110,225 individuals (n=48,410, 43.92% male participants) were analyzed from 2005 to 2021, with prevalence rates remaining stable over time and higher in female than in male participants. Notably, during the pandemic, female participants aged 60 years and older exhibited a prevalence of osteoarthritis that was 4.92 times greater than male participants and a prevalence of RA that was 6.44 times greater (osteoarthritis: prevalence ratio [PR] 69.78, 95% CI 41.66-116.88; RA: PR 17.27, 95% CI 8.75-34.07). In terms of osteoarthritis, male participants did not show a significant association with BMI (PR 1.40, 95% CI 1.21-1.61; P=.47), whereas female participants exhibited a significantly higher vulnerability within the obese group (PR 1.68, 95% CI 1.55-1.83; P<.001). Regarding RA, lower education levels were associated with increased vulnerability, with male participants showing a greater risk than female participants (male participants: PR 2.29, 95% CI 1.61-3.27 and female participants: PR 1.50, 95% CI 1.23-1.84). Conclusions: This study reveals that women in South Korea have a higher prevalence of osteoarthritis and RA than men. Understanding these sex-specific trends and identifying vulnerability factors can enhance preventive efforts and patient care. %M 39486025 %R 10.2196/57359 %U https://publichealth.jmir.org/2024/1/e57359 %U https://doi.org/10.2196/57359 %U http://www.ncbi.nlm.nih.gov/pubmed/39486025 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59018 %T Impact of Dance or Music and Meditation on the Progression of Parkinson Disease With Mild or Moderate Severity: Protocol for a Pilot Randomized Controlled Trial %A Mehrotra,Bhagyashree %A Rai,Neha %A MR,Rajani %A Budhakar,Aparna %A Aggarwal,Ritika %A Agarbattiwala,Raj Vinodkumar %A Thomas,Mona %A Patole,Sampada %A Doshi,Paresh %+ Stereotactic and Functional Neurosurgery Department, Jaslok Hospital and Research Centre, 15, G Deshmukh Marg, Pedder Road, IT Colony, Tardeo, Mumbai, 400026, India, 91 9820063854, pdoshi@neurologicalsurgery.in %K music therapy %K dance therapy %K neurodegenerative disorders %K meditation %K quality of life %K music %K pilot study %K Parkinson disease %K well-being %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunctions and nonmotor symptoms. Current treatments do not alter disease progression, highlighting the need for alternative therapies. Music, dance, and mindfulness meditation have shown the potential to improve symptoms and quality of life in patients with PD. Objective: This study aims to evaluate the effectiveness of dance or music and meditation on PD progression, cognitive functions, mood, behavior, and caregiver burden. Methods: This study is a single-blinded, longitudinal, parallel, randomized controlled trial. The participants consist of 30 patients with mild to moderate PD residing in Mumbai, India, who can physically participate in the activities. The exclusion criteria include advanced PD, severe balance issues, age >80 years, and other movement disorders. Participants in the intervention group will engage in dance or music sessions and guided meditation thrice weekly for 6 months. The control group will continue their usual activities and medication. The primary outcome is the progression of PD symptoms, measured using the Unified Parkinson’s Disease Rating Scale I-III, and quality of life, measured using the Parkinson’s Disease Questionnaire-39. The secondary outcomes include cognitive functions (Mini-Mental State Examination), mood (Beck Depression Inventory and Parkinson Anxiety Scale), mobility (timed up and go and Berg Balance Test), behavioral disorders (Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale), and caregiver burden (Zarit Burden Interview and Parkinson’s Disease Questionnaire-Carer). Results: Data collection was completed in February 2024, with 28 participants finishing the study (intervention group: n=15, 54% and control group: n=13, 46%). Data analysis is underway, with results expected to be published in December 2024. Conclusions: This study aims to provide significant insights into the effectiveness of dance or music and meditation in improving the quality of life and slowing the progression of PD. The findings are anticipated to support using these nonpharmaceutical therapies as complementary approaches to managing PD. Trial Registration: CTRI/2023/03/051064; https://tinyurl.com/2xdus53j International Registered Report Identifier (IRRID): DERR1-10.2196/59018 %M 39471378 %R 10.2196/59018 %U https://www.researchprotocols.org/2024/1/e59018 %U https://doi.org/10.2196/59018 %U http://www.ncbi.nlm.nih.gov/pubmed/39471378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58048 %T Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial %A Lin,Yu-Chih %A Wu,Chen-Ching %A Sung,Wan-Yu %A Yen,Jeng-Hsien %A Lin,Yi-Ching %+ Department of Laboratory Medicine, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist, Kaohsiung, 80756, Taiwan, 886 7 3121101 ext 7233, winterjeanne@gmail.com %K ankylosing spondylitis %K galvanic response %K home medical device %K rehabilitation %K transcutaneous electrical stimulation %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. Objective: This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. Methods: The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. Results: A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference –0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference –0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). Conclusions: The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients’ physical functions and spinal flexibility. %M 39467549 %R 10.2196/58048 %U https://formative.jmir.org/2024/1/e58048 %U https://doi.org/10.2196/58048 %U http://www.ncbi.nlm.nih.gov/pubmed/39467549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55715 %T Exploring the Potential of Electronic Patient-Generated Health Data for Evaluating Treatment Response to Intramuscular Steroids in Rheumatoid Arthritis: Case Series %A Al-Attar,Mariam %A Assawamartbunlue,Kesmanee %A Gandrup,Julie %A van der Veer,Sabine N %A Dixon,William G %+ Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9GB, United Kingdom, 44 161 306 7876, mariam.al-attar@manchester.ac.uk %K patient-reported outcome measures %K remote monitoring %K patient-generated health data %K mobile health %K intramuscular steroid injections %K rheumatoid arthritis %K app %K remote monitoring %K case series %K symptom tracking %K pain score %D 2024 %7 28.10.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Mobile health devices are increasingly available, presenting exciting opportunities to remotely collect high-frequency, electronic patient-generated health data (ePGHD). This novel data type may provide detailed insights into disease activity outside usual clinical settings. Assessing treatment responses, which can be hampered by the infrequency of appointments and recall bias, is a promising, novel application of ePGHD. Drugs with short treatment effects, such as intramuscular steroid injections, illustrate the challenge, as patients are unlikely to accurately recall treatment responses at follow-ups, which often occur several months later. Retrospective assessment means that responses may be over- or underestimated. High-frequency ePGHD, such as daily, app-collected, patient-reported symptoms between clinic appointments, may bridge this gap. However, the potential of ePGHD remains untapped due to the absence of established definitions for treatment response using ePGHD or established methodological approaches for analyzing this type of data. Objective: This study aims to explore the feasibility of evaluating treatment responses to intramuscular steroid therapy in a case series of patients with rheumatoid arthritis tracking daily symptoms using a smartphone app. Methods: We report a case series of patients who collected ePGHD through the REmote Monitoring Of Rheumatoid Arthritis (REMORA) smartphone app for daily remote symptom tracking. Symptoms were tracked on a 0-10 scale. We described the patients’ longitudinal pain scores before and after intramuscular steroid injections. The baseline pain score was calculated as the mean pain score in the 10 days prior to the injection. This was compared to the pain scores in the days following the injection. “Response” was defined as any improvement from the baseline score on the first day following the injection. The response end time was defined as the first date when the pain score exceeded the pre-steroid baseline. Results: We included 6 patients who, between them, received 9 steroid injections. Average pre-injection pain scores ranged from 3.3 to 9.3. Using our definitions, 7 injections demonstrated a response. Among the responders, the duration of response ranged from 1 to 54 days (median 9, IQR 7-41), average pain score improvement ranged from 0.1 to 5.3 (median 3.3, IQR 2.2-4.0), and maximum pain score improvement ranged from 0.1 to 7.0 (median 4.3, IQR 1.7 to 6.0). Conclusions: This case series demonstrates the feasibility of using ePGHD to evaluate treatment response and is an important exploratory step toward developing more robust methodological approaches for analysis of this novel data type. Issues highlighted by our analysis include the importance of accounting for one-off data points, varying response start times, and confounders such as other medications. Future analysis of ePGHD across a larger population is required to address issues highlighted by our analysis and to develop meaningful consensus definitions for treatment response in time-series data. %M 39467551 %R 10.2196/55715 %U https://formative.jmir.org/2024/1/e55715 %U https://doi.org/10.2196/55715 %U http://www.ncbi.nlm.nih.gov/pubmed/39467551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51753 %T Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design %A Le Roux,Enora %A Ursino,Moreno %A Milovanovic,Ivana %A Picq,Paul %A Haignere,Jeremie %A Rault,Gilles %A Pougheon Bertrand,Dominique %A Alberti,Corinne %+ Inserm, Hôpital Universitaire Robert Debré, Assistance publique – Hôpitaux de Paris.Nord - Université Paris Cité, 48 Boulevard Serurier, Paris, 75019, France, 33 679690998, enora.leroux@aphp.fr %K connected devices %K cystic fibrosis %K patient education %K self-management %K medical device %K home monitoring %K remote monitoring %K statistical process control %K connected health %K alerts %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home. Objective: This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment. Methods: A multicenter interventional pilot study including 36 patients was conducted. Statistical process control—the cumulative sum control chart (CUSUM)—was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected. Results: One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients. Conclusions: The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028 %M 39467550 %R 10.2196/51753 %U https://formative.jmir.org/2024/1/e51753 %U https://doi.org/10.2196/51753 %U http://www.ncbi.nlm.nih.gov/pubmed/39467550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57219 %T Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study %A Strandberg,Susanna %A Ekstedt,Mirjam %A Fagerström,Cecilia %A Backåberg,Sofia %+ Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 35195, Sweden, 46 725673309, susanna.strandberg@lnu.se %K chronic illness %K eHealth %K experience-based co-design %K older adults %K self-care %K video feedback %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. Results: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, “Breathing exercises” and “Picking up from the floor,” revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support. %M 39466305 %R 10.2196/57219 %U https://formative.jmir.org/2024/1/e57219 %U https://doi.org/10.2196/57219 %U http://www.ncbi.nlm.nih.gov/pubmed/39466305 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57840 %T Population-Level Distribution, Risk Factors, and Burden of Mortality and Disability-Adjusted Life Years Attributable to Major Noncommunicable Diseases in Western Europe (1990-2021): Ecological Analysis %A Mubarik,Sumaira %A Naeem,Shafaq %A Shen,Hui %A Mubarak,Rabia %A Luo,Lisha %A Hussain,Syeda Rija %A Hak,Eelko %A Yu,Chuanhua %A Liu,Xiaoxue %K mortality %K smoking %K Western Europe %K CVDs %K cardiovascular disease %K HDI %K Human Development Index %K neoplasms %K cancer %K DALYs %K disability-adjusted life years %D 2024 %7 17.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Cardiovascular diseases (CVDs) and neoplasms are leading causes of mortality worldwide. Objective: This study aims to provide a comprehensive analysis of the mortality burden and disability-adjusted life years (DALYs) attributable to CVDs and neoplasms in Western Europe, investigate associated risk factors, and identify regional disparities. Additionally, the study evaluates the effectiveness of the Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) in promoting healthier lives in the region. Methods: The study collected data on mortality and DALYs due to CVDs and cancers from 24 Western European countries using the Global Burden of Disease Study 2021. The analysis explored age, sex, and country-specific patterns, as well as risk factors contributing to these deaths. Additionally, the study examined time trends by calculating the annual percent change in mortality rates from 1990 to 2021 by region and cause. Results: In 2021, CVDs and neoplasms accounted for 27.8% and 27.1% of total deaths in Western Europe, with age-standardized death rates of 106.8 and 125.8 per 100,000, respectively. The top two CVDs in this region were ischemic heart disease and stroke, with age-standardized death rates of 47.27 (95% uncertainty interval [UI] 50.42-41.45) and 27.06 (95% UI 29.17-23.00), respectively. Similarly, the top two neoplasms were lung cancer and colorectal cancer, with age-standardized death rates of 26.4 (95% UI 27.69-24.47) and 15.1 (95% UI 16.25-13.53), respectively. Between 1990 and 2021, CVD mortality rates decreased by 61.9%, while cancer rates decreased by 28.27%. Finland had the highest CVD burden (39.5%), and Monaco had the highest rate of cancer-related deaths (34.8%). Gender differences were observed, with males experiencing a higher burden of both CVDs and cancer. Older individuals were also more at risk. Smoking had a stronger impact on CVD mortality and DALYs in males, while a higher Human Development Index was associated with increased cancer deaths and DALYs in females. Conclusions: The study findings highlight the substantial burden of NCDs, particularly CVDs and cancer, in Western Europe. This underscores the critical need for targeted interventions and effective implementation of the Action Plan for the Prevention and Control of NCDs to achieve the goal of ensuring healthy lives for all. %R 10.2196/57840 %U https://publichealth.jmir.org/2024/1/e57840 %U https://doi.org/10.2196/57840 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55034 %T Game-Based eHealth Interventions for the Reduction of Fatigue in People With Chronic Diseases: Systematic Review and Meta-Analysis %A Warlo,Leonie S %A El Bardai,Souraya %A de Vries,Andrica %A van Veelen,Marie-Lise %A Moors,Suzan %A Rings,Edmond HHM %A Legerstee,Jeroen S %A Dierckx,Bram %+ Department of Child and Adolescent Psychiatry/Psychology, Sophia Children’s Hospital, Erasmus Medical Center, Wytemaweg 80, Rotterdam, 3015 CN, Netherlands, 31 630403394, s.elbardai@erasmusmc.nl %K fatigue %K chronic disease %K eHealth %K serious games %K exergames %D 2024 %7 17.10.2024 %9 Review %J JMIR Serious Games %G English %X Background: Fatigue is a common and debilitating side effect of chronic diseases, significantly impacting patients’ quality of life. While physical exercise and psychological treatments have been shown to reduce fatigue, patients often struggle with adherence to these interventions in clinical practice. Game-based eHealth interventions are believed to address adherence issues by making the intervention more accessible and engaging. Objective: This study aims to compile empirical evidence on game-based eHealth interventions for fatigue in individuals with chronic diseases and to evaluate their effectiveness in alleviating fatigue. Methods: A comprehensive literature search was performed across Embase, MEDLINE ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in August 2021. Study characteristics and outcomes from the included studies were extracted, and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity. Results: Of 1742 studies identified, 17 were included in the meta-analysis. These studies covered 5 different chronic diseases: multiple sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1), and Parkinson disease (n=1). All but 1 study used exergaming interventions. The meta-analysis revealed a significant moderate effect size in reducing fatigue favoring the experimental interventions (standardized mean difference [SMD] –0.65, 95% CI –1.09 to –0.21, P=.003) compared with control conditions consisting of conventional care and no care. However, heterogeneity was high (I2=85.87%). Subgroup analyses were conducted for the 2 most prevalent diseases. The effect size for the multiple sclerosis subgroup showed a trend in favor of eHealth interventions (SMD –0.47, 95% CI –0.95 to 0.01, P=.05, I2=63.10%), but was not significant for the cancer group (SMD 0.61, 95% CI –0.36 to 1.58, P=.22). Balance exercises appeared particularly effective in reducing fatigue (SMD –1.19, 95% CI –1.95 to –0.42, P=.002). Conclusions: Game-based eHealth interventions appear effective in reducing fatigue in individuals with chronic diseases. Further research is needed to reinforce these findings and explore their impact on specific diseases. Additionally, there is a lack of investigation into interventions beyond exergaming within the field of game-based learning. %M 39419502 %R 10.2196/55034 %U https://games.jmir.org/2024/1/e55034 %U https://doi.org/10.2196/55034 %U http://www.ncbi.nlm.nih.gov/pubmed/39419502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54916 %T Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework %A Pack,Allison P %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %+ Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0274, allison.pack@northwestern.edu %K older adults %K polypharmacy %K medication adherence %K intervention development %K qualitative research %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. %M 39418094 %R 10.2196/54916 %U https://formative.jmir.org/2024/1/e54916 %U https://doi.org/10.2196/54916 %U http://www.ncbi.nlm.nih.gov/pubmed/39418094 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63024 %T Exploring the Linkages Among Chronic Illness, Substance Use, and COVID-19 Infection in Adults Aged 50 Years and Older: Retrospective Cross-Sectional Analysis of National Representative Data %A Ruksakulpiwat,Suebsarn %A Niyomyart,Atsadaporn %A Riangkam,Chontira %A Phianhasin,Lalipat %A Benjasirisan,Chitchanok %A Adams,Jon %+ Department of Medical Nursing, Faculty of Nursing, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand, 66 984782692, suebsarn25@gmail.com %K multiple chronic conditions %K medical complexity %K co-occurring conditions %K substance use %K COVID-19 %K SARS-CoV-2 %K older adults %K gerontology %K geriatrics %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The co-occurrence of chronic illnesses and substance use presents complex challenges for health care systems. Understanding the interplay between these factors, compounded by the context of the COVID-19 pandemic, is essential for effective intervention strategies. Objective: This study aims to investigate the relationships among chronic illness, substance use, and COVID-19 infection in adults aged 50 years and older. Methods: Participants were 1196 adults aged 50 years and older. Descriptive statistics were used to describe demographic information. Logistic regressions and multiple regression analyses were used to determine associations between chronic illnesses, substance use, and COVID-19 infection. Mediation analysis was used to determine the effect of chronic illness mediators in the association between COVID-19 concerns and substance use. Results: The mean age was 68 (SD 10.3) years, with 58.6% (701/1196) being women. Adjusted analysis revealed that age and sex (women) significantly predicted a lower level of substance use (P<.05). However, marital status (separated or widowed) and chronic illness significantly predicted a higher level of substance use (P<.05). Furthermore, having dementia, arthritis, and high cholesterol significantly predicted a higher level of concern about the COVID-19 pandemic (P<.05). Logistic regression analysis indicated that individuals with hypertension (odds ratio [OR] 1.91, 95% CI 1.37-2.66; P<.001), lung disease (OR 2.42, 95% CI 1.23-4.75; P=.01), heart condition (OR 1.99, 95% CI 1.28-3.10; P=.002), stroke (OR 2.35, 95% CI 1.07-5.16; P=.03), and arthritis (OR 1.72, 95% CI 1.25-2.37; P=.001) were more likely to have their work affected by the COVID-19 pandemic. The mediation analysis showed a significant effect of COVID-19 concern on substance use through the mediation of chronic illness, with a 95% CI of –0.02 to –0.01 and an indirect effect of –0.01. Conclusions: Our study reveals complex associations among chronic illnesses, substance use, and COVID-19 infection among adults aged 50 years and older. It underscores the impact of demographics and specific chronic conditions on substance use behaviors and COVID-19 concerns. In addition, certain chronic illnesses were linked to heightened vulnerability in employment status during the pandemic. These findings emphasize the need for targeted interventions addressing physical health and substance use in this population during the COVID-19 pandemic. %M 39405517 %R 10.2196/63024 %U https://aging.jmir.org/2024/1/e63024 %U https://doi.org/10.2196/63024 %U http://www.ncbi.nlm.nih.gov/pubmed/39405517 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55472 %T Applying Implementation Science to Advance Electronic Health Record–Driven Learning Health Systems: Case Studies, Challenges, and Recommendations %A Trinkley,Katy E %A Maw,Anna M %A Torres,Cristina Huebner %A Huebschmann,Amy G %A Glasgow,Russell E %+ Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Mail Stop F496, Aurora, CO, 80045, United States, 1 303 724 3103, katy.trinkley@cuanschutz.edu %K learning health systems %K implementation science %K chronic care %K electronic health record %K evidence-based medicine %K information technology %K research and technology %D 2024 %7 7.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X With the widespread implementation of electronic health records (EHRs), there has been significant progress in developing learning health systems (LHSs) aimed at improving health and health care delivery through rapid and continuous knowledge generation and translation. To support LHSs in achieving these goals, implementation science (IS) and its frameworks are increasingly being leveraged to ensure that LHSs are feasible, rapid, iterative, reliable, reproducible, equitable, and sustainable. However, 6 key challenges limit the application of IS to EHR-driven LHSs: barriers to team science, limited IS experience, data and technology limitations, time and resource constraints, the appropriateness of certain IS approaches, and equity considerations. Using 3 case studies from diverse health settings and 1 IS framework, we illustrate these challenges faced by LHSs and offer solutions to overcome the bottlenecks in applying IS and utilizing EHRs, which often stymie LHS progress. We discuss the lessons learned and provide recommendations for future research and practice, including the need for more guidance on the practical application of IS methods and a renewed emphasis on generating and accessing inclusive data. %M 39374069 %R 10.2196/55472 %U https://www.jmir.org/2024/1/e55472 %U https://doi.org/10.2196/55472 %U http://www.ncbi.nlm.nih.gov/pubmed/39374069 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57651 %T Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study %A Josendal,Anette Vik %A Bergmo,Trine Strand %K home care %K medication management %K adherence %K self-management %K multidose drug dispensing %K Norway %K primary care %K older adults %D 2024 %7 4.10.2024 %9 %J JMIR Aging %G English %X Background: Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. Objective: The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. Methods: We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants’ homes, and the interview transcripts were analyzed thematically. Results: All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. Conclusions: MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy. %R 10.2196/57651 %U https://aging.jmir.org/2024/1/e57651 %U https://doi.org/10.2196/57651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54991 %T Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts %A Bjarnadóttir,Margrét Vilborg %A Anderson,David %A Anderson,Kelley M %A Aljwfi,Omar %A Peluso,Alina %A Ghannoum,Adam %A Balba,Gayle %A Shara,Nawar %+ Decisions, Operations and Information Technology, University of Maryland, College Park, 4353 Van Munching Hall, College Park, MD, 20742, United States, 1 301 405 2061, mbjarnad@umd.edu %K telehealth utilization %K health care utilization %K demographic differences %K cohort study %K telehealth %K COVID-19 %K telehealth adaption %D 2024 %7 3.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions. %M 39361360 %R 10.2196/54991 %U https://www.jmir.org/2024/1/e54991 %U https://doi.org/10.2196/54991 %U http://www.ncbi.nlm.nih.gov/pubmed/39361360 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54891 %T Analyzing Comorbidity Patterns in Patients With Thyroid Disease Using Large-Scale Electronic Medical Records: Network-Based Retrospective Observational Study %A Huang,Yanqun %A Chen,Siyuan %A Wang,Yongfeng %A Ou,Xiaohong %A Yan,Huanhuan %A Gan,Xin %A Wei,Zhixiao %+ Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, Number 6, Shuangyong Road, Nanning, Guangxi, 530021, China, 86 13517880896, weizhixiao196493@126.com %K thyroid disease %K comorbidity patterns %K prevalence %K network analysis %K electronic medical records %D 2024 %7 3.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Thyroid disease (TD) is a prominent endocrine disorder that raises global health concerns; however, its comorbidity patterns remain unclear. Objective: This study aims to apply a network-based method to comprehensively analyze the comorbidity patterns of TD using large-scale real-world health data. Methods: In this retrospective observational study, we extracted the comorbidities of adult patients with TD from both private and public data sets. All comorbidities were identified using ICD-10 (International Classification of Diseases, 10th Revision) codes at the 3-digit level, and those with a prevalence greater than 2% were analyzed. Patients were categorized into several subgroups based on sex, age, and disease type. A phenotypic comorbidity network (PCN) was constructed, where comorbidities served as nodes and their significant correlations were represented as edges, encompassing all patients with TD and various subgroups. The associations and differences in comorbidities within the PCN of each subgroup were analyzed and compared. The PageRank algorithm was used to identify key comorbidities. Results: The final cohorts included 18,311 and 50,242 patients with TD in the private and public data sets, respectively. Patients with TD demonstrated complex comorbidity patterns, with coexistence relationships differing by sex, age, and type of TD. The number of comorbidities increased with age. The most prevalent TDs were nontoxic goiter, hypothyroidism, hyperthyroidism, and thyroid cancer, while hypertension, diabetes, and lipoprotein metabolism disorders had the highest prevalence and PageRank values among comorbidities. Males and patients with benign TD exhibited a greater number of comorbidities, increased disease diversity, and stronger comorbidity associations compared with females and patients with thyroid cancer. Conclusions: Patients with TD exhibited complex comorbidity patterns, particularly with cardiocerebrovascular diseases and diabetes. The associations among comorbidities varied across different TD subgroups. This study aims to enhance the understanding of comorbidity patterns in patients with TD and improve the integrated management of these individuals. %M 39361379 %R 10.2196/54891 %U https://www.i-jmr.org/2024/1/e54891 %U https://doi.org/10.2196/54891 %U http://www.ncbi.nlm.nih.gov/pubmed/39361379 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56632 %T Design of a Health Education Program to Manage Chronic Neck Pain: Protocol for a Development Study %A Pérez-Muñoz,Milagros %A Rodríguez-Costa,Isabel %A Lebrijo-Pérez,Gerard %A Pecos-Martín,Daniel %A Gallego-Izquierdo,Tomás %A Pérez-Martín,Yolanda %+ Physical Therapy Department, University of Alcalá, Av. de León, 3A, Alcalá de Henares, 28805, Spain, 34 918852586, isabelrodriguezcosta@gmail.com %K neck pain %K chronic pain %K physiotherapy %K health education %K emotional expression %K biopsychosocial model %D 2024 %7 1.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic neck pain (CNP) needs attention to its physical, cognitive, and social dimensions. Objective: We aimed to design a health education program (HEP) with a biopsychosocial approach for patients with CNP. Methods: A literature search on CNP, health education, and biopsychosocial models was carried out. Seven physiotherapists with expertise in HEPs and chronic pain participated in three teams that evaluated the literature and prepared a synthesis document in relation to the three target topics. Experts compiled the information obtained and prepared a proposal for an HEP with a biopsychosocial approach aimed at patients with CNP. This proposal was tested in the physiotherapy units of primary care health centers belonging to the East Assistance Directorate of Madrid, and suggestions were included in the final program. Results: The HEP for CNP with a biopsychosocial approach consists of 5 educational sessions lasting between 90 and 120 minutes, carried out every other day. Cognitive, emotional, and physical dimensions were addressed in all sessions, with particular attention to the psychosocial factors associated with people who have CNP. Conclusions: The proposed HEP with a biopsychosocial approach emphasizes emotional management, especially stress, without neglecting the importance of physical and recreational exercises for the individual’s return to social activities. The objective of this program was to achieve a clinically relevant reduction in perceived pain intensity and functional disability as well as an improvement in quality of life in the short and medium term. Trial Registration: ClinicalTrials.gov NCT02703506; https://clinicaltrials.gov/study/NCT02703506 International Registered Report Identifier (IRRID): DERR1-10.2196/56632 %M 39353191 %R 10.2196/56632 %U https://www.researchprotocols.org/2024/1/e56632 %U https://doi.org/10.2196/56632 %U http://www.ncbi.nlm.nih.gov/pubmed/39353191 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59469 %T Controlled and Real-Life Investigation of Optical Tracking Sensors in Smart Glasses for Monitoring Eating Behavior Using Deep Learning: Cross-Sectional Study %A Stankoski,Simon %A Kiprijanovska,Ivana %A Gjoreski,Martin %A Panchevski,Filip %A Sazdov,Borjan %A Sofronievski,Bojan %A Cleal,Andrew %A Fatoorechi,Mohsen %A Nduka,Charles %A Gjoreski,Hristijan %+ Emteq Ltd., Science Park Square, Brighton, BN1 9SB, United Kingdom, 44 1273 769251, simon.stankoski@emteqlabs.com %K chewing detection %K eating detection %K smart glasses %K automatic dietary monitoring %K eating behavior %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The increasing prevalence of obesity necessitates innovative approaches to better understand this health crisis, particularly given its strong connection to chronic diseases such as diabetes, cancer, and cardiovascular conditions. Monitoring dietary behavior is crucial for designing effective interventions that help decrease obesity prevalence and promote healthy lifestyles. However, traditional dietary tracking methods are limited by participant burden and recall bias. Exploring microlevel eating activities, such as meal duration and chewing frequency, in addition to eating episodes, is crucial due to their substantial relation to obesity and disease risk. Objective: The primary objective of the study was to develop an accurate and noninvasive system for automatically monitoring eating and chewing activities using sensor-equipped smart glasses. The system distinguishes chewing from other facial activities, such as speaking and teeth clenching. The secondary objective was to evaluate the system’s performance on unseen test users using a combination of laboratory-controlled and real-life user studies. Unlike state-of-the-art studies that focus on detecting full eating episodes, our approach provides a more granular analysis by specifically detecting chewing segments within each eating episode. Methods: The study uses OCO optical sensors embedded in smart glasses to monitor facial muscle activations related to eating and chewing activities. The sensors measure relative movements on the skin’s surface in 2 dimensions (X and Y). Data from these sensors are analyzed using deep learning (DL) to distinguish chewing from other facial activities. To address the temporal dependence between chewing events in real life, we integrate a hidden Markov model as an additional component that analyzes the output from the DL model. Results: Statistical tests of mean sensor activations revealed statistically significant differences across all 6 comparison pairs (P<.001) involving 2 sensors (cheeks and temple) and 3 facial activities (eating, clenching, and speaking). These results demonstrate the sensitivity of the sensor data. Furthermore, the convolutional long short-term memory model, which is a combination of convolutional and long short-term memory neural networks, emerged as the best-performing DL model for chewing detection. In controlled laboratory settings, the model achieved an F1-score of 0.91, demonstrating robust performance. In real-life scenarios, the system demonstrated high precision (0.95) and recall (0.82) for detecting eating segments. The chewing rates and the number of chews evaluated in the real-life study showed consistency with expected real-life eating behaviors. Conclusions: The study represents a substantial advancement in dietary monitoring and health technology. By providing a reliable and noninvasive method for tracking eating behavior, it has the potential to revolutionize how dietary data are collected and used. This could lead to more effective health interventions and a better understanding of the factors influencing eating habits and their health implications. %M 39325528 %R 10.2196/59469 %U https://mhealth.jmir.org/2024/1/e59469 %U https://doi.org/10.2196/59469 %U http://www.ncbi.nlm.nih.gov/pubmed/39325528 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59876 %T Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis With Ambulatory Cognitive Tests: Protocol for the Longitudinal Observational CogDetect-MS Study %A Kratz,Anna Louise %A Ehde,Dawn M %A Alschuler,Kevin N %A Pickup,Kristen %A Ginell,Keara %A Fritz,Nora E %+ Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Room G17-W, Ann Arbor, MI, 48109, United States, 1 734 647 5982, alkratz@med.umich.edu %K ambulatory assessment %K longitudinal data collection %K ecological momentary assessment %K cognitive function %K cognitive assessment %K multiple sclerosis %K physical activity %K neuropsychology %K physical function %K observational study %K wrist-worn accelerometry %K social function %K smartphone app %K mobile phone %D 2024 %7 26.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive dysfunction is a common problem in multiple sclerosis (MS). Progress toward understanding and treating cognitive dysfunction is thwarted by the limitations of traditional cognitive tests, which demonstrate poor sensitivity and ecological validity. Ambulatory methods of assessing cognitive function in the lived environment may improve the detection of subtle changes in cognitive function and the identification of predictors of cognitive changes and downstream effects of cognitive change on other functional domains. Objective: This paper describes the study design and protocol for the Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis (CogDetect-MS) study, a 2-year longitudinal observational study designed to examine short- and long-term changes in cognition, predictors of cognitive change, and effects of cognitive change on social and physical function in MS. Methods: Participants—ambulatory adults with medically documented MS—are assessed over the course of 2 years on an annual basis (3 assessments: T1, T2, and T3). A comprehensive survey battery, in-laboratory cognitive and physical performance tests, and 14 days of ambulatory data collection are completed at each annual assessment. The 14-day ambulatory data collection includes continuous wrist-worn accelerometry (to measure daytime activity and sleep); ecological momentary assessments (real-time self-report) of somatic symptoms, mood, and contextual factors; and 2 brief, validated cognitive tests, administered by smartphone app 4 times per day. Our aim was to recruit 250 participants. To ensure standard test protocol administration, all examiners passed a rigorous examiner certification process. Planned analyses include (1) nonparametric 2-tailed t tests to compare in-person to ambulatory cognitive test scores; (2) mixed effects models to examine cognitive changes over time; (3) mixed effects multilevel models to evaluate whether ambulatory measures of physical activity, sleep, fatigue, pain, mood, and stress predict changes in objective or subjective measures of cognitive functioning; and (4) mixed effects multilevel models to examine whether ambulatory measures of cognitive functioning predict social and physical functioning over short (within-day) and long (over years) time frames. Results: The study was funded in August 2021 and approved by the University of Michigan Medical Institutional Review Board on January 27, 2022. A total of 274 adults with MS (first participant enrolled on May 12, 2022) have been recruited and provided T1 data. Follow-up data collection will continue through March 2026. Conclusions: Results from the CogDetect-MS study will shed new light on the temporal dynamics of cognitive function, somatic and mood symptoms, sleep, physical activity, and physical and social function. These insights have the potential to improve our understanding of changes in cognitive function in MS and enable us to generate new interventions to maintain or improve cognitive function in those with MS. Trial Registration: ClinicalTrials.gov NCT05252195; https://clinicaltrials.gov/study/NCT05252195 International Registered Report Identifier (IRRID): DERR1-10.2196/59876 %M 39325510 %R 10.2196/59876 %U https://www.researchprotocols.org/2024/1/e59876 %U https://doi.org/10.2196/59876 %U http://www.ncbi.nlm.nih.gov/pubmed/39325510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55546 %T Evaluating the National Rollout of a Type 2 Diabetes Self-Management Intervention: Qualitative Interview Study With Local National Health Service Leads Responsible for Implementation %A Brunton,Lisa %A Cotterill,Sarah %A Wilson,Paul %+ Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Suite 3, 6th Floor Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 161 275 7603, lisa.brunton@manchester.ac.uk %K type 2 diabetes %K structured education %K self-management %K digital interventions %K implementation %K qualitative methods %K evaluation %D 2024 %7 25.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately 4.5 million people live with type 2 diabetes mellitus (T2DM) in the United Kingdom. Evidence shows that structured education programs can improve glycemic control and reduce the risk of complications from T2DM, but they have low attendance rates. To widen access to T2DM structured education, National Health Service England commissioned a national rollout of Healthy Living, a digital self-management program. Objective: The objectives were to understand the barriers and enablers to adopting, implementing, and integrating Healthy Living into existing T2DM care pathways across England. Methods: We undertook a cross-sectional, qualitative telephone semistructured interview study to address the objectives. In total, 17 local National Health Service leads responsible for implementing Healthy Living across their locality were recruited. We conducted 16 one-time interviews across 16 case sites (1 of the interviews was conducted with 2 local leads from the same case site). Interview data were analyzed using thematic analysis. Results: Three overarching themes were generated: (1) implementation activities, (2) where Healthy Living fits within existing pathways, and (3) contextual factors affecting implementation. Of the 16 sites, 14 (88%) were implementing Healthy Living; the barrier to not implementing it in 2 case sites was not wanting Healthy Living to compete with their current education provision for T2DM. We identified 6 categories of implementation activities across sites: communication strategies to raise awareness of Healthy Living, developing bespoke local resources to support general practices with referrals, providing financial reimbursement or incentives to general practices, promoting Healthy Living via public events, monitoring implementation across their footprint, and widening access across high-need groups. However, outside early engagement sites, most implementation activities were “light touch,” consisting mainly of one-way communications to raise awareness. Local leads were generally positive about Healthy Living as an additional part of their T2DM structured education programs, but some felt it was more suited to specific patient groups. Barriers to undertaking more prolonged, targeted implementation campaigns included implementation not being mandated, sites not receiving data on uptake across their footprint, and confusion in understanding where Healthy Living fit within existing care pathways. Conclusions: A passive process of disseminating information about Healthy Living to general practices rather than an active process of implementation occurred across most sites sampled. This study identified that there is a need for clearer communications regarding the type of patients that may benefit from the Healthy Living program, including when it should be offered and whether it should be offered instead of or in addition to other education programs. No sites other than early engagement sites received data to monitor uptake across their footprint. Understanding variability in uptake across practices may have enabled sites to plan targeted referral campaigns in practices that were not using the service. %M 39321457 %R 10.2196/55546 %U https://www.jmir.org/2024/1/e55546 %U https://doi.org/10.2196/55546 %U http://www.ncbi.nlm.nih.gov/pubmed/39321457 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58845 %T Self-Management Systems for Patients and Clinicians in Parkinson Care: Protocol for an Integrated Scoping Review, Product Search, and Evaluation %A Boege,Selina %A Milne-Ives,Madison %A Meinert,Edward %A Carroll,Camille %+ Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, United Kingdom, 44 0191 208 6000, e.meinert14@imperial.ac.uk %K Parkinson’s disease %K digital health %K self-management %K health care systems %K self-care %K Parkinson %K mobile health %K mHeath %K evaluation %K acceptability %K usability %K decision-making support %K database %K qualitative %K quantitative %K mixed method %K perception %D 2024 %7 24.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) poses emotional and financial challenges to patients, families, caregivers, and health care systems. Self-management systems show promise in empowering people with PD and enabling more control over their treatment. The collaborative nature of PD care requires communication between patients and health care professionals. While past reviews explored self-management systems in PD diagnosis and symptom management with a focus on patient portals, there is limited research addressing the interconnectivity of systems catering to the needs of both patients and clinicians. A system’s acceptability and usability for clinicians are pivotal for enabling comprehensive data collection and supporting clinical decision-making, which can enhance patient care and treatment outcomes. Objective: This review study aims to assess PD self-management systems that include a clinician portal and to determine which features enhance acceptability and usability for clinicians. The primary aim is to assess evidence of clinicians’ acceptability and usability of self-management systems with a focus on the integration of systems into clinical workflows, data collection points, monitoring, clinical decision-making support, and extended education and training. Methods: The review will entail 3 separate stages: a literature review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a product search, and an evaluation of the level of evidence for the identified products. For the first stage, 5 databases will be searched: PubMed, CINAHL, Scopus, ACM digital library, and IEEE Xplore. Studies eligible for inclusion will be qualitative, quantitative, and mixed methods studies examining patients’ and clinician’s perceptions of the acceptability and usability of digital health interventions, synthesized by a narrative qualitative analysis. A web search in the iOS Apple App Store and Android Google Play Store will identify currently available tools; the level of evidence for these will then be assessed using the Oxford Centre for Evidence-Based Medicine guidelines. Results: Literature search and screening began soon after submission of the protocol, and the review is expected to be completed by end of September 2024. Conclusions: This review will examine currently available self-management systems in PD care, focusing on their acceptability and usability. This is significant because there is limited research addressing the integration of clinicians into these systems. The findings from this study may provide critical knowledge and insight to help inform future research and will contribute to the design of self-management systems that promote collaborative efforts in PD care. International Registered Report Identifier (IRRID): PRR1-10.2196/58845 %M 39316796 %R 10.2196/58845 %U https://www.researchprotocols.org/2024/1/e58845 %U https://doi.org/10.2196/58845 %U http://www.ncbi.nlm.nih.gov/pubmed/39316796 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56816 %T Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study %A Butler,Sonia %A Sculley,Dean %A Santos,Derek %A Gironès,Xavier %A Singh-Grewal,Davinder %A Coda,Andrea %K phone app %K smart watch %K juvenile idiopathic arthritis %K pain %K medication adherence %K physical activity %K integrated care %K medication %K development %K usability study %K chronic inflammatory disorder %K children %K child %K usability %K survey %K thematic analysis %K gamification %K modules %K web-based platform %K support %D 2024 %7 17.9.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7%) and 1 parent for each child (n=12; female: n=8, 66.7%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Trial Registration: ANZCTR ACTRN12616000665437; https://tinyurl.com/mwwfje8r %R 10.2196/56816 %U https://pediatrics.jmir.org/2024/1/e56816 %U https://doi.org/10.2196/56816 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54467 %T Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study %A Guo,Ying %A Hong,Zixuan %A Cao,Chenglin %A Cao,Wenwen %A Chen,Ren %A Yan,Jing %A Hu,Zhi %A Bai,Zhongliang %K eHealth literacy %K medication adherence %K frailty %K older people %K China %D 2024 %7 11.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods: Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results: There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82‐1.63), less evaluation (AOR 1.29, 95% CI 0.92‐1.81), and less decision ability (AOR 1.20, 95% CI 0.86‐1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56‐2.13), less evaluation (AOR 1.05, 95% CI 0.61‐1.79), and less decision ability (AOR 1.10, 95% CI 0.64‐1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48‐1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47‐1.54), evaluation (AOR 0.89, 95% CI 0.50‐1.57), and decision ability (AOR 0.99, 95% CI 0.55‐1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48‐1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62‐2.44), evaluation (AOR 0.98, 95% CI 0.53‐1.82), and decision ability (AOR 0.90, 95% CI 0.49‐1.67), were associated with medication adherence in rural areas. Conclusions: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions. %R 10.2196/54467 %U https://publichealth.jmir.org/2024/1/e54467 %U https://doi.org/10.2196/54467 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57033 %T User Experience of a Large-Scale Smartphone-Based Observational Study in Multiple Sclerosis: Global, Open-Access, Digital-Only Study %A Galati,Adriano %A Kriara,Lito %A Lindemann,Michael %A Lehner,Rea %A Jones,JB %+ F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 61 682 25 79, adriano.galati@roche.com %K smartphone %K multiple sclerosis %K user experience %K retention %K digital health %K digital health technology %K mobile phone %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Floodlight Open app is a digital health technology tool (DHTT) that comprises remote, smartphone sensor–based tests (daily activities) for assessing symptoms of multiple sclerosis (MS). User acquisition, engagement, and retention remain a barrier to successfully deploying such tools. Objective: This study aims to quantitatively and qualitatively investigate key user experience (UX) factors associated with the Floodlight Open app. Methods: Floodlight Open is a global, open-access, digital-only study designed to understand the drivers and barriers in deploying a DHTT in a naturalistic setting without supervision and onboarding by a clinician. Daily activities included tests assessing cognition (Information Processing Speed and Information Processing Speed Digit–Digit), hand-motor function (Pinching Test and Draw a Shape Test), and postural stability and gait (Static Balance Test, U-Turn Test, and Two-Minute Walk Test [2MWT]). All daily activities except the 2MWT were taken in a fixed sequence. Qualitative UX was studied through semistructured interviews in a substudy of US participants with MS. The quantitative UX analysis investigated the impact of new UX design features on user engagement and retention in US participants for 3 separate test series: all daily activities included in the fixed sequence (DA), all daily activities included in the fixed sequence except the Static Balance Test and U-Turn Test (DAx), and the 2MWT. Results: The qualitative UX substudy (N=22) revealed the need for 2 new UX design features: a more seamless user journey during the activation process that eliminates the requirement of switching back and forth between the app and the email that the participants received upon registration, and configurable reminders and push notifications to help plan and remind the participants to complete their daily activities. Both UX design features were assessed in the quantitative UX analysis. Introducing the more seamless user journey (original user journey: n=608; more seamless user journey: n=481) improved the conversion rate of participants who enrolled in the study and proceeded to successfully activate the app from 53.9% (328/608) to 74.6% (359/481). Introducing reminders and push notifications (with reminders and notifications: n=350; without reminders and notifications: n=172) improved continuous usage time (proportion of participants with ≥3 consecutive days of usage: DA and DAx: ~30% vs ~12%; 2MWT: ~30% vs ~20%); test completion rates (maximum number of test series completed: DA: 279 vs 64; DAx: 283 vs 126; 2MWT: 302 vs 76); and user retention rates (at day 30: DA: 53/172, 30.8% vs 34/350, 9.7%; DAx: 53/172, 30.8% vs 60/350, 17.1%; 2MWT: 39/172, 22.6% vs 22/350, 6.2%). Inactivity times remained comparable. Conclusions: The remote assessment of MS with DHTTs is a relatively nascent but growing field of research. The continued assessment and improvement of UX design features can play a crucial role in the successful long-term adoption of new DHTTs. %M 39259964 %R 10.2196/57033 %U https://humanfactors.jmir.org/2024/1/e57033 %U https://doi.org/10.2196/57033 %U http://www.ncbi.nlm.nih.gov/pubmed/39259964 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60860 %T Quality Indicators for Transition from Pediatric to Adult Care for Youth With Chronic Conditions: Proposal for an Online Modified Delphi Study %A Toulany,Alene %A Khodyakov,Dmitry %A Mooney,Sarah %A Stromquist,Lisa %A Bailey,Katherine %A Barber,Claire EH %A Batthish,Michelle %A Cleverley,Kristin %A Dimitropoulos,Gina %A Gorter,Jan Willem %A Grahovac,Danijela %A Grimes,Ruth %A Guttman,Beverly %A Hébert,Michèle L %A John,Tomisin %A Lo,Lisha %A Luong,Dorothy %A MacGregor,Laura %A Mukerji,Geetha %A Pidduck,Jacklynn %A Senthilnathan,Vjura %A Shulman,Rayzel %A Trbovich,Patricia %A Munce,Sarah EP %+ Department of Adolescent Medicine, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada, 1 416 813 7654 ext 428939, alene.toulany@sickkids.ca %K transition to adult care %K adolescent health %K chronic conditions %K quality indicators %K consensus %K caregivers %K adolescent %K stakeholder engagement %K patient engagement %K Delphi %D 2024 %7 10.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: The transition from pediatric to adult care poses a significant health system–level challenge impeding the delivery of quality health services for youth with chronic health conditions. In Canada and globally, the transition to adult care is regarded as a top priority in adolescent health in need of readily applicable, adaptable, and relevant national metrics to evaluate and benchmark transition success across disease populations and clinical care settings. Unfortunately, existing literature fails to account for the lack of engagement from youth and caregivers in developing indicators, and its applicability across chronic conditions, primary care involvement, and health equity considerations. Objective: Our proposed study aims to establish a consensus-driven set of quality indicators for the transition to adult care that are universally applicable across physical, developmental, and mental health conditions, clinical care settings, and health jurisdictions. Methods: Using an integrated knowledge translation (iKT) approach, a panel comprising youth, caregivers, interdisciplinary health care providers, and health system leaders will be established to collaborate with our research team to ensure that the study methodology, materials, and knowledge dissemination are suitable and reflect the perspectives of youth and their families. We will then conduct an iterative 3-round Online Modified Delphi (OMD) study (n=160) to (1) compare and contrast the perspectives of youth, caregivers, health care providers, and health system leaders on quality indicators for transition; and (2) prioritize a key set of quality indicators for transition applicable across disease populations that are the most important, useful, and feasible in the Canadian context. Using the RAND/UCLA Appropriateness Method (RAM) multistage analytic approach, data from each panel and stakeholder group will be examined separately and compared to establish a key set of indicators endorsed by both panels. Results: The study is funded by the Canadian Institutes of Health Research and Physicians Services Incorporated. Conclusions: This study will produce quality indicators to evaluate and inform action equitably to improve transition from pediatric to adult care for youth and their families in Canada. International Registered Report Identifier (IRRID): PRR1-10.2196/60860 %M 38889353 %R 10.2196/60860 %U https://www.researchprotocols.org/2024/1/e60860 %U https://doi.org/10.2196/60860 %U http://www.ncbi.nlm.nih.gov/pubmed/38889353 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60621 %T Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial %A Werner,Nicole E %A Morgen,Makenzie %A Kooiman,Sophie %A Jolliff,Anna %A Warner,Gemma %A Feinstein,James %A Chui,Michelle %A Katz,Barbara %A Storhoff,Brittany %A Sodergren,Kristan %A Coller,Ryan %+ University of Wisconsin-Madison School of Medicine and Public Health, H6/559, 600 Highland Ave, Madison, WI, 53792, United States, 1 (608) 265 5445, rcoller@pediatrics.wisc.edu %K medication safety %K children with medical complexity %K caregiving %K polypharmacy %K medication management %D 2024 %7 9.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: This study will pilot-test the mobile app, Medication Safety @HOME—Meds@HOME intervention to improve medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management for children with medical complexity (CMC). The Meds@HOME app was co-designed with CMC families, secondary caregivers (SCGs), and health professionals to support medication management for primary caregivers (PCGs) and SCGs of CMC. We hypothesize that Meds@HOME will improve caregivers’ medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management. Objective: This study aims to evaluate the effectiveness of Meds@HOME on medication administration accuracy for PCGs and SCGs. Methods: This study will recruit up to 152 PCGs and 304 SCGs of CMC who are prescribed at least 1 scheduled high-risk medication and receive care at the University of Wisconsin American Family Children’s Hospital. PCGs will be randomly assigned, for the 6-month trial, to either the control group (not trialing Meds@HOME) or the intervention group (trialing Meds@HOME) using 1:1 ratio. The Meds@HOME app allows caregivers to create a child profile, store medication and care instructions, and receive reminders for upcoming and overdue care routines and medication refills. Surveys completed both at the start and end of the trial measure demographics, medication delivery knowledge, confidence in the CMC’s caregiving network, and comfort with medical information. Univariate and multivariate generalized estimation equations will be used for primary statistical analysis. The primary outcome is the PCG’s rate of medication administration accuracy measured as correct identification of each of the following for a randomly selected high-risk medication: indication, formulation, dose, frequency, and route at baseline and after 6 months. Secondary outcomes include SCG medication administration accuracy (indication, formulation, dose, frequency, and route), count of University of Wisconsin hospital and emergency department encounters, PCG-reported medication adherence, count of deaths, and PCG medication confidence and understanding. Results: Recruitment for this study began on November 29, 2023. As of May 15, 2024, we have enrolled 94/152 (62%) PCGs. We expect recruitment to end by August 1, 2024, and the final participant will complete the study by January 28, 2025, at which point we will start analyzing the complete responses. We expect publication of results at the end of 2025. Conclusions: The Meds@HOME mobile app provides a promising strategy for improving PCG medication safety for CMC who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety. Trial Registration: ClinicalTrials.gov NCT05816590; https://clinicaltrials.gov/study/NCT05816590 International Registered Report Identifier (IRRID): DERR1-10.2196/60621 %M 39250787 %R 10.2196/60621 %U https://www.researchprotocols.org/2024/1/e60621 %U https://doi.org/10.2196/60621 %U http://www.ncbi.nlm.nih.gov/pubmed/39250787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52143 %T Remote Patient Monitoring and Machine Learning in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Dual Systematic Literature Review and Narrative Synthesis %A Glyde,Henry Mark Granger %A Morgan,Caitlin %A Wilkinson,Tom M A %A Nabney,Ian T %A Dodd,James W %+ EPSRC Centre for Doctoral Training in Digital Health and Care, University of Bristol, 2nd Floor, Learning and Research Southmead Hospital, Bristol, BS10 5NB, United Kingdom, 44 7843037078, hglyde18@gmail.com %K acute exacerbations of COPD %K chronic obstructive pulmonary disease %K exacerbate %K exacerbation %K exacerbations %K remote patient monitoring %K RPM %K predict %K prediction %K predictions %K predictive %K machine learning %K monitoring %K remote %K COPD %K pulmonary %K respiratory %K lung %K lungs %K literature review %K literature reviews %K synthesis %K narrative review %K narrative reviews %K review methods %K review methodology %D 2024 %7 9.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high mortality, morbidity, and poor quality of life and constitute a substantial burden to patients and health care systems. New approaches to prevent or reduce the severity of AECOPD are urgently needed. Internationally, this has prompted increased interest in the potential of remote patient monitoring (RPM) and digital medicine. RPM refers to the direct transmission of patient-reported outcomes, physiological, and functional data, including heart rate, weight, blood pressure, oxygen saturation, physical activity, and lung function (spirometry), directly to health care professionals through automation, web-based data entry, or phone-based data entry. Machine learning has the potential to enhance RPM in chronic obstructive pulmonary disease by increasing the accuracy and precision of AECOPD prediction systems. Objective: This study aimed to conduct a dual systematic review. The first review focuses on randomized controlled trials where RPM was used as an intervention to treat or improve AECOPD. The second review examines studies that combined machine learning with RPM to predict AECOPD. We review the evidence and concepts behind RPM and machine learning and discuss the strengths, limitations, and clinical use of available systems. We have generated a list of recommendations needed to deliver patient and health care system benefits. Methods: A comprehensive search strategy, encompassing the Scopus and Web of Science databases, was used to identify relevant studies. A total of 2 independent reviewers (HMGG and CM) conducted study selection, data extraction, and quality assessment, with discrepancies resolved through consensus. Data synthesis involved evidence assessment using a Critical Appraisal Skills Programme checklist and a narrative synthesis. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: These narrative syntheses suggest that 57% (16/28) of the randomized controlled trials for RPM interventions fail to achieve the required level of evidence for better outcomes in AECOPD. However, the integration of machine learning into RPM demonstrates promise for increasing the predictive accuracy of AECOPD and, therefore, early intervention. Conclusions: This review suggests a transition toward the integration of machine learning into RPM for predicting AECOPD. We discuss particular RPM indices that have the potential to improve AECOPD prediction and highlight research gaps concerning patient factors and the maintained adoption of RPM. Furthermore, we emphasize the importance of a more comprehensive examination of patient and health care burdens associated with RPM, along with the development of practical solutions. %M 39250789 %R 10.2196/52143 %U https://www.jmir.org/2024/1/e52143 %U https://doi.org/10.2196/52143 %U http://www.ncbi.nlm.nih.gov/pubmed/39250789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45858 %T Peer Support for Chronic Pain in Online Health Communities: Quantitative Study on the Dynamics of Social Interactions in a Chronic Pain Forum %A Necaise,Aaron %A Amon,Mary Jean %+ School of Modeling, Simulation, and Training, University of Central Florida, Partnership II, 3100 Technology Parkway, Orlando, FL, 32816, United States, 1 321 300 4582, aaron.necaise@ucf.edu %K social media %K chronic pain %K peer support %K sentiment analysis %K wavelet analysis %K nonlinear dynamics %K growth curve modeling %K online health communities %K affective synchrony %D 2024 %7 5.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Peer support for chronic pain is increasingly taking place on social media via social networking communities. Several theories on the development and maintenance of chronic pain highlight how rumination, catastrophizing, and negative social interactions can contribute to poor health outcomes. However, little is known regarding the role web-based health discussions play in the development of negative versus positive health attitudes relevant to chronic pain. Objective: This study aims to investigate how participation in online peer-to-peer support communities influenced pain expressions by examining how the sentiment of user language evolved in response to peer interactions. Methods: We collected the comment histories of 199 randomly sampled Reddit (Reddit, Inc) users who were active in a popular peer-to-peer chronic pain support community over 10 years. A total of 2 separate natural language processing methods were compared to calculate the sentiment of user comments on the forum (N=73,876). We then modeled the trajectories of users’ language sentiment using mixed-effects growth curve modeling and measured the degree to which users affectively synchronized with their peers using bivariate wavelet analysis. Results: In comparison to a shuffled baseline, we found evidence that users entrained their language sentiment to match the language of community members they interacted with (t198=4.02; P<.001; Cohen d=0.40). This synchrony was most apparent in low-frequency sentiment changes unfolding over hundreds of interactions as opposed to reactionary changes occurring from comment to comment (F2,198=17.70; P<.001). We also observed a significant trend in sentiment across all users (β=–.02; P=.003), with users increasingly using more negative language as they continued to interact with the community. Notably, there was a significant interaction between affective synchrony and community tenure (β=.02; P=.02), such that greater affective synchrony was associated with negative sentiment trajectories among short-term users and positive sentiment trajectories among long-term users. Conclusions: Our results are consistent with the social communication model of pain, which describes how social interactions can influence the expression of pain symptoms. The difference in long-term versus short-term affective synchrony observed between community members suggests a process of emotional coregulation and social learning. Participating in health discussions on Reddit appears to be associated with both negative and positive changes in sentiment depending on how individual users interacted with their peers. Thus, in addition to characterizing the sentiment dynamics existing within online chronic pain communities, our work provides insight into the potential benefits and drawbacks of relying on support communities organized on social media platforms. %M 39235845 %R 10.2196/45858 %U https://www.jmir.org/2024/1/e45858 %U https://doi.org/10.2196/45858 %U http://www.ncbi.nlm.nih.gov/pubmed/39235845 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57196 %T Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain %A De Lucia,Annalisa %A Donisi,Valeria %A Pasini,Ilenia %A Polati,Enrico %A Del Piccolo,Lidia %A Schweiger,Vittorio %A Perlini,Cinzia %+ Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro, 10, Verona, 37134, Italy, 39 045 812 6414, valeria.donisi@univr.it %K older adults %K qualitative method %K pain %K coping strategies %K eHealth %K pain management %K mobile phone %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people’s experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management. Objective: This study’s objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management. Methods: A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis. Results: Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants’ opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations. Conclusions: The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people. %M 39235831 %R 10.2196/57196 %U https://aging.jmir.org/2024/1/e57196 %U https://doi.org/10.2196/57196 %U http://www.ncbi.nlm.nih.gov/pubmed/39235831 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e48359 %T Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study %A Brands,Martijn R %A Haverman,Lotte %A Muis,Jelmer J %A Driessens,Mariëtte H E %A Meijer,Stephan %A van der Meer,Felix J M %A de Jong,Marianne %A van der Bom,Johanna G %A Cnossen,Marjon H %A Fijnvandraat,Karin %A Gouw,Samantha C %+ Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands, 31 020 566 2727, s.c.gouw@amsterdamumc.nl %K hemophilia %K telemedicine %K health records %K personal %K decision-making %K shared %K patient participation %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial. Objective: This study aims to assess patients’ and health care providers’ perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns. Methods: In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities. Results: Participants expected a PHR would increase the transparency of health information, improve patients’ understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload. Conclusions: People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition. %M 39226550 %R 10.2196/48359 %U https://humanfactors.jmir.org/2024/1/e48359 %U https://doi.org/10.2196/48359 %U http://www.ncbi.nlm.nih.gov/pubmed/39226550 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53119 %T Automated Pain Spots Recognition Algorithm Provided by a Web Service–Based Platform: Instrument Validation Study %A Cescon,Corrado %A Landolfi,Giuseppe %A Bonomi,Niko %A Derboni,Marco %A Giuffrida,Vincenzo %A Rizzoli,Andrea Emilio %A Maino,Paolo %A Koetsier,Eva %A Barbero,Marco %K pain drawing %K image processing %K body charts %K scan %K pain %K draw %K drawing %K scanner %K scanners %K app %K apps %K applications %K device %K devices %K image %K images %K smartphone %K smartphones %K scale %K musculoskeletal %K body chart %K accuracy %K reliability %K accurate %K reliable %K picture %K pictures %K mobile phone %D 2024 %7 27.8.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Understanding the causes and mechanisms underlying musculoskeletal pain is crucial for developing effective treatments and improving patient outcomes. Self-report measures, such as the Pain Drawing Scale, involve individuals rating their level of pain on a scale. In this technique, individuals color the area where they experience pain, and the resulting picture is rated based on the depicted pain intensity. Analyzing pain drawings (PDs) typically involves measuring the size of the pain region. There are several studies focusing on assessing the clinical use of PDs, and now, with the introduction of digital PDs, the usability and reliability of these platforms need validation. Comparative studies between traditional and digital PDs have shown good agreement and reliability. The evolution of PD acquisition over the last 2 decades mirrors the commercialization of digital technologies. However, the pen-on-paper approach seems to be more accepted by patients, but there is currently no standardized method for scanning PDs. Objective: The objective of this study was to evaluate the accuracy of PD analysis performed by a web platform using various digital scanners. The primary goal was to demonstrate that simple and affordable mobile devices can be used to acquire PDs without losing important information. Methods: Two sets of PDs were generated: one with the addition of 216 colored circles and another composed of various red shapes distributed randomly on a frontal view body chart of an adult male. These drawings were then printed in color on A4 sheets, including QR codes at the corners in order to allow automatic alignment, and subsequently scanned using different devices and apps. The scanners used were flatbed scanners of different sizes and prices (professional, portable flatbed, and home printer or scanner), smartphones with varying price ranges, and 6 virtual scanner apps. The acquisitions were made under normal light conditions by the same operator. Results: High-saturation colors, such as red, cyan, magenta, and yellow, were accurately identified by all devices. The percentage error for small, medium, and large pain spots was consistently below 20% for all devices, with smaller values associated with larger areas. In addition, a significant negative correlation was observed between the percentage of error and spot size (R=−0.237; P=.04). The proposed platform proved to be robust and reliable for acquiring paper PDs via a wide range of scanning devices. Conclusions: This study demonstrates that a web platform can accurately analyze PDs acquired through various digital scanners. The findings support the use of simple and cost-effective mobile devices for PD acquisition without compromising the quality of data. Standardizing the scanning process using the proposed platform can contribute to more efficient and consistent PD analysis in clinical and research settings. %R 10.2196/53119 %U https://mhealth.jmir.org/2024/1/e53119 %U https://doi.org/10.2196/53119 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53322 %T Predicting Long COVID in the National COVID Cohort Collaborative Using Super Learner: Cohort Study %A Butzin-Dozier,Zachary %A Ji,Yunwen %A Li,Haodong %A Coyle,Jeremy %A Shi,Junming %A Phillips,Rachael V %A Mertens,Andrew N %A Pirracchio,Romain %A van der Laan,Mark J %A Patel,Rena C %A Colford,John M %A Hubbard,Alan E %A , %+ Division of Biostatistics, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 3024376262, zbutzin@berkeley.edu %K long COVID %K COVID-19 %K machine learning %K respiratory %K infectious %K SARS-CoV-2 %K sequelae %K chronic %K long term %K covariate %K covariates %K risk %K risks %K predict %K prediction %K predictions %K predictive %K Super Learner %K ensemble %K stacking %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Postacute sequelae of COVID-19 (PASC), also known as long COVID, is a broad grouping of a range of long-term symptoms following acute COVID-19. These symptoms can occur across a range of biological systems, leading to challenges in determining risk factors for PASC and the causal etiology of this disorder. An understanding of characteristics that are predictive of future PASC is valuable, as this can inform the identification of high-risk individuals and future preventative efforts. However, current knowledge regarding PASC risk factors is limited. Objective: Using a sample of 55,257 patients (at a ratio of 1 patient with PASC to 4 matched controls) from the National COVID Cohort Collaborative, as part of the National Institutes of Health Long COVID Computational Challenge, we sought to predict individual risk of PASC diagnosis from a curated set of clinically informed covariates. The National COVID Cohort Collaborative includes electronic health records for more than 22 million patients from 84 sites across the United States. Methods: We predicted individual PASC status, given covariate information, using Super Learner (an ensemble machine learning algorithm also known as stacking) to learn the optimal combination of gradient boosting and random forest algorithms to maximize the area under the receiver operator curve. We evaluated variable importance (Shapley values) based on 3 levels: individual features, temporal windows, and clinical domains. We externally validated these findings using a holdout set of randomly selected study sites. Results: We were able to predict individual PASC diagnoses accurately (area under the curve 0.874). The individual features of the length of observation period, number of health care interactions during acute COVID-19, and viral lower respiratory infection were the most predictive of subsequent PASC diagnosis. Temporally, we found that baseline characteristics were the most predictive of future PASC diagnosis, compared with characteristics immediately before, during, or after acute COVID-19. We found that the clinical domains of health care use, demographics or anthropometry, and respiratory factors were the most predictive of PASC diagnosis. Conclusions: The methods outlined here provide an open-source, applied example of using Super Learner to predict PASC status using electronic health record data, which can be replicated across a variety of settings. Across individual predictors and clinical domains, we consistently found that factors related to health care use were the strongest predictors of PASC diagnosis. This indicates that any observational studies using PASC diagnosis as a primary outcome must rigorously account for heterogeneous health care use. Our temporal findings support the hypothesis that clinicians may be able to accurately assess the risk of PASC in patients before acute COVID-19 diagnosis, which could improve early interventions and preventive care. Our findings also highlight the importance of respiratory characteristics in PASC risk assessment. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293272 %R 10.2196/53322 %U https://publichealth.jmir.org/2024/1/e53322 %U https://doi.org/10.2196/53322 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57595 %T Illicit Cannabis Use to Self-Treat Chronic Health Conditions in the United Kingdom: Cross-Sectional Study %A Erridge,Simon %A Troup,Lucy %A Sodergren,Mikael Hans %K cannabis %K chronic pain %K anxiety %K multiple sclerosis %K posttraumatic stress disorder %K PTSD %K fibromyalgia %K misuse %K cannabis misuse %K cannabis use %K self-treatment %K chronic health condition %K cross-sectional study %K United Kingdom %K illicit cannabis %K adult %K consumption %K adults %K survey %K cannabis-based %K medicinal products %K cannabis-based medicinal products %D 2024 %7 14.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In 2019, it was estimated that approximately 1.4 million adults in the United Kingdom purchased illicit cannabis to self-treat chronic physical and mental health conditions. This analysis was conducted following the rescheduling of cannabis-based medicinal products (CBMPs) in the United Kingdom but before the first specialist clinics had started treating patients. Objective: The aim of this study was to assess the prevalence of illicit cannabis consumption to treat a medically diagnosed condition following the introduction of specialist clinics that could prescribe legal CBMPs in the United Kingdom. Methods: Adults older than 18 years in the United Kingdom were invited to participate in a cross-sectional survey through YouGov between September 22 and 29, 2022. A series of questions were asked about respondents’ medical diagnoses, illicit cannabis use, the cost of purchasing illicit cannabis per month, and basic demographics. The responding sample was weighted to generate a sample representative of the adult population of the United Kingdom. Modeling of population size was conducted based on an adult (18 years or older) population of 53,369,083 according to 2021 national census data. Results: There were 10,965 respondents to the questionnaire, to which weighting was applied. A total of 5700 (51.98%) respondents indicated that they were affected by a chronic health condition. The most reported condition was anxiety (n=1588, 14.48%). Of those enduring health conditions, 364 (6.38%) purchased illicit cannabis to self-treat health conditions. Based on survey responses, it was modeled that 1,770,627 (95% CI 1,073,791‐2,467,001) individuals consume illicit cannabis for health conditions across the United Kingdom. In the multivariable logistic regression, the following were associated with an increased likelihood of reporting illicit cannabis use for health reasons—chronic pain, fibromyalgia, posttraumatic stress disorder, multiple sclerosis, other mental health disorders, male sex, younger age, living in London, being unemployed or not working for other reasons, and working part-time (P<.05). Conclusions: This study highlights the scale of illicit cannabis use for health reasons in the United Kingdom and the potential barriers to accessing legally prescribed CBMPs. This is an important step in developing harm reduction policies to transition these individuals, where appropriate, to CBMPs. Such policies are particularly important considering the potential risks from harmful contaminants of illicit cannabis and self-treating a medical condition without clinical oversight. Moreover, it emphasizes the need for further funding of randomized controlled trials and the use of novel methodologies to determine the efficacy of CBMPs and their use in common chronic conditions. %R 10.2196/57595 %U https://publichealth.jmir.org/2024/1/e57595 %U https://doi.org/10.2196/57595 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55625 %T Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review %A Armfield,Nigel %A Elphinston,Rachel %A Liimatainen,Jenna %A Scotti Requena,Simone %A Eather,Chloe-Emily %A Edirippulige,Sisira %A Ritchie,Carrie %A Robins,Sarah %A Sterling,Michele %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Brisbane, 4029, Australia, 61 733655560, N.R.Armfield@uq.edu.au %K musculoskeletal %K pain %K SMS text messaging %K mobile health %K mHealth %K intervention design %K design %K scoping review %K musculoskeletal pain %K development %K mobile messaging %K behavior change %K efficacy %K effectiveness %K messaging %K implementation %K sustainability %K mobile phone %D 2024 %7 14.8.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. Objective: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. Methods: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. Results: We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and “other” (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. Conclusions: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048964 %M 39141913 %R 10.2196/55625 %U https://mhealth.jmir.org/2024/1/e55625 %U https://doi.org/10.2196/55625 %U http://www.ncbi.nlm.nih.gov/pubmed/39141913 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57865 %T Efficacy and Safety of Shi Cervical Rotational Manipulation in Patients With Atlantoaxial Joint Subluxation: Protocol for a Randomized Controlled Trial %A Zhen,Deng %A Haibin,Shang %A Youli,Ai %A Weian,Yuan %A Huihao,Wang %A Hongsheng,Zhan %A Guozhong,Li %A Ren,Ding %A Zhibi,Shen %+ Department of Orthopedics & Traumatology, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, No. 301 You yi zhi lu Road, Baoshan Area, Shanghai, 201999, China, 86 15921667516, bs0873@shutcm.edu.cn %K atlantoaxial joint subluxation %K Shi cervical rotational manipulation %K efficacy %K safety %K randomized controlled trial %D 2024 %7 13.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The clinical diagnosis of atlantoaxial joint subluxation (AJS) in traditional Chinese medicine (TCM) is characterized by an unequal distance between the lateral mass of the atlas and the odontoid process on imaging, resulting in neck pain accompanied by symptoms such as dizziness, headache, and limited cervical mobility. In Shanghai, Shi cervical rotational manipulation (SCRM) is a commonly employed TCM manual therapy for treating this condition. Nevertheless, there is a lack of evidence-based medical information regarding the clinical efficacy and safety of this technique. Objective: The principal aim of this study is to evaluate the efficacy and safety of SCRM in patients diagnosed with AJS. Methods: This study is a prospective randomized controlled clinical trial that will be conducted at a single center and that has a follow-up period of 24 weeks. A total of 96 patients diagnosed with AJS will be recruited from outpatient and inpatient clinics at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine. These patients will be randomly assigned to either the experimental group (SCRM) or the comparison group (basic cervical manipulation [BCM]). Treatment sessions consisting of SCRM or BCM will be administered twice a week for a duration of 4 weeks. Clinical monitoring indicators include the presence or absence of clinical symptoms as recorded on a symptom recording form, cervical imaging examination findings using cervical computed tomography, degree of neck pain measured by a visual analog scale (VAS), cervical range of motion assessed through cervical mobility measurement, degree of vertigo evaluated using the Vertigo Symptoms Scale-Chinese Version (VSS-C), and adverse events that may occur during the follow-up period. The time points for data collection and follow-up are baseline and postintervention (weeks 4, 8, 12, 16, 20, and 24). Results: This paper presents an overview of the reasoning and structure of a prospective randomized controlled trial with the objective of investigating the clinical efficacy and safety of SCRM in patients with AJS by assessing improvements in clinical symptoms, neck pain severity, and vertigo severity and evaluating changes in cervical imaging findings. Recruitment was started in March 2023. By the end of May 2024, 76 patients were included in this project. The last follow-up data are predicted to be collected by the end of February 2025. Conclusions: This investigation will yield dependable evidence regarding the efficacy and safety of SCRM in patients with AJS. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068510; https://www.chictr.org.cn/showprojEN.html?proj=186883 International Registered Report Identifier (IRRID): DERR1-10.2196/57865 %M 39137417 %R 10.2196/57865 %U https://www.researchprotocols.org/2024/1/e57865 %U https://doi.org/10.2196/57865 %U http://www.ncbi.nlm.nih.gov/pubmed/39137417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53926 %T Sex Differences in Pain Sensitivity in a Dutch Cohort: Cross-Sectional and Web-Based Multidimensional Study %A Smits,Rachel J H %A van der Wal,Selina E I %A van Boekel,Regina L M %A Timmerman,Hans %A Bronkhorst,Ewald M %A Abrar,Diana %A Vissers,Kris C P %A Blaney Davidson,Esmeralda N %A Steegers,Monique A H %+ Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Postbus 9101, Nijmegen, 6500 HB, Netherlands, 31 6 29698822, rachel.smits@radboudumc.nl %K pain sensitivity %K pain sensitivity questionnaire %K chronic pain %K digital interventions %K mobile health %K film %K sex %K Dutch population %K personalized medicine %K individualized care %D 2024 %7 9.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sex is an important factor influencing the development and treatment of chronic pain, but the extent of its influence is still unclear. Other demographic factors as well as nonpharmacological interventions might influence pain sensitivity differently in men and women. Objective: In this study, we aimed to investigate the influence of sex and other demographic, lifestyle, behavioral, clinical, and environmental factors on pain sensitivity in the Dutch population. Different films were used to investigate how they would impact pain sensitivity and what influence sex and other variables have on the effect of this simple intervention. Methods: We performed a study consisting of 2 parts: (1) a cross-sectional research to investigate pain sensitivity differences between men and women and the influence of other demographic variables on the pain sensitivity in a Dutch cohort and (2) an internet intervention study to determine whether a short film could skew pain sensitivity. Results: All respondents filled in a web-based demographic questionnaire and were randomized into 4 groups. The control group filled in the Pain Sensitivity Questionnaire without watching a preliminary film. A cross-sectional analysis was performed in the control group (n=1746). The other 3 groups watched short films: one group watched a film with scenes of nature (n=2650), another group watched a film on laughing people (n=2735), and the last group watched a film on physically painful events (n=2708). Immediately after the film viewing, participants were directed to the Pain Sensitivity Questionnaire to measure their pain sensitivity. The Pain Sensitivity Questionnaire score was stated as a mean per question on the numeric rating scale from 0-1. The cross-sectional study revealed no significant differences between men and women but showed male-female differences in the Pain Sensitivity Questionnaire when specific background factors were present. Watching a short film had a positive impact on the pain sensitivity of the respondents who had chronic pain, with a higher effect observed in female respondents. Conclusions: Scientists performing pain research need to account for factors that can influence the outcome of their study and be aware that these factors can be sex-dependent, and pain sensitivity should be analyzed accordingly. Even relatively small interventions such as watching a film can impact pain sensitivity, especially in respondents with current chronic pain. This effect can vary as well when different background factors are present. Our findings warrant further explorations of the possibilities that simple interventions bring for patients in personalized medicine. Trial Registration: Landelijk Trial Register NTR-new NL8182; https://onderzoekmetmensen.nl/en/trial/29537 %M 39121479 %R 10.2196/53926 %U https://www.jmir.org/2024/1/e53926 %U https://doi.org/10.2196/53926 %U http://www.ncbi.nlm.nih.gov/pubmed/39121479 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e46220 %T The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals %A Lonati,Caterina %A Wellhausen,Marie %A Pennig,Stefan %A Röhrßen,Thomas %A Kircelli,Fatih %A Arendt,Svenja %A Tschulena,Ulrich %+ Fresenius Medical Care, Else-Kröner-Str. 1, Bad Homburg, 61352, Germany, 49 61722688932, Ulrich.Tschulena@freseniusmedicalcare.com %K peritoneal dialysis %K virtual reality %K patient education %K patient training %K chronic kidney disease %K nursing %K qualitative assessment %D 2024 %7 6.8.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay•safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay•safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay•safe MyTraining VR ranged from 2 to 5 for each professional. The stay•safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents’ perspective, the technology improved patients’ learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient’s needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients’ acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay•safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. %M 39106093 %R 10.2196/46220 %U https://mededu.jmir.org/2024/1/e46220 %U https://doi.org/10.2196/46220 %U http://www.ncbi.nlm.nih.gov/pubmed/39106093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49576 %T Using Wearables to Study Biopsychosocial Dynamics in Couples Who Cope With a Chronic Health Condition: Ambulatory Assessment Study %A Pauly,Theresa %A Lüscher,Janina %A Wilhelm,Lea Olivia %A Amrein,Melanie Alexandra %A Boateng,George %A Kowatsch,Tobias %A Fleisch,Elgar %A Bodenmann,Guy %A Scholz,Urte %+ Department of Gerontology, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada, 1 778 782 7834, theresa_pauly@sfu.ca %K couples %K wearables %K type II diabetes %K heart rate %K biopsychosocial dynamics %K physiological linkage %K mobile health %K technology %K social support %K chronic disease %K usability %K utility %K mHealth %D 2024 %7 5.8.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology has become an integral part of our everyday life, and its use to manage and study health is no exception. Romantic partners play a critical role in managing chronic health conditions as they tend to be a primary source of support. Objective: This study tests the feasibility of using commercial wearables to monitor couples’ unique way of communicating and supporting each other and documents the physiological correlates of interpersonal dynamics (ie, heart rate linkage). Methods: We analyzed 617 audio recordings of 5-minute duration (384 with concurrent heart rate data) and 527 brief self-reports collected from 11 couples in which 1 partner had type II diabetes during the course of their typical daily lives. Audio data were coded by trained raters for social support. The extent to which heart rate fluctuations were linked among couples was quantified using cross-correlations. Random-intercept multilevel models explored whether cross-correlations might differ by social contexts and exchanges. Results: Sixty percent of audio recordings captured speech between partners and partners reported personal contact with each other in 75% of self-reports. Based on the coding, social support was found in 6% of recordings, whereas at least 1 partner self-reported social support about half the time (53%). Couples, on average, showed small to moderate interconnections in their heart rate fluctuations (r=0.04-0.22). Couples also varied in the extent to which there was lagged linkage, that is, meaning that changes in one partner’s heart rate tended to precede changes in the other partner’s heart rate. Exploratory analyses showed that heart rate linkage was stronger (1) in rater-coded partner conversations (vs moments of no rater-coded partner conversations: rdiff=0.13; P=.03), (2) when partners self-reported interpersonal contact (vs moments of no self-reported interpersonal contact: rdiff=0.20; P<.001), and (3) when partners self-reported social support exchanges (vs moments of no self-reported social support exchange: rdiff=0.15; P=.004). Conclusions: Our study provides initial evidence for the utility of using wearables to collect biopsychosocial data in couples managing a chronic health condition in daily life. Specifically, heart rate linkage might play a role in fostering chronic disease management as a couple. Insights from collecting such data could inform future technology interventions to promote healthy lifestyle engagement and adaptive chronic disease management. International Registered Report Identifier (IRRID): RR2-10.2196/13685 %M 39102683 %R 10.2196/49576 %U https://mhealth.jmir.org/2024/1/e49576 %U https://doi.org/10.2196/49576 %U http://www.ncbi.nlm.nih.gov/pubmed/39102683 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56487 %T Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol %A Nikkhah,Janis %A Steinbeck,Viktoria %A Grobe,Thomas G %A Breitkreuz,Thorben %A Pross,Christoph %A Busse,Reinhard %+ Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Straße des 17. Juni 135, H80, Berlin, 10623, Germany, 49 151 689 414 32, janis.nikkhah@tu-berlin.de %K health care policy %K PROM %K PREM %K PRO feedback %K health behavior %K chronic disease %K asthma %K COPD %K diabetes %K coronary artery disease %K value-based health care %K quality of care %K artery disease %K chronic %K self-management %K effectiveness %K Germany %K cohort study %K pulmonary disease %K utilization %D 2024 %7 5.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients’ perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management. Objective: This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany. Methods: This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients’ reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed. Results: The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025. Conclusions: We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study’s results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients’ health behaviors. Trial Registration: German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656 International Registered Report Identifier (IRRID): DERR1-10.2196/56487 %M 39102279 %R 10.2196/56487 %U https://www.researchprotocols.org/2024/1/e56487 %U https://doi.org/10.2196/56487 %U http://www.ncbi.nlm.nih.gov/pubmed/39102279 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52536 %T Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study %A Yuan,Lei %A Jiang,Qinqin %A Liu,Yuqing %A Liu,Yijun %A Du,Maolin %A Sun,Jinhai %A Li,Meina %K depression %K older %K hypertension %K Fairlie decomposition %K China %K older adult %K elderly %D 2024 %7 1.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Hypertension is the most prevalent chronic disease among China’s older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China’s older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution −9.6%), and comorbidities (contribution −22.9%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption. %R 10.2196/52536 %U https://publichealth.jmir.org/2024/1/e52536 %U https://doi.org/10.2196/52536 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54376 %T Efficacy and Mechanism of Acupoint Catgut Embedding in the Treatment of Chronic Spontaneous Urticaria: Protocol for a Randomized Double-Blind Placebo-Controlled Trial %A Bi,Jianing %A Liu,Li %A Fan,Zhu %A Qu,Shengyuan %A Yang,Jiao %A Xu,Chenchen %A Cui,Bingnan %+ Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixiange, Xicheng District, Beijing, 100053, China, 86 10 88001009, cbn1998@163.com %K chronic spontaneous urticaria %K acupoint catgut embedding %K functional magnetic resonance imaging %K randomized controlled trial %K mechanism of action %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic spontaneous urticaria (CSU) is a common chronic inflammatory skin disease that manifests as itching and wheals, seriously affecting quality of life. Clinical observations and previous research trials have shown that acupuncture is safe and effective for the treatment of CSU. However, there are problems, such as a short duration of action and frequent treatment. Compared with traditional acupuncture, acupoint catgut embedding (ACE) has the advantages of a longer effect and higher compliance. Clinical trials are needed to prove its efficacy and mechanism of action. Objective: This trial aims to provide definitive evidence for the treatment of CSU with ACE and explore the mechanism of ACE. Methods: This is a randomized, double-blind, placebo-controlled trial. In this trial, 108 participants aged 18-60 years with a diagnosis of CSU and no history of ACE will be randomly assigned to 2 groups (1:1 ratio) using the Statistical Analysis System: treatment (ACE) and control (sham ACE). The participants and efficacy evaluators will be blinded to the grouping. Both the ACE and sham ACE groups will undergo acupuncture, but the sham ACE group will not receive catgut sutures. Treatment will be performed twice weekly for 8 weeks, with a 1-week run-in period and a 16-week follow-up period. Twenty patients will be randomly selected to undergo functional magnetic resonance imaging before and after the treatment period. The primary outcome will be the urticaria activity score over 7 days (UAS7). We will use R (version 4.0.1; R Project for Statistical Computing) to perform ANOVA and independent samples t tests to compare the differences within and between groups before and after treatment by judging the rejection range based on a significance level of .05. Results: The study protocol has been approved by the Ethics Committee of Guang’anmen Hospital on September 7, 2022, and has been registered on November 30, 2022. Recruitment began on March 1, 2023. A total of 4-6 participants are expected to be recruited each month. The recruitment is planned to be completed on March 1, 2025, and we expect to publish our results by the winter of 2025. As of November 1, 2023, we have enrolled 25 participants with CSU. Conclusions: This randomized, double-blind, placebo-controlled trial aims to provide definitive evidence for the treatment of CSU with ACE and explore the mechanism of ACE. We hypothesize that wheals and itching will show greater improvement in participants receiving active therapy than in those receiving sham treatment. The limitations of this study include its single-center trial design, small sample size, and short treatment duration, which may have certain impacts on the research results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200066274; https://www.chictr.org.cn/showprojEN.html?proj=179056 International Registered Report Identifier (IRRID): DERR1-10.2196/54376 %M 39083341 %R 10.2196/54376 %U https://www.researchprotocols.org/2024/1/e54376 %U https://doi.org/10.2196/54376 %U http://www.ncbi.nlm.nih.gov/pubmed/39083341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55366 %T eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review %A De Lucia,Annalisa %A Perlini,Cinzia %A Chiarotto,Alessandro %A Pachera,Sara %A Pasini,Ilenia %A Del Piccolo,Lidia %A Donisi,Valeria %+ Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro 10, Verona, 37134, Italy, 39 0458124038, cinzia.perlini@univr.it %K chronic pain %K older adults %K eHealth %K scoping review %K psychological intervention %K physical intervention %K multimodal intervention %K biopsychosocial model for chronic pain %K self-management %K mobile phone %D 2024 %7 29.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. Objective: The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. Methods: This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. Results: A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality–based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants’ engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. Conclusions: Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293235 %M 39073865 %R 10.2196/55366 %U https://www.jmir.org/2024/1/e55366 %U https://doi.org/10.2196/55366 %U http://www.ncbi.nlm.nih.gov/pubmed/39073865 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55699 %T Cardiovascular Comorbidities in COVID-19: Comprehensive Analysis of Key Topics %A Markovič,Rene %A Ternar,Luka %A Trstenjak,Tim %A Marhl,Marko %A Grubelnik,Vladimir %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, SI-2000, Slovenia, 386 2 220 73 96, vlado.grubelnik@um.si %K COVID-19 %K cardiovascular diseases %K metabolic disorders %K embolism and thrombosis %K hypertension %K hyperglycemia %K iron metabolism disorders %K MeSH %K embolism %K thrombosis %K heart failure %K nutritional %K vascular disease %K glucose %K effective %D 2024 %7 24.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The interrelation between COVID-19 and various cardiovascular and metabolic disorders has been a critical area of study. There is a growing need to understand how comorbidities such as cardiovascular diseases (CVDs) and metabolic disorders affect the risk and severity of COVID-19. Objective: The objective of this study is to systematically analyze the association between COVID-19 and cardiovascular and metabolic disorders. The focus is on comorbidity, examining the roles of CVDs such as embolism, thrombosis, hypertension, and heart failure, as well as metabolic disorders such as disorders of glucose and iron metabolism. Methods: Our study involved a systematic search in PubMed for literature published from 2000 to 2022. We established 2 databases: one for COVID-19–related articles and another for CVD-related articles, ensuring all were peer-reviewed. In terms of data analysis, statistical methods were applied to compare the frequency and relevance of MeSH (Medical Subject Headings) terms between the 2 databases. This involved analyzing the differences and ratios in the usage of these terms and employing statistical tests to determine their significance in relation to key CVDs within the COVID-19 research context. Results: The study revealed that “Cardiovascular Diseases” and “Nutritional and Metabolic Diseases” were highly relevant as level 1 Medical Subject Headings descriptors in COVID-19 comorbidity research. Detailed analysis at level 2 and level 3 showed “Vascular Disease” and “Heart Disease” as prominent descriptors under CVDs. Significantly, “Glucose Metabolism Disorders” were frequently associated with COVID-19 comorbidities such as embolism, thrombosis, and heart failure. Furthermore, iron deficiency (ID) was notably different in its occurrence between COVID-19 and CVD articles, underlining its significance in the context of COVID-19 comorbidities. Statistical analysis underscored these differences, highlighting the importance of both glucose and iron metabolism disorders in COVID-19 research. Conclusions: This work lays the foundation for future research that utilizes a knowledge-based approach to elucidate the intricate relationships between these conditions, aiming to develop more effective health care strategies and interventions in the face of ongoing pandemic challenges. %M 39046774 %R 10.2196/55699 %U https://www.i-jmr.org/2024/1/e55699 %U https://doi.org/10.2196/55699 %U http://www.ncbi.nlm.nih.gov/pubmed/39046774 %0 Journal Article %@ 2292-9495 %I %V 11 %N %P e51086 %T AI Hesitancy and Acceptability—Perceptions of AI Chatbots for Chronic Health Management and Long COVID Support: Survey Study %A Wu,Philip Fei %A Summers,Charlotte %A Panesar,Arjun %A Kaura,Amit %A Zhang,Li %K AI hesitancy %K chatbot %K long COVID %K diabetes %K chronic disease management %K technology acceptance %K post–COVID-19 condition %K artificial intelligence %D 2024 %7 23.7.2024 %9 %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI) chatbots have the potential to assist individuals with chronic health conditions by providing tailored information, monitoring symptoms, and offering mental health support. Despite their potential benefits, research on public attitudes toward health care chatbots is still limited. To effectively support individuals with long-term health conditions like long COVID (or post–COVID-19 condition), it is crucial to understand their perspectives and preferences regarding the use of AI chatbots. Objective: This study has two main objectives: (1) provide insights into AI chatbot acceptance among people with chronic health conditions, particularly adults older than 55 years and (2) explore the perceptions of using AI chatbots for health self-management and long COVID support. Methods: A web-based survey study was conducted between January and March 2023, specifically targeting individuals with diabetes and other chronic conditions. This particular population was chosen due to their potential awareness and ability to self-manage their condition. The survey aimed to capture data at multiple intervals, taking into consideration the public launch of ChatGPT, which could have potentially impacted public opinions during the project timeline. The survey received 1310 clicks and garnered 900 responses, resulting in a total of 888 usable data points. Results: Although past experience with chatbots (P<.001, 95% CI .110-.302) and online information seeking (P<.001, 95% CI .039-.084) are strong indicators of respondents’ future adoption of health chatbots, they are in general skeptical or unsure about the use of AI chatbots for health care purposes. Less than one-third of the respondents (n=203, 30.1%) indicated that they were likely to use a health chatbot in the next 12 months if available. Most were uncertain about a chatbot’s capability to provide accurate medical advice. However, people seemed more receptive to using voice-based chatbots for mental well-being, health data collection, and analysis. Half of the respondents with long COVID showed interest in using emotionally intelligent chatbots. Conclusions: AI hesitancy is not uniform across all health domains and user groups. Despite persistent AI hesitancy, there are promising opportunities for chatbots to offer support for chronic conditions in areas of lifestyle enhancement and mental well-being, potentially through voice-based user interfaces. %R 10.2196/51086 %U https://humanfactors.jmir.org/2024/1/e51086 %U https://doi.org/10.2196/51086 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58158 %T Evaluating and Enhancing Large Language Models’ Performance in Domain-Specific Medicine: Development and Usability Study With DocOA %A Chen,Xi %A Wang,Li %A You,MingKe %A Liu,WeiZhi %A Fu,Yu %A Xu,Jie %A Zhang,Shaoting %A Chen,Gang %A Li,Kang %A Li,Jian %+ Sports Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, China, 86 18980601388, lijian_sportsmed@163.com %K large language model %K retrieval-augmented generation %K domain-specific benchmark framework %K osteoarthritis management %D 2024 %7 22.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The efficacy of large language models (LLMs) in domain-specific medicine, particularly for managing complex diseases such as osteoarthritis (OA), remains largely unexplored. Objective: This study focused on evaluating and enhancing the clinical capabilities and explainability of LLMs in specific domains, using OA management as a case study. Methods: A domain-specific benchmark framework was developed to evaluate LLMs across a spectrum from domain-specific knowledge to clinical applications in real-world clinical scenarios. DocOA, a specialized LLM designed for OA management integrating retrieval-augmented generation and instructional prompts, was developed. It can identify the clinical evidence upon which its answers are based through retrieval-augmented generation, thereby demonstrating the explainability of those answers. The study compared the performance of GPT-3.5, GPT-4, and a specialized assistant, DocOA, using objective and human evaluations. Results: Results showed that general LLMs such as GPT-3.5 and GPT-4 were less effective in the specialized domain of OA management, particularly in providing personalized treatment recommendations. However, DocOA showed significant improvements. Conclusions: This study introduces a novel benchmark framework that assesses the domain-specific abilities of LLMs in multiple aspects, highlights the limitations of generalized LLMs in clinical contexts, and demonstrates the potential of tailored approaches for developing domain-specific medical LLMs. %M 38833165 %R 10.2196/58158 %U https://www.jmir.org/2024/1/e58158 %U https://doi.org/10.2196/58158 %U http://www.ncbi.nlm.nih.gov/pubmed/38833165 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57290 %T Prevalence, Mortality, and Access to Care for Chronic Kidney Disease in Medicaid-Enrolled Adults With Sickle Cell Disease in California: Retrospective Cohort Study %A Valle,Jhaqueline %A Lebensburger,Jeffrey D %A Garimella,Pranav S %A Gopal,Srila %+ Tracking California, Public Health Institute, 555 12th Street, Oakland, CA, 94607, United States, 1 4085942436, jhaqueline.valle@trackingcalifornia.org %K sickle cell disease %K chronic kidney disease %K prevalence %K mortality %K access to care %K Medicaid %K California %K United States %K retrospective %K cohort study %K investigate %K emergency department %K hospitalization %K specialized care %K adult %K adults %K hematologist %K hematologists %K nephrologist %K nephrologists %K t-test %D 2024 %7 15.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality. Objective: This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care. Methods: This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists. Results: Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study’s period. Conclusions: This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD. %M 39008353 %R 10.2196/57290 %U https://publichealth.jmir.org/2024/1/e57290 %U https://doi.org/10.2196/57290 %U http://www.ncbi.nlm.nih.gov/pubmed/39008353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53266 %T Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review %A Dhunnoo,Pranavsingh %A Kemp,Bridie %A McGuigan,Karen %A Meskó,Bertalan %A O’Rourke,Vicky %A McCann,Michael %+ Department of Computing, Atlantic Technological University, CoLab Building, ATU, Port Road, Letterkenny, F92 FC93, Ireland, 353 74 918 6000, pranavsingh.dhunnoo@research.atu.ie %K telemedicine %K internet-based consultation %K chronic illnesses %K cyberpsychology %K digital health %K scoping review %D 2024 %7 9.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. Objective: With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. Methods: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. Results: Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality’s convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. Conclusions: For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits. %M 38980704 %R 10.2196/53266 %U https://www.jmir.org/2024/1/e53266 %U https://doi.org/10.2196/53266 %U http://www.ncbi.nlm.nih.gov/pubmed/38980704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59121 %T Characterizing Mental Health Status and Service Utilization in Chinese Americans With Type 2 Diabetes in New York City: Cross-Sectional Study %A Shi,Yun %A Wu,Bei %A Islam,Nadia %A Sevick,Mary Ann %A Shallcross,Amanda J %A Levy,Natalie %A Tamura,Kosuke %A Bao,Han %A Lieu,Ricki %A Xu,Xinyi %A Jiang,Yulin %A Hu,Lu %+ Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, 7th floor, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyulangone.org %K mental health %K diabetes distress %K depression %K anxiety %K service utilization %K psychological distress %K type 2 diabetes %K diabetes %K United States %K mental health burden %K Chinese American %K cross-sectional %K telephone survey %K stress %K depressive symptoms %K mental health care %K mental health screening %D 2024 %7 2.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging evidence indicates that individuals with type 2 diabetes (T2D) are more prone to mental health issues than the general population; however, there is a significant lack of data concerning the mental health burden in Chinese Americans with T2D. Objective: The aim of this study was to explore the comorbid mental health status, health-seeking behaviors, and mental service utilization among Chinese Americans with T2D. Methods: A cross-sectional telephone survey was performed among 74 Chinese Americans with T2D in New York City. We used standardized questionnaires to assess mental health status and to gather data on mental health–seeking behaviors and service utilization. Descriptive statistics were applied for data analysis. Results: A total of 74 Chinese Americans with T2D completed the survey. Most participants (mean age 56, SD 10 years) identified as female (42/74, 57%), were born outside the United States (73/74, 99%), and had limited English proficiency (71/74, 96%). Despite nearly half of the participants (34/74, 46%) reporting at least one mental health concern (elevated stress, depressive symptoms, and/or anxiety), only 3% (2/74) were currently using mental health services. Common reasons for not seeking care included no perceived need, lack of information about Chinese-speaking providers, cost, and time constraints. The cultural and language competence of the provider was ranked as the top factor related to seeking mental health care. Conclusions: Chinese Americans with T2D experience relatively high comorbid mental health concerns yet have low service utilization. Clinicians may consider team-based care to incorporate mental health screening and identify strategies to provide culturally and linguistically concordant mental health services to engage Chinese Americans with T2D. %M 38954806 %R 10.2196/59121 %U https://formative.jmir.org/2024/1/e59121 %U https://doi.org/10.2196/59121 %U http://www.ncbi.nlm.nih.gov/pubmed/38954806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56196 %T Implementing Systematic Patient-Reported Measures for Chronic Conditions Through the Naveta Value-Based Telemedicine Initiative: Observational Retrospective Multicenter Study %A Mercadal-Orfila,Gabriel %A Herrera-Pérez,Salvador %A Piqué,Núria %A Mateu-Amengual,Francesc %A Ventayol-Bosch,Pedro %A Maestre-Fullana,María Antonia %A Serrano-López de las Hazas,Joaquín Ignacio %A Fernández-Cortés,Francisco %A Barceló-Sansó,Francesc %A Rios,Santiago %+ Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Diagonal Sud, Facultat de Farmàcia, Edifici A, Av Joan XXIII, 27-31, Barcelona, 08028, Spain, 34 934024496, npique@gmail.com %K chronic conditions %K eHealth %K value-based care %K patient-reported outcome measures %K patient-reported experience measures %K questionnaires %K response rate %K telemedicine platform %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based health care to a growing population of patients who are chronically ill. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into health care systems. Objective: This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative and its correlations with sociodemographic and clinical characteristics, as well as the evolution of the response rates over time. Methods: Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via chi-square and post hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. Results: A total of 3372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12% (24,704/53,364), with a baseline rate of 53.33% (7198/13,496). Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions (P<.001), with the highest rates being for respiratory (433/606, 71.5%), oncologic (200/319, 62.7%), digestive (2247/3601, 62.4%), and rheumatic diseases (7506/12,982, 57.82%) and the lowest being for HIV infection (7473/22,695, 32.93%). During the first 6 months of follow-up, the response rates decreased in all disease types, except in the case of the group of patients with oncologic disease, among whom the response rate increased up to 100% (6/6). Subsequently, the overall response rate approached baseline levels. Conclusions: Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered health care practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations. %M 38545697 %R 10.2196/56196 %U https://mhealth.jmir.org/2024/1/e56196 %U https://doi.org/10.2196/56196 %U http://www.ncbi.nlm.nih.gov/pubmed/38545697 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52103 %T Predicting the Transition to Metabolically Unhealthy Obesity Among Young Adults With Metabolically Healthy Obesity in South Korea: Nationwide Population-Based Study %A Lee,HyunHae %A Kim,Ji-Su %A Shin,Hyerine %+ Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, Seoul, 06974, Republic of Korea, 82 2 820 5991, jisu80@cau.ac.kr %K metabolically healthy obesity %K metabolic syndrome %K metabolically unhealthy obesity %K nomogram %K obesity %K young adult %K male %K noncommunicable disease %K South Korea %K population-based study %K intervention %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status. Objective: The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition. Methods: This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors. Results: Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50%. Conclusions: This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions. %M 38941611 %R 10.2196/52103 %U https://publichealth.jmir.org/2024/1/e52103 %U https://doi.org/10.2196/52103 %U http://www.ncbi.nlm.nih.gov/pubmed/38941611 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57404 %T Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study %A Bass,Alec %A Géphine,Sarah %A Martin,Mickaël %A Belley,Marianne %A Robic,Manon %A Fabre,Claudine %A Grosbois,Jean-Marie %A Dion,Geneviève %A Saey,Didier %A Chambellan,Arnaud %A Maltais,François %+ Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, 2725, chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada, 1 418 656 8711, francois.maltais@fmed.ulaval.ca %K chronic obstructive pulmonary disease %K COPD %K exercise capacity test %K interstitial lung diseases %K physiotherapy %K rehabilitation %K telerehabilitation %K validation study %K stepper test %D 2024 %7 28.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a “stepper” for 6 minutes. Objective: This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings. Methods: Three centers (Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec in Québec, Groupement des Hôpitaux de l’Institut Catholique de Lille in France, and FormAction Santé in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Québec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Québec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants’ perspectives. Results: Ethical approval was received for this project (October 12, 2023, in Québec and September 25, 2023, in France) and the first participant was recruited in February 2024. Conclusions: This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11). Trial Registration: ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831 International Registered Report Identifier (IRRID): DERR1-10.2196/57404 %M 38941132 %R 10.2196/57404 %U https://www.researchprotocols.org/2024/1/e57404 %U https://doi.org/10.2196/57404 %U http://www.ncbi.nlm.nih.gov/pubmed/38941132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55855 %T Using Automated Machine Learning to Predict Necessary Upcoming Therapy Changes in Patients With Psoriasis Vulgaris and Psoriatic Arthritis and Uncover New Influences on Disease Progression: Retrospective Study %A Schaffert,Daniel %A Bibi,Igor %A Blauth,Mara %A Lull,Christian %A von Ahnen,Jan Alwin %A Gross,Georg %A Schulze-Hagen,Theresa %A Knitza,Johannes %A Kuhn,Sebastian %A Benecke,Johannes %A Schmieder,Astrid %A Leipe,Jan %A Olsavszky,Victor %+ Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 2280, victor.olsavszky@medma.uni-heidelberg.de %K psoriasis vulgaris %K psoriatic arthritis %K automated machine learning %K therapy change %K Psoriasis Area and Severity Index %K PASI score change %K Bath Ankylosing Spondylitis Disease Activity Index %K BASDAI classification %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are complex, multifactorial diseases significantly impacting health and quality of life. Predicting treatment response and disease progression is crucial for optimizing therapeutic interventions, yet challenging. Automated machine learning (AutoML) technology shows promise for rapidly creating accurate predictive models based on patient features and treatment data. Objective: This study aims to develop highly accurate machine learning (ML) models using AutoML to address key clinical questions for PsV and PsA patients, including predicting therapy changes, identifying reasons for therapy changes, and factors influencing skin lesion progression or an abnormal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Methods: Clinical study data from 309 PsV and PsA patients were extensively prepared and analyzed using AutoML to build and select the most accurate predictive models for each variable of interest. Results: Therapy change at 24 weeks follow-up was modeled using the extreme gradient boosted trees classifier with early stopping (area under the receiver operating characteristic curve [AUC] of 0.9078 and logarithmic loss [LogLoss] of 0.3955 for the holdout partition). Key influencing factors included the initial systemic therapeutic agent, the Classification Criteria for Psoriatic Arthritis score at baseline, and changes in quality of life. An average blender incorporating three models (gradient boosted trees classifier, ExtraTrees classifier, and Eureqa generalized additive model classifier) with an AUC of 0.8750 and LogLoss of 0.4603 was used to predict therapy changes for 2 hypothetical patients, highlighting the significance of these factors. Treatments such as methotrexate or specific biologicals showed a lower propensity for change. An average blender of a random forest classifier, an extreme gradient boosted trees classifier, and a Eureqa classifier (AUC of 0.9241 and LogLoss of 0.4498) was used to estimate PASI (Psoriasis Area and Severity Index) change after 24 weeks. Primary predictors included the initial PASI score, change in pruritus levels, and change in therapy. A lower initial PASI score and consistently low pruritus were associated with better outcomes. BASDAI classification at onset was analyzed using an average blender of a Eureqa generalized additive model classifier, an extreme gradient boosted trees classifier with early stopping, and a dropout additive regression trees classifier with an AUC of 0.8274 and LogLoss of 0.5037. Influential factors included initial pain, disease activity, and Hospital Anxiety and Depression Scale scores for depression and anxiety. Increased pain, disease activity, and psychological distress generally led to higher BASDAI scores. Conclusions: The practical implications of these models for clinical decision-making in PsV and PsA can guide early investigation and treatment, contributing to improved patient outcomes. %M 38738977 %R 10.2196/55855 %U https://formative.jmir.org/2024/1/e55855 %U https://doi.org/10.2196/55855 %U http://www.ncbi.nlm.nih.gov/pubmed/38738977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58501 %T Improving the Acceptability and Implementation of Information and Communication Technology–Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders %A Ahmed,Mona %A Marín,Mayca %A Gangas,Pilar %A Bentlage,Ellen %A Louro,Claudia %A Brach,Michael %+ Institute of Sport and Exercise Sciences, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 8334812, mona.ahmad@uni-muenster.de %K acceptability %K implementation %K neurodegenerative diseases %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K older people %K stakeholders %K information and communication technology %K ICT %K user-centered design %K co-design %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union–funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users’ needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 38935424 %R 10.2196/58501 %U https://formative.jmir.org/2024/1/e58501 %U https://doi.org/10.2196/58501 %U http://www.ncbi.nlm.nih.gov/pubmed/38935424 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e50980 %T An Ontology-Based Decision Support System for Tailored Clinical Nutrition Recommendations for Patients With Chronic Obstructive Pulmonary Disease: Development and Acceptability Study %A Spoladore,Daniele %A Colombo,Vera %A Fumagalli,Alessia %A Tosi,Martina %A Lorenzini,Erna Cecilia %A Sacco,Marco %+ Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Via G. Previati 1E, Lecco, 23900, Italy, 39 03412350202, daniele.spoladore@stiima.cnr.it %K ontology-based decision support system %K nutritional recommendation %K chronic obstructive pulmonary disease %K clinical decision support system %K pulmonary rehabilitation %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a chronic condition among the main causes of morbidity and mortality worldwide, representing a burden on health care systems. Scientific literature highlights that nutrition is pivotal in respiratory inflammatory processes connected to COPD, including exacerbations. Patients with COPD have an increased risk of developing nutrition-related comorbidities, such as diabetes, cardiovascular diseases, and malnutrition. Moreover, these patients often manifest sarcopenia and cachexia. Therefore, an adequate nutritional assessment and therapy are essential to help individuals with COPD in managing the progress of the disease. However, the role of nutrition in pulmonary rehabilitation (PR) programs is often underestimated due to a lack of resources and dedicated services, mostly because pneumologists may lack the specialized training for such a discipline. Objective: This work proposes a novel knowledge-based decision support system to support pneumologists in considering nutritional aspects in PR. The system provides clinicians with patient-tailored dietary recommendations leveraging expert knowledge. Methods: The expert knowledge—acquired from experts and clinical literature—was formalized in domain ontologies and rules, which were developed leveraging the support of Italian clinicians with expertise in the rehabilitation of patients with COPD. Thus, by following an agile ontology engineering methodology, the relevant formal ontologies were developed to act as a backbone for an application targeted at pneumologists. The recommendations provided by the decision support system were validated by a group of nutrition experts, whereas the acceptability of such an application in the context of PR was evaluated by pneumologists. Results: A total of 7 dieticians (mean age 46.60, SD 13.35 years) were interviewed to assess their level of agreement with the decision support system’s recommendations by evaluating 5 patients’ health conditions. The preliminary results indicate that the system performed more than adequately (with an overall average score of 4.23, SD 0.52 out of 5 points), providing meaningful and safe recommendations in compliance with clinical practice. With regard to the acceptability of the system by lung specialists (mean age 44.71, SD 11.94 years), the usefulness and relevance of the proposed solution were extremely positive—the scores on each of the perceived usefulness subscales of the technology acceptance model 3 were 4.86 (SD 0.38) out of 5 points, whereas the score on the intention to use subscale was 4.14 (SD 0.38) out of 5 points. Conclusions: Although designed for the Italian clinical context, the proposed system can be adapted for any other national clinical context by modifying the domain ontologies, thus providing a multidisciplinary approach to the management of patients with COPD. %M 38922666 %R 10.2196/50980 %U https://medinform.jmir.org/2024/1/e50980 %U https://doi.org/10.2196/50980 %U http://www.ncbi.nlm.nih.gov/pubmed/38922666 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e54159 %T Stroke Survivors’ Interaction With Hand Rehabilitation Devices: Observational Study %A Wodu,Chioma Obinuchi %A Sweeney,Gillian %A Slachetka,Milena %A Kerr,Andrew %+ Department of Biomedical Engineering, University of Strathclyde, 106 Rottenrow, G4 0NW, Glasgow, , United Kingdom, 44 79 3058 4076, chiomawodu@gmail.com %K stroke %K rehabilitation %K hand rehabilitation devices %K accessibility %K stroke survivors %K rehabilitation technologies %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55% to 75% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. Objective: In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Methods: Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. Results: A total of 29 participants were included in this study, of whom 10 (34%) had poor hand function, 17 (59%) had moderate hand function, and 2 (7%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Conclusions: Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function. %M 38922668 %R 10.2196/54159 %U https://biomedeng.jmir.org/2024/1/e54159 %U https://doi.org/10.2196/54159 %U http://www.ncbi.nlm.nih.gov/pubmed/38922668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53162 %T Multicentric Assessment of a Multimorbidity-Adjusted Disability Score to Stratify Depression-Related Risks Using Temporal Disease Maps: Instrument Validation Study %A González-Colom,Rubèn %A Mitra,Kangkana %A Vela,Emili %A Gezsi,Andras %A Paajanen,Teemu %A Gál,Zsófia %A Hullam,Gabor %A Mäkinen,Hannu %A Nagy,Tamas %A Kuokkanen,Mikko %A Piera-Jiménez,Jordi %A Roca,Josep %A Antal,Peter %A Juhasz,Gabriella %A Cano,Isaac %+ Fundació de Recerca Clínic Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer, C/Rosselló 149-153, Barcelona, 08036, Spain, 34 932275707, rgonzalezc@recerca.clinic.cat %K health risk assessment %K multimorbidity %K disease trajectories %K major depressive disorder %D 2024 %7 24.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Comprehensive management of multimorbidity can significantly benefit from advanced health risk assessment tools that facilitate value-based interventions, allowing for the assessment and prediction of disease progression. Our study proposes a novel methodology, the Multimorbidity-Adjusted Disability Score (MADS), which integrates disease trajectory methodologies with advanced techniques for assessing interdependencies among concurrent diseases. This approach is designed to better assess the clinical burden of clusters of interrelated diseases and enhance our ability to anticipate disease progression, thereby potentially informing targeted preventive care interventions. Objective: This study aims to evaluate the effectiveness of the MADS in stratifying patients into clinically relevant risk groups based on their multimorbidity profiles, which accurately reflect their clinical complexity and the probabilities of developing new associated disease conditions. Methods: In a retrospective multicentric cohort study, we developed the MADS by analyzing disease trajectories and applying Bayesian statistics to determine disease-disease probabilities combined with well-established disability weights. We used major depressive disorder (MDD) as a primary case study for this evaluation. We stratified patients into different risk levels corresponding to different percentiles of MADS distribution. We statistically assessed the association of MADS risk strata with mortality, health care resource use, and disease progression across 1 million individuals from Spain, the United Kingdom, and Finland. Results: The results revealed significantly different distributions of the assessed outcomes across the MADS risk tiers, including mortality rates; primary care visits; specialized care outpatient consultations; visits in mental health specialized centers; emergency room visits; hospitalizations; pharmacological and nonpharmacological expenditures; and dispensation of antipsychotics, anxiolytics, sedatives, and antidepressants (P<.001 in all cases). Moreover, the results of the pairwise comparisons between adjacent risk tiers illustrate a substantial and gradual pattern of increased mortality rate, heightened health care use, increased health care expenditures, and a raised pharmacological burden as individuals progress from lower MADS risk tiers to higher-risk tiers. The analysis also revealed an augmented risk of multimorbidity progression within the high-risk groups, aligned with a higher incidence of new onsets of MDD-related diseases. Conclusions: The MADS seems to be a promising approach for predicting health risks associated with multimorbidity. It might complement current risk assessment state-of-the-art tools by providing valuable insights for tailored epidemiological impact analyses of clusters of interrelated diseases and by accurately assessing multimorbidity progression risks. This study paves the way for innovative digital developments to support advanced health risk assessment strategies. Further validation is required to generalize its use beyond the initial case study of MDD. %M 38913991 %R 10.2196/53162 %U https://www.jmir.org/2024/1/e53162 %U https://doi.org/10.2196/53162 %U http://www.ncbi.nlm.nih.gov/pubmed/38913991 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54970 %T Combination of Curcuminoids and Acupressure for Inflammation and Pain in Older People with Osteoarthritis Genu: Protocol for a Randomized Controlled Trial %A Mahanani,Srinalesti %A Kertia,Nyoman %A Madyaningrum,Ema %+ Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan Sendowo No 1, Sendowo, Sinduadi, Kec. Mlati, Kabupaten Sleman, Yogyakarta, 55281, Indonesia, 62 274 545458, nyoman.kertia@ugm.ac.id %K osteoarthritis %K acupressure %K curcuminoids %K endorphins %K biomarkers %K genu %K older people %K randomized controlled trial %D 2024 %7 24.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Curcuminoids and acupressure have beneficial effects in reducing pain and inflammation in patients with osteoarthritis. However, only a few clinical trials are investigating biomarkers to prove this objectively. Objective: This study aims to investigate the effect of acupressure and curcuminoids on inflammatory markers and pain in older people with osteoarthritis genu. Methods: A randomized controlled trial (RCT) was conducted among older people with osteoarthritis. All participants were randomized to a group that received 30 mg of curcuminoids in turmeric extract capsules and acupressure (group 1) or a group that received a placebo and sham acupressure (group 2) for 3 weeks. Results: The study was approved by the research ethics board; ClinicalTrials.gov reviewed this protocol. The extracts were manufactured from May 2023 to June 2023. Participant recruitment was conducted in September and October 2023; a total of 72 participants aged 60 years or older participated, of whom 75% (n=54) were female. Data were analyzed in April 2024, and dissemination of results is expected by the end of 2024. Conclusions: Primary outcomes were assessed at baseline and after the intervention. Relationships were assessed with inflammatory markers, endorphin hormones, and blood level of cycloxygenase-2 hormone. Additionally, secondary outcomes included pain, ability to perform activities of daily living, and quality of life. The beneficial effects that may be found in this trial may be exceptionally relevant in clinical practice, justifying this scientific inquiry. The benefits of herbs and acupressure can be helpful as additional options in treating inflammation and pain in patients with osteoarthritis. Trial Registration: ClinicalTrials.gov NCT06105840; https://clinicaltrials.gov/study/NCT06105840 International Registered Report Identifier (IRRID): DERR1-10.2196/54970 %M 38771152 %R 10.2196/54970 %U https://www.researchprotocols.org/2024/1/e54970 %U https://doi.org/10.2196/54970 %U http://www.ncbi.nlm.nih.gov/pubmed/38771152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55751 %T Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study %A Porta,Xènia %A Nieto,Rubén %A Serrat,Mayte %A Bourdin Kreitz,Pierre %+ eHealthLab, Faculty of Psychology and Education, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933263538, xeniaporta@uoc.edu %K fibromyalgia %K chronic pain %K pain management %K information and communication technologies %K use %K satisfaction %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. %M 38888943 %R 10.2196/55751 %U https://formative.jmir.org/2024/1/e55751 %U https://doi.org/10.2196/55751 %U http://www.ncbi.nlm.nih.gov/pubmed/38888943 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52069 %T Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation %A Steinman,Lesley %A Chadwick,Kelly %A Chavez Santos,Erica %A Sravanam,Sruthi %A Johnson,Selisha Snowy %A Rensema,Elspeth %A Mayotte,Caitlin %A Denison,Paige %A Lorig,Kate %+ Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, UW Box 351621, Seattle, WA, 98195, United States, 1 2065439837, lesles@uw.edu %K older adults %K health equity %K rural %K chronic disease %K outcome evaluation %K behavior change %K technology %K community based %K evidence based %K health promotion %K mobile phone %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. Objective: This study evaluated changes in remote EBP participants’ health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. Methods: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. Results: A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery. Conclusions: The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults. %M 38869932 %R 10.2196/52069 %U https://aging.jmir.org/2024/1/e52069 %U https://doi.org/10.2196/52069 %U http://www.ncbi.nlm.nih.gov/pubmed/38869932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48605 %T Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach %A Shen,Hongxia %A van der Kleij,Rianne %A van der Boog,Paul J M %A Chavannes,Niels H %+ School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, 510000, China, 86 13937118104, H.Shen@lumc.nl %K eHealth %K self-management %K intervention mapping %K chronic kidney disease %K intervention development %K mobile phone %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. Objective: This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. Methods: We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR–Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. Results: An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including “knowledge and beliefs” in the domain “individual characteristics,” “quality and advantage of eHealth intervention” in the domain “intervention characteristics,” “compatibility” in the domain “inner setting,” and “cultural context” in the domain “outer setting.” To ensure the effectiveness of the Dutch MD–based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention’s appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. Conclusions: Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, our study’s research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. Trial Registration: ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923 %M 38869943 %R 10.2196/48605 %U https://formative.jmir.org/2024/1/e48605 %U https://doi.org/10.2196/48605 %U http://www.ncbi.nlm.nih.gov/pubmed/38869943 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54579 %T Mobile Health App and Web Platform (eDOL) for Medical Follow-Up of Patients With Chronic Pain: Cohort Study Involving the French eDOL National Cohort After 1 Year %A Delage,Noémie %A Cantagrel,Nathalie %A Soriot-Thomas,Sandrine %A Frost,Marie %A Deleens,Rodrigue %A Ginies,Patrick %A Eschalier,Alain %A Corteval,Alice %A Laveyssière,Alicia %A Phalip,Jules %A Bertin,Célian %A Pereira,Bruno %A Chenaf,Chouki %A Doreau,Bastien %A Authier,Nicolas %A , %A Kerckhove,Nicolas %+ Service de pharmacologie médicale, CHU Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand, 63000, France, 33 473754833, nkerckhove@chu-clermontferrand.fr %K mHealth %K mobile health %K eHealth %K self-monitoring %K chronic pain %K observational study %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic pain affects approximately 30% of the general population, severely degrades quality of life and professional life, and leads to additional health care costs. Moreover, the medical follow-up of patients with chronic pain remains complex and provides only fragmentary data on painful daily experiences. This situation makes the management of patients with chronic pain less than optimal and may partly explain the lack of effectiveness of current therapies. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs could better characterize patients, chronic pain, pain medications, and daily impact to help medical management. Objective: This cohort study aimed to assess the ability of our mHealth tool (eDOL) to collect extensive real-life medical data from chronic pain patients after 1 year of use. The data collected in this way would provide new epidemiological and pathophysiological data on chronic pain. Methods: A French national cohort of patients with chronic pain treated at 18 pain clinics has been established and followed up using mHealth tools. This cohort makes it possible to collect the determinants and repercussions of chronic pain and their evolutions in a real-life context, taking into account all environmental events likely to influence chronic pain. The patients were asked to complete several questionnaires, body schemes, and weekly meters, and were able to interact with a chatbot and use educational modules on chronic pain. Physicians could monitor their patients’ progress in real time via an online platform. Results: The cohort study included 1427 patients and analyzed 1178 patients. The eDOL tool was able to collect various sociodemographic data; specific data for characterizing pain disorders, including body scheme; data on comorbidities related to chronic pain and its psychological and overall impact on patients’ quality of life; data on drug and nondrug therapeutics and their benefit-to-risk ratio; and medical or treatment history. Among the patients completing weekly meters, 49.4% (497/1007) continued to complete them after 3 months of follow-up, and the proportion stabilized at 39.3% (108/275) after 12 months of follow-up. Overall, despite a fairly high attrition rate over the follow-up period, the eDOL tool collected extensive data. This amount of data will increase over time and provide a significant volume of health data of interest for future research involving the epidemiology, care pathways, trajectories, medical management, sociodemographic characteristics, and other aspects of patients with chronic pain. Conclusions: This work demonstrates that the mHealth tool eDOL is able to generate a considerable volume of data concerning the determinants and repercussions of chronic pain and their evolutions in a real-life context. The eDOL tool can incorporate numerous parameters to ensure the detailed characterization of patients with chronic pain for future research and pain management. Trial Registration: ClinicalTrials.gov NCT04880096; https://clinicaltrials.gov/ct2/show/NCT04880096 %M 38865173 %R 10.2196/54579 %U https://mhealth.jmir.org/2024/1/e54579 %U https://doi.org/10.2196/54579 %U http://www.ncbi.nlm.nih.gov/pubmed/38865173 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54089 %T Multivisceral Oncological Resections Involving the Pancreas: Protocol for a Systematic Review and Meta-Analysis %A Neuhaus,Melina %A Friedrichs,Juliane %A Grilli,Maurizio %A Ukkat,Jörg %A Klose,Johannes %A Ronellenfitsch,Ulrich %A Kleeff,Jörg %A Rebelo,Artur %+ Uniklinikum Halle, Ernst-Grube-Straße 40, Halle, 06120, Germany, 49 03455577712, artur.rebelo@uk-halle.de %K meta-analysis %K systematic review %K multivisceral resection %K pancreatic resection %K oncological resection %K surgery %K outcomes %K mortality %K morbidity %K survival %K cancer %K tumor %K pancreas %D 2024 %7 11.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking. Objective: This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing evidence concerning the outcomes of multivisceral oncological pancreatic resections across diverse tumor entities. Methods: We will conduct a systematic search of the PubMed or MEDLINE, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov databases in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The predefined outcomes encompass postoperative mortality, postoperative morbidity, overall and disease-free survival (1- to 5-year survival rates), the proportion of macroscopically complete (R0) resections (according to the Royal College of Pathologists definition), duration of hospital stay (in days), reoperation rate (%), postoperative complications (covering all complications according to the Clavien-Dindo classification), as well as pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying (all according to the definitions of the International Study Group of Pancreas Surgery). Results: Systematic database searches will begin in July 2024. The completion of the meta-analysis is anticipated by December 2024. Before completion, the literature search will be checked for new publications that must be considered in the context of the work. Conclusions: The forthcoming findings will provide an up-to-date overview of the feasibility, safety, and oncological efficacy of multivisceral pancreatic resections across diverse tumor entities. This data will serve as a valuable resource for health care professionals and patients to make well-informed clinical decisions. Trial Registration: PROSPERO CRD42023437858; https://tinyurl.com/bde5xmfw International Registered Report Identifier (IRRID): PRR1-10.2196/54089 %M 38861712 %R 10.2196/54089 %U https://www.researchprotocols.org/2024/1/e54089 %U https://doi.org/10.2196/54089 %U http://www.ncbi.nlm.nih.gov/pubmed/38861712 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52182 %T Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study %A Lee,Jae Jun %A Lee,Kyung Hee %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222283321, kyungheelee@yuhs.ac %K aged %K blood pressure %K cardiovascular diseases %K hypertension %K mortality %K older adults %K geriatric %K elderly %K cardiovascular %K Korea %K Korean %K insurance %K cohort study %K systolic %K risk %K aging %K health outcome %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. Objective: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. Methods: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). Results: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. Conclusions: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years. %M 38861307 %R 10.2196/52182 %U https://publichealth.jmir.org/2024/1/e52182 %U https://doi.org/10.2196/52182 %U http://www.ncbi.nlm.nih.gov/pubmed/38861307 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55014 %T Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study %A Hong,Hye Chong %A Kim,Young Man %+ College of Nursing, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, 54896, Republic of Korea, 82 10 3498 5078, ymk@jbnu.ac.kr %K chronic disease %K multimorbidity %K shift work schedule %K shift workers %K population-based study %K Korea %K network analysis %K logistic regression %K cross-sectional study %K public health %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12% to 14% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported. Objective: This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea. Methods: This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis. Results: The overall prevalence of multimorbidity was 13.7% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease). Conclusions: The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future. %M 38857074 %R 10.2196/55014 %U https://publichealth.jmir.org/2024/1/e55014 %U https://doi.org/10.2196/55014 %U http://www.ncbi.nlm.nih.gov/pubmed/38857074 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54485 %T U-Shaped Relationship Between Fibrinogen Level and 10-year Mortality in Patients With Acute Coronary Syndrome: Prospective Cohort Study %A Li,Yi ming %A Jia,Yuheng %A Bai,Lin %A Yang,Bosen %A Chen,Mao %A Peng,Yong %+ Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Street, Sichuan Province, Chengdu City, 610041, China, 86 85423169, pengyong@scu.edu.cn %K fibrinogen %K acute coronary syndrome %K 10-year mortality %K risk factor %K coronary artery disease %K myocardial %K heart disease %K inflammatory factor %K retrospective study %K Kaplan-Meier analysis %K mortality %K all-cause mortality %K cubic-spline curve %K regression model %D 2024 %7 7.6.2024 %9 Research Letter %J JMIR Public Health Surveill %G English %X This study demonstrated that fibrinogen is an independent risk factor for 10-year mortality in patients with acute coronary syndrome (ACS), with a U-shaped nonlinear relationship observed between the two. These findings underscore the importance of monitoring fibrinogen levels and the consideration of long-term anti-inflammatory treatment in the clinical management of patients with ACS. %M 38848124 %R 10.2196/54485 %U https://publichealth.jmir.org/2024/1/e54485 %U https://doi.org/10.2196/54485 %U http://www.ncbi.nlm.nih.gov/pubmed/38848124 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53784 %T Feasibility of Web-Based Single-Session Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Protocol for a Single-Arm Trial %A Klein,Morgan R %A Darnall,Beth D %A You,Dokyoung S %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Rd, Suite 200, Palo Alto, CA, 94304, United States, 1 650 724 9320, dsyou@stanford.edu %K chronic pain %K opioid use disorder %K methadone %K buprenorphine %K behavioral medicine %K telehealth %K psychology %D 2024 %7 6.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain affects tens of millions of US adults and continues to rise in prevalence. Nonpharmacologic behavioral pain treatments are greatly needed and yet are often inaccessible, particularly in settings where medication prescribing is prioritized. Objective: This study aims to test the feasibility of a live-instructor, web-based 1-session pain relief skills class in an underserved and potentially at-risk population: people with chronic pain prescribed methadone or buprenorphine either solely for pain or for comorbid opioid use disorder (OUD). Methods: This is a national, prospective, single-arm, uncontrolled feasibility trial. The trial is untethered from medical care; to enhance participants’ willingness to join the study, no medical records or drug-monitoring records are accessed. At least 45 participants will be recruited from outpatient pain clinics and from an existing research database of individuals who have chronic pain and are taking methadone or buprenorphine. Patient-reported measures will be collected at 6 time points (baseline, immediately post treatment, 2 weeks, and months 1-3) via a web-based platform, paper, or phone formats to include individuals with limited internet or computer access and low literacy skills. At baseline, participants complete demographic questions and 13 study measures (Treatment Expectations, Body Pain Map, Medication Use, Pain Catastrophizing Scale [PCS], Patient-Reported Outcomes Measurement Information System [PROMIS] Measures, and Opioid Craving Scale). Immediately post treatment, a treatment satisfaction and acceptability measure is administered on a 0 (very dissatisfied) to 10 (completely satisfied) scale, with 3 of these items being the primary outcome (perceived usefulness, participant satisfaction, and likelihood of using the skills). At each remaining time point, the participants complete all study measures minus treatment expectations and satisfaction. Participants who do not have current OUD will be assessed for historical OUD, with presence of OUD (yes or no), and history of OUD (yes or no) reported separately. Feasibility threshold is set as an overall group treatment satisfaction rating of 8 of 10. In-depth qualitative interviews will be conducted with about 10 participants to obtain additional data on patient perceptions, satisfactions, needs, and wants. To assess preliminary efficacy, we will examine changes in pain catastrophizing, pain intensity, pain bothersomeness, sleep disturbance, pain interference, depression, anxiety, physical function, global impression of change, and opioid craving at 1 month post treatment. Results: This project opened to enrollment in September 2021 and completed the recruitment in October 2023. The data collection was completed in February 2024. Results are expected to be published in late 2024. Conclusions: Results from this trial will inform the feasibility and preliminary efficacy of Empowered Relief in this population and will inform the design of a future randomized controlled trial testing web-based Empowered Relief in chronic pain and comorbid OUD. Trial Registration: ClinicalTrials.gov NCT05057988; https://clinicaltrials.gov/study/NCT05057988 International Registered Report Identifier (IRRID): DERR1-10.2196/53784 %M 38843513 %R 10.2196/53784 %U https://www.researchprotocols.org/2024/1/e53784 %U https://doi.org/10.2196/53784 %U http://www.ncbi.nlm.nih.gov/pubmed/38843513 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52457 %T Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study %A Cai,Wenfei %A Liang,Wei %A Liu,Huaxuan %A Zhou,Rundong %A Zhang,Jie %A Zhou,Lin %A Su,Ning %A Zhu,Hanxiao %A Yang,Yide %+ School of Physical Education, Shenzhen University, 3688 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 15217940540, wliang1020@szu.edu.cn %K eHealth literacy %K measurement %K Web 3.0 %K psychometric properties %K NCD %K older adults %K noncommunicable diseases %K Electronic Health Literacy %K health literacy %K eHealth %K reliability %K validity %D 2024 %7 3.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals’ abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. Objective: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. Methods: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. Results: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=–.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. Conclusions: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere. %M 38830207 %R 10.2196/52457 %U https://www.jmir.org/2024/1/e52457 %U https://doi.org/10.2196/52457 %U http://www.ncbi.nlm.nih.gov/pubmed/38830207 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e57668 %T Nurses’ Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey %A Shiyab,Wa'ed %A Rolls,Kaye %A Ferguson,Caleb %A Halcomb,Elizabeth %+ School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 42213784, weys741@uowmail.edu.au %K mHealth apps %K adoption %K smartphone %K chronic conditions %K nursing %K technology %K chronic %K nurse %K nurses %K mHealth %K mobile health %K app %K apps %K use %K cross-sectional %K survey %K surveys %K questionnaire %K questionnaires %K mobile phone %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. Objective: The aim of the study is to explore nurses’ use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. Methods: A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. Results: A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5% to n=108, 68.4%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. Conclusions: While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care. %M 38809593 %R 10.2196/57668 %U https://nursing.jmir.org/2024/1/e57668 %U https://doi.org/10.2196/57668 %U http://www.ncbi.nlm.nih.gov/pubmed/38809593 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56067 %T Effects of Empagliflozin in Type 2 Diabetes With and Without Chronic Kidney Disease and Nondiabetic Chronic Kidney Disease: Protocol for 3 Crossover Randomized Controlled Trials (SiRENA Project) %A Nielsen,Steffen Flindt %A Duus,Camilla Lundgreen %A Buus,Niels Henrik %A Bech,Jesper Nørgaard %A Mose,Frank Holden %+ University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Hospitalsparken 15, Herning, 7400, Denmark, 45 21278747, stfnel@rm.dk %K SGLT2i %K empagliflozin %K renal function %K blood flow %K DM2 %K diabetes mellitus type 2 %K CKD %K chronic kidney disease %K vascular function %K sodium-glucose cotransporter 2 inhibitors %K T2DM %K type 2 diabetes mellitus %K randomized controlled trial %K RCT %K CVD %K placebo %K renal %K recruitment %K Denmark %K cardiovascular disease %D 2024 %7 29.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sodium-glucose-cotransporter 2 inhibitors (SGLT2is) have revolutionized the treatment of type 2 diabetes mellitus (DM2) and chronic kidney disease (CKD), reducing the risk of cardiovascular and renal end points by up to 40%. The underlying mechanisms are not fully understood. Objective: The study aims to examine the effects of empagliflozin versus placebo on renal hemodynamics, sodium balance, vascular function, and markers of the innate immune system in patients with DM2, DM2 and CKD, and nondiabetic CKD. Methods: We conducted 3 double-blind, crossover, randomized controlled trials, each with identical study protocols but different study populations. We included patients with DM2 and preserved kidney function (estimated glomerular filtration rate >60 mL/min/1.73 m2), DM2 and CKD, and nondiabetic CKD (both with estimated glomerular filtration rate 20-60 mL/min/1.73 m2). Each participant was randomly assigned to 4 weeks of treatment with either 10 mg of empagliflozin once daily or a matching placebo. After a wash-out period of at least 2 weeks, participants were crossed over to the opposite treatment. End points were measured at the end of each treatment period. The primary end point was renal blood flow measured with 82Rubidium positron emission tomography–computed tomography (82Rb-PET/CT). Secondary end points include glomerular filtration rate measured with 99mTechnetium-diethylene-triamine-pentaacetate (99mTc-DTPA) clearance, vascular function assessed by forearm venous occlusion strain gauge plethysmography, measurements of the nitric oxide (NO) system, water and sodium excretion, body composition measurements, and markers of the complement immune system. Results: Recruitment began in April 2021 and was completed in September 2022. Examinations were completed by December 2022. In total, 49 participants completed the project: 16 participants in the DM2 and preserved kidney function study, 17 participants in the DM2 and CKD study, and 16 participants in the nondiabetic CKD study. Data analysis is ongoing. Results are yet to be published. Conclusions: This paper describes the rationale, design, and methods used in a project consisting of 3 double-blind, crossover, randomized controlled trials examining the effects of empagliflozin versus placebo in patients with DM2 with and without CKD and patients with nondiabetic CKD, respectively. Trial Registration: EU Clinical Trials Register 2019-004303-12; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2019-004303-12, EU Clinical Trials Register 2019-004447-80; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2019-004447-80, EU Clinical Trials Register 2019-004467-50; https://www.clinicaltrialsregister.eu/ctr-search/search?query=and+2019-004467-50 International Registered Report Identifier (IRRID): DERR1-10.2196/56067 %M 38680116 %R 10.2196/56067 %U https://www.researchprotocols.org/2024/1/e56067 %U https://doi.org/10.2196/56067 %U http://www.ncbi.nlm.nih.gov/pubmed/38680116 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52647 %T Mobile Electrocardiograms in the Detection of Subclinical Atrial Fibrillation in High-Risk Outpatient Populations: Protocol for an Observational Study %A Mittal,Ajay %A Elkaldi,Yasmine %A Shih,Susana %A Nathu,Riken %A Segal,Mark %+ College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32611, United States, 1 352 615 8883, ajaymittal2400@gmail.com %K mobile ECG %K digital health %K cardiology %K ECG %K electrocardiogram %K atrial fibrillation %K outpatient %K randomized %K controlled trial %K controlled trials %K smartphone %K mobile health %K app %K apps %K feasibility %K effectiveness %K KardiaMobile single-lead ECGs %K mobile phone %D 2024 %7 27.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial fibrillation (AFib) in outpatient settings. AFib has been associated with various comorbid diseases that prompt further investigation and screening methodologies for at-risk populations. A simple 30-second sinus rhythm strip from the KardiaMobile ECG (AliveCor) can provide an effective screen for cardiac rhythm abnormalities. Objective: The aim of this study is to demonstrate the feasibility of performing Kardia-enabled ECG recordings routinely in outpatient settings in high-risk populations and its potential use in uncovering previous undiagnosed cases of AFib. Specific aim 1 is to determine the feasibility and accuracy of performing routine cardiac rhythm sampling in patients deemed at high risk for AFib. Specific aim 2 is to determine whether routine rhythm sampling in outpatient clinics with high-risk patients can be used cost-effectively in an outpatient clinic without increasing the time it takes for the patient to be seen by a physician. Methods: Participants were recruited across 6 clinic sites across the University of Florida Health Network: University of Florida Health Nephrology, Sleep Center, Ophthalmology, Urology, Neurology, and Pre-Surgical. Participants, aged 18-99 years, who agreed to partake in the study were given a consent form and completed a questionnaire regarding their past medical history and risk factors for cardiovascular disease. Single-lead, 30-second ECGs were taken by the KardiaMobile ECG device. If patients are found to have newly diagnosed AFib, the attending physician is notified, and a 12-lead ECG or standard ECG equivalent will be ordered. Results: As of March 1, 2024, a total of 2339 participants have been enrolled. Of the data collected thus far, the KardiaMobile rhythm strip reported 381 abnormal readings, which are pending analysis from a cardiologist. A total of 78 readings were labeled as possible AFib, 159 readings were labeled unclassified, and 49 were unreadable. Of note, the average age of participants was 61 (SD 10.25) years, and the average self-reported weight was 194 (SD 14.26) pounds. Additionally, 1572 (67.25%) participants report not regularly seeing a cardiologist. Regarding feasibility, the average length of enrolling a patient into the study was 3:30 (SD 0.5) minutes after informed consent was completed, and medical staff across clinic sites (n=25) reported 9 of 10 level of satisfaction with the impact of the screening on clinic flow. Conclusions: Preliminary data show promise regarding the feasibility of using KardiaMobile ECGs for the screening of AFib and prevention of cardiological disease in vulnerable outpatient populations. The use of a single-lead mobile ECG strip can serve as a low-cost, effective AFib screen for implementation across free clinics attempting to provide increased health care accessibility. International Registered Report Identifier (IRRID): DERR1-10.2196/52647 %M 38801762 %R 10.2196/52647 %U https://www.researchprotocols.org/2024/1/e52647 %U https://doi.org/10.2196/52647 %U http://www.ncbi.nlm.nih.gov/pubmed/38801762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57001 %T Assessing and Optimizing Large Language Models on Spondyloarthritis Multi-Choice Question Answering: Protocol for Enhancement and Assessment %A Wang,Anan %A Wu,Yunong %A Ji,Xiaojian %A Wang,Xiangyang %A Hu,Jiawen %A Zhang,Fazhan %A Zhang,Zhanchao %A Pu,Dong %A Tang,Lulu %A Ma,Shikui %A Liu,Qiang %A Dong,Jing %A He,Kunlun %A Li,Kunpeng %A Teng,Da %A Li,Tao %+ Department of Medical Innovation Research, Chinese PLA General Hospital, No.28 Fuxing Road, Wanshou Road, Haidian District, Beijing, China, 86 13810398393, litao301hospital@163.com %K spondyloarthritis %K benchmark %K large language model %K artificial intelligence %K AI %K AI chatbot %K AI-assistant diagnosis %D 2024 %7 24.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Spondyloarthritis (SpA), a chronic inflammatory disorder, predominantly impacts the sacroiliac joints and spine, significantly escalating the risk of disability. SpA’s complexity, as evidenced by its diverse clinical presentations and symptoms that often mimic other diseases, presents substantial challenges in its accurate diagnosis and differentiation. This complexity becomes even more pronounced in nonspecialist health care environments due to limited resources, resulting in delayed referrals, increased misdiagnosis rates, and exacerbated disability outcomes for patients with SpA. The emergence of large language models (LLMs) in medical diagnostics introduces a revolutionary potential to overcome these diagnostic hurdles. Despite recent advancements in artificial intelligence and LLMs demonstrating effectiveness in diagnosing and treating various diseases, their application in SpA remains underdeveloped. Currently, there is a notable absence of SpA-specific LLMs and an established benchmark for assessing the performance of such models in this particular field. Objective: Our objective is to develop a foundational medical model, creating a comprehensive evaluation benchmark tailored to the essential medical knowledge of SpA and its unique diagnostic and treatment protocols. The model, post-pretraining, will be subject to further enhancement through supervised fine-tuning. It is projected to significantly aid physicians in SpA diagnosis and treatment, especially in settings with limited access to specialized care. Furthermore, this initiative is poised to promote early and accurate SpA detection at the primary care level, thereby diminishing the risks associated with delayed or incorrect diagnoses. Methods: A rigorous benchmark, comprising 222 meticulously formulated multiple-choice questions on SpA, will be established and developed. These questions will be extensively revised to ensure their suitability for accurately evaluating LLMs’ performance in real-world diagnostic and therapeutic scenarios. Our methodology involves selecting and refining top foundational models using public data sets. The best-performing model in our benchmark will undergo further training. Subsequently, more than 80,000 real-world inpatient and outpatient cases from hospitals will enhance LLM training, incorporating techniques such as supervised fine-tuning and low-rank adaptation. We will rigorously assess the models’ generated responses for accuracy and evaluate their reasoning processes using the metrics of fluency, relevance, completeness, and medical proficiency. Results: Development of the model is progressing, with significant enhancements anticipated by early 2024. The benchmark, along with the results of evaluations, is expected to be released in the second quarter of 2024. Conclusions: Our trained model aims to capitalize on the capabilities of LLMs in analyzing complex clinical data, thereby enabling precise detection, diagnosis, and treatment of SpA. This innovation is anticipated to play a vital role in diminishing the disabilities arising from delayed or incorrect SpA diagnoses. By promoting this model across diverse health care settings, we anticipate a significant improvement in SpA management, culminating in enhanced patient outcomes and a reduced overall burden of the disease. International Registered Report Identifier (IRRID): DERR1-10.2196/57001 %M 38788208 %R 10.2196/57001 %U https://www.researchprotocols.org/2024/1/e57001 %U https://doi.org/10.2196/57001 %U http://www.ncbi.nlm.nih.gov/pubmed/38788208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46108 %T Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review %A Kelley,Marjorie M %A Powell,Tia %A Camara,Djibril %A Shah,Neha %A Norton,Jenna M %A Deitelzweig,Chelsea %A Vaidy,Nivedha %A Hsiao,Chun-Ju %A Wang,Jing %A Bierman,Arlene S %+ Agency for Health Care Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, United States, 1 (301) 427 1104, arlene.bierman@ahrq.hhs.gov %K caregivers %K carers %K informal caregivers %K family caregivers %K mHealth applications %K telemedicine %K mobile health %K mHealth %K eHealth %K digital health %K apps %K chronic condition %K caregiver %K application %K support %K clinicians %K development %K electronic health record %K implementation %K mobile phone %D 2024 %7 23.5.2024 %9 Review %J J Med Internet Res %G English %X Background: People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. Objective: We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. Methods: Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. Results: We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. Conclusions: Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination. %M 38781588 %R 10.2196/46108 %U https://www.jmir.org/2024/1/e46108 %U https://doi.org/10.2196/46108 %U http://www.ncbi.nlm.nih.gov/pubmed/38781588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53761 %T Application of Machine Learning in Multimorbidity Research: Protocol for a Scoping Review %A Anthonimuthu,Danny Jeganathan %A Hejlesen,Ole %A Zwisler,Ann-Dorthe Olsen %A Udsen,Flemming Witt %+ Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark, 45 41627109, dant@hst.aau.dk %K multimorbidity %K multiple long-term conditions %K machine learning %K artificial intelligence %K scoping review %K protocol %K chronic conditions %K health care system %K health care %D 2024 %7 20.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multimorbidity, defined as the coexistence of multiple chronic conditions, poses significant challenges to health care systems on a global scale. It is associated with increased mortality, reduced quality of life, and increased health care costs. The burden of multimorbidity is expected to worsen if no effective intervention is taken. Machine learning has the potential to assist in addressing these challenges since it offers advanced analysis and decision-making capabilities, such as disease prediction, treatment development, and clinical strategies. Objective: This paper represents the protocol of a scoping review that aims to identify and explore the current literature concerning the use of machine learning for patients with multimorbidity. More precisely, the objective is to recognize various machine learning models, the patient groups involved, features considered, types of input data, the maturity of the machine learning algorithms, and the outcomes from these machine learning models. Methods: The scoping review will be based on the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Five databases (PubMed, Embase, IEEE, Web of Science, and Scopus) are chosen to conduct a literature search. Two reviewers will independently screen the titles, abstracts, and full texts of identified studies based on predefined eligibility criteria. Covidence (Veritas Health Innovation Ltd) will be used as a tool for managing and screening papers. Only studies that examine more than 1 chronic disease or individuals with a single chronic condition at risk of developing another will be included in the scoping review. Data from the included studies will be collected using Microsoft Excel (Microsoft Corp). The focus of the data extraction will be on bibliographical information, objectives, study populations, types of input data, types of algorithm, performance, maturity of the algorithms, and outcome. Results: The screening process will be presented in a PRISMA-ScR flow diagram. The findings of the scoping review will be conveyed through a narrative synthesis. Additionally, data extracted from the studies will be presented in more comprehensive formats, such as charts or tables. The results will be presented in a forthcoming scoping review, which will be published in a peer-reviewed journal. Conclusions: To our knowledge, this may be the first scoping review to investigate the use of machine learning in multimorbidity research. The goal of the scoping review is to summarize the field of literature on machine learning in patients with multiple chronic conditions, highlight different approaches, and potentially discover research gaps. The results will offer insights for future research within this field, contributing to developments that can enhance patient outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/53761 %M 38767948 %R 10.2196/53761 %U https://www.researchprotocols.org/2024/1/e53761 %U https://doi.org/10.2196/53761 %U http://www.ncbi.nlm.nih.gov/pubmed/38767948 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e53129 %T Barriers and Facilitators to the Implementation of Virtual Reality Interventions for People With Chronic Pain: Scoping Review %A Elser,Alexander %A Lange,Marina %A Kopkow,Christian %A Schäfer,Axel Georg %+ Faculty of Social Work and Health, HAWK Hildesheim/Holzminden/Göttingen University of Applied Sciences and Arts, Goschentor 1, Hildesheim, Germany, 49 5121881121, alexander.elser@hawk.de %K virtual reality %K VR %K chronic pain %K implementation science %K scoping review %K barriers %K facilitators %D 2024 %7 15.5.2024 %9 Review %J JMIR XR Spatial Comput %G English %X Background: Chronic pain is a growing health problem worldwide with a significant impact on individuals and societies. In regard to treatment, there is a gap between guideline recommendations and common practice in health care, especially concerning cognitive and psychological interventions. Virtual reality (VR) may provide a way to improve this situation. A growing body of evidence indicates that VR therapy has positive effects on pain and physical function. However, there is limited knowledge about barriers and facilitators to the implementation of VR interventions for people with chronic pain in health care settings. Objective: The aim of this study was to identify and analyze the barriers and facilitators involved in implementing VR interventions for people with chronic pain. Methods: We conducted a scoping review of the German and English literature using the MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, LILACS, and Web of Science (inception to November 2023) databases, including quantitative, qualitative, and mixed methods studies reporting barriers and facilitators to the implementation of VR interventions for people with chronic pain, as reported by patients or health care professionals. Two reviewers systematically screened the abstracts and full texts of retrieved articles according to the inclusion criteria. All mentioned barriers and facilitators were extracted and categorized according to the Theoretical Domains Framework (TDF). Results: The database search resulted in 1864 records after removal of duplicates. From the 14 included studies, 30 barriers and 33 facilitators from the patient perspective and 2 facilitators from the health care professional perspective were extracted. Barriers reported by people with chronic pain were most frequently assigned to the TDF domains environmental context (60%) and skills (16.7%). Most facilitators were found in three domains for both the patients and health care professionals: beliefs about consequences (30.3%), emotions (18.2%), and environmental context (18.2%). Conclusions: The findings of this review can inform the development of strategies for future implementations of VR interventions for people with chronic pain. Additionally, further research should address knowledge gaps about the perspective of health care professionals regarding the implementation of VR interventions for people with chronic pain. %R 10.2196/53129 %U https://xr.jmir.org/2024/1/e53129 %U https://doi.org/10.2196/53129 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50851 %T Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study %A Tran,Steven %A Smith,Lorraine %A Carter,Stephen %+ School of Pharmacy, Faculty of Medicine and Health, University of Sydney, A15, Science Rd, Camperdown, 2050, Australia, 61 93512222, steventran@hotmail.com.au %K qualitative %K patient %K perspectives %K gamification %K incentives %K mobile app %K mobile health %K mHealth %K medication adherence %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. Objective: This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions. Methods: A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. Results: Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively. Conclusions: The study’s findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework. %M 38743461 %R 10.2196/50851 %U https://mhealth.jmir.org/2024/1/e50851 %U https://doi.org/10.2196/50851 %U http://www.ncbi.nlm.nih.gov/pubmed/38743461 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47064 %T Giving a Voice to Patients With Smell Disorders Associated With COVID-19: Cross-Sectional Longitudinal Analysis Using Natural Language Processing of Self-Reports %A Menger,Nick S %A Tognetti,Arnaud %A Farruggia,Michael C %A Mucignat,Carla %A Bhutani,Surabhi %A Cooper,Keiland W %A Rohlfs Domínguez,Paloma %A Heinbockel,Thomas %A Shields,Vonnie D C %A D'Errico,Anna %A Pereda-Loth,Veronica %A Pierron,Denis %A Koyama,Sachiko %A Croijmans,Ilja %+ Department of Molecular Medicine, University of Padova, Via Francesco Marzolo, Padua, 35131, Italy, 39 0498275304, carla.mucignat@unipd.it %K parosmia %K anosmia %K phantosmia %K hyposmia %K hyperosmia %K long-hauler %K sentiment classification %K web-based study %K COVID-19 %K smell disorders %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Smell disorders are commonly reported with COVID-19 infection. The smell-related issues associated with COVID-19 may be prolonged, even after the respiratory symptoms are resolved. These smell dysfunctions can range from anosmia (complete loss of smell) or hyposmia (reduced sense of smell) to parosmia (smells perceived differently) or phantosmia (smells perceived without an odor source being present). Similar to the difficulty that people experience when talking about their smell experiences, patients find it difficult to express or label the symptoms they experience, thereby complicating diagnosis. The complexity of these symptoms can be an additional burden for patients and health care providers and thus needs further investigation. Objective: This study aims to explore the smell disorder concerns of patients and to provide an overview for each specific smell disorder by using the longitudinal survey conducted in 2020 by the Global Consortium for Chemosensory Research, an international research group that has been created ad hoc for studying chemosensory dysfunctions. We aimed to extend the existing knowledge on smell disorders related to COVID-19 by analyzing a large data set of self-reported descriptive comments by using methods from natural language processing. Methods: We included self-reported data on the description of changes in smell provided by 1560 participants at 2 timepoints (second survey completed between 23 and 291 days). Text data from participants who still had smell disorders at the second timepoint (long-haulers) were compared with the text data of those who did not (non–long-haulers). Specifically, 3 aims were pursued in this study. The first aim was to classify smell disorders based on the participants’ self-reports. The second aim was to classify the sentiment of each self-report by using a machine learning approach, and the third aim was to find particular food and nonfood keywords that were more salient among long-haulers than those among non–long-haulers. Results: We found that parosmia (odds ratio [OR] 1.78, 95% CI 1.35-2.37; P<.001) as well as hyposmia (OR 1.74, 95% CI 1.34-2.26; P<.001) were more frequently reported in long-haulers than in non–long-haulers. Furthermore, a significant relationship was found between long-hauler status and sentiment of self-report (P<.001). Finally, we found specific keywords that were more typical for long-haulers than those for non–long-haulers, for example, fire, gas, wine, and vinegar. Conclusions: Our work shows consistent findings with those of previous studies, which indicate that self-reports, which can easily be extracted online, may offer valuable information to health care and understanding of smell disorders. At the same time, our study on self-reports provides new insights for future studies investigating smell disorders. %M 38728069 %R 10.2196/47064 %U https://publichealth.jmir.org/2024/1/e47064 %U https://doi.org/10.2196/47064 %U http://www.ncbi.nlm.nih.gov/pubmed/38728069 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49841 %T Defining the Subtypes of Long COVID and Risk Factors for Prolonged Disease: Population-Based Case-Crossover Study %A Resendez,Skyler %A Brown,Steven H %A Ruiz Ayala,Hugo Sebastian %A Rangan,Prahalad %A Nebeker,Jonathan %A Montella,Diane %A Elkin,Peter L %+ Department of Biomedical Informatics, University at Buffalo, State University of New York, 77 Goodell Street, Suite 540, Buffalo, NY, 14203, United States, 1 5073581341, elkinp@buffalo.edu %K long COVID %K PASC %K postacute sequelae of COVID-19 %K public health %K policy initiatives %K pandemic %K diagnosis %K COVID-19 treatment %K long COVID cause %K health care support %K public safety %K COVID-19 %K Veterans Affairs %K United States %K COVID-19 testing %K clinician %K mobile phone %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There have been over 772 million confirmed cases of COVID-19 worldwide. A significant portion of these infections will lead to long COVID (post–COVID-19 condition) and its attendant morbidities and costs. Numerous life-altering complications have already been associated with the development of long COVID, including chronic fatigue, brain fog, and dangerous heart rhythms. Objective: We aim to derive an actionable long COVID case definition consisting of significantly increased signs, symptoms, and diagnoses to support pandemic-related clinical, public health, research, and policy initiatives. Methods: This research employs a case-crossover population-based study using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) data generated at Veterans Affairs medical centers nationwide between January 1, 2020, and August 18, 2022. In total, 367,148 individuals with ICD-10-CM data both before and after a positive COVID-19 test were selected for analysis. We compared ICD-10-CM codes assigned 1 to 7 months following each patient’s positive test with those assigned up to 6 months prior. Further, 350,315 patients had novel codes assigned during this window of time. We defined signs, symptoms, and diagnoses as being associated with long COVID if they had a novel case frequency of ≥1:1000, and they significantly increased in our entire cohort after a positive test. We present odds ratios with CIs for long COVID signs, symptoms, and diagnoses, organized by ICD-10-CM functional groups and medical specialty. We used our definition to assess long COVID risk based on a patient’s demographics, Elixhauser score, vaccination status, and COVID-19 disease severity. Results: We developed a long COVID definition consisting of 323 ICD-10-CM diagnosis codes grouped into 143 ICD-10-CM functional groups that were significantly increased in our 367,148 patient post–COVID-19 population. We defined 17 medical-specialty long COVID subtypes such as cardiology long COVID. Patients who were COVID-19–positive developed signs, symptoms, or diagnoses included in our long COVID definition at a proportion of at least 59.7% (268,320/449,450, based on a denominator of all patients who were COVID-19–positive). The long COVID cohort was 8 years older with more comorbidities (2-year Elixhauser score 7.97 in the patients with long COVID vs 4.21 in the patients with non–long COVID). Patients who had a more severe bout of COVID-19, as judged by their minimum oxygen saturation level, were also more likely to develop long COVID. Conclusions: An actionable, data-driven definition of long COVID can help clinicians screen for and diagnose long COVID, allowing identified patients to be admitted into appropriate monitoring and treatment programs. This long COVID definition can also support public health, research, and policy initiatives. Patients with COVID-19 who are older or have low oxygen saturation levels during their bout of COVID-19, or those who have multiple comorbidities should be preferentially watched for the development of long COVID. %M 38687984 %R 10.2196/49841 %U https://publichealth.jmir.org/2024/1/e49841 %U https://doi.org/10.2196/49841 %U http://www.ncbi.nlm.nih.gov/pubmed/38687984 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54388 %T Leveraging AI and Machine Learning to Develop and Evaluate a Contextualized User-Friendly Cough Audio Classifier for Detecting Respiratory Diseases: Protocol for a Diagnostic Study in Rural Tanzania %A Isangula,Kahabi Ganka %A Haule,Rogers John %+ School of Nursing and Midwifery, Aga Khan University, Salama House, 344 Urambo St, PO Box 125, Dar Es Salaam, 255, United Republic of Tanzania, 255 754030726, kahabi.isangula@aku.edu %K artificial intelligence %K machine learning %K respiratory diseases %K cough classifiers %K Tanzania %K Africa %K mobile phone %K user-friendly %K cough %K detecting respiratory disease %K diagnostic study %K tuberculosis %K asthma %K chronic obstructive pulmonary disease %K treatment %K management %K noninvasive %K rural %K cross-sectional research %K analysis %K cough sound %D 2024 %7 23.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Respiratory diseases, including active tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD), constitute substantial global health challenges, necessitating timely and accurate diagnosis for effective treatment and management. Objective: This research seeks to develop and evaluate a noninvasive user-friendly artificial intelligence (AI)–powered cough audio classifier for detecting these respiratory conditions in rural Tanzania. Methods: This is a nonexperimental cross-sectional research with the primary objective of collection and analysis of cough sounds from patients with active TB, asthma, and COPD in outpatient clinics to generate and evaluate a noninvasive cough audio classifier. Specialized cough sound recording devices, designed to be nonintrusive and user-friendly, will facilitate the collection of diverse cough sound samples from patients attending outpatient clinics in 20 health care facilities in the Shinyanga region. The collected cough sound data will undergo rigorous analysis, using advanced AI signal processing and machine learning techniques. By comparing acoustic features and patterns associated with TB, asthma, and COPD, a robust algorithm capable of automated disease discrimination will be generated facilitating the development of a smartphone-based cough sound classifier. The classifier will be evaluated against the calculated reference standards including clinical assessments, sputum smear, GeneXpert, chest x-ray, culture and sensitivity, spirometry and peak expiratory flow, and sensitivity and predictive values. Results: This research represents a vital step toward enhancing the diagnostic capabilities available in outpatient clinics, with the potential to revolutionize the field of respiratory disease diagnosis. Findings from the 4 phases of the study will be presented as descriptions supported by relevant images, tables, and figures. The anticipated outcome of this research is the creation of a reliable, noninvasive diagnostic cough classifier that empowers health care professionals and patients themselves to identify and differentiate these respiratory diseases based on cough sound patterns. Conclusions: Cough sound classifiers use advanced technology for early detection and management of respiratory conditions, offering a less invasive and more efficient alternative to traditional diagnostics. This technology promises to ease public health burdens, improve patient outcomes, and enhance health care access in under-resourced areas, potentially transforming respiratory disease management globally. International Registered Report Identifier (IRRID): PRR1-10.2196/54388 %M 38652526 %R 10.2196/54388 %U https://www.researchprotocols.org/2024/1/e54388 %U https://doi.org/10.2196/54388 %U http://www.ncbi.nlm.nih.gov/pubmed/38652526 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54833 %T Impact of Digital Interventions on the Treatment Burden of Patients With Chronic Conditions: Protocol for a Systematic Review %A Polus,Manria %A Keikhosrokiani,Pantea %A Korhonen,Olli %A Behutiye,Woubshet %A Isomursu,Minna %+ Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran Katu 1, Oulu, 90570, Finland, 358 294 48 0000, manria.polus@oulu.fi %K chronic illness %K treatment burden %K eHealth %K mHealth %K digital health %K mobile health %D 2024 %7 23.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is great potential for delivering cost-effective, quality health care for patients with chronic conditions through digital interventions. Managing chronic conditions often includes a substantial workload required for adhering to the treatment regimen and negative consequences on the patient’s function and well-being. This treatment burden affects adherence to treatment and disease outcomes. Digital interventions can potentially exacerbate the burden but also alleviate it. Objective: The objective of this review is to identify, summarize, and synthesize the evidence of how digital interventions impact the treatment burden of people with chronic conditions. Methods: The search, selection, and data synthesis processes were designed according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015. A systematic search was conducted on October 16, 2023, from databases PubMed, Scopus, Web of Science, ACM, PubMed Central, and CINAHL. Results: Preliminary searches have been conducted, and screening has been started. The review is expected to be completed in October 2024. Conclusions: As the number of patients with chronic conditions is increasing, it is essential to design new digital interventions for managing chronic conditions in a way that supports patients with their treatment burden. To the best of our knowledge, the proposed systematic review will be the first review that investigates the impact of digital interventions on the treatment burden of patients. The results of this review will contribute to the field of health informatics regarding knowledge of the treatment burden associated with digital interventions and practical implications for developing better digital health care for patients with chronic conditions. Trial Registration: PROSPERO CRD42023477605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477605 International Registered Report Identifier (IRRID): DERR1-10.2196/54833 %M 38652531 %R 10.2196/54833 %U https://www.researchprotocols.org/2024/1/e54833 %U https://doi.org/10.2196/54833 %U http://www.ncbi.nlm.nih.gov/pubmed/38652531 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55829 %T Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study %A Novella-Navarro,Marta %A Iniesta-Chamorro,Jose M %A Benavent,Diego %A Bachiller-Corral,Javier %A Calvo-Aranda,Enrique %A Borrell,Helena %A Berbel-Arcobé,Laura %A Navarro-Compan,Victoria %A Michelena,Xabier %A Lojo-Oliveira,Leticia %A Arroyo-Palomo,Jaime %A Diaz-Almiron,Mariana %A García García,Verónica %A Monjo-Henry,Irene %A Gómez González,Claudia María %A Gomez,Enrique J %A Balsa,Alejandro %A Plasencia-Rodríguez,Chamaida %+ Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, 28046, Spain, 34 9172777108, mnovellanavarro@gmail.com %K digital health %K mHealth, telemonitoring, rheumatic musculoskeletal diseases %K digital resources, mixed attention model %K rheumatic disease %K musculoskeletal diseases %K chronic diseases %K pain %K inflammation %K antirheumatic drugs %K telemonitoring %K rheumatology %K hybrid care model %K care model %K MAM %K implementation %K clinical outcome %D 2024 %7 22.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient’s quality of life. Often, delays in outpatient consultations or the patient’s difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. Objective: The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. Methods: This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. Results: Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. Conclusions: This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. Trial Registration: ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306 International Registered Report Identifier (IRRID): PRR1-10.2196/55829 %M 38501508 %R 10.2196/55829 %U https://www.researchprotocols.org/2024/1/e55829 %U https://doi.org/10.2196/55829 %U http://www.ncbi.nlm.nih.gov/pubmed/38501508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52344 %T Machine Learning–Based Prediction of Changes in the Clinical Condition of Patients With Complex Chronic Diseases: 2-Phase Pilot Prospective Single-Center Observational Study %A Alvarez-Romero,Celia %A Polo-Molina,Alejandro %A Sánchez-Úbeda,Eugenio Francisco %A Jimenez-De-Juan,Carlos %A Cuadri-Benitez,Maria Pastora %A Rivas-Gonzalez,Jose Antonio %A Portela,Jose %A Palacios,Rafael %A Rodriguez-Morcillo,Carlos %A Muñoz,Antonio %A Parra-Calderon,Carlos Luis %A Nieto-Martin,Maria Dolores %A Ollero-Baturone,Manuel %A Hernández-Quiles,Carlos %+ Internal Medicine Department, Virgen del Rocio University Hospital, Av Manuel Siurot s/n, Sevilla, 41013, Spain, 34 697950012, quiles_es@yahoo.es %K patients with complex chronic diseases %K functional impairment %K Barthel Index %K artificial intelligence %K machine learning %K prediction model %K pilot study %K chronic patients %K chronic %K development study %K prognostic %K diagnostic %K therapeutic %K wearable %K wearables %K wearable activity tracker %K mobility device %K device %K physical activity %K caregiver %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Functional impairment is one of the most decisive prognostic factors in patients with complex chronic diseases. A more significant functional impairment indicates that the disease is progressing, which requires implementing diagnostic and therapeutic actions that stop the exacerbation of the disease. Objective: This study aimed to predict alterations in the clinical condition of patients with complex chronic diseases by predicting the Barthel Index (BI), to assess their clinical and functional status using an artificial intelligence model and data collected through an internet of things mobility device. Methods: A 2-phase pilot prospective single-center observational study was designed. During both phases, patients were recruited, and a wearable activity tracker was allocated to gather physical activity data. Patients were categorized into class A (BI≤20; total dependence), class B (2060; moderate or mild dependence, or independent). Data preprocessing and machine learning techniques were used to analyze mobility data. A decision tree was used to achieve a robust and interpretable model. To assess the quality of the predictions, several metrics including the mean absolute error, median absolute error, and root mean squared error were considered. Statistical analysis was performed using SPSS and Python for the machine learning modeling. Results: Overall, 90 patients with complex chronic diseases were included: 50 during phase 1 (class A: n=10; class B: n=20; and class C: n=20) and 40 during phase 2 (class B: n=20 and class C: n=20). Most patients (n=85, 94%) had a caregiver. The mean value of the BI was 58.31 (SD 24.5). Concerning mobility aids, 60% (n=52) of patients required no aids, whereas the others required walkers (n=18, 20%), wheelchairs (n=15, 17%), canes (n=4, 7%), and crutches (n=1, 1%). Regarding clinical complexity, 85% (n=76) met patient with polypathology criteria with a mean of 2.7 (SD 1.25) categories, 69% (n=61) met the frailty criteria, and 21% (n=19) met the patients with complex chronic diseases criteria. The most characteristic symptoms were dyspnea (n=73, 82%), chronic pain (n=63, 70%), asthenia (n=62, 68%), and anxiety (n=41, 46%). Polypharmacy was presented in 87% (n=78) of patients. The most important variables for predicting the BI were identified as the maximum step count during evening and morning periods and the absence of a mobility device. The model exhibited consistency in the median prediction error with a median absolute error close to 5 in the training, validation, and production-like test sets. The model accuracy for identifying the BI class was 91%, 88%, and 90% in the training, validation, and test sets, respectively. Conclusions: Using commercially available mobility recording devices makes it possible to identify different mobility patterns and relate them to functional capacity in patients with polypathology according to the BI without using clinical parameters. %M 38640473 %R 10.2196/52344 %U https://formative.jmir.org/2024/1/e52344 %U https://doi.org/10.2196/52344 %U http://www.ncbi.nlm.nih.gov/pubmed/38640473 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50832 %T Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach %A Blanchard,Marc %A Koller,Cinja Nadana %A Azevedo,Pedro Ming %A Prétat,Tiffany %A Hügle,Thomas %+ Department of Rheumatology, Lausanne University Hospital (CHUV), University of Lausanne, Pierre-Decker 4, Lausanne, 1011, Switzerland, 41 794266883, marc_blanchard@bluewin.ch %K digital health %K patient preference %K user experience %K patient-centricity %K platform %K development %K fibromyalgia %K self-management %K quality of life %K patient outcome %K musculoskeletal %K usability testing %K digital health solution %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30% of patients with post–COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. Objective: This research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app’s design and functionality, the study intends to facilitate better self-management practices and improve adherence. Methods: Using an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients’ expectations regarding design features, content, and usability to steer the iterative app development. Results: The study uncovered crucial insights from patient surveys and usability testing, which influenced the app’s design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. Conclusions: Incorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID): RR2-10.2196/32193 %M 38639986 %R 10.2196/50832 %U https://formative.jmir.org/2024/1/e50832 %U https://doi.org/10.2196/50832 %U http://www.ncbi.nlm.nih.gov/pubmed/38639986 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54406 %T Psychotherapy for Ketamine’s Enhanced Durability in Chronic Neuropathic Pain: Protocol for a Pilot Randomized Controlled Trial %A Goel,Akash %A Kapoor,Bhavya %A Chan,Hillary %A Ladha,Karim %A Katz,Joel %A Clarke,Hance %A Pazmino-Canizares,Janneth %A Thomas,Zaaria %A Philip,Kaylyssa %A Mattina,Gabriella %A Ritvo,Paul %+ Department of Anesthesia and Pain Medicine, St Michael’s Hospital, 30 Bond Street, 65-501 Donnelly South, Toronto, ON, M5B1W8, Canada, 1 4168645071, akash.goel@unityhealth.to %K 3-arm parallel group %K cognitive behavior therapy %K ketamine hydrochloride %K pain intensity %K pain interference %K psychotherapy %K randomized controlled trial %D 2024 %7 17.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain affects approximately 8 million Canadians (~20%), impacting their physical and mental health while burdening the health care system with costs of upwards of US $60 billion a year. Indeed, patients are often trialed on numerous medications over several years without reductions to their symptoms. Therefore, there is an urgent need to identify new therapies for chronic pain to improve patients’ quality of life, increase the availability of treatment options, and reduce the burden on the health care system. Objective: The primary objective of this study is to examine the feasibility of a parallel 3-arm pilot randomized controlled trial whereby patients are randomized to either intravenous ketamine alone, cognitive behavioral therapy (CBT) and mindfulness meditation (MM) training (CBT/MM), or the combination of intravenous ketamine and CBT/MM. The secondary outcome is to assess the durability and efficacy of combination intravenous ketamine and CBT/MM for treatment of chronic pain as compared to CBT/MM or intravenous ketamine alone (assessed at week 20 of the study). Methods: This is a single-center, 16-week, 3-arm pilot study that will take place at the Chronic Pain Clinic at St. Michael’s Hospital, Toronto, Ontario, which receives 1000 referrals per year. Patients will be enrolled in the study for a total of 20 weeks. Participants who are allocated CBT/MM therapy will receive remote weekly psychotherapy from week 1 to week 16, inclusive of health coaching administered through the NexJ Health Inc (NexJ Health) platform. Patients who are allocated ketamine-infusion therapy will receive monthly ketamine infusion treatments on weeks 2, 7, and 12. Patients who are allocated ketamine+CBT/MM will receive weekly psychotherapy from weeks 1 to 16, inclusive, as well as ketamine infusion treatments on weeks 2, 7, and 12. We will be assessing recruitment rates, consent rates, withdrawal rates, adherence, missing data, and adverse events as pilot outcome measures. Secondary clinical outcomes include changes relative to baseline in pain intensity and pain interference. Results: As of November 1, 2023, the recruitment process has not been initiated. Given the recruitment, consent, and intervention target of 30 participants for this feasibility study, with each patient undergoing monitoring and treatments for a course of 20 weeks, we expect to complete the study by December 2025. Conclusions: This study assesses the feasibility of conducting a 3-arm randomized controlled trial to examine the effects of ketamine administration with the concurrent use of CBT/MM in a population with chronic neuropathic pain. The results of this pilot randomized controlled trial will inform the development of a larger-scale randomized controlled trial. Future studies will be aimed at including a sufficiently powered sample that will inform decisions about optimal treatment calibration and treatment effect duration. Trial Registration: ClinicalTrials.gov NCT05639322; https://classic.clinicaltrials.gov/ct2/show/NCT05639322 International Registered Report Identifier (IRRID): PRR1-10.2196/54406 %M 38630524 %R 10.2196/54406 %U https://www.researchprotocols.org/2024/1/e54406 %U https://doi.org/10.2196/54406 %U http://www.ncbi.nlm.nih.gov/pubmed/38630524 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50434 %T From the Cochrane Library: Leukotriene Receptor Antagonists for Eczema %A Toledo,Lauren Marie %A Rodriguez,Ramiro %A Sivesind,Torunn E %A Vakirlis,Efstratios %A Kojima,Reiji %A Dellavalle,Robert P %+ University of Colorado School of Medicine, 1700 N Wheeling St, Rm E1-342, Aurora, CO, 80045, United States, 1 720 857 5562, robert.dellavalle@gmail.com %K eczema %K atopic dermatitis %K leukotriene receptor antagonists %K systematic reviews %K dermatitis %K inflammatory %K skin disease %K skin %K clinical %K medications %K management %K receptor %K antagonist %D 2024 %7 12.4.2024 %9 Research Letter %J JMIR Dermatol %G English %X %M 38607671 %R 10.2196/50434 %U https://derma.jmir.org/2024/1/e50434 %U https://doi.org/10.2196/50434 %U http://www.ncbi.nlm.nih.gov/pubmed/38607671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55795 %T Examining and Comparing the Validity and Reproducibility of Scales to Determine the Variety of Vegetables Consumed: Validation Study %A Ominami,Kaya %A Kushida,Osamu %+ Department of Nutrition and Life Sciences, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan, 81 542645832, kushida@u-shizuoka-ken.ac.jp %K vegetable %K variety %K scale %K validity %K reproducibility %K dietary records %K nutrition %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have reported that vegetable variety reduces the risk for noncommunicable diseases independent of the amount consumed. Objective: This study aimed to examine and compare the validity and reproducibility of several scales to determine vegetable variety. Methods: In total, 23 nutrition students in Japan reported their vegetable intake over the past month using a self-administered questionnaire between July and August 2021. Specifically, four scales were used: (1) a single question regarding the number of vegetables consumed (scale A); (2) a scale containing 9 vegetable subgroups included in the brief-type self-administered diet history questionnaire (scale B); (3) a scale containing 19 vegetable items included in a self-administered diet history questionnaire (scale C); and (4) a scale containing 20 vegetable items from the Ranking of Vegetable Consumers in Japan, which was analyzed based on a report on the National Health and Nutrition Survey in Japan (scale D). Scale validity was assessed by correlation with the number of vegetables consumed, which was collected from dietary records for 7 consecutive days. Reproducibility was assessed by test-retest reliability. Results: Regarding the validity of the 4 scales, significant correlations were found between scales C (ρ=0.51) and D (ρ=0.44) with vegetable variety based on dietary records, but scales A (ρ=0.28) and B (ρ=0.22) were not significantly correlated. Reproducibility showed a significant correlation in scale B (ρ=0.45) and strong correlations in scales C (ρ=0.73) and D (ρ=0.75). Conclusions: The scales for vegetable items have acceptable validity and reproducibility compared to the scales that used a single question or vegetable subgroup and, therefore, may determine the variety of vegetables consumed. %M 38603775 %R 10.2196/55795 %U https://formative.jmir.org/2024/1/e55795 %U https://doi.org/10.2196/55795 %U http://www.ncbi.nlm.nih.gov/pubmed/38603775 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47525 %T National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study %A Chabrak,Sonia %A Haggui,Abdeddayem %A Allouche,Emna %A Ouali,Sana %A Ben Halima,Afef %A Kacem,Slim %A Krichen,Salma %A Marrakchi,Sonia %A Fehri,Wafa %A Mourali,Mohamed Sami %A Jabbari,Zeineb %A Ben Halima,Manel %A Neffati,Elyes %A Heraiech,Aymen  %A Slim,Mehdi %A Kachboura,Salem %A Gamra,Habib %A Hassine,Majed %A Kraiem,Sondes %A Kammoun,Sofien %A Bezdah,Leila %A Jridi,Gouider %A Bouraoui,Hatem %A Kammoun,Samir %A Hammami,Rania %A Chettaoui,Rafik %A Ben Ameur,Youssef %A Azaiez,Fares %A Tlili,Rami %A Battikh,Kais %A Ben Slima,Hedi %A Chrigui,Rim %A Fazaa,Samia %A Sanaa,Islem %A Ellouz,Yassine %A Mosrati,Mohamed %A Milouchi,Sami %A Jarmouni,Soumaya %A Ayadi,Wacef %A Akrout,Malek %A Razgallah,Rabie %A Neffati,Wissal %A Drissa,Meriem %A Charfeddine,Selma %A Abdessalem,Salem %A Abid,Leila %A Zakhama,Lilia %+ Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Elkhadhra avenue, X 2 Pathway, Tunis, 1003, Tunisia, 216 22 889 349, chabraksonia04@gmail.com %K Tunisia %K study %K pacemaker %K implantable cardioverter defibrillator %K cardiac resynchronization therapy %K design %K complication %D 2024 %7 8.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. Objective: The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. Methods: The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). Results: The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. Conclusions: This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial Registration: ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID): RR1-10.2196/47525 %M 38588529 %R 10.2196/47525 %U https://www.researchprotocols.org/2024/1/e47525 %U https://doi.org/10.2196/47525 %U http://www.ncbi.nlm.nih.gov/pubmed/38588529 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48947 %T Sex- and Age-Specific Prevalence of Osteopenia and Osteoporosis: Sampling Survey %A Fan,Yao %A Li,Qun %A Liu,Yu %A Miao,Jing %A Zhao,Ting %A Cai,Jinxin %A Liu,Min %A Cao,Jun %A Xu,Haifeng %A Wei,Lai %A Li,Mengxia %A Shen,Chong %+ Department of Epidemiology, School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 25 86868443, sc@njmu.edu.cn %K cross-sectional study %K osteopenia %K osteoporosis %K prevalence %K quantitative ultrasound %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Osteopenia and osteoporosis are posing a long-term influence on the aging population’s health contributing to a higher risk of mortality, loss of autonomy, hospitalization, and huge health system costs and social burden. Therefore, more pertinent data are needed to demonstrate the current state of osteoporosis. Objective: This sampling survey seeks to assess the trends in the prevalence of osteopenia and osteoporosis in a Chinese Han population. Methods: A community-based cross-sectional study involving 16,377 participants used a multistage sampling method. Bone mineral density was measured using the quantitative ultrasonic densitometry. Student t test and Mann-Whitney U test were used to test the difference between normally and nonnormally distributed quantitative variables between male and female participants. A chi-square (χ2) test was used to compare categorized variables. Stratified analysis was conducted to describe the prevalence rates of osteoporosis (T score ≤–2.5) and osteopenia (T score –2.5 to –1.0) across age, sex, calcium intake, and menopause. A direct standardization method was used to calculate the age-standardized prevalence rates of osteoporosis and osteopenia. T-score was further categorized into quartiles (T1-T4) by age- and sex-specified groups. Results: The prevalence rates of osteopenia and osteoporosis were 40.5% (6633/16,377) and 7.93% (1299/16,377), respectively, and the age-standardized prevalence rates were 27.32% (287,877,129.4/1,053,861,940) and 3.51% (36,974,582.3/1,053,861,940), respectively. There was an increase in osteopenia and osteoporosis prevalence from 21.47% (120/559) to 56.23% (754/1341) and 0.89% (5/559) to 17.23% (231/1341), respectively, as age increased from 18 years to 75 years old. The prevalence rates of osteopenia and osteoporosis were significantly higher in female participants (4238/9645, 43.94% and 1130/9645, 11.72%) than in male participants (2395/6732, 35.58% and 169/6732, 2.51%; P<.001), and in postmenopausal female participants (3638/7493, 48.55% and 1053/7493, 14.05%) than in premenopausal female participants (538/2026, 26.55% and 53/2026, 2.62%; P<.001). In addition, female participants with a history of calcium intake had a lower osteoporosis prevalence rate than female participants without any history of calcium intake in all age groups (P=.004). From low quartile to high quartile of T-score, the prevalence of diabetes mellitus (752/4037, 18.63%; 779/4029, 19.33%; 769/3894, 19.75%; and 869/3879, 22.4%) and dyslipidemia (2228/4036, 55.2%; 2304/4027, 57.21%; 2306/3891, 59.26%; and 2379/3878, 61.35%) were linearly increased (P<.001), while the prevalence of cancer (112/4037, 2.77%; 110/4029, 2.73%; 103/3894, 2.65%; and 77/3879, 1.99%) was decreased (P=.03). Conclusions: Our data imply that as people age, osteopenia and osteoporosis are more common in females than in males, particularly in postmenopausal females than in premenopausal females, and bone mineral density significantly affects the prevalence of chronic diseases. These findings offer information that can be applied to intervention programs meant to prevent or lessen the burden of osteoporosis in China. %M 38578689 %R 10.2196/48947 %U https://publichealth.jmir.org/2024/1/e48947 %U https://doi.org/10.2196/48947 %U http://www.ncbi.nlm.nih.gov/pubmed/38578689 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54352 %T Heat and Acupuncture to Manage Osteoarthritis of the Knee (HARMOKnee): Protocol for an Effectiveness-Implementation Hybrid Randomized Controlled Trial %A Tan,Bryan Yijia %A Tan,Chun Yue %A Tan,Tong Leng %A Yang,Su-Yin %A Chew,Gillian Long Szu %A Tan,Siang Ing %A Chua,Yu Chun %A Yan,Yew Wai %A Soh,Derrick Bing Quan %A Goh,Tong Hwee %A Ng,Pu Jue %A Ng,Yee Teck %A Kuan,Swee Boey %A Teo,Bo Siang %A Kong,Keng He %A Pereira,Michelle Jessica %A Ng,Hui Ping %+ Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, 17 Woodlands Dr 17, Singapore, 737628, Singapore, 65 90057277, bryan_tan@wh.com.sg %K knee osteoarthritis %K acupuncture %K heat therapy %K effectiveness-implementation hybrid study %K randomized controlled trial %K RCT %D 2024 %7 3.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Knee osteoarthritis (KOA) is one of most prevalent and fastest-growing causes of pain, impaired mobility, and poor quality of life in the rapidly aging population worldwide. There is a lack of high-quality evidence on the efficacy of traditional Chinese medicine (TCM), particularly acupuncture, and a lack of KOA practice guidelines that are tailored to unique population demographics and tropical climates. Objective: Our HARMOKnee (Heat and Acupuncture to Manage Osteoarthritis of the Knee) trial aims to address these gaps by evaluating the short- and medium-term clinical and cost-effectiveness of acupuncture with heat therapy in addition to standard care, compared to standard care alone. Through a robust process and economic evaluation, we aim to inform evidence-based practice for patients with KOA to facilitate the large-scale implementation of a comprehensive and holistic model of care that harmonizes elements of Western medicine and TCM. We hypothesize that acupuncture with heat therapy as an adjunct to standard care is clinically more effective than standard care alone. Methods: A multicenter, pragmatic, parallel-arm, single-blinded, effectiveness-implementation hybrid randomized controlled trial will be conducted. We intend to recruit 100 patients with KOA randomized to either the control arm (standard care only) or intervention arm (acupuncture with heat therapy, in addition to standard care). The inclusion criteria are being a community ambulator and having primary KOA, excluding patients with secondary arthritis or previous knee replacements. The primary outcome measure is the Knee Osteoarthritis Outcome Score at 6 weeks. Secondary outcome measures include psychological, physical, quality of life, satisfaction, and global outcome measures at 6, 12, and 26 weeks. A mixed method approach through an embedded process evaluation will facilitate large-scale implementation. An economic evaluation will be performed to assess financial sustainability. Results: Patient enrollment has been ongoing since August 2022. The recruitment process is anticipated to conclude by July 2024, and the findings will be analyzed and publicized as they are obtained. As of November 6, 2023, our patient enrollment stands at 65 individuals. Conclusions: The findings of our HARMOKnee study will contribute substantial evidence to the current body of literature regarding the effectiveness of acupuncture treatment for KOA. Additionally, we aim to facilitate the creation of standardized national guidelines for evidence-based practice that are specifically tailored to our unique population demographics. Furthermore, we seek to promote the adoption and integration of acupuncture and heat therapy into existing treatment models. Trial Registration: ClinicalTrials.gov NCT05507619; https://clinicaltrials.gov/study/NCT05507619 International Registered Report Identifier (IRRID): DERR1-10.2196/54352 %M 38568718 %R 10.2196/54352 %U https://www.researchprotocols.org/2024/1/e54352 %U https://doi.org/10.2196/54352 %U http://www.ncbi.nlm.nih.gov/pubmed/38568718 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53995 %T Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study %A Bendtsen,Magnus Grønlund %A Schönwandt,Bodil Marie Thuesen %A Rubæk,Mette %A Hitz,Mette Friberg %+ Research Unit, Medical Department, Zealand University Hospital, Lykkebækvej 1, Koege, 4600, Denmark, 45 22893352, mag.bendtsen@gmail.com %K eHealth literacy %K health literacy %K mHealth %K mobile health %K eHealth %K mobile health apps %K self-management %K osteoporosis %K usability %K acceptability %D 2024 %7 1.4.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients’ experiences with these apps are underexplored. Objective: This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app “My Bones.” Methods: Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. Results: Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. Conclusions: Danish patients with osteoporosis are both motivated and capable of using digital health services. The app’s usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services. %M 38557362 %R 10.2196/53995 %U https://www.i-jmr.org/2024/1/e53995 %U https://doi.org/10.2196/53995 %U http://www.ncbi.nlm.nih.gov/pubmed/38557362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47523 %T Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians’ Views on Access, Expectations, and Communication %A Zhong,Yuqiong %A Hahne,Jessica %A Wang,Xiaomin %A Wang,Xuxi %A Wu,Ying %A Zhang,Xin %A Liu,Xing %+ Office of International Cooperation and Exchanges, Xiangya Hospital, Central South University, No 87 Xiangya Road, Kaifu District, Changsha, 410008, China, 86 18229765509, xingliu0706@csu.edu.cn %K China %K internet hospital %K health care access %K telehealth %K doctor-patient relationship %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. Objective: We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. Methods: We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). Results: Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients’ expectations and the reality of limitations regarding both physicians’ availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. Conclusions: This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients’ expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults. %M 38551618 %R 10.2196/47523 %U https://www.jmir.org/2024/1/e47523 %U https://doi.org/10.2196/47523 %U http://www.ncbi.nlm.nih.gov/pubmed/38551618 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55199 %T Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study %A He,Yunfan %A Zhu,Wei %A Wang,Tong %A Chen,Han %A Xin,Junyi %A Liu,Yongcheng %A Lei,Jianbo %A Liang,Jun %+ Department of AI and IT, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Shangcheng District, Hangzhou, 310000, China, 86 571 87783942, junl@zju.edu.cn %K hypertension management %K mobile health %K topic modeling %K satisfaction %K 2-factor model %K comparative study %D 2024 %7 28.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73%) compared with that for American HMAs (73,907/100,125, 73.81%). Chinese users primarily focus on reliability (2165/16,561, 13.07%) and measurement accuracy (2091/16,561, 12.63%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26%) and data synchronization (12,837/100,125, 12.82%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD (β=.354, P<.001), while cost had the most significant impact on ND (β=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD (β=0.312, P<.001), while data synchronization had the most significant impact on ND (β=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. %M 38547475 %R 10.2196/55199 %U https://mhealth.jmir.org/2024/1/e55199 %U https://doi.org/10.2196/55199 %U http://www.ncbi.nlm.nih.gov/pubmed/38547475 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46287 %T Augmenting K-Means Clustering With Qualitative Data to Discover the Engagement Patterns of Older Adults With Multimorbidity When Using Digital Health Technologies: Proof-of-Concept Trial %A Sheng,Yiyang %A Bond,Raymond %A Jaiswal,Rajesh %A Dinsmore,John %A Doyle,Julie %+ NetwellCASALA, Dundalk Institution of Technology, Dublin Road, PJ Carrolls Building, Dundalk Institute of Technology, Co.Louth, Ireland, Dundalk, A91 K584, Ireland, 353 894308214, shengexz@gmail.com %K aging %K digital health %K multimorbidity %K chronic disease %K engagement %K k-means clustering %D 2024 %7 28.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple chronic conditions (multimorbidity) are becoming more prevalent among aging populations. Digital health technologies have the potential to assist in the self-management of multimorbidity, improving the awareness and monitoring of health and well-being, supporting a better understanding of the disease, and encouraging behavior change. Objective: The aim of this study was to analyze how 60 older adults (mean age 74, SD 6.4; range 65-92 years) with multimorbidity engaged with digital symptom and well-being monitoring when using a digital health platform over a period of approximately 12 months. Methods: Principal component analysis and clustering analysis were used to group participants based on their levels of engagement, and the data analysis focused on characteristics (eg, age, sex, and chronic health conditions), engagement outcomes, and symptom outcomes of the different clusters that were discovered. Results: Three clusters were identified: the typical user group, the least engaged user group, and the highly engaged user group. Our findings show that age, sex, and the types of chronic health conditions do not influence engagement. The 3 primary factors influencing engagement were whether the same device was used to submit different health and well-being parameters, the number of manual operations required to take a reading, and the daily routine of the participants. The findings also indicate that higher levels of engagement may improve the participants’ outcomes (eg, reduce symptom exacerbation and increase physical activity). Conclusions: The findings indicate potential factors that influence older adult engagement with digital health technologies for home-based multimorbidity self-management. The least engaged user groups showed decreased health and well-being outcomes related to multimorbidity self-management. Addressing the factors highlighted in this study in the design and implementation of home-based digital health technologies may improve symptom management and physical activity outcomes for older adults self-managing multimorbidity. %M 38546724 %R 10.2196/46287 %U https://www.jmir.org/2024/1/e46287 %U https://doi.org/10.2196/46287 %U http://www.ncbi.nlm.nih.gov/pubmed/38546724 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49130 %T Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review %A Ashraf,Mir Nabila %A Gallant,Natasha L %A Bradley,Cara %+ Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4219, Natasha.Gallant@uregina.ca %K chronic disease %K high-income countries %K digital health %K interventions %K older adults %K quality of life %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. Objective: In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. Methods: We will follow the Arksey and O’Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. Results: This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. Conclusions: This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/49130 %M 38546710 %R 10.2196/49130 %U https://www.researchprotocols.org/2024/1/e49130 %U https://doi.org/10.2196/49130 %U http://www.ncbi.nlm.nih.gov/pubmed/38546710 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47517 %T Association Between Adherence to 24-Hour Movement Guidelines and Noncommunicable Disease Risk in Chinese Adults: Prospective Cohort Study %A Huang,Siyi %A Gu,Yuxuan %A Ali,Shahmir H %A Xue,Jingjing %A Zhang,Ronghua %A Wen,Xu %+ Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, China, 86 13958109105, rhzhang@cdc.zj.cn %K chronic diseases %K 24-hour movement guidelines %K obesity %K noncommunicable disease %K sleep %K risk %K overweight %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The increasing annual global deaths are attributable to noncommunicable chronic diseases (NCDs). Adhering to healthy lifestyle behaviors is associated with lower NCD risk, particularly among individuals with ample movement, enough sleep, and reduced sedentariness. Nevertheless, there are only few prospective assessments on the association of interactions between daily activities with NCD prevention, while the associations between adhering to Canadian 24-Hour Movement Guidelines (24HGs) for adults and NCD risks are still unknown. Compared to the general population, obese and overweight populations are at a higher risk of developing NCDs. Currently, it is unclear whether the health benefits of adhering to 24HGs differ between the general population and the obese population. Objective: This study explores prospective associations between adherence to 24HGs and NCD risks by weight status among overweight and obese adults in China. Methods: This decadal study consists of 9227 adults aged 35 years and older without any major NCDs at enrolment in the China Health and Nutrition Survey (2004-2011) and followed up until 2015. The exposure of interest was the overall score of compliance with 24HGs measured by participants’ self-report, wherein 1 point was assigned for compliance to each component, resulting in an aggregated score ranging from 0 to 3. The primary outcome was the first occurrence of major NCDs (high blood pressure, stroke, diabetes, cancer, and acute myocardial infarction). Log-binomial regression models were used to evaluate the associations. Results: : Overall, 4315 males and 4912 females, with 25,175 person-years of follow-up, were included in our analyses. The average baseline age was 50.21 (SD 11.04) years. Among the overweight and obese groups, those adhering to 1 (risk ratio [RR] 0.37, 95% CI 0.19-0.74; P=.004), 2 (RR 0.37, 95% CI 0.19-0.72; P=.003), and 3 (RR 0.32, 95% CI 0.14-0.73; P=.006) recommendations of 24HGs had a significantly lower NCD risk than those not adhering to any of the activity guidelines. Among the normal or underweight groups, those adhering to 1 (RR 0.49, 95% CI 0.27-0.96; P=.03) and 3 (RR 0.40, 95% CI 0.17-0.94; P=.03) components had a significantly lower NCD risk than those not adhering to any of the activity guidelines. Conclusions: In this prospective study, we found that active adherence to recommendations of 24HGs was associated with lower risks of NCDs, especially among overweight and obese participants. Additionally, overweight and obese individuals who met at least 1 component of 24HGs were at a significantly lower risk for NCDs, but this protective effect was not found among individuals in the normal and underweight groups. Individuals with excess body weight who tend to be more susceptible to health risks may gain greater health benefits than the general population by adhering to the recommendations of 24HGs. %M 38536210 %R 10.2196/47517 %U https://publichealth.jmir.org/2024/1/e47517 %U https://doi.org/10.2196/47517 %U http://www.ncbi.nlm.nih.gov/pubmed/38536210 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54342 %T Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment %A MacLean,R Ross %A Ankawi,Brett %A Driscoll,Mary A %A Gordon,Melissa A %A Frankforter,Tami L %A Nich,Charla %A Szollosy,Sara K %A Loya,Jennifer M %A Brito,Larissa %A Ribeiro,Margaridha I P %A Edmond,Sara N %A Becker,William C %A Martino,Steve %A Sofuoglu,Mehmet %A Heapy,Alicia A %+ VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, United States, 1 2039325711, ross.maclean@yale.edu %K chronic pain %K digital treatment %K medications for opioid use disorder %K methadone %K opioid use disorder %D 2024 %7 20.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. Objective: This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. Methods: Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. Results: The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. Conclusions: Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576 International Registered Report Identifier (IRRID): DERR1-10.2196/54342 %M 38506917 %R 10.2196/54342 %U https://www.researchprotocols.org/2024/1/e54342 %U https://doi.org/10.2196/54342 %U http://www.ncbi.nlm.nih.gov/pubmed/38506917 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52469 %T Patients’ Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Protocol for a Systematic Review and Thematic Synthesis %A Main,Ashleigh %A McCartney,Haruno %A Ibrar,Maryam %A Rai,Harleen Kaur %A Muirhead,Fiona %A Mavroeidi,Alexandra %A Maguire,Roma %+ Department of Computer and Information Sciences, University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 (0)141 552 4400, ashleigh.main@strath.ac.uk %K chronic pain %K digital health %K digital tool %K digital health intervention %K mHealth %K eHealth %K pain-management %K person-centered %K experience %K protocol %K patients' experiences %K patient experiences %K self-management %K systematic review %K thematic synthesis %K protocol. %D 2024 %7 7.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a highly prevalent condition that requires multidisciplinary treatment. However, in the United Kingdom, access to specialist pain clinics where patients can receive medical multidisciplinary treatment is limited, and provision varies between health boards. As such, self-management of chronic pain using digital tools has been gaining traction recently, but evidence of its effectiveness from clinical-based trials focuses mainly on quantitative outcomes. Objective: This systematic review aims to identify, appraise, and synthesize qualitative evidence on patients’ experiences with digital health interventions (DHIs) for the management of chronic pain. Methods: This systematic review will consider qualitative and mixed methods studies that explore the experience of patients (aged 18 years and older) with chronic pain engaging in DHIs to manage their pain. MEDLINE Ovid, PubMed, Embase, CINAHL, PsycINFO, and Scopus databases will be searched for published studies. The systematic review will be conducted in accordance with the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Following the 3-step thematic synthesis methodology of Thomas and Harden, titles and abstracts will be screened by 2 independent reviewers (AM and HM), and a third reviewer (MI or FM) will resolve any conflict that arises before the full-text screening. The Critical Appraisal Skills Programme checklist tool will be used to critically appraise the included studies. The extracted data will be imported to NVivo (QSR International), where thematic synthesis will be used to derive analytical themes from the included studies. Results: Themes that encapsulate the patient experience will be identified from qualitative evidence, and these themes will shed light on the perceived benefits and disadvantages, usability, acceptability, and the overall impact digital tools can have on the lives of those with chronic pain. Conclusions: This systematic review will identify, appraise, and synthesize the overall experience of patients engaging in DHI to manage a diverse range of chronic pain conditions. By elaborating the patient experience through qualitative analysis, the findings from this review will enhance our current understanding of the experiences of patients with chronic pain using digital tools for the self-management of their pain and highlight what person-centered elements are essential for future DHI development. Trial Registration: PROSPERO CRD42023445100; http://tinyurl.com/4z77khfs International Registered Report Identifier (IRRID): DERR1-10.2196/52469 %M 38451694 %R 10.2196/52469 %U https://www.researchprotocols.org/2024/1/e52469 %U https://doi.org/10.2196/52469 %U http://www.ncbi.nlm.nih.gov/pubmed/38451694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53728 %T Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial %A Alotaibi,Mansour %A Almutairi,Anwar B %A Alhirsan,Saleh %A Alkazemi,Afrah %A Alharbi,Maha %A Alrashdi,Naif %A Taqi,Ahmad %A Alamiri,Bibi %A Vogtle,Laura %A Alqahtani,Mohammed M %+ Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, 4636 Jawhara Dist, Arar, 73551, Saudi Arabia, 966 558811790, mansour.alotaibi@nbu.edu.sa %K cerebral palsy %K CNS stimulants %K spasticity %K motor performance %K gross motor function %K psychostimulant %K medications %K physical function %K CP %K children %K child %K pediatrics %K pediatric %K impairment %K movement %K central nervous system %K safety %K tolerability %K efficacy %K methylphenidate %K modafinil %K Kuwait %K rehabilitation %K physical therapy %D 2024 %7 5.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. Objective: The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. Methods: This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure–66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. Results: The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. Conclusions: The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. Trial Registration: ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098 International Registered Report Identifier (IRRID): PRR1-10.2196/53728 %M 38441919 %R 10.2196/53728 %U https://www.researchprotocols.org/2024/1/e53728 %U https://doi.org/10.2196/53728 %U http://www.ncbi.nlm.nih.gov/pubmed/38441919 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50415 %T Relationship Between Lipoprotein(a), Renal Function Indicators, and Chronic Kidney Disease: Evidence From a Large Prospective Cohort Study %A Liu,Yingxin %A Wang,Ruoting %A Li,Shuai %A Zhang,Changfa %A Lip,Gregory Y H %A Thabane,Lehana %A Li,Guowei %+ Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, No. 466 Xingang Middle Road, Haizhu district, Guangzhou, 510317, China, 86 020 32640264, lig28@mcmaster.ca %K lipoprotein(a) %K chronic kidney disease %K renal function %K urinary albumin-to-creatinine ratio %K glomerular filtration rate %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Chronic kidney disease (CKD) poses a significant global public health challenge. While lipoprotein(a) (Lp[a]) has been established as a significant factor in cardiovascular disease, its connection to CKD risk remains a topic of debate. Existing evidence indicates diverse risks of kidney disease among individuals with various renal function indicators, even when within the normal range. Objective: This study aims to investigate the joint associations between different renal function indicators and Lp(a) regarding the risks of incident CKD in the general population. Methods: The analysis involved a cohort of 329,415 participants without prior CKD who were enrolled in the UK Biobank between 2006 and 2010. The participants, with an average age of 56 (SD 8.1) years, included 154,298/329,415 (46.84%) males. At baseline, Lp(a) levels were measured using an immunoturbidimetric assay and classified into 2 groups: low (<75 nmol/L) and high (≥75 nmol/L). To assess participants’ baseline renal function, we used the baseline urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). The relationship between Lp(a), renal function indicators, and the risk of CKD was evaluated using multivariable Cox regression models. These models were adjusted for various factors, including sociodemographic variables, lifestyle factors, comorbidities, and laboratory measures. Results: A total of 6003 incident CKD events were documented over a median follow-up period of 12.5 years. The association between elevated Lp(a) levels and CKD risk did not achieve statistical significance among all participants, with a hazard ratio (HR) of 1.05 and a 95% CI ranging from 0.98 to 1.13 (P=.16). However, a notable interaction was identified between Lp(a) and UACR in relation to CKD risk (P for interaction=.04), whereas no significant interaction was observed between Lp(a) and eGFR (P for interaction=.96). When compared with the reference group with low Lp(a) and low-normal UACR (<10 mg/g), the group with high Lp(a) and low-normal UACR exhibited a nonsignificant association with CKD risk (HR 0.98, 95% CI 0.90-1.08; P=.74). By contrast, both the low Lp(a) and high-normal UACR (≥10 mg/g) group (HR 1.16, 95% CI 1.08-1.24; P<.001) and the high Lp(a) and high-normal UACR group (HR 1.32, 95% CI 1.19-1.46; P<.001) demonstrated significant associations with increased CKD risks. In individuals with high-normal UACR, elevated Lp(a) was linked to a significant increase in CKD risk, with an HR of 1.14 and a 95% CI ranging from 1.03 to 1.26 (P=.01). Subgroup analyses and sensitivity analyses consistently produced results that were largely in line with the main findings. Conclusions: The analysis revealed a significant interaction between Lp(a) and UACR in relation to CKD risk. This implies that Lp(a) may act as a risk factor for CKD even when considering UACR. Our findings have the potential to provide valuable insights into the assessment and prevention of CKD, emphasizing the combined impact of Lp(a) and UACR from a public health perspective within the general population. This could contribute to enhancing public awareness regarding the management of Lp(a) for the prevention of CKD. %M 38294877 %R 10.2196/50415 %U https://publichealth.jmir.org/2024/1/e50415 %U https://doi.org/10.2196/50415 %U http://www.ncbi.nlm.nih.gov/pubmed/38294877 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47295 %T Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation %A Robinson,Billy %A Proimos,Eleni %A Zou,Daniel %A Gong,Enying %A Oldenburg,Brian %A See,Katharine %+ Department of Respiratory Medicine, Northern Health, 185 Cooper St, Epping, 3076, Australia, 61 38405 8000, billymed1994@gmail.com %K asthma %K mobile health %K mHealth %K app %K mobile %K chronic disease %K systematic review %K smartphone %K review methodology %K respiratory %K compliance %K guideline %K guidelines %K review of apps %K evaluation %K quality %K best practices %K apps %K mobile phone %D 2024 %7 10.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. Objective: This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. Methods: The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Results: Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51%) achieved a total MARS score of ≥3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17%), 12 (25%), 11 (28%), and 14 (31%) apps, respectively; 19 (37%) apps could track or record “asthma symptoms,” which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20%) apps. Five (10%) apps provided an area for patients to store or enter their asthma action plan. Conclusions: This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. Trial Registration: PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894 International Registered Report Identifier (IRRID): RR2-10.2196/33103 %M 38198204 %R 10.2196/47295 %U https://mhealth.jmir.org/2024/1/e47295 %U https://doi.org/10.2196/47295 %U http://www.ncbi.nlm.nih.gov/pubmed/38198204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44265 %T The Role of a Smart Health Ecosystem in Transforming the Management of Chronic Health Conditions %A Nourse,Rebecca %A Dingler,Tilman %A Kelly,Jaimon %A Kwasnicka,Dominika %A Maddison,Ralph %+ School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 0392443075, rnourse@deakin.edu.au %K smart home %K health %K chronic condition %K chronic illness %K digital health %K technology %K behavior change %K wearable %K smart technology %K smart health %K economic %K cost %K security %K data storage %K implementation %D 2023 %7 18.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X The effective management of chronic conditions requires an approach that promotes a shift in care from the clinic to the home, improves the efficiency of health care systems, and benefits all users irrespective of their needs and preferences. Digital health can provide a solution to this challenge, and in this paper, we provide our vision for a smart health ecosystem. A smart health ecosystem leverages the interoperability of digital health technologies and advancements in big data and artificial intelligence for data collection and analysis and the provision of support. We envisage that this approach will allow a comprehensive picture of health, personalization, and tailoring of behavioral and clinical support; drive theoretical advancements; and empower people to manage their own health with support from health care professionals. We illustrate the concept with 2 use cases and discuss topics for further consideration and research, concluding with a message to encourage people with chronic conditions, their caregivers, health care professionals, policy and decision makers, and technology experts to join their efforts and work toward adopting a smart health ecosystem. %M 38109188 %R 10.2196/44265 %U https://www.jmir.org/2023/1/e44265 %U https://doi.org/10.2196/44265 %U http://www.ncbi.nlm.nih.gov/pubmed/38109188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44919 %T RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review %A Hodgson,William %A Kirk,Alison %A Lennon,Marilyn %A Janssen,Xanne %A Russell,Eilidh %A Wani,Carolina %A Eskandarani,Dina %+ School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Graham Hills Building, 40, George Street, Glasgow, G1 1QE, United Kingdom, 44 1857616479, william.hodgson@strath.ac.uk %K activity trackers %K clinical care %K physical activity %K sedentary behavior %K adults %K chronic diseases %K Reach, Effectiveness, Adoption, Implementation, and Maintenance %K RE-AIM %K mortality %K sedentary lifestyle %K intervention %K mobile phone %D 2023 %7 13.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. Objective: The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. Methods: A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. Results: The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. Conclusions: Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. Trial Registration: PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635 %M 37955960 %R 10.2196/44919 %U https://www.jmir.org/2023/1/e44919 %U https://doi.org/10.2196/44919 %U http://www.ncbi.nlm.nih.gov/pubmed/37955960 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48079 %T A Web-Based Patient Empowerment to Medication Adherence Program for Patients With Rheumatoid Arthritis: Feasibility Randomized Controlled Trial %A Lim,Siriwan %A Athilingam,Ponrathi %A Lahiri,Manjari %A Cheung,Peter Pak Moon %A He,Hong-Gu %A Lopez,Violeta %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012759, nursl@nus.edu.sg %K patient empowerment %K rheumatoid arthritis %K intervention %K feasibility study %K adherence %K chronic %K arthritis %K rheumatism %K medication %K prescription %K drug %K mapping %K design %K development %K web based %K internet based %K web-based tool %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen. Objective: This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA. Methods: The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP. Results: The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants. Conclusions: The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA. %M 37930758 %R 10.2196/48079 %U https://formative.jmir.org/2023/1/e48079 %U https://doi.org/10.2196/48079 %U http://www.ncbi.nlm.nih.gov/pubmed/37930758 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48970 %T Impact of Mobile Apps in Conjunction With Percutaneous Endoscopic Gastrostomy on Patients' Complications, Quality of Life, and Health-Related Self-Care Behaviors: Randomized Clinical Trial %A Chen,Bi-Lian %A Lien,Han-Chung %A Yang,Shyh-Sheng %A Wu,Shiao-Chi %A Chiang,Hsien-Hsien %A Lin,Li-Chan %+ Department of Nursing, Asia University, 500 Lioufeng Road, Wufeng, Taichung, 41354, Taiwan, 886 4 23323456 ext 1827, lichan2009@gmail.com %K percutaneous endoscopic gastrostomy %K mobile applications tracking system %K self-care %K complications %K quality of life %K mobile application %K mHealth app %K mHealth intervention %K health promotion %K health education %K endoscopy %K application %K education %K gastrostomy %K care %K prevention %K behavior %K tracking %K utilization %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Percutaneous endoscopic gastrostomy (PEG) is commonly chosen for long-term enteral nutrition support. However, common complications of PEG include wound infection, leakage, obstruction, bleeding, dislodgement, pneumonia, peritonitis, and more. The anticipation of these complications by both patients and their family caregivers underscores the essential requirement of ongoing technical guidance for the daily care of PEG and the adoption of preventative strategies. Objective: This study aimed to establish and compare a health education program utilizing a tracking system for PEG using a mobile app (PEG app) and instant messaging software versus a paper-based health education program with instant messaging software. Their effectiveness to prevent complications, avoid hospital readmissions, improve self-care practices, and enhance quality of life outcomes was assessed. Methods: A randomized controlled trial design was used, and the study sample consisted of patients from a medical center in central Taiwan who underwent thoracic surgery or gastroenterology procedures. Inclusion criteria were being a new case undergoing his or her first gastric tube insertion and having the ability to operate a smartphone. Exclusion criteria were cases requiring tube replacement or nasogastric tubes. A total of 74 participants were enrolled, with 37 participants in the experimental group and 37 participants in the control group. Data collection took place from hospitalization until 1 month after discharge. The experimental group received care utilizing the gastric tube tracking system (PEG app) and the Line app that included phone, text, and photo capture capabilities, while the control group received routine nursing care and used the Line app. Results: The experimental group demonstrated a significant reduction in the occurrence of complications compared with the control group (χ21=12.087, P=.001). Specifically, the occurrence of leakage events was significantly lower in the experimental group than in the control group (χ21=12.906, P=.001). However, the experimental group exhibited superior self-care ability compared with the control group (t72=2.203, P=.03). There was no significant difference in overall quality of life scores between the experimental and control groups (t72=1.603, P=.11). However, the experimental group showed better social aspects of quality of life than the control group (t72=2.164, P=.03). Conclusions: Integration of the PEG app with instant messaging can enhance self-care ability, improve social aspects of quality of life, and reduce complications. The study results suggest that the PEG app could be used as an adjunct tool to promote patients’ self-directed management of their gastric tube at home, particularly for patients who have undergone their first PEG placement and are being discharged from the hospital. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300071271; https://tinyurl.com/4vvy584e %R 10.2196/48970 %U https://mhealth.jmir.org/2023/1/e48970/ %U https://doi.org/10.2196/48970 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e47114 %T Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review %A Pittara,Melpo %A Matsangidou,Maria %A Pattichis,Constantinos S %+ Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, Nijenborgh 4 9747 AG Groningen, Groningen, , Netherlands, 31 050 363 9111, melpopittara@gmail.com %K breathing exercise %K breathing exercise gaming %K pulmonary rehabilitation %K respiratory biofeedback %K virtual reality %D 2023 %7 2.10.2023 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients’ functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. Objective: This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. Methods: The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. Results: A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health–related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. Conclusions: The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases. %M 37782529 %R 10.2196/47114 %U https://rehab.jmir.org/2023/1/e47114 %U https://doi.org/10.2196/47114 %U http://www.ncbi.nlm.nih.gov/pubmed/37782529 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40560 %T Segmenting Patients With Diabetes With the Navigator Service in Primary Care and a Description of the Self-Acting Patient Group: Cross-Sectional Study %A Riihimies,Riikka %A Kosunen,Elise %A Koskela,Tuomas H %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Building, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 505262556, riikka.riihimies@tuni.fi %K patient segmentation %K Navigator %K self-acting patient %K diabetes %K primary care %K self-management %K skills %K care %K nurse %K medication %K quality of life %K well-being %K digital %K patient %D 2023 %7 8.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients’ characteristics is lacking. Objective: The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses’ appointments at a health center, the self-acting patient group’s characteristics compared with other patient groups, and the concordance between the nurse’s evaluation of the patient’s group and the actual group assigned by Navigator (criterion validity). Methods: Patients with diabetes ≥18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients’ upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients’ diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients’ responses to Navigator’s question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients’ distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups. Results: Most patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good. Conclusions: The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients’ self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results. International Registered Report Identifier (IRRID): RR2-10.2196/20570 %M 37682585 %R 10.2196/40560 %U https://www.jmir.org/2023/1/e40560 %U https://doi.org/10.2196/40560 %U http://www.ncbi.nlm.nih.gov/pubmed/37682585 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45955 %T Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study %A Kouri,Andrew %A Gupta,Samir %A Straus,Sharon E %A Sale,Joanna E M %+ Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, andrew.kouri@mail.utoronto.ca %K older adults %K mHealth %K asthma %K chronic obstructive pulmonary disease %K qualitative research %K digital health %K qualitative study %K airway disease %K barrier %K health technology %K interview %K smartphone %K airway %K implementation %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. Objective: In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Methods: Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults’ use of airway mHealth. Results: Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults’ use of asthma and COPD mHealth tools. Conclusions: Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts. %M 37606961 %R 10.2196/45955 %U https://www.jmir.org/2023/1/e45955 %U https://doi.org/10.2196/45955 %U http://www.ncbi.nlm.nih.gov/pubmed/37606961 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41574 %T Cardiovascular Risk Assessment Among Adolescents and Youths Living With HIV: Evaluation of Electronic Health Record Findings and Implications %A Gurung,Sitaji %A Simpson,Kit N %A Grov,Christian %A Rendina,H Jonathon %A Huang,Terry T K %A Budhwani,Henna %A Jones,Stephen Scott %A Dark,Tyra %A Naar,Sylvie %+ Department of Health Sciences, New York City College of Technology (City Tech), The City University of New York, 285 Jay Street, A811D, Brooklyn, NY, 11201, United States, 1 718 260 5673, Sitaji.Gurung65@citytech.cuny.edu %K cardiovascular risk %K cluster of differentiation 4 lymphocyte %K electronic health record %K viral load %K youths living with HIV %D 2023 %7 16.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: The HIV epidemic remains a major public health concern, particularly among youths living with HIV. While the availability of antiretroviral therapy has significantly improved the health outcomes of people living with HIV, there is growing evidence that youths living with HIV may be at increased risk of cardiovascular disease. However, the underlying mechanisms linking HIV and cardiovascular disease among youths living with HIV remain poorly understood. One potential explanation is that HIV-related biomarkers, including detectable viral load (VL) and low cluster of differentiation 4 (CD4) lymphocyte counts, may contribute to increased cardiovascular risk. Despite the potential importance of these biomarkers, the relationship between HIV-related biomarkers and cardiovascular risk among youths living with HIV has been understudied. Objective: To address this gap, we examined whether detectable VL and low CD4 lymphocyte counts, both of which are indications of unsuppressed HIV, were associated with cardiovascular risk among youths living with HIV. Methods: We analyzed electronic health record data from 7 adolescent HIV clinics in the United States (813 youths living with HIV). We used multivariable linear regression to examine the relationship between detectable VL and CD4 lymphocyte counts of ≤200 and cardiovascular risk scores, which were adapted from the gender-specific Framingham algorithm. Results: In our study, nearly half of the participants (366/766, 47.8%) had detectable VL, indicating unsuppressed HIV, while 8.6% (51/593) of them had CD4 lymphocyte counts of ≤200, suggesting weakened immune function. We found that those with CD4 lymphocyte counts of ≤200 had significantly higher cardiovascular risk, as assessed by Cardiac Risk Score2, than those with CD4 lymphocyte counts of >200 (P=.002). After adjusting for demographic and clinical factors, we found that for every 1000-point increase in VL copies/mL, the probability of having cardiovascular risk (Cardiac Risk Score2) increased by 38%. When measuring the strength of this connection, we observed a minor effect of VL on increased cardiovascular risk (β=.134, SE 0.014; P=.006). We obtained similar results with Cardiac Risk Score1, but the effect of CD4 lymphocyte counts of ≤200 was no longer significant. Overall, our findings suggest that detectable VL is associated with increased cardiovascular risk among youths living with HIV, and that CD4 lymphocyte counts may play a role in this relationship as well. Conclusions: Our study highlights a significant association between unsuppressed HIV, indicated by detectable VL, and increased cardiovascular risk in youths living with HIV. These findings emphasize the importance of implementing interventions that address both VL suppression and cardiovascular risk reduction in this population. By tailoring interventions to meet the unique needs of youths, we can promote overall well-being throughout the HIV care continuum and across the life span. Ultimately, these efforts have the potential to improve the health outcomes and quality of life of youths living with HIV. International Registered Report Identifier (IRRID): RR2-10.2196/11185 %M 37585242 %R 10.2196/41574 %U https://www.i-jmr.org/2023/1/e41574 %U https://doi.org/10.2196/41574 %U http://www.ncbi.nlm.nih.gov/pubmed/37585242 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48645 %T Comprehensive Ontology of Fibroproliferative Diseases: Protocol for a Semantic Technology Study %A Golec,Marcin %A Kamdar,Maulik %A Barteit,Sandra %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 352 0691800035, marcin.golec@uni-heidelberg.de %K fibroproliferative disease %K fibrosis %K fibrotic disease %K ontology %K OWL %K semantic technology %K Web Ontology Language %D 2023 %7 11.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Fibroproliferative or fibrotic diseases (FDs), which represent a significant proportion of age-related pathologies and account for over 40% of mortality in developed nations, are often underrepresented in focused research. Typically, these conditions are studied individually, such as chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis (IPF), rather than as a collective entity, thereby limiting the holistic understanding and development of effective treatments. To address this, we propose creating and publicizing a comprehensive fibroproliferative disease ontology (FDO) to unify the understanding of FDs. Objective: This paper aims to delineate the study protocol for the creation of the FDO, foster transparency and high quality standards during its development, and subsequently promote its use once it becomes publicly available. Methods: We aim to establish an ontology encapsulating the broad spectrum of FDs, constructed in the Web Ontology Language format using the Protégé ontology editor, adhering to ontology development life cycle principles. The modeling process will leverage Protégé in accordance with a methodologically defined process, involving targeted scoping reviews of MEDLINE and PubMed information, expert knowledge, and an ontology development process. A hybrid top-down and bottom-up strategy will guide the identification of core concepts and relations, conducted by a team of domain experts based on systematic iterations of scientific literature reviews. Results: The result will be an exhaustive FDO accommodating a wide variety of crucial biomedical concepts, augmented with synonyms, definitions, and references. The FDO aims to encapsulate diverse perspectives on the FD domain, including those of clinicians, health informaticians, medical researchers, and public health experts. Conclusions: The FDO is expected to stimulate broader and more in-depth FD research by enabling reasoning, inference, and the identification of relationships between concepts for application in multiple contexts, such as developing specialized software, fostering research communities, and enhancing domain comprehension. A common vocabulary and understanding of relationships among medical professionals could potentially expedite scientific progress and the discovery of innovative solutions. The publicly available FDO will form the foundation for future research, technological advancements, and public health initiatives. International Registered Report Identifier (IRRID): PRR1-10.2196/48645 %M 37566458 %R 10.2196/48645 %U https://www.researchprotocols.org/2023/1/e48645 %U https://doi.org/10.2196/48645 %U http://www.ncbi.nlm.nih.gov/pubmed/37566458 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46542 %T Creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions: Protocol for the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS) %A Pujolar-Díaz,Georgina %A Vidal-Alaball,Josep %A Forcada,Anna %A Descals-Singla,Elisabet %A Basora,Josep %A , %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Carrer Pica d'Estats 13-15, Sant Fruitós de Bages, 08272, Spain, 34 93 693 00 40, jvidal.cc.ics@gencat.cat %K chronic disease %K multiple chronic conditions %K primary health care %K diffusion of innovation %K health data %K data sharing %D 2023 %7 26.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the increasing prevalence of chronic diseases, partly due to the increase in life expectancy and the aging of the population, the complexity of the approach faced by the structures, dynamics, and actors that are part of the current care and attention systems is evident. The territory of Bages (Catalonia, Spain) presents characteristics of a highly complex ecosystem where there is a need to develop new, more dynamic structures for the various actors in the health and social systems, aimed at incorporating new actors in the technological and business field that would allow innovation in the management of this context. Within the framework of the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS), the aim is to address these challenges through various entities that will develop 7 interrelated operations. Of these, the operation of the IDIAP Jordi Gol-Catalan Health Institute focuses on the creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions in the Bages region, in the form of a database that will collect the most relevant information from the different environments that affect the management of chronic conditions and dependence: health, social, economic, and environment. Objective: This study aims to create a laboratory for statistical, dependence, and chronic condition analysis in the Bages region, to determine the chronic conditions and conditions that generate dependence in the Bages area, in order to propose products and services that respond to the needs of people in these situations. Methods: PECT BAGESS originated from the Shared Agenda initiative, which was established in the Bages region with the goal of enhancing the quality of life and fostering social inclusion for individuals with chronic diseases. This study presents part of this broader project, consisting of the creation of a database. Data from chronic conditions and dependence service providers will be combined, using a unique identifier for the different sources of information. A thorough legal analysis was conducted to establish a secure data sharing mechanism among the entities participating in the project. Results: The laboratory will be a key piece in the structure generated in the environment of the PECT BAGESS, which will allow relevant information to be passed on from the different sectors involved to respond to the needs of people with chronic conditions and dependence, as well as to generate opportunities for products and services. Conclusions: The emerging organizational dynamics and structures are expected to demonstrate a health and social management model that may have a remarkable impact on these sectors. Products and services developed may be very useful for generating synergies and facilitating the living conditions of people who can benefit from all these services. However, secure data sharing circuits must be considered. International Registered Report Identifier (IRRID): PRR1-10.2196/46542 %M 37494102 %R 10.2196/46542 %U https://www.researchprotocols.org/2023/1/e46542 %U https://doi.org/10.2196/46542 %U http://www.ncbi.nlm.nih.gov/pubmed/37494102 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47524 %T The Design, Development, and Usability Testing of an eHealth Program for Youths With Osteogenesis Imperfecta: Protocol for a 2-Phase User-Centered Mixed Methods Study %A Tsimicalis,Argerie %A Stinson,Jennifer %A Thorstad,Kelly %A Rauch,Frank %A Hamdy,Reggie %A Chougui,Khadidja %A Addab,Sofia %A Palomo,Telma %A Bernstein,Mitchell %A Dahan-Oliel,Noemi %A Veilleux,Louis-Nicolas %A Massochin Nunes Pinto,Laura %A Passos dos Santos,Raissa %+ Shriners Hospitals for Children-Canada, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada, 1 514 842 4464, argerie.tsimicalis@mcgill.ca %K eHealth program %K osteogenesis imperfecta %K self-management %K youth %K transition of care %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called “Teens Taking Charge: Managing OI Online,” hereafter named “Teens OI.” This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI. Objective: The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents. Methods: A user-centered design is presently in progress to design and develop Teens OI. A “Website Design and Development Council” (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification. Results: As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care. Conclusions: The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths’ openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition. International Registered Report Identifier (IRRID): DERR1-10.2196/47524 %M 37351933 %R 10.2196/47524 %U https://www.researchprotocols.org/2023/1/e47524 %U https://doi.org/10.2196/47524 %U http://www.ncbi.nlm.nih.gov/pubmed/37351933 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46741 %T Recovery of Breakthrough Asthma Attacks Treated With Oral Steroids While on Monoclonal Antibody Therapy: Protocol for a Prospective Observational Study (BOOST) %A Howell,Imran %A Mahdi,Mahdi %A Bafadhel,Mona %A Hinks,Timothy S C %A Ramakrishnan,Sanjay %A Melhorn,James %A Jabeen,Maisha %A Pavord,Ian D %+ Nuffield Department of Medicine, University of Oxford, Level 7 E/F, Rm 7400, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom, 44 01865 221753, imran.howell@ndm.ox.ac.uk %K asthma %K monoclonal antibodies %K steroids %K monoclonal antibody %K oral steroid %K asthma attack %K quality of life %K adult %K inflammatory response %K prednisolone treatment %K treatment %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma attacks are a common and important problem. Someone experiences an asthma attack in the United Kingdom every 10 seconds. Asthma attacks cause coughing, wheezing, breathlessness, and chest tightness and are highly stressful for patients. They result in reduced quality of life, with days lost from work or school. Asthma attacks are treated with oral corticosteroids (OCSs), but these have many short- and long-term side effects. Asthma monoclonal antibodies (mAbs) have revolutionized the treatment of severe asthma by reducing asthma attacks and OCS burden by over 50%, but some people still experience attacks while on mAbs. The MEX study showed that residual asthma attacks are broadly eosinophilic (high fractional exhaled nitric oxide [FeNO]) or noneosinophilic (low FeNO), but it did not measure response to OCS treatment. There is an evidence gap in understanding the clinical and inflammatory responses that occur when using OCSs to treat residual asthma attacks in patients taking asthma mAbs. Objective: The primary objective is to compare the clinical recovery between high-FeNO and low-FeNO attacks after acute treatment with oral prednisolone among people established on long-term asthma mAb treatment. The exploratory objective is to compare the inflammatory response to acute treatment with oral prednisolone between high-FeNO and low-FeNO attacks. Methods: BOOST (Breakthrough Asthma Attacks Treated With Oral Steroids) is a single-center, prospective observational study of 60 adults established on long-term asthma mAb treatment who receive acute treatment with oral prednisolone (usual care) for an asthma attack. The primary outcome will be the proportion of treatment failure (the need to start oral prednisolone or antibiotics or an unscheduled health care visit for asthma, following an attack) at day 28. The secondary outcomes will be the change in forced expiratory volume in 1 second and the change in visual analogue scale symptom score between the stable state, attack, day 7, and day 28 visits. The exploratory outcomes include the changes in sputum, nasal, and blood inflammometry between the stable state, attack, day 7, and day 28 visits. Results: The last asthma attack visit is anticipated to occur in December 2023. Data analysis and publication will take place in 2024. Conclusions: We will test the hypothesis that there is a difference in the rate of recovery of clinical and inflammatory measures between high-FeNO and low-FeNO asthma attacks that occur in patients on mAb therapy. The study data will help power a future randomized placebo-controlled trial of prednisolone treatment for nonsevere attacks in patients treated with asthma mAbs and will provide important information on whether corticosteroid treatment should be FeNO-directed. International Registered Report Identifier (IRRID): DERR1-10.2196/46741 %M 37351918 %R 10.2196/46741 %U https://www.researchprotocols.org/2023/1/e46741 %U https://doi.org/10.2196/46741 %U http://www.ncbi.nlm.nih.gov/pubmed/37351918 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46307 %T A Comprehensive Self-Management Intervention for Inflammatory Bowel Disease (CSM-IBD): Protocol for a Pilot Randomized Controlled Trial %A Kamp,Kendra %A Clark-Snustad,Kindra %A Yoo,Linda %A Winders,Samantha %A Cain,Kevin %A Levy,Rona L %A Dey,Neelendu %A Lee,Scott %A Keefer,Laurie %A Heitkemper,Margaret %+ Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Box 357266, Seattle, WA, 98195, United States, 1 206 221 4617, kamp@uw.edu %K inflammatory bowel disease %K self-management %K symptom management %K pilot %K intervention %K randomized controlled trial %D 2023 %7 7.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) experience a variety of symptoms, including abdominal pain, fatigue, anxiety, and depression. Few nonmedical self-management interventions are available for people with IBD. A validated comprehensive self-management (CSM) intervention is effective for patients with irritable bowel syndrome who can have symptoms similar to those of individuals with IBD. We created a modified CSM intervention tailored to individuals with IBD (CSM-IBD). The CSM-IBD is an 8-session program delivered over 8-12 weeks with check-ins with a registered nurse. Objective: The primary objective of this pilot study is to determine the feasibility and acceptability of study procedures and the CSM-IBD intervention and to evaluate preliminary efficacy on quality of life and daily symptoms for a future randomized controlled trial. Additionally, we will examine the association of socioecological, clinical, and biological factors with symptoms at baseline and response to intervention. Methods: We are conducting a pilot randomized controlled trial of the CSM-IBD intervention. Participants aged 18-75 years who are experiencing at least 2 symptoms are eligible for inclusion. We plan to enroll 54 participants who will be randomized (2:1) into the CSM-IBD program or usual care. Patients in the CSM-IBD program will have 8 intervention sessions. Primary study outcomes include the feasibility of recruitment, randomization, and data or sample collection, as well as the acceptability of study procedures and interventions. Preliminary efficacy outcome variables include quality of life and symptoms. Outcomes data will be assessed at baseline, immediately post intervention, and 3 months post intervention. Participants in the usual care group will have access to the intervention after study participation. Results: This project is funded by the National Institutes of Nursing Research and reviewed by the University of Washington’s institutional review board. Recruitment began in February 2023. As of April 2023, we have enrolled 4 participants. We expect the study to be completed by March 2025. Conclusions: This pilot study will evaluate the feasibility and efficacy of a self-management intervention (a web-based program with weekly check-ins with a registered nurse) that aims to improve symptom management in individuals with IBD. In the long term, we aim to validate a self-management intervention to improve patient quality of life, reduce direct and indirect costs related to IBD, and be culturally appropriate and accessible, particularly in rural and underserved communities. Trial Registration: ClinicalTrials.gov NCT05651542; https://clinicaltrials.gov/ct2/show/NCT05651542 International Registered Report Identifier (IRRID): PRR1-10.2196/46307 %M 37285195 %R 10.2196/46307 %U https://www.researchprotocols.org/2023/1/e46307 %U https://doi.org/10.2196/46307 %U http://www.ncbi.nlm.nih.gov/pubmed/37285195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45654 %T A Smart System for Remote Monitoring of Patients in Palliative Care (HumanITcare Platform): Mixed Methods Study %A Castillo Padrós,Manuel Ramón %A Pastor,Nuria %A Altarriba Paracolls,Júlia %A Mosquera Peña,Marcelino %A Pergolizzi,Denise %A Salvador Vergès,Àngels %+ Innohealth Academy, C/Magi Casanovas 11, Barcelona, 08870, Spain, 34 630887995, angels.salvador@innohealth.academy %K palliative care %K advanced illness %K remote monitoring %K eHealth %K telemedicine %K mHealth %D 2023 %7 31.5.2023 %9 Viewpoint %J JMIR Form Res %G English %X Background: Due to the complexities of advanced illnesses and their treatments, it can be difficult for patients in palliative care to maintain their quality of life. Telemedicine interventions in chronic disease management engage patients in their care, provide continuous follow-up by their health care providers, identify symptoms earlier, and allow a quick response to illness-related decline. Objective: We aimed to detail and reflect on the design of an app and evaluate its feasibility to monitor the clinical situation of patients with advanced illnesses. Methods: This study used a mixed methods design using qualitative methods to inform app development and design and quantitative methods for data collection and analysis of patient evaluations. Palliative care units in 2 Spanish university hospitals (Nuestra Señora de la Candelaria in Santa Cruz de Tenerife and University Hospital Complex of Ferrol in A Coruña) carried out a literature review, designed the study protocol, and obtained approval from the Ethics Committee from June to December 2020. In addition, focus group meetings were held, and the design and technical development of the app were elaborated on and subsequently presented in the participating palliative care units. From January to March 2021, the app was made public on the App Store and Play Store, and a pilot study with patients was carried out in April to September 2021. Results: Six focus group meetings were held that included doctors, nurses, app developers, technology consultants, and sponsors. In addition, the technology consultants presented their results 3 times in the participating palliative care units to obtain feedback. After the app’s final design, it was possible to publish it on the usual servers and begin its evaluation in patients (n=60, median age 72 years). Sixty percent (n=36) of the participants were women and 40% (n=24) were men. The most prevalent advanced pathology was cancer (n=46, 76%), followed by other diseases (n=7, 12%) and amyotrophic lateral sclerosis (n=5, 8%). Seventy percent (n=42) of the patients were already in follow-up prior to the start of the study, while 30% (n=18) were included at the start of their follow-up. The information in the app was collected and entered by relatives or caregivers in 60% (n=36) of the cases. The median follow-up was 52 (IQR 14-104) days. In all, 69% (n=41) had a follow-up >30 days (10 were deceased and 9 were missing data). The use of the different sections of the app ranged from 37% (n=22) for the glycemic record to 90% (n=54) for the constipation scale). Patients and caregivers were delighted with its ease of use and usefulness. Conclusions: Incorporating an intelligent remote patient monitoring system in clinical practice for patients in palliative care can improve access to health services and provide more information to professionals. %M 37256664 %R 10.2196/45654 %U https://formative.jmir.org/2023/1/e45654 %U https://doi.org/10.2196/45654 %U http://www.ncbi.nlm.nih.gov/pubmed/37256664 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48109 %T Comprehensive Acute Kidney Injury Survivor Care: Protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot Trial %A May,Heather P %A Griffin,Joan M %A Herges,Joseph R %A Kashani,Kianoush B %A Kattah,Andrea G %A Mara,Kristin C %A McCoy,Rozalina G %A Rule,Andrew D %A Tinaglia,Angeliki G %A Barreto,Erin F %+ Mayo Clinic, 200 1st Ave SW, Rochester, MN, 55905, United States, 1 5072555866, barreto.erin@mayo.edu %K acute kidney injury %K acute renal failure %K care transitions %K chronic kidney disease %K nephrologists %K randomized controlled trials %D 2023 %7 22.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Innovative care models are needed to address gaps in kidney care follow-up among acute kidney injury (AKI) survivors. We developed the multidisciplinary AKI in Care Transitions (ACT) program, which embeds post-AKI care in patients’ primary care clinic. Objective: The objective of this randomized pilot trial is to test the feasibility and acceptability of the ACT program and study protocol, including recruitment and retention, procedures, and outcome measures. Methods: The study will be conducted at Mayo Clinic in Rochester, Minnesota, a tertiary care center with a local primary care practice. Individuals who are included have stage 3 AKI during their hospitalization, do not require dialysis at discharge, have a local primary care provider, and are discharged to their home. Patients unable or unwilling to provide informed consent and recipients of any transplant within 100 days of enrollment are excluded. Consented patients are randomized to receive the intervention (ie, ACT program) or usual care. The ACT program intervention includes predischarge kidney health education from nurses and coordinated postdischarge laboratory monitoring (serum creatinine and urine protein assessment) and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no specific study-related intervention, and any aspects of AKI care are at the direction of the treating team. This study will examine the feasibility of the ACT program, including recruitment, randomization and retention in a trial setting, and intervention fidelity. The feasibility and acceptability of participating in the ACT program will also be examined in qualitative interviews with patients and staff and through surveys. Qualitative interviews will be deductively and inductively coded and themes compared across data types. Observations of clinical encounters will be examined for discussion and care plans related to kidney health. Descriptive analyses will summarize quantitative measures of the feasibility and acceptability of ACT. Participants’ knowledge about kidney health, quality of life, and process outcomes (eg, type and timing of laboratory assessments) will be described for both groups. Clinical outcomes (eg, unplanned rehospitalization) up to 12 months will be compared with Cox proportional hazards models. Results: This study received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups. Conclusions: Feasible and generalizable AKI survivor care delivery models are needed to improve care processes and health outcomes. This pilot trial will test the ACT program, which uses a multidisciplinary model focused on primary care to address this gap. Trial Registration: ClinicalTrials.gov NCT05184894; https://www.clinicaltrials.gov/ct2/show/NCT05184894 International Registered Report Identifier (IRRID): DERR1-10.2196/48109 %M 37213187 %R 10.2196/48109 %U https://www.researchprotocols.org/2023/1/e48109 %U https://doi.org/10.2196/48109 %U http://www.ncbi.nlm.nih.gov/pubmed/37213187 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39904 %T Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model %A Park,Minah %A Yun,Choa %A Joo,Jae Hong %A Kang,Soo Hyun %A Jeong,Sung Hoon %A Nam,Chung-Mo %A Park,Eun-Cheol %A Han,Yoondae %A Jang,Sung In %+ Department of Preventive Medicine, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 1863, jangsi@yuhs.ac %K chronic kidney disease %K cost analysis %K medical expenses %K medically vulnerable regions %K kidney %K public health %K cost %K economic %K chronic disease %K insurance %K regional %K longitudinal model %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There are regional gaps in the access to medical services for patients with chronic kidney disease (CKD), and it is necessary to reduce those gaps, including the gaps involving medical costs. Objective: This study aimed to analyze regional differences in the medical costs associated with CKD in the South Korean population. Methods: This longitudinal cohort study included participants randomly sampled from the National Health Insurance Service-National Sample Cohort of South Korea. To select those who were newly diagnosed with CKD, we excluded those who were diagnosed in 2002-2003 and 2018-2019. A total of 5903 patients with CKD were finally included. We used a marginalized two-part longitudinal model to assess total medical costs. Results: Our cohort included 4775 (59.9%) men and 3191 (40.1%) women. Of these, 971 (12.2%) and 6995 (87.8%) lived in medically vulnerable and nonvulnerable regions, respectively. The postdiagnosis costs showed a significant difference between the regions (estimate: –0.0152, 95% confidence limit: –0.0171 to –0.0133). The difference in medical expenses between the vulnerable and nonvulnerable regions showed an increase each year after the diagnosis. Conclusions: Patients with CKD living in medically vulnerable regions are likely to have higher postdiagnostic medical expenses compared to those living in regions that are not medically vulnerable. Efforts to improve early diagnosis of CKD are needed. Relevant policies should be drafted to decrease the medical costs of patients with CKD disease living in medically deprived areas. %M 36995749 %R 10.2196/39904 %U https://publichealth.jmir.org/2023/1/e39904 %U https://doi.org/10.2196/39904 %U http://www.ncbi.nlm.nih.gov/pubmed/36995749 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37697 %T Analyzing the Perspectives of Health Professionals and Legal Cannabis Users on the Treatment of Chronic Pain With Cannabidiol: Protocol for a Scoping Review %A Kumar,Priyanka %A Mpofu,Charles %A Wepa,Dianne %+ School of Public Health, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 99219999, rgz5670@autuni.ac.nz %K CBD %K cannabidiol %K medicinal cannabis %K medical cannabis %K chronic pain %K pain %K perspectives %K opinions %K health professionals %K medical professionals %K users %K medicinal cannabis users %K medical cannabis users %K New Zealand %K NZ %D 2023 %7 20.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Medical cannabis is one of the most commonly reported treatments for chronic pain. The wide acceptance and research in alternative medicine have put medical cannabis in the limelight, where researchers are widely examining its therapeutic benefits, including treatment of chronic pain. Objective: The purpose of this scoping review is to provide an overview of the perspectives on cannabidiol as an alternative treatment for chronic pain among health professionals and legal cannabis users. Methods: The framework of Arksey and O'Malley guides the design of this scoping review, and the elements reported use the recommended guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive literature search accessed the databases CINAHL Complete and MEDLINE via EBSCO, Australia/New Zealand Reference Centre, PsycINFO, Ovid Emcare, Wiley Online Library, Scopus, Informit New Zealand Collection, and Google Scholar for published literature, and then it was extended to include gray literature. Gray literature searches included searching the databases Australia/New Zealand Reference Centre, Informit New Zealand Collection, INNZ: Index New Zealand, ProQuest Dissertations & Theses Global, and AUT Tuwhera Research Repository, and the website nzresearch.org.nz. The studies included in this scoping review were assessed for eligibility for inclusion using the following criteria: published in English after 2000, conducted in New Zealand (NZ) or Australia, and aimed to investigate the perspectives of health professionals and medical cannabis users using interviews for data collection. Studies were screened for inclusion using Covidence, a software tool to filter search results, and the risk of bias was assessed using the Critical Appraisal Skills Programme tool. Although this is not a required step for scoping reviews, it added an element of strength to this scoping review. Data will be analyzed using thematic analysis guided by Braun and Clarke. The findings from the data analysis will be presented in a table, which will then inform the key themes for discussion. Results: The database search started in October 2021 and was completed in December 2021. The total number of studies included in this review is 5 (n=5). Studies included were conducted in NZ or Australia and examined the perspectives using participant interviews. This scoping review is anticipated to be submitted for publication in December 2022. Conclusions: Using perspectives is a valuable tool to understand the challenges experienced by health professionals and medical cannabis users associated with medical cannabis treatment. Addressing these challenges through interventions that are highlighted through perspectives such as educating health professionals to increase access to medical cannabis in NZ may aid in policy reformulation for medical cannabis in the context of NZ. Thus, this scoping review highlights the importance of medical cannabis research and suggests recommendations to guide and inform medical cannabis policy in the context of NZ. International Registered Report Identifier (IRRID): DERR1-10.2196/37697 %M 36662570 %R 10.2196/37697 %U https://www.researchprotocols.org/2023/1/e37697 %U https://doi.org/10.2196/37697 %U http://www.ncbi.nlm.nih.gov/pubmed/36662570 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e38182 %T Associations Among Multimorbid Conditions in Hospitalized Middle-aged and Older Adults in China: Statistical Analysis of Medical Records %A Zhang,Yan %A Chen,Chao %A Huang,Lingfeng %A Liu,Gang %A Lian,Tingyu %A Yin,Mingjuan %A Zhao,Zhiguang %A Xu,Jian %A Chen,Ruoling %A Fu,Yingbin %A Liang,Dongmei %A Zeng,Jinmei %A Ni,Jindong %+ Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, China, 86 15817668208, nijd-gw@gdmu.edu.cn %K multimorbidity %K chronic conditions %K aging %K association rule mining %K decision tree analysis %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multimorbidity has become a new challenge for medical systems and public health policy. Understanding the patterns of and associations among multimorbid conditions should be given priority. It may assist with the early detection of multimorbidity and thus improve quality of life in older adults. Objective: This study aims to comprehensively analyze and compare associations among multimorbid conditions by age and sex in a large number of middle-aged and older Chinese adults. Methods: Data from the home pages of inpatient medical records in the Shenzhen National Health Information Platform were evaluated. From January 1, 2017, to December 31, 2018, inpatients aged 50 years and older who had been diagnosed with at least one of 40 conditions were included in this study. Their demographic characteristics (age and sex) and inpatient diagnoses were extracted. Association rule mining, Chi-square tests, and decision tree analyses were combined to identify associations between multiple chronic conditions. Results: In total, 306,264 hospitalized cases with available information on related chronic conditions were included in this study. The prevalence of multimorbidity in the overall population was 76.46%. The combined results of the 3 analyses showed that, in patients aged 50 years to 64 years, lipoprotein metabolism disorder tended to be comorbid with multiple chronic conditions. Gout and lipoprotein metabolism disorder had the strongest association. Among patients aged 65 years or older, there were strong associations between cerebrovascular disease, heart disease, lipoprotein metabolism disorder, and peripheral vascular disease. The strongest associations were observed between senile cataract and glaucoma in men and women. In particular, the association between osteoporosis and malignant tumor was only observed in middle-aged and older men, while the association between anemia and chronic kidney disease was only observed in older women. Conclusions: Multimorbidity was prevalent among middle-aged and older Chinese individuals. The results of this comprehensive analysis of 4 age-sex subgroups suggested that associations between particular conditions within the sex and age groups occurred more frequently than expected by random chance. This provides evidence for further research on disease clusters and for health care providers to develop different strategies based on age and sex to improve the early identification and treatment of multimorbidity. %M 36422885 %R 10.2196/38182 %U https://publichealth.jmir.org/2022/11/e38182 %U https://doi.org/10.2196/38182 %U http://www.ncbi.nlm.nih.gov/pubmed/36422885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e35508 %T Interactive Remote Patient Monitoring Devices for Managing Chronic Health Conditions: Systematic Review and Meta-analysis %A Leo,Donato Giuseppe %A Buckley,Benjamin J R %A Chowdhury,Mahin %A Harrison,Stephanie L %A Isanejad,Masoud %A Lip,Gregory Y H %A Wright,David J %A Lane,Deirdre A %A , %+ Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, United Kingdom, 44 01517949334, Deirdre.Lane@liverpool.ac.uk %K chronic condition %K telemonitoring %K telemedicine %K eHealth %K self-monitoring %K systematic review %K meta-analysis %D 2022 %7 3.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients’ acceptability of this technology and their rate of uptake. Objective: The aim of this study was to systematically review the current evidence on telemonitoring in the management of patients with long-term conditions and evaluate the patients’ uptake and acceptability of this technology. Methods: MEDLINE, Scopus, and CENTRAL (the Cochrane Central Register of Controlled Trials) were searched from the date of inception to February 5, 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: intervention uptake and adherence; study retention; patient acceptability, satisfaction, and experience using the intervention; changes in physiological values; all-cause and cardiovascular-related hospitalization; all-cause and disease-specific mortality; patient-reported outcome measures; and quality of life. In total, 2 reviewers independently assessed the articles for eligibility. Results: A total of 96 studies were included, and 58 (60%) were pooled for the meta-analyses. Meta-analyses showed a reduction in mortality (risk ratio=0.71, 95% CI 0.56-0.89; P=.003; I2=0%) and improvements in blood pressure (mean difference [MD]=−3.85 mm Hg, 95% CI −7.03 to −0.68; P=.02; I2=100%) and glycated hemoglobin (MD=−0.33, 95% CI −0.57 to −0.09; P=.008; I2=99%) but no significant improvements in quality of life (MD=1.45, 95% CI −0.10 to 3; P=.07; I2=80%) and an increased risk of hospitalization (risk ratio=1.02, 95% CI 0.85-1.23; P=.81; I2=79%) with telemonitoring compared with usual care. A total of 12% (12/96) of the studies reported adherence outcomes, and 9% (9/96) reported on satisfaction and acceptance outcomes; however, heterogeneity in the assessment methods meant that a meta-analysis could not be performed. Conclusions: Telemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalization rates and a lack of positive impact on patients’ quality of life. Trial Registration: PROSPERO CRD42021236291; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236291 %M 36326818 %R 10.2196/35508 %U https://www.jmir.org/2022/11/e35508 %U https://doi.org/10.2196/35508 %U http://www.ncbi.nlm.nih.gov/pubmed/36326818 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40856 %T Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND): Protocol for a Multimodal Feasibility Study %A Gutierrez,Robert %A McCrady,Allison %A Masterson,Chelsea %A Tolman,Sarah %A Boukhechba,Mehdi %A Barnes,Laura %A Blemker,Silvia %A Scharf,Rebecca %+ University of Virginia Children's Hospital, 1204 W. Main St., Charlottesville, VA, 22903, United States, 1 434 924 1647, rebeccascharf@virginia.edu %K mHealth %K ubiquitous computing %K neuromuscular disorders %K inertial measurement unit %K motor function %K specific torque %K cross-sectional area %K echogenicity %D 2022 %7 27.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuromuscular diseases, such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), may result in the loss of motor movements, respiratory failure, and early mortality in young children and in adulthood. With novel treatments now available, new evaluation methods are needed to assess progress that is not currently captured in existing motor scale tests. Objective: With our feasibility study, our interdisciplinary team of investigators aims to develop a novel, multimodal paradigm of measuring motor function in children with neuromuscular diseases that will revolutionize the way that clinical trial end points are measured, thereby accelerating the pipeline of new treatments for childhood neuromuscular diseases. Through the Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND) study, we hypothesize that the novel objective measures of upper extremity muscle structure and function proposed herein will be able to capture small changes and differences in function that cannot be measured with current clinical metrics. Methods: U-EXTEND introduces a novel paradigm in which concrete, quantitative measures are used to assess motor function in patients with SMA and DMD. Aim 1 will focus on the use of ultrasound techniques to study muscle size, quality, and function, specifically isolating the biceps and pronator muscles of the upper extremities for follow-ups over time. To achieve this, clinical investigators will extract a set of measurements related to muscle structure, quality, and function by using ultrasound imaging and handheld dynamometry. Aim 2 will focus on leveraging wearable wireless sensor technology to capture motion data as participants perform activities of daily living. Measurement data will be examined and compared to those from a healthy cohort, and a motor function score will be calculated. Results: Data collection for both aims began in January 2021. As of July 2022, we have enrolled 44 participants (9 with SMA, 20 with DMD, and 15 healthy participants). We expect the initial results to be published in summer 2022. Conclusions: We hypothesize that by applying the described tools and techniques for measuring muscle structure and upper extremity function, we will have created a system for the precise quantification of changes in motor function among patients with neuromuscular diseases. Our study will allow us to track the minimal clinically important difference over time to assess progress in novel treatments. By comparing the muscle scores and functional scores over multiple visits, we will be able to detect small changes in both the ability of the participants to perform the functional tasks and their intrinsic muscle properties. International Registered Report Identifier (IRRID): DERR1-10.2196/40856 %M 36301603 %R 10.2196/40856 %U https://www.researchprotocols.org/2022/10/e40856 %U https://doi.org/10.2196/40856 %U http://www.ncbi.nlm.nih.gov/pubmed/36301603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e39909 %T Evaluation of the SUCCESS Health Literacy App for Australian Adults With Chronic Kidney Disease: Protocol for a Pragmatic Randomized Controlled Trial %A Isautier,Jennifer %A Webster,Angela C %A Lambert,Kelly %A Shepherd,Heather L %A McCaffery,Kirsten %A Sud,Kamal %A Kim,Jinman %A Liu,Na %A De La Mata,Nicole %A Raihana,Shahreen %A Kelly,Patrick J %A Muscat,Danielle M %A , %+ Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 127A Edward Ford Building, Sydney, 2006, Australia, 61 93517819, danielle.muscat@sydney.edu.au %K chronic kidney disease %K health literacy %K shared decision-making %K eHealth %K smartphone app %D 2022 %7 31.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: We developed a smartphone app—the SUCCESS (Supporting Culturally and Linguistically Diverse CKD Patients to Engage in Shared Decision-Making Successfully) app—to support Australian adults with kidney failure undertaking dialysis to actively participate in self-management and decision-making. The content of the SUCCESS app was informed by a theoretical model of health literacy that recognizes the importance of reducing the complexity of health information as well as providing skills necessary to access, understand, and act on this information. Objective: The purpose of this study is to investigate the efficacy of the SUCCESS app intervention. Methods: We designed a multicenter pragmatic randomized controlled trial to compare the SUCCESS app plus usual care (intervention) to usual care alone (control). A total of 384 participants receiving in-center or home-based hemodialysis or peritoneal dialysis will be recruited from six local health districts in the Greater Sydney region, New South Wales, Australia. To avoid intervention contamination, a pragmatic randomization approach will be used for participants undergoing in-center dialysis, in which randomization will be based on the days they receive hemodialysis and by center (ie, Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday). Participants undergoing home-based dialysis will be individually randomized centrally using simple randomization and two stratification factors: language spoken at home and research site. Consenting participants will be invited to use the SUCCESS app for 12 months. The primary endpoints, which will be assessed after 3, 6, and 12 months of app usage, are health literacy skills, evaluated using the Health Literacy Questionnaire; decision self-efficacy, evaluated using the Decision Self-Efficacy Scale; and rates of unscheduled health encounters. Secondary outcomes include patient-reported outcomes (ie, quality of life, evaluated with the 5-level EQ-5D; knowledge; confidence; health behavior; and self-management) and clinical outcomes (ie, symptom burden, evaluated with the Palliative care Outcome Scale–Renal; nutritional status, evaluated with the Patient-Generated Subjective Global Assessment; and intradialytic weight gain). App engagement will be determined via app analytics. All analyses will be undertaken using an intention-to-treat approach comparing the intervention and usual care arms. Results: The study has been approved by Nepean Blue Mountains Human Research Ethics Committee (2020/ETH00910) and recruitment has begun at nine sites. We expect to finalize data collection by 2023 and publish the manuscript by 2024. Conclusions: Enhancing health literacy skills for patients undergoing hemodialysis is an important endeavor, given the association between poor health literacy and poor health outcomes, especially among culturally diverse groups. The findings from this trial will be published in peer-reviewed journals and disseminated at conferences, and updates will be shared with partners, including participating local health districts, Kidney Health Australia, and consumers. The SUCCESS app will continue to be available to all participants following trial completion. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000235808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380754&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/39909 %M 36044265 %R 10.2196/39909 %U https://www.researchprotocols.org/2022/8/e39909 %U https://doi.org/10.2196/39909 %U http://www.ncbi.nlm.nih.gov/pubmed/36044265 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e35283 %T Technology-Delivered Adaptations of Motivational Interviewing for the Prevention and Management of Chronic Diseases: Scoping Review %A Pedamallu,Havisha %A Ehrhardt,Matthew J %A Maki,Julia %A Carcone,April Idalski %A Hudson,Melissa M %A Waters,Erika A %+ Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, School of Medicine, 600 S Euclid Ave, Campus Box 8100, St Louis, MO, 63110, United States, 1 314 747 5705, waterse@wustl.edu %K motivational interviewing %K technology %K telehealth %K health behavior %K chronic disease %K socioeconomic factors %K health promotion %K disease management %K primary prevention %K secondary prevention %K minority health %D 2022 %7 9.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health–based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. Objective: We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. Methods: We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). Results: Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. Conclusions: Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice. %M 35943775 %R 10.2196/35283 %U https://www.jmir.org/2022/8/e35283 %U https://doi.org/10.2196/35283 %U http://www.ncbi.nlm.nih.gov/pubmed/35943775 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e37039 %T Association Between Neighborhood Factors and Adult Obesity in Shelby County, Tennessee: Geospatial Machine Learning Approach %A Brakefield,Whitney S %A Olusanya,Olufunto A %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, 491R, Memphis, TN, 38103, United States, 1 901 287 5836, ashabann@uthsc.edu %K obesity %K obesity surveillance %K disease surveillance %K machine learning %K geographic information systems %K social determinants of health %K SDOH %K disparities %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Obesity is a global epidemic causing at least 2.8 million deaths per year. This complex disease is associated with significant socioeconomic burden, reduced work productivity, unemployment, and other social determinants of health (SDOH) disparities. Objective: The objective of this study was to investigate the effects of SDOH on obesity prevalence among adults in Shelby County, Tennessee, the United States, using a geospatial machine learning approach. Methods: Obesity prevalence was obtained from the publicly available 500 Cities database of Centers for Disease Control and Prevention, and SDOH indicators were extracted from the US census and the US Department of Agriculture. We examined the geographic distributions of obesity prevalence patterns, using Getis-Ord Gi* statistics and calibrated multiple models to study the association between SDOH and adult obesity. Unsupervised machine learning was used to conduct grouping analysis to investigate the distribution of obesity prevalence and associated SDOH indicators. Results: Results depicted a high percentage of neighborhoods experiencing high adult obesity prevalence within Shelby County. In the census tract, the median household income, as well as the percentage of individuals who were Black, home renters, living below the poverty level, 55 years or older, unmarried, and uninsured, had a significant association with adult obesity prevalence. The grouping analysis revealed disparities in obesity prevalence among disadvantaged neighborhoods. Conclusions: More research is needed to examine links between geographical location, SDOH, and chronic diseases. The findings of this study, which depict a significantly higher prevalence of obesity within disadvantaged neighborhoods, and other geospatial information can be leveraged to offer valuable insights, informing health decision-making and interventions that mitigate risk factors of increasing obesity prevalence. %M 35943795 %R 10.2196/37039 %U https://publichealth.jmir.org/2022/8/e37039 %U https://doi.org/10.2196/37039 %U http://www.ncbi.nlm.nih.gov/pubmed/35943795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38424 %T Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders’ Perspectives %A van de Vijver,Steven %A Hummel,Deirdre %A van Dijk,Annericht Hester %A Cox,Jan %A van Dijk,Oscar %A Van den Broek,Nicoline %A Metting,Esther %+ Amsterdam Health & Technology Institute, Amsterdam University Medical Center, Paasheuvelweg 25, Amsterdam, 1105 BP, Netherlands, 31 6 19053595, s.vandevijver@ahti.nl %K primary care %K chronic disease %K telemonitoring %K digital health %K self-management %K patient-centered care %K chronic care %K chronic care management %K illness %K healthcare %K healthcare professional %K user %K patient %K platform %K tool %K communication %K empowerment %K online %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. %M 35921145 %R 10.2196/38424 %U https://formative.jmir.org/2022/8/e38424 %U https://doi.org/10.2196/38424 %U http://www.ncbi.nlm.nih.gov/pubmed/35921145 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e27990 %T A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study %A Román-Villarán,Esther %A Alvarez-Romero,Celia %A Martínez-García,Alicia %A Escobar-Rodríguez,German Antonio %A García-Lozano,María José %A Barón-Franco,Bosco %A Moreno-Gaviño,Lourdes %A Moreno-Conde,Jesús %A Rivas-González,José Antonio %A Parra-Calderón,Carlos Luis %+ Computational Health Informatics Group, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas, University of Seville, Avenida Manuel Siurot s/n, Seville, 41013, Spain, 34 955 013 662, celia.alvarez@juntadeandalucia.es %K adherence %K ontology %K clinical decision support system %K CDSS %K complex chronic patients %K functional validation %K multimorbidity %K polypharmacy %K atrial fibrillation %K anticoagulants %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to an increase in life expectancy, the prevalence of chronic diseases is also on the rise. Clinical practice guidelines (CPGs) provide recommendations for suitable interventions regarding different chronic diseases, but a deficiency in the implementation of these CPGs has been identified. The PITeS-TiiSS (Telemedicine and eHealth Innovation Platform: Information Communications Technology for Research and Information Challenges in Health Services) tool, a personalized ontology-based clinical decision support system (CDSS), aims to reduce variability, prevent errors, and consider interactions between different CPG recommendations, among other benefits. Objective: The aim of this study is to design, develop, and validate an ontology-based CDSS that provides personalized recommendations related to drug prescription. The target population is older adult patients with chronic diseases and polypharmacy, and the goal is to reduce complications related to these types of conditions while offering integrated care. Methods: A study scenario about atrial fibrillation and treatment with anticoagulants was selected to validate the tool. After this, a series of knowledge sources were identified, including CPGs, PROFUND index, LESS/CHRON criteria, and STOPP/START criteria, to extract the information. Modeling was carried out using an ontology, and mapping was done with Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT; International Health Terminology Standards Development Organisation). Once the CDSS was developed, validation was carried out by using a retrospective case study. Results: This project was funded in January 2015 and approved by the Virgen del Rocio University Hospital ethics committee on November 24, 2015. Two different tasks were carried out to test the functioning of the tool. First, retrospective data from a real patient who met the inclusion criteria were used. Second, the analysis of an adoption model was performed through the study of the requirements and characteristics that a CDSS must meet in order to be well accepted and used by health professionals. The results are favorable and allow the proposed research to continue to the next phase. Conclusions: An ontology-based CDSS was successfully designed, developed, and validated. However, in future work, validation in a real environment should be performed to ensure the tool is usable and reliable. %M 35916719 %R 10.2196/27990 %U https://formative.jmir.org/2022/8/e27990 %U https://doi.org/10.2196/27990 %U http://www.ncbi.nlm.nih.gov/pubmed/35916719 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38980 %T Digital Health Technologies Enabling Partnerships in Chronic Care Management: Scoping Review %A Wannheden,Carolina %A Åberg-Wennerholm,Matilda %A Dahlberg,Marie %A Revenäs,Åsa %A Tolf,Sara %A Eftimovska,Elena %A Brommels,Mats %+ Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavaegen 18a, Stockholm, 171 77, Sweden, 46 0852483934, carolina.wannheden@ki.se %K participatory health %K digital health %K eHealth %K collaborative care %K participatory health informatics %K cocare %K partnership care management %K chronic disease %K long-term conditions %K mobile phone %K scoping review %D 2022 %7 1.8.2022 %9 Review %J J Med Internet Res %G English %X Background: An increasing number of patients expect and want to play a greater role in their treatment and care decisions. This emphasizes the need to adopt collaborative health care practices, which implies collaboration among interprofessional health care teams and patients, their families, caregivers, and communities. In recent years, digital health technologies that support self-care and collaboration between the community and health care providers (ie, participatory health technologies) have received increasing attention. However, knowledge regarding the features of such technologies that support effective patient-professional partnerships is still limited. Objective: This study aimed to map and assess published studies on participatory health technologies intended to support partnerships among patients, caregivers, and health care professionals in chronic care, focusing specifically on identifying the main features of these technologies. Methods: A scoping review covering scientific publications in English between January 2008 and December 2020 was performed. We searched PubMed and Web of Science databases. Peer-reviewed qualitative, quantitative, and mixed methods studies that evaluated digital health technologies for patient-professional partnerships in chronic care settings were included. The data were charted and analyzed thematically. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist was used. Results: This review included 32 studies, reported in 34 papers. The topic of participatory health technologies experienced a slightly increasing trend across publication years, with most papers originating from the United States and Norway. Diabetes and cardiovascular diseases were the most common conditions addressed. Of the 32 studies, 12 (38%) evaluated the influence of participatory health technologies on partnerships, mostly with positive outcomes, although we also identified how partnership relationships and the nature of collaborative work could be challenged when the roles and expectations between users were unclear. Six common features of participatory health technologies were identified: patient-professional communication, self-monitoring, tailored self-care support, self-care education, care planning, and community forums for peer-to-peer interactions. Conclusions: Our findings emphasize the importance of clarifying mutual expectations and carefully considering the implications that the introduction of participatory health technologies may have on the work of patients and health care professionals, both individually and in collaboration. A knowledge gap remains regarding the use of participatory health technologies to effectively support patient-professional partnerships in chronic care management. %M 35916720 %R 10.2196/38980 %U https://www.jmir.org/2022/8/e38980 %U https://doi.org/10.2196/38980 %U http://www.ncbi.nlm.nih.gov/pubmed/35916720 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35173 %T Self-care Behaviors and Technology Used During COVID-19: Systematic Review %A Sakur,Fareeya %A Ward,Kanesha %A Khatri,Neha Nafees %A Lau,Annie Y S %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Australia, 61 (02) 9850 2400, fareeya.sakur@hdr.mq.edu.au %K self-care %K self-management %K chronic conditions %K COVID-19 %K pandemic %K technology %K digital health %K telehealth %K health technology %D 2022 %7 21.6.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Self-care behaviors are essential for people living with chronic conditions; however, the outbreak of the COVID-19 pandemic has imposed additional complications on their daily routines. Few studies have analyzed how self-care behaviors have changed during COVID-19 and the role of digital technology, especially among people with chronic conditions. Objective: This study aims to review how self-care behaviors have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period. Methods: A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and Google Scholar, including articles from December 2019 onward. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (ie, self-care maintenance, monitoring, and management). The methodological quality of the included articles was assessed with the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Results: In total, 36 primary research articles were included. Changes to self-care behaviors during COVID-19 among people with chronic conditions were organized according to the middle-range theory of self-care of chronic illness focusing on self-care maintenance (ie, medication adherence, physical activity, and diet control), self-care monitoring (ie, monitoring signs and symptoms), and self-care management (ie, consultations with health care providers). Positive self-care behaviors observed include the following: individuals trying to maintain good glycemic control during COVID-19 increased their medication adherence in 27% (10/36) of studies; and diet control improved in 50% (18/36) of studies. Negative self-care behaviors observed include the following: decline in physical activities and increased sedentariness were observed in 65% (23/36) of studies; poor diet control was observed in 57% (21/36) of studies; and self-monitoring of health status dropped in 43% (15/36) of studies. The use of technology to support self-care of chronic conditions during COVID-19 was reported in 72% (26/36) of studies. The actual use of telehealth in place of physical consultations during COVID-19 was observed in 50% (18/36) of studies, and other digital technologies (eg, social media apps, smartphone apps, web-based platforms, and web browsing) were used in 50% (18/36) of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% (28/36) of studies. Conclusions: This review highlighted the necessity to rethink how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) among a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions. %M 35442904 %R 10.2196/35173 %U https://humanfactors.jmir.org/2022/2/e35173 %U https://doi.org/10.2196/35173 %U http://www.ncbi.nlm.nih.gov/pubmed/35442904 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35929 %T Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review %A Singh,Hardeep %A Tang,Terence %A Steele Gray,Carolyn %A Kokorelias,Kristina %A Thombs,Rachel %A Plett,Donna %A Heffernan,Matthew %A Jarach,Carlotta M %A Armas,Alana %A Law,Susan %A Cunningham,Heather V %A Nie,Jason Xin %A Ellen,Moriah E %A Thavorn,Kednapa %A Nelson,Michelle LA %+ Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada, 1 416 946 3724, hardeepk.singh@mail.utoronto.ca %K transitions %K health %K medical informatics %K aged %K mobile phone %D 2022 %7 19.5.2022 %9 Review %J JMIR Aging %G English %X Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 %M 35587874 %R 10.2196/35929 %U https://aging.jmir.org/2022/2/e35929 %U https://doi.org/10.2196/35929 %U http://www.ncbi.nlm.nih.gov/pubmed/35587874 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35408 %T eHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review %A Egan,Lyra %A Gardner,Lauren Anne %A Newton,Nicola %A Champion,Katrina %+ The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building (G02), University of Sydney, Sydney, 2006, Australia, 61 2 9114 4753, lyra.egan@sydney.edu.au %K eHealth %K adolescent %K health promotion %K diet %K alcohol %K smoking %K vaping %K socioeconomic status %K remoteness %K rural %K disadvantage %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas. Objective: This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping. Methods: A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool. Results: As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022. Conclusions: This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations. Trial Registration: PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119 International Registered Report Identifier (IRRID): PRR1-10.2196/35408 %M 35560002 %R 10.2196/35408 %U https://www.researchprotocols.org/2022/5/e35408 %U https://doi.org/10.2196/35408 %U http://www.ncbi.nlm.nih.gov/pubmed/35560002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e29787 %T The Effects of a Web-Based Tool for Parents of Children With Juvenile Idiopathic Arthritis: Randomized Controlled Trial %A Mulligan,Kathleen %A Hirani,Shashivadan P %A Harris,Sally %A Taylor,Jo %A Wedderburn,Lucy R %A Newman,Stanton %A , %+ Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom, 44 020 7040 3090, Stanton.Newman.1@city.ac.uk %K parenting stress %K juvenile idiopathic arthritis %K web-based intervention %K randomized controlled trial %K parenting %K pediatrics %K arthritis %K RCT %K rheumatology %K children %K youth %K web-based tool %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Juvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child’s treatment and may experience anxiety and powerlessness concerning their child’s illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents’ confidence in managing their child’s illness and reduce parenting stress. Objective: The aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. Methods: A multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ≤12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child’s health care, satisfaction with health care, and child’s health-related quality of life. Results: A total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. Conclusions: The WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730 %M 35551065 %R 10.2196/29787 %U https://www.jmir.org/2022/5/e29787 %U https://doi.org/10.2196/29787 %U http://www.ncbi.nlm.nih.gov/pubmed/35551065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36114 %T Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial %A Morcillo-Muñoz,Yolanda %A Sánchez-Guarnido,Antonio José %A Calzón-Fernández,Silvia %A Baena-Parejo,Isabel %+ Primary Care, Andalusian Health Service, Plaza de la Mujer s/n, District Campo de Gibraltar, Algeciras, 11207, Spain, 34 670946860, ymmcadiz1969@gmail.com %K chronic pain %K eHealth %K multimodal intervention %K catastrophizing %K self-management %K mHealth %K mobile phone %K randomized controlled trials %D 2022 %7 11.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions. Objective: The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting. Methods: A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment. Results: Positive effects were found in the intervention group (T2–T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (−0.72 vs 0.1; P=.002), rumination (−1.59 vs −0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs −0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs −0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; −0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (−0.65 vs 0.01; P=.07), rumination (1.23 vs −0.59; P=.04), and magnification (0.1 vs 0.86; P=.02). Conclusions: The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments. Trial Registration: ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154 %M 35373 %R 10.2196/36114 %U https://www.jmir.org/2022/5/e36114 %U https://doi.org/10.2196/36114 %U http://www.ncbi.nlm.nih.gov/pubmed/35373 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33967 %T Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform %A Brown,Ethan G %A Schleimer,Erica %A Bledsoe,Ian O %A Rowles,William %A Miller,Nicolette A %A Sanders,Stephan J %A Rankin,Katherine P %A Ostrem,Jill L %A Tanner,Caroline M %A Bove,Riley %+ University of California San Francisco Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States, 1 415 353 2311, riley.bove@ucsf.edu %K human-centered design %K personal health record %K visualization in eHealth %K Parkinson disease %K digital health %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: People with Parkinson disease (PD) have a variety of complex medical problems that require detailed review at each clinical encounter for appropriate management. Care of other complex conditions has benefited from digital health solutions that efficiently integrate disparate clinical information. Although various digital approaches have been developed for research and care in PD, no digital solution to personalize and improve communication in a clinical encounter is readily available. Objective: We intend to improve the efficacy and efficiency of clinical encounters with people with PD through the development of a platform (PD-BRIDGE) with personalized clinical information from the electronic health record (EHR) and patient-reported outcome (PRO) data. Methods: Using human-centered design (HCD) processes, we engaged clinician and patient stakeholders in developing PD-BRIDGE through three phases: an inspiration phase involving focus groups and discussions with people having PD, an ideation phase generating preliminary mock-ups for feedback, and an implementation phase testing the platform. To qualitatively evaluate the platform, movement disorders neurologists and people with PD were sent questionnaires asking about the technical validity, usability, and clinical relevance of PD-BRIDGE after their encounter. Results: The HCD process led to a platform with 4 modules. Among these, 3 modules that pulled data from the EHR include a longitudinal module showing motor ratings over time, a display module showing the most recently collected clinical rating scales, and another display module showing relevant laboratory values and diagnoses; the fourth module displays motor symptom fluctuation based on an at-home diary. In the implementation phase, PD-BRIDGE was used in 17 clinical encounters for patients cared for by 1 of 11 movement disorders neurologists. Most patients felt that PD-BRIDGE facilitated communication with their clinician (n=14, 83%) and helped them understand their disease trajectory (n=11, 65%) and their clinician’s recommendations (n=11, 65%). Neurologists felt that PD-BRIDGE improved their ability to understand the patients’ disease course (n=13, 75% of encounters), supported clinical care recommendations (n=15, 87%), and helped them communicate with their patients (n=14, 81%). In terms of improvements, neurologists noted that data in PD-BRIDGE were not exhaustive in 62% (n=11) of the encounters. Conclusions: Integrating clinically relevant information from EHR and PRO data into a visually efficient platform (PD-BRIDGE) can facilitate clinical encounters with people with PD. Developing new modules with more disparate information could improve these complex encounters even further. %M 35522472 %R 10.2196/33967 %U https://humanfactors.jmir.org/2022/2/e33967 %U https://doi.org/10.2196/33967 %U http://www.ncbi.nlm.nih.gov/pubmed/35522472 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e32456 %T Exploring Human-Data Interaction in Clinical Decision-making Using Scenarios: Co-design Study %A Tendedez,Helena %A Ferrario,Maria-Angela %A McNaney,Roisin %A Gradinar,Adrian %+ Lancaster Institute for the Contemporary Arts, Lancaster University, The LICA Building, Lancaster, , United Kingdom, 44 1524510302, a.gradinar@lancaster.ac.uk %K data-supported decision-making %K health care professionals %K respiratory care %K scenario-based design %K clinical decision-making %K decision support %K COPD %K respiratory conditions %K digital health %K user-centered design %K health technologies %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When caring for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD), health care professionals (HCPs) rely on multiple data sources to make decisions. Collating and visualizing these data, for example, on clinical dashboards, holds the potential to support timely and informed decision-making. Most studies on data-supported decision-making (DSDM) technologies for health care have focused on their technical feasibility or quantitative effectiveness. Although these studies are an important contribution to the literature, they do not further our limited understanding of how HCPs engage with these technologies and how they can be designed to support specific contexts of use. To advance our knowledge in this area, we must work with HCPs to explore this space and the real-world complexities of health care work and service structures. Objective: This study aimed to qualitatively explore how DSDM technologies could support HCPs in their decision-making regarding COPD care. We created a scenario-based research tool called Respire, which visualizes HCPs’ data needs about their patients with COPD and services. We used Respire with HCPs to uncover rich and nuanced findings about human-data interaction in this context, focusing on the real-world challenges that HCPs face when carrying out their work and making decisions. Methods: We engaged 9 respiratory HCPs from 2 collaborating health care organizations to design Respire. We then used Respire as a tool to investigate human-data interaction in the context of decision-making about COPD care. The study followed a co-design approach that had 3 stages and spanned 2 years. The first stage involved 5 workshops with HCPs to identify data interaction scenarios that would support their work. The second stage involved creating Respire, an interactive scenario-based web app that visualizes HCPs’ data needs, incorporating feedback from HCPs. The final stage involved 11 one-to-one sessions with HCPs to use Respire, focusing on how they envisaged that it could support their work and decisions about care. Results: We found that HCPs trust data differently depending on where it came from and who recorded it, sporadic and subjective data generated by patients have value but create challenges for decision-making, and HCPs require support in interpreting and responding to new data and its use cases. Conclusions: Our study uncovered important lessons for the design of DSDM technologies to support health care contexts. We show that although DSDM technologies have the potential to support patient care and health care delivery, important sociotechnical and human-data interaction challenges influence the design and deployment of these technologies. Exploring these considerations during the design process can ensure that DSDM technologies are designed with a holistic view of how decision-making and engagement with data occur in health care contexts. %M 35522463 %R 10.2196/32456 %U https://humanfactors.jmir.org/2022/2/e32456 %U https://doi.org/10.2196/32456 %U http://www.ncbi.nlm.nih.gov/pubmed/35522463 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37672 %T Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study %A Elf,Marie %A Klockar,Erika %A Kylén,Maya %A von Koch,Lena %A Ytterberg,Charlotte %A Wallin,Lars %A Finch,Tracy %A Gustavsson,Catharina %A Jones,Fiona %+ School of Health and Welfare, Dalarna University, Högskolegatan 2, Falun, 79188, Sweden, 46 701917856, mel@du.se %K self-management %K self-management support %K self-efficacy %K stroke rehabilitation %K home rehabilitation %K person-centered care %D 2022 %7 6.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients’ confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided. Objective: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context. Methods: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design. Results: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022. Conclusions: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management. International Registered Report Identifier (IRRID): DERR1-10.2196/37672 %M 35522476 %R 10.2196/37672 %U https://www.researchprotocols.org/2022/5/e37672 %U https://doi.org/10.2196/37672 %U http://www.ncbi.nlm.nih.gov/pubmed/35522476 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e27277 %T A Multifaceted Intervention to Improve Medication Adherence in Kidney Transplant Recipients: An Exploratory Analysis of the Fidelity of the TAKE IT Trial %A Yoon,Esther S %A Hur,Scott %A Curtis,Laura M %A Wynia,Aiden H %A Zheng,Pauline %A Nair,Sumi S %A Bailey,Stacy C %A Serper,Marina %A Reese,Peter P %A Ladner,Daniela P %A Wolf,Michael S %+ Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125034948, esther.yoon@northwestern.edu %K kidney transplantation %K medication adherence %K fidelity %K digital health %K patient portal %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Inadequate adherence to prescribed immunosuppressive medication regimens among kidney transplant recipients is common, yet interventions are needed to support patients in sustaining adequate adherence to prescribed regimens and achieving optimal transplant outcomes. Objective: We examined the preliminary fidelity of a transplant center-based, multifaceted adherence monitoring strategy known as TAKE IT. Methods: The TAKE IT strategy includes: (1) routine, online, monthly patient self-report adherence assessments; (2) care alerts directed to nurses; (3) quarterly reports monitoring tacrolimus values and adherence trends; (4) support tools tailored to specific adherence concerns. A 2-arm, patient-randomized trial is underway at two large transplant centers (N=449). To evaluate the initial fidelity of TAKE IT, we investigated patient uptake of monthly adherence assessments during the course of a 3-month period, whether any disparities emerged, and the nature of any reported adherence concerns. Results: Among 202 patients randomized and exposed to TAKE IT for 3-months or more, 81% (164/202) completed an adherence assessment, 73% (148/202) completed at least two, and 57% (116/202) completed all monthly assessments. Overall, 50% (82/164) of kidney transplant recipients reported at least one adherence concern over the 3-month assessment period. The most common barriers were classified as regimen-related (eg, regimen complexity), cognitive (eg, forgetfulness), and medical (eg, side effects). Higher-income participants were more likely to complete all surveys compared to lower-income participants (P=.01). Conclusions: TAKE IT demonstrated 81% (164/202) completion of an adherence assessment, 73% (148/202) completion of at least two, and 57% (116/202) completion of all monthly assessments during this brief, initial observation period. Among those that did respond to the online assessments, the majority demonstrated sustained engagement. Additional monitoring modalities could also be offered to meet patient preferences to ensure all patients’ medication use can be properly monitored. Trial Registration: ClinicalTrials.gov NCT03104868; https://clinicaltrials.gov/ct2/show/NCT03104868 %M 35511225 %R 10.2196/27277 %U https://formative.jmir.org/2022/5/e27277 %U https://doi.org/10.2196/27277 %U http://www.ncbi.nlm.nih.gov/pubmed/35511225 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37522 %T Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial %A Gustafson,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Landucci,Gina %A Pe-Romashko,Klaren %A Vjorn,Olivia J %A Hu,Yaxin %A Gustafson,David H %A Maus,Adam %A Mahoney,Jane E %A Mutlu,Bilge %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering Bldg, 4th Fl., 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K eHealth %K aged %K geriatrics %K multiple chronic conditions %K chronic pain %K smart displays %K smart speakers %K quality of life %K primary care %K health expenditures %K mobile phone %D 2022 %7 5.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective: The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods: A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions: To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID): PRR1-10.2196/37522 %M 35511229 %R 10.2196/37522 %U https://www.researchprotocols.org/2022/5/e37522 %U https://doi.org/10.2196/37522 %U http://www.ncbi.nlm.nih.gov/pubmed/35511229 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e31720 %T Humanizing Health and Social Care Support for People With Intellectual and Developmental Disabilities: Protocol for a Scoping Review %A Milne-Ives,Madison %A Shankar,Rohit %A Goodley,Dan %A Lamb,Kirsten %A Laugharne,Richard %A Harding,Tracey %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 01752600600, edward.meinert@plymouth.ac.uk %K developmental disabilities %K intellectual disability %K delivery of health care %K patient care management %K social work %K social support %K patient-centered care %K empathy %K respect %K social care %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into health and social care practices for people with intellectual and developmental disabilities to ensure that they are receiving equitable treatment and support. Objective: The purpose of our scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the development and implementation of interventions based on humanizing principles that aim to improve health and social care practices for people with intellectual and developmental disabilities. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PICOS (Population, Intervention, Comparator, Outcome, and Study) frameworks will be used to structure the review. A total of 6 databases (PubMed, MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) will be searched for English articles published in the previous 10 years that describe or evaluate health and social care practice interventions underpinned by the humanizing principles of empathy, compassion, dignity, and respect. Two reviewers will screen and select references based on the eligibility criteria and extract the data into a predetermined form. A descriptive analysis will be conducted to summarize the results and provide an overview of interventions in the following three main care areas: health care, social care, and informal social support. Results: The results will be included in the scoping review, which is expected to begin in October 2022 and be completed and submitted for publication by January 2023. Conclusions: Our scoping review will summarize the state of the field of interventions that are using humanizing principles to improve health and social care for adults with intellectual and developmental disabilities. International Registered Report Identifier (IRRID): PRR1-10.2196/31720 %M 35507388 %R 10.2196/31720 %U https://www.researchprotocols.org/2022/5/e31720 %U https://doi.org/10.2196/31720 %U http://www.ncbi.nlm.nih.gov/pubmed/35507388 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37255 %T Effectiveness of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Patients With Spinal Cord Injury: Protocol for a Pilot Trial Study %A Campo,Andrés Reyes %A Pacichana-Quinayáz,Sara Gabriela %A Bonilla-Escobar,Francisco Javier %A Leiva-Pemberthy,Luz Miriam %A Tovar-Sánchez,Maria Ana %A Hernández-Orobio,Olga Marina %A Arango-Hoyos,Gloria-Patricia %A Mujanovic,Adnan %+ Departamento de Medicina Física y Rehabilitación, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Universidad del Valle, Hospital Universitario del Valle, Cl 5#36-08, Cali, 760001, Colombia, 57 2 6206000, fjbonillaescobar@gmail.com %K spinal cord injury %K neuropathic pain %K quality of life %K catastrophization %K hydrotherapy %K neurology %K spinal cord %K nonpharmacological %D 2022 %7 29.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuropathic pain (NP) is one of the most frequent spinal cord injury (SCI) complications. Pain, quality of life, and functionality are associated and can lead to pain catastrophization. Pharmacological management of patients with NP secondary to SCI is widely known and there is increasing evidence in the area. Nevertheless, nonpharmacological management is not fully elucidated since its efficacy is inconclusive. Objective: We hypothesize that (1) hydrotherapy is effective in reducing NP secondary to SCI. Additionally, our secondary hypotheses are that (2) hydrotherapy decreases the catastrophization of NP, and that (3) hydrotherapy improves life quality and minimizes the degree of disability, when compared to physical therapy. Methods: A sample of approximately 20 participants will be randomly assigned to either the intervention (hydrotherapy) or control group (standard physical therapy). Both interventions will be administered twice a week over a 9-week period (18 sessions in total). Primary outcomes are changes in neuropathic pain perception and pain catastrophization. Secondary outcomes are changes in disability and quality of life scores. They will be assessed at baseline and follow-up at 4 weeks after discharge. Validated Spanish language scales that will be used are the following: Numerical Pain Rating Scale, Pain Catastrophization, Health-related Quality of life, and the World Health Organization’s Disability Assessment Schedule 2.0. Generalized mixed linear models will be used for comparing baseline and postintervention means of each group and their differences, together with 95% CIs and P values. A P value of less than .05 will be considered significant. Results: Recruitment began in April 2019, and we recruited the last participants by December 2019, with 10 individuals assigned to hydrotherapy and 8 to physical therapy (control). Results from this study will be disseminated via scientific publication, in ClinicalTrials.gov, and in national and international conferences in the latter half of 2022. Conclusions: This trial will explore the effects of hydrotherapy on neuropathic pain, together with functionality and quality of life, in patients with SCI. Furthermore, this study aims to evaluate these therapeutic modalities, including perception variables, and mental processes, which may affect the clinical condition and rehabilitation outcomes in these patients. Hydrotherapy is likely to be a safe, efficient, and cost-effective alternative to the current standard of care for NP secondary to SCI, with comparable results between the two. Trial Registration: ClinicalTrials.gov NCT04164810; https://clinicaltrials.gov/ct2/show/NCT04164810 International Registered Report Identifier (IRRID): DERR1-10.2196/37255 %M 35486436 %R 10.2196/37255 %U https://www.researchprotocols.org/2022/4/e37255 %U https://doi.org/10.2196/37255 %U http://www.ncbi.nlm.nih.gov/pubmed/35486436 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35945 %T Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial %A Bas-Sarmiento,Pilar %A Fernández-Gutiérrez,Martina %A Poza-Méndez,Miriam %A Marín-Paz,Antonio Jesús %A Paloma-Castro,Olga %A Romero-Sánchez,José Manuel %A , %+ Department of Nursing and Physiotherapy, University of Cádiz, Ana de Viya Avenue, 52, Cádiz, 11009, Spain, 34 956028100, martina.fernandez@uca.es %K complex health needs %K health literacy %K heart failure %K mHealth %K multimorbidity %D 2022 %7 29.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL). Objective: This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs. Methods: This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months. Results: The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months. Conclusions: The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts. Trial Registration: ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w International Registered Report Identifier (IRRID): DERR1-10.2196/35945 %M 35486437 %R 10.2196/35945 %U https://www.researchprotocols.org/2022/4/e35945 %U https://doi.org/10.2196/35945 %U http://www.ncbi.nlm.nih.gov/pubmed/35486437 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e36346 %T Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study %A Gordon,Kayleigh %A Dainty,Katie N %A Steele Gray,Carolyn %A DeLacy,Jane %A Shah,Amika %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, kayleigh.gordon@mail.utoronto.ca %K telemonitoring %K TM %K nurse practitioner %K NP-led care %K models of care %K integrated care %K disease care model %K disease %K nurse %K nurse-led implementation %K complex chronic conditions %K CCC %K clinical team %K mobile phone %D 2022 %7 28.4.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective: This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods: A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results: Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions: Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model. %M 35482375 %R 10.2196/36346 %U https://nursing.jmir.org/2022/1/e36346 %U https://doi.org/10.2196/36346 %U http://www.ncbi.nlm.nih.gov/pubmed/35482375 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34466 %T Contrasting Social Media Use Between Young Adults With Inflammatory Bowel Disease and Type 1 Diabetes: Cross-sectional Study %A Rajanala,Susruthi %A Wilson,Jennifer K %A Mitchell,Paul D %A Garvey,Katharine C %A Fishman,Laurie N %+ Division of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Harvard University, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 617 355 1836, laurie.fishman@childrens.harvard.edu %K social media %K inflammatory bowel disease %K type 1 diabetes %K internet %K young adult %K children %K Instagram %K Facebook %K type 1 %K diabetes %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social media is used by young adult patients for social connection and self-identification. Objective: This study aims to compare the social media habits of young adults with inflammatory bowel disease (IBD) and type 1 diabetes (T1D). Methods: This is a cross-sectional study of subjects from Boston Children’s Hospital outpatient IBD and diabetes clinics. Patients above 18 years of age were invited to complete a brief anonymous survey, which asked about the various ways they use several social media platforms. Results: Responses were received from 108 patients (92.5% response rate), evenly split across disease type. We found that 83% of participants spent at least 30 minutes per day on social media, most commonly on Instagram and Facebook. Although the content varied based on the platform, patients with IBD posted or shared content related to their disease significantly less than those with T1D (23% vs 38%, P=.02). Among Instagram users, patients with IBD were less likely to engage with support groups (22% vs 56%, P=.04). Among Twitter users, patients with IBD were less likely to seek disease information (77% vs 29%, P=.005). Among Facebook users, patients with IBD were less likely to post about research and clinical trials (31% vs 65%, P=.04) or for information seeking (49% vs 87%, P=.003). Patients with IBD were also less likely to share their diagnosis with friends or family in person. Conclusions: Young adults with IBD were less willing to share their diagnosis and post about or explore the disease on social media compared to those with T1D. This could lead to a sense of isolation and should be further explored. %M 35139484 %R 10.2196/34466 %U https://pediatrics.jmir.org/2022/2/e34466 %U https://doi.org/10.2196/34466 %U http://www.ncbi.nlm.nih.gov/pubmed/35139484 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e32825 %T Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study %A McBeth,John %A Dixon,William G %A Moore,Susan Mary %A Hellman,Bruce %A James,Ben %A Kyle,Simon D %A Lunt,Mark %A Cordingley,Lis %A Yimer,Belay Birlie %A Druce,Katie L %+ Centre for Epidemiology Versus Arthritis, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom, 44 1612755788, john.mcbeth@manchester.ac.uk %K mobile health %K sleep %K rheumatoid arthritis %K pain %K fatigue %K mood %K sleep disturbance %K HRQoL %K quality of life %K health-related quality of life %K QoL %K sleep efficiency %K WHOQoL-BREF %K mobile phone %D 2022 %7 22.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disturbances and poor health-related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of nonrestorative sleep, may be a driver of HRQoL. However, understanding whether these sleep disturbances reduce HRQoL has, to date, been challenging because of the need to collect complex time-varying data at high resolution. Such data collection is now made possible by the widespread availability and use of mobile health (mHealth) technologies. Objective: This mHealth study aimed to test whether sleep disturbance (both absolute values and variability) causes poor HRQoL. Methods: The quality of life, sleep, and RA study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, wore a triaxial accelerometer for 30 days to objectively assess sleep, and provided daily reports via a smartphone app that assessed sleep (Consensus Sleep Diary), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multilevel modeling tested the relationship between sleep variables and the WHOQoL-BREF domains (physical, psychological, environmental, and social). Results: Of the 268 recruited participants, 254 were included in the analysis. Across all WHOQoL-BREF domains, participants’ scores were lower than the population average. Consensus Sleep Diary sleep parameters predicted the WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β=1.11, 95% CI 0.07-2.15) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, anxiety levels, sleep quality, or clinical sleep disorders. However, these changes were attenuated and no longer significant when pain, fatigue, and mood were included in the model. Increased variability in total time asleep was associated with poorer physical and psychological domain scores, independent of all covariates. There was no association between actigraphy-measured sleep and WHOQoL-BREF. Conclusions: Optimizing total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing variability in total sleep time could improve HRQoL in people with RA. %M 35451978 %R 10.2196/32825 %U https://www.jmir.org/2022/4/e32825 %U https://doi.org/10.2196/32825 %U http://www.ncbi.nlm.nih.gov/pubmed/35451978 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35075 %T An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis %A Miranda,Rafael N %A Bhuiya,Aunima R %A Thraya,Zak %A Hancock-Howard,Rebecca %A Chan,Brian CF %A Steele Gray,Carolyn %A Wodchis,Walter P %A Thavorn,Kednapa %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, The General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899 ext 72330, kthavorn@ohri.ca %K eHealth %K multimorbidity %K primary care %K cost-effectiveness %K older adult %K elder %K cost %K patient reported outcome %K community %K complex care %K aging %K Canada %K North America %K chronic disease %K chronic condition %K decision tree %K model %K sensitivity analysis %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada. Methods: We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings. Results: The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (–0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions’ capacity to respond to complex aging populations within finite-resourced health systems. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 %M 35442194 %R 10.2196/35075 %U https://aging.jmir.org/2022/2/e35075 %U https://doi.org/10.2196/35075 %U http://www.ncbi.nlm.nih.gov/pubmed/35442194 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e34312 %T Promoting Physical Activity in a Spanish-Speaking Latina Population of Low Socioeconomic Status With Chronic Neurological Disorders: Proof-of-Concept Study %A Garbin,Alexander %A Díaz,Jesús %A Bui,Vy %A Morrison,Janina %A Fisher,Beth E %A Palacios,Carina %A Estrada-Darley,Ingrid %A Haase,Danielle %A Wing,David %A Amezcua,Lilyana %A Jakowec,Michael W %A Kaplan,Charles %A Petzinger,Giselle %+ Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave, Room 310B, Aurora, CO, 80045, United States, 1 303 724 9590, alexander.garbin@cuanschutz.edu %K exercise %K quality of life %K motivation %K promotion %K community study %K clinical trial %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) is known to improve quality of life (QoL) as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latina women are less likely to participate in recommended levels of PA due to common socioeconomic barriers, including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting PA. Objective: The aim of this study was to determine the feasibility and efficacy of a community-based intervention to promote PA through self-monitoring via a Fitbit and behavioral coaching among Latina participants with chronic neurological disorders.  Methods: We conducted a proof-of-concept study among 21 Spanish-speaking Latina participants recruited from the Los Angeles County and University of Southern California (LAC+USC) neurology clinic; participants enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital in Los Angeles. Demographic data were assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. PA promotion was determined by examining change in time spent performing moderate-to-vigorous PA (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days when coaching occurred versus on days without coaching. Change in psychometric measures (baseline vs postintervention) and medical center visits (16 weeks preintervention vs during the intervention) were also examined. Results: Participants were of low socioeconomic status and acculturation. A total of 19 out of 21 (90%) participants completed the study (attrition 10%), with high Fitbit wear adherence (mean 90.31%, SD 10.12%). Time performing MVPA gradually increased by a mean of 0.16 (SD 0.23) minutes per day (P<.001), which was equivalent to an increase of approximately 18 minutes in MVPA over the course of the 16-week study period. Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent on MVPA on days when coaching occurred via phone (37 min/day, P=.02) and in person (45.5 min/day, P=.01) relative to days without coaching (24 min/day). Participants improved their illness perception (effect size g=0.30) and self-rated QoL (effect size g=0.32). Additionally, a reduction in the number of medical center visits was observed (effect size r=0.44), and this reduction was associated with a positive change in step count during the study period (P.=04). Conclusions: Self-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion among Latina women of low socioeconomic status with chronic neurological conditions. PA is known to be important for brain health in neurological conditions but remains relatively unexplored in minority populations. Trial Registration: ClinicalTrials.gov NCT04820153; https://clinicaltrials.gov/ct2/show/NCT04820153 %M 35442197 %R 10.2196/34312 %U https://formative.jmir.org/2022/4/e34312 %U https://doi.org/10.2196/34312 %U http://www.ncbi.nlm.nih.gov/pubmed/35442197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33372 %T The Willingness to Pay for Telemedicine Among Patients With Chronic Diseases: Systematic Review %A Chua,Valerie %A Koh,Jin Hean %A Koh,Choon Huat Gerald %A Tyagi,Shilpa %+ Office of Healthcare Transformation, Ministry of Health, 1 Maritime Square, #12-10 Harborfront Centre, Singapore, 099253, Singapore, 65 6679 3147, valerie.chua.ruisi@u.nus.edu %K willingness to pay %K telemedicine %K chronic disease %K patients %K systematic review %K mobile phone %D 2022 %7 13.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine is increasingly being leveraged, as the need for remote access to health care has been driven by the rising chronic disease incidence and the COVID-19 pandemic. It is also important to understand patients’ willingness to pay (WTP) for telemedicine and the factors contributing toward it, as this knowledge may inform health policy planning processes, such as resource allocation or the development of a pricing strategy for telemedicine services. Currently, most of the published literature is focused on cost-effectiveness analysis findings, which guide health care financing from the health system’s perspective. However, there is limited exploration of the WTP from a patient’s perspective, despite it being pertinent to the sustainability of telemedicine interventions. Objective: To address this gap in research, this study aims to conduct a systematic review to describe the WTP for telemedicine interventions and to identify the factors influencing WTP among patients with chronic diseases in high-income settings. Methods: We systematically searched 4 databases (PubMed, PsycINFO, Embase, and EconLit). A total of 2 authors were involved in the appraisal. Studies were included if they reported the WTP amounts or identified the factors associated with patients’ WTP, involved patients aged ≥18 years who were diagnosed with chronic diseases, and were from high-income settings. Results: A total of 11 studies from 7 countries met this study’s inclusion criteria. The proportion of people willing to pay for telemedicine ranged from 19% to 70% across the studies, whereas the values for WTP amounts ranged from US $0.89 to US $821.25. We found a statistically significant correlation of age and distance to a preferred health facility with the WTP for telemedicine. Higher age was associated with a lower WTP, whereas longer travel distance was associated with a higher WTP. Conclusions: On the basis of our findings, the following are recommendations that may enhance the WTP: exposure to the telemedicine intervention before assessing the WTP, the lowering of telemedicine costs, and the provision of patient education to raise awareness on telemedicine’s benefits and address patients’ concerns. In addition, we recommend that future research be directed at standardizing the reporting of WTP studies with the adoption of a common metric for WTP amounts, which may facilitate the generalization of findings and effect estimates. %M 35416779 %R 10.2196/33372 %U https://www.jmir.org/2022/4/e33372 %U https://doi.org/10.2196/33372 %U http://www.ncbi.nlm.nih.gov/pubmed/35416779 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28260 %T Detecting Anomalies in Daily Activity Routines of Older Persons in Single Resident Smart Homes: Proof-of-Concept Study %A Shahid,Zahraa Khais %A Saguna,Saguna %A Åhlund,Christer %+ Division of Computer Science, Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, Forskargatan 1, Skellefteå, 931 77, Sweden, 46 704741624, zahraa.shahid@ltu.se %K Activities of daily living %K smart homes %K elderly care %K anomaly detection %K IoT devices %K smart device %K elderly %K sensors %K digital sensors %K Internet of things %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: One of the main challenges of health monitoring systems is the support of older persons in living independently in their homes and with relatives. Smart homes equipped with internet of things devices can allow older persons to live longer in their homes. Previous surveys used to identify sensor-based data sets in human activity recognition systems have been limited by the use of public data set characteristics, data collected in a controlled environment, and a limited number of older participants. Objective: The objective of our study is to build a model that can learn the daily routines of older persons, detect deviations in daily living behavior, and notify these anomalies in near real-time to relatives. Methods: We extracted features from large-scale sensor data by calculating the time duration and frequency of visits. Anomalies were detected using a parametric statistical approach, unusually short or long durations being detected by estimating the mean (μ) and standard deviation (σ) over hourly time windows (80 to 355 days) for different apartments. The confidence level is at least 75% of the tested values within two (σ) from the mean. An anomaly was triggered where the actual duration was outside the limits of 2 standard deviations (μ−2σ, μ+2σ), activity nonoccurrence, or absence of activity. Results: The patterns detected from sensor data matched the routines self-reported by users. Our system observed approximately 1000 meals and bathroom activities and notifications sent to 9 apartments between July and August 2020. A service evaluation of received notifications showed a positive user experience, an average score of 4 being received on a 1 to 5 Likert-like scale. One was poor, two fair, three good, four very good, and five excellent. Our approach considered more than 75% of the observed meal activities were normal. This figure, in reality, was 93%, normal observed meal activities of all participants falling within 2 standard deviations of the mean. Conclusions: In this research, we developed, implemented, and evaluated a real-time monitoring system of older participants in an uncontrolled environment, with off-the-shelf sensors and internet of things devices being used in the homes of older persons. We also developed an SMS-based notification service and conducted user evaluations. This service acts as an extension of the health/social care services operated by the municipality of Skellefteå provided to older persons and relatives. %M 35404260 %R 10.2196/28260 %U https://aging.jmir.org/2022/2/e28260 %U https://doi.org/10.2196/28260 %U http://www.ncbi.nlm.nih.gov/pubmed/35404260 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e26307 %T Differences in Learning and Persistency Characterizing Behavior in Chronic Pain for the Iowa Gambling Task: Web-Based Laboratory-in-the-Field Study %A Zhang,Lili %A Vashisht,Himanshu %A Nethra,Alekhya %A Slattery,Brian %A Ward,Tomas %+ School of Computing, Dublin City University, McNulty Building, Glasnevin Campus, Dublin 9, Ireland, 353 0873747816, lili.zhang27@mail.dcu.ie %K chronic pain %K decision-making %K computational modeling %K Iowa Gambling Task %K lab-in-the-field experiment %D 2022 %7 6.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic pain is a significant worldwide health problem. It has been reported that people with chronic pain experience decision-making impairments, but these findings have been based on conventional laboratory experiments to date. In such experiments, researchers have extensive control of conditions and can more precisely eliminate potential confounds. In contrast, there is much less known regarding how chronic pain affects decision-making captured via laboratory-in-the-field experiments. Although such settings can introduce more experimental uncertainty, collecting data in more ecologically valid contexts can better characterize the real-world impact of chronic pain. Objective: We aim to quantify decision-making differences between individuals with chronic pain and healthy controls in a laboratory-in-the-field environment by taking advantage of internet technologies and social media. Methods: A cross-sectional design with independent groups was used. A convenience sample of 45 participants was recruited through social media: 20 (44%) participants who self-reported living with chronic pain, and 25 (56%) people with no pain or who were living with pain for <6 months acting as controls. All participants completed a self-report questionnaire assessing their pain experiences and a neuropsychological task measuring their decision-making (ie, the Iowa Gambling Task) in their web browser at a time and location of their choice without supervision. Results: Standard behavioral analysis revealed no differences in learning strategies between the 2 groups, although qualitative differences could be observed in the learning curves. However, computational modeling revealed that individuals with chronic pain were quicker to update their behavior than healthy controls, which reflected their increased learning rate (95% highest–posterior-density interval [HDI] 0.66-0.99) when fitted to the Values-Plus-Perseverance model. This result was further validated and extended on the Outcome-Representation Learning model as higher differences (95% HDI 0.16-0.47) between the reward and punishment learning rates were observed when fitted to this model, indicating that individuals with chronic pain were more sensitive to rewards. It was also found that they were less persistent in their choices during the Iowa Gambling Task compared with controls, a fact reflected by their decreased outcome perseverance (95% HDI −4.38 to −0.21) when fitted using the Outcome-Representation Learning model. Moreover, correlation analysis revealed that the estimated parameters had predictive value for the self-reported pain experiences, suggesting that the altered cognitive parameters could be potential candidates for inclusion in chronic pain assessments. Conclusions: We found that individuals with chronic pain were more driven by rewards and less consistent when making decisions in our laboratory-in-the-field experiment. In this case study, it was demonstrated that, compared with standard statistical summaries of behavioral performance, computational approaches offered superior ability to resolve, understand, and explain the differences in decision-making behavior in the context of chronic pain outside the laboratory. %M 35384855 %R 10.2196/26307 %U https://www.jmir.org/2022/4/e26307 %U https://doi.org/10.2196/26307 %U http://www.ncbi.nlm.nih.gov/pubmed/35384855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e22124 %T The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review %A Senteio,Charles %A Murdock,Paul Joseph %+ Department of Library and Information Science, School of Communication and Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901-1071, United States, 1 8489327586, charles.senteio@rutgers.edu %K chronic disease %K minority health %K technology assessment %K biomedical %K self-management %K systematic review %K mobile phone %D 2022 %7 4.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective: This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods: We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results: In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions: This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations. %M 35377331 %R 10.2196/22124 %U https://www.jmir.org/2022/4/e22124 %U https://doi.org/10.2196/22124 %U http://www.ncbi.nlm.nih.gov/pubmed/35377331 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e27486 %T Constructing an Adapted Cascade of Diabetes Care Using Inpatient Admissions Data: Cross-sectional Study %A Ryan,Irene %A Herrick,Cynthia %A Ebeling,Mary F E %A Foraker,Randi %+ Institute for Public Health, Washington University, 600 S Taylor Ave, St Louis, MO, 63110-1035, United States, 1 314 747 9212, Ryan.irene3@gmail.com %K diabetes mellitus %K cascade of care %K EHR data %K health care monitoring %K inpatient care %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The diabetes mellitus cascade of care has been constructed to evaluate diabetes care at a population level by determining the percentage of individuals diagnosed and linked to care as well as their reported glycemic control. Objective: We sought to adapt the cascade of care to an inpatient-only setting using the electronic health record (EHR) data of 81,633 patients with type 2 diabetes. Methods: In this adaptation, linkage to care was defined as prescription of diabetes medications within 3 months of discharge, and control was defined as hemoglobin A1c (HbA1c) below individual target levels, as these are the most reliably captured items in the inpatient setting. We applied the cascade model to assess differences in demographics and percent loss at each stage of the cascade; we then conducted two-sample chi-square equality of proportions tests for each demographic. Based on findings in the previous literature, we hypothesized that women, Black patients, younger patients (<45 years old), uninsured patients, and patients living in an economically deprived area called the Promise Zone would be disproportionately unlinked and uncontrolled. We also predicted that patients who received inpatient glycemic care would be more likely to reach glycemic control. Results: We found that out of 81,633 patients, 28,716 (35.2%) were linked to care via medication prescription. Women and younger patients were slightly less likely to be linked to care than their male and older counterparts, while Black patients (n=19,141, 23.4% of diagnosed population vs n=6741, 23.5% of the linked population) were as proportionately part of the linked population as White patients (n=58,291, 71.4% of diagnosed population vs n=20,402, 71.0% of the linked population). Those living in underserved communities (ie, the Promise Zone) and uninsured patients were slightly overrepresented (n=6789, 8.3% of diagnosed population vs n=2773, 9.7% of the linked population) in the linked population as compared to patients living in wealthier zip codes and those who were insured. Similar patterns were observed among those more likely to reach glycemic control via HbA1c. However, conclusions are limited by the relatively large amount of missing glycemic data. Conclusions: We conclude that inpatient EHR data do not adequately capture the care cascade as defined in the outpatient setting. In particular, missing data in this setting may preclude assessment of glycemic control. Future work should integrate inpatient and outpatient data sources to complete the picture of diabetes care. %M 35333182 %R 10.2196/27486 %U https://diabetes.jmir.org/2022/1/e27486 %U https://doi.org/10.2196/27486 %U http://www.ncbi.nlm.nih.gov/pubmed/35333182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28978 %T Role of Telemedicine in Inflammatory Bowel Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Pang,Lanlan %A Liu,Hengyu %A Liu,Zhidong %A Tan,Jinyu %A Zhou,Long-yuan %A Qiu,Yun %A Lin,Xiaoqing %A He,Jinshen %A Li,Xuehua %A Lin,Sinan %A Ghosh,Subrata %A Mao,Ren %A Chen,Minhu %+ Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, China, 86 13286834857, maor5@mail.sysu.edu.cn %K telemedicine %K inflammatory bowel disease %K quality of life %K disease activity %K mobile phone %D 2022 %7 24.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine plays an important role in the management of inflammatory bowel disease (IBD), particularly during a pandemic such as COVID-19. However, the effectiveness and efficiency of telemedicine in managing IBD are unclear. Objective: This systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD. Methods: We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases on April 22, 2020. Randomized controlled trials comparing telemedicine with standard care in patients with IBD were included, while conference abstracts, letters, reviews, laboratory studies, and case reports were excluded. The IBD-specific quality of life (QoL), disease activity, and remission rate in patients with IBD were assessed as primary outcomes, and the number of in-person clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were assessed as secondary outcomes. Review Manage 5.3 and Stata 15.1 were used for data analysis. Results: A total of 17 randomized controlled trials (2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group (standard mean difference 0.18, 95% CI 0.01 to 0.34; P.03). The number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (standard mean difference −0.71, 95% CI −1.07 to −0.36; P<.001). Subgroup analysis showed that adolescents in the telemedicine group had significantly higher IBD-specific QoL than those in the standard care group (standard mean difference 0.42, 95% CI 0.15 to 0.69; I2=0; P.002), but there was no significant difference between adults in the 2 groups. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between the telemedicine and standard care groups. Conclusions: Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits among patients with IBD. Further research is warranted to identify the group of patients with IBD who would most benefit from telemedicine. %M 35323120 %R 10.2196/28978 %U https://www.jmir.org/2022/3/e28978 %U https://doi.org/10.2196/28978 %U http://www.ncbi.nlm.nih.gov/pubmed/35323120 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e35134 %T User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials %A Lee,Jennifer M %A Woon,Rex %A Ramsum,Mandy %A Halperin,Daniel S %A Jain,Roshini %+ Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA, 91355, United States, 1 66169494350, Roshini.Jain@bsci.com %K spinal cord stimulation %K SCS %K chronic pain %K digital health %K smartphone app %K mobile health %K mHealth %K smart device %K digital application %K application %K app %K spine %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR eHum Factors %G English %X Background: Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective: In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods: This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new “mySCS” mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results: When provided the opportunity, the percentage of users who engaged with the tracking app for ≥50% of the time during their trial was found to be 64.43% (n=8589). Among the 13,331 patients who used the app, 58.24% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05%). Of those patients who undertook a 7-day SCS trial, 62.30% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04% (n=11,070) of those who reached trial completion. A trial success rate of 91% was determined for those who used the app (versus 85% success rate for nonusers). Conclusions: Data from this initial, real-world examination of a mobile, digital-health–based tracking app (“mySCS”), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success. %M 35167484 %R 10.2196/35134 %U https://humanfactors.jmir.org/2022/1/e35134 %U https://doi.org/10.2196/35134 %U http://www.ncbi.nlm.nih.gov/pubmed/35167484 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e16430 %T Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework %A Nugent,Lisa %A Anthony Kouyate,Robin %A Jackson,Shawna %A Smith,Meredith Y %+ Amgen, 1224 Paseo Rancho Serrano, Thousand Oaks, CA, 91362, United States, 1 4102413997, rakouyate@gmail.com %K human-centered design %K patient-reported outcomes %K rheumatoid arthritis %K digital journal %K patient diaries %K data visualization %K mobile phone %D 2022 %7 22.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Involving chronically ill patients in the management of their health is widely recognized as a vital component of high-quality health care. However, to assume the role of informed participants, patients need both access to their health information and assistance in interpreting such data. Smartphone technology with SMS text messaging functionality offers a convenient and minimally demanding mechanism for providing such dual capabilities to patients. To date, a number of similar digital tools have been developed for use in various chronic and progressive disease conditions, including rheumatoid arthritis. Objective: This paper aims to describe the development of a research protocol that applies a human-centered design (HCD) approach to develop a mobile health (mHealth) intervention to support symptom management and treatment adherence for rheumatoid arthritis. Methods: To guide the development of the mHealth intervention for use within a commercial biotechnology context, we selected and applied an HCD framework consisting of three phases: understanding, ideation, and implementation. Results: Leveraging the framework, we mapped the key objectives and research questions to each phase and identified the HCD techniques and methods most suitable for addressing them. In addition, we identified the need to include a fourth phase, one that referred to postimplementation assessment, which would enable evaluation of patient engagement and intervention impact on symptom self-management. Conclusions: This paper presents a research protocol that applied an HCD framework to guide the development of an mHealth intervention within a commercial biotechnology context. This type of guidance is salient because commercial entities are becoming one of the leading producers of this type of intervention. However, the methodologies used and challenges faced from a research and development perspective are not well-represented in the published research literature to date. Our application of the HCD framework yielded important findings. Each phase of the HCD framework provided important guidance for increasing the likelihood that the final product would be understandable, acceptable, feasible, and engaging to use. Consistent with other researchers in the field of mHealth interventions, we identified the need to add a fourth phase to the HCD framework, one that focused on a postimplementation assessment to guide further improvements to support adoption in real-world settings. International Registered Report Identifier (IRRID): RR1-10.2196/16430 %M 35315784 %R 10.2196/16430 %U https://www.researchprotocols.org/2022/3/e16430 %U https://doi.org/10.2196/16430 %U http://www.ncbi.nlm.nih.gov/pubmed/35315784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31912 %T Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis %A Wong,Arkers Kwan Ching %A Bayuo,Jonathan %A Wong,Frances Kam Yuet %A Yuen,Wing Shan %A Lee,Athena Yin Lam %A Chang,Pui King %A Lai,Jojo Tsz Chui %+ School of Nursing, The Hong Kong Polytechnic University, Hung Hom Campus, FG 512, Kowloon, Hong Kong, 852 34003805, arkers.wong@polyu.edu.hk %K telehealth %K meta-analysis %K self-care %K community-dwelling older adult %K nurse %D 2022 %7 21.3.2022 %9 Review %J J Med Internet Res %G English %X Background: In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults. Objective: This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults. Methods: A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel–Haenszel test. Results: From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I2=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I2=0%), and depression level (SMD –0.22; 95% CI –0.36 to –0.08; P=.003; I2=89%). Conclusions: This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery. Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299 %M 35311680 %R 10.2196/31912 %U https://www.jmir.org/2022/3/e31912 %U https://doi.org/10.2196/31912 %U http://www.ncbi.nlm.nih.gov/pubmed/35311680 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31974 %T The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review %A Sawa,Ryuichi %A Saitoh,Masakazu %A Morisawa,Tomoyuki %A Takahashi,Tetsuya %A Morimoto,Yuh %A Kagiyama,Nobuyuki %A Kasai,Takatoshi %A Dinesen,Birthe %A Daida,Hiroyuki %+ Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12 Hongo, Bunkyoku, Tokyo, 113-0033, Japan, 81 3 3813 3111, daida@juntendo.ac.jp %K active video game %K cardiac rehabilitation %K physical exercise %K rehabilitation %K serious games %K CVD %K AVG %K cardiovascular disease %K exercise %K safety %K adherence %D 2022 %7 18.3.2022 %9 Review %J JMIR Serious Games %G English %X Background: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results: Among 120 nonduplicate articles reviewed, 5 (4.2%) were eligible for inclusion, of which 3 (2.5%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited. %M 35302503 %R 10.2196/31974 %U https://games.jmir.org/2022/1/e31974 %U https://doi.org/10.2196/31974 %U http://www.ncbi.nlm.nih.gov/pubmed/35302503 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31164 %T The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study %A Gulde,Philipp %A Rieckmann,Peter %+ Center for Clinical Neuroplasticity, Medical Park Loipl, Medical Park Societas Europaea, Thanngasse 15, Bischofswiesen, 83483, Germany, 49 865289522, p.gulde@medicalpark.de %K multiple sclerosis %K actigraphy %K cluster analysis %K fatigue %K physical activity %K neurology %K neurorehabilitation %K rehabilitation %K digital health %K health technology %K digital tools %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment. Objective: The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability. Methods: We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis. Results: Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants’ reported levels of fatigue (d=0.99-1.28). Conclusions: Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology. %M 35297774 %R 10.2196/31164 %U https://rehab.jmir.org/2022/1/e31164 %U https://doi.org/10.2196/31164 %U http://www.ncbi.nlm.nih.gov/pubmed/35297774 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35936 %T Survivorship of Patients After Long Intensive Care Stay With Exploration and Experience in a New Zealand Cohort (SPLIT ENZ): Protocol for a Mixed Methods Study %A Sutton,Lynsey %A Bell,Elliot %A Every-Palmer,Susanna %A Weatherall,Mark %A Skirrow,Paul %+ Intensive Care Unit, Level 3, Wellington Regional Hospital, Capital and Coast District Health Board, 49 Riddiford Street, Newtown, Wellington, 6021, New Zealand, 64 211211385, lynsey.sutton-smith@ccdhb.org.nz %K COVID-19 %K critical illness %K disability %K intensive care unit %K survivorship %K Post Intensive Care Syndrome %D 2022 %7 17.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective: The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods: This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment–BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results: This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions: Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/35936 %M 35297773 %R 10.2196/35936 %U https://www.researchprotocols.org/2022/3/e35936 %U https://doi.org/10.2196/35936 %U http://www.ncbi.nlm.nih.gov/pubmed/35297773 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e24172 %T Personas for Better Targeted eHealth Technologies: User-Centered Design Approach %A ten Klooster,Iris %A Wentzel,Jobke %A Sieverink,Floor %A Linssen,Gerard %A Wesselink,Robin %A van Gemert-Pijnen,Lisette %+ Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 620730557, i.tenklooster@utwente.nl %K personas %K clustering %K heart failure %K eHealth %K user-centered design %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The full potential of eHealth technologies to support self-management and disease management for patients with chronic diseases is not being reached. A possible explanation for these lacking results is that during the development process, insufficient attention is paid to the needs, wishes, and context of the prospective end users. To overcome such issues, the user-centered design practice of creating personas is widely accepted to ensure the fit between a technology and the target group or end users throughout all phases of development. Objective: In this study, we integrate several approaches to persona development into the Persona Approach Twente to attain a more holistic and structured approach that aligns with the iterative process of eHealth development. Methods: In 3 steps, a secondary analysis was carried out on different parts of the data set using the Partitioning Around Medoids clustering method. First, we used health-related electronic patient record data only. Second, we added person-related data that were gathered through interviews and questionnaires. Third, we added log data. Results: In the first step, 2 clusters were found, with average silhouette widths of 0.12 and 0.27. In the second step, again 2 clusters were found, with average silhouette widths of 0.08 and 0.12. In the third step, 3 clusters were identified, with average silhouette widths of 0.09, 0.12, and 0.04. Conclusions: The Persona Approach Twente is applicable for mixed types of data and allows alignment of this user-centered design method to the iterative approach of eHealth development. A variety of characteristics can be used that stretches beyond (standardized) medical and demographic measurements. Challenges lie in data quality and fitness for (quantitative) clustering. %M 35289759 %R 10.2196/24172 %U https://humanfactors.jmir.org/2022/1/e24172 %U https://doi.org/10.2196/24172 %U http://www.ncbi.nlm.nih.gov/pubmed/35289759 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34029 %T A Lifestyle Intervention to Delay Early Chronic Kidney Disease in African Americans With Diabetic Kidney Disease: Pre-Post Pilot Study %A Ozieh,Mukoso N %A Egede,Leonard E %+ Department of Medicine, Division of Nephrology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States, 1 4149558839, mozieh@mcw.edu %K type 2 diabetes mellitus %K chronic kidney insufficiency %K healthy lifestyle %K outcomes research %K African Americans %K quasiexperimental study %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavioral factors, such as lifestyle, have been shown to explain approximately 24% of the excess risk of chronic kidney disease (CKD) among African Americans. However, there are limited intervention studies culturally tailored to African Americans with type 2 diabetes mellitus and CKD. Objective: The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention among African Americans with type 2 diabetes mellitus and CKD. Methods: A pre-post design was used to test the feasibility of a lifestyle intervention in 30 African American adults recruited from the Medical University of South Carolina between January 2017 and February 2017. A research nurse delivered the manualized study intervention weekly for 6 weeks. Clinical outcomes (hemoglobin A1c, blood pressure, and estimated glomerular filtration rate [eGFR]) were measured at baseline and postintervention. Disease knowledge, self-care, and behavior outcomes were also measured using validated structured questionnaires at baseline and postintervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline. Results: Significant pre-post mean differences and decreases were observed for hemoglobin A1c (mean 0.75%, 95% CI 0.16-1.34; P=.01), total cholesterol (mean 16.38 mg/dL, 95% CI 5.82-26.94; P=.004), low-density lipoprotein (mean 13.73 mg/dL, 95% CI 3.91-23.54; P=.008), and eGFR (mean 6.73 mL/min/1.73m2, 95% CI 0.97-12.48; P=.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean −11.15, 95% CI −21.55 to −0.75; P=.03), CKD knowledge (mean −2.62, 95% CI −3.98 to −1.25; P<.001), exercise behavior (mean −1.21, 95% CI −1.96 to −0.46; P=.003), and blood sugar testing (mean −2.15, 95% CI −3.47 to −0.83; P=.003). Conclusions: This study provides preliminary data for a large-scale appropriately powered randomized controlled trial to examine a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and CKD in order to improve clinical, knowledge, self-care, and behavior outcomes in this population. %M 35289751 %R 10.2196/34029 %U https://formative.jmir.org/2022/3/e34029 %U https://doi.org/10.2196/34029 %U http://www.ncbi.nlm.nih.gov/pubmed/35289751 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e33920 %T The Importance of Exploring the Role of Anger in People With Psoriasis %A Hughes,Olivia %A Hunter,Rachael %+ School of Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff, CF10 3AT, United Kingdom, 44 0 29 2087 4000, hughesoa@cardiff.ac.uk %K psoriasis %K skin conditions %K psychodermatology %K stigma %K chronic illness %K dermatology %K mental health %K quality of life %D 2022 %7 15.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632869 %R 10.2196/33920 %U https://derma.jmir.org/2022/1/e33920 %U https://doi.org/10.2196/33920 %U http://www.ncbi.nlm.nih.gov/pubmed/37632869 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30364 %T The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach %A Wiljén,Angelica %A Chaplin,John Eric %A Crine,Vanessa %A Jobe,William %A Johnson,Ensa %A Karlsson,Katarina %A Lindroth,Tomas %A Schwarz,Anneli %A Stenmarker,Margaretha %A Thunberg,Gunilla %A Öhlén,Joakim %A Nilsson,Stefan %+ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden, 46 738538951, stefan.nilsson.4@gu.se %K children %K communication %K long-term illness %K mHealth %K pediatric care %K person-centered care %K symptom assessment %K universal design %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents’ views and health care professionals’ expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non–clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child’s voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings. %M 35258466 %R 10.2196/30364 %U https://pediatrics.jmir.org/2022/1/e30364 %U https://doi.org/10.2196/30364 %U http://www.ncbi.nlm.nih.gov/pubmed/35258466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31016 %T The Characteristics and Functionalities of Mobile Apps Aimed at Patients Diagnosed With Immune-Mediated Inflammatory Diseases: Systematic App Search %A Romero-Jimenez,Rosa %A Escudero-Vilaplana,Vicente %A Chamorro-De-Vega,Esther %A Ais-Larisgoitia,Arantza %A Lobato Matilla,Maria Elena %A Herranz-Alonso,Ana %A Sanjurjo,Maria %+ Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, Madrid, 28007, Spain, 34 915868414, rosa.romero@salud.madrid.org %K immune-mediated inflammatory disease %K mobile app %K mHealth %K mobile health %K chronic disease %K disease management %K outcomes %K functionality %K quality %K patient education %K health outcomes %K reliability %D 2022 %7 4.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Immune-mediated inflammatory diseases (IMIDs) are systemic conditions associated with a high social and health impact. New treatments have changed the prognosis of IMIDs and have increased patient autonomy in disease management. Mobile apps have enormous potential to improve health outcomes in patients with IMIDs. Although a large number of IMID apps are available, the app market is not regulated, and functionality and reliability remain uncertain. Objective: Our aims are to review available apps for patients with IMIDs or caregivers and to describe the main characteristics and functionalities of these apps. Methods: We performed an observational, cross-sectional, descriptive study of all apps for patients with IMIDs. Between April 5 and 14, 2021, we conducted a search of the App Store (iOS) and Play Store (Android) platforms. We used the names of the different IMIDs as search terms. The inclusion criteria were as follows: content related to IMIDs, English or Spanish language, and user population consisting of patients and health care consumers, including family and caregivers. The variables analyzed were as follows: app name, type of IMID, platform (Android or iOS), country of origin, language, category of the app, cost, date of the last update, size, downloads, author affiliation, and functionalities. Results: We identified 713 apps in the initial search, and 243 apps met the criteria and were analyzed. Of these, 37% (n=90) were on Android, 27.2% (n=66) on iOS, and 35.8% (n=87) on both platforms. The most frequent categories were health and well-being/fitness apps (n=188, 48.5%) and medicine (n=82, 37.9%). A total of 211 (82.3%) apps were free. The mean time between the date of the analysis and the date of the most recent update was 18.5 (SD 19.3) months. Health care professionals were involved in the development of 100 (41.1%) apps. We found differences between Android and iOS in the mean time since the last update (16.2, SD 14.7 months vs 30.3, SD 25.7 months) and free apps (85.6% vs 75.8%; respectively). The functionalities were as follows: general information about lifestyles, nutrition, or exercises (n=135, 55.6%); specific information about the disease or treatment (n=102, 42%); recording of symptoms or adverse events (n=51, 21%); agenda/calendar (n=44, 18.1%); reminder medication (n=41, 16.9%); and recording of patient-reported outcomes (n=41, 16.9%). A total of 147 (60.5%) apps had more than one functionality. Conclusions: IMID-related apps are heterogeneous in terms of functionality and reliability. Apps may be a useful complement to IMID care, especially inpatient education (their most frequent functionality). However, more than half of the IMID apps had not been developed by health care professionals or updated in the last year. %M 35254286 %R 10.2196/31016 %U https://www.jmir.org/2022/3/e31016 %U https://doi.org/10.2196/31016 %U http://www.ncbi.nlm.nih.gov/pubmed/35254286 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28697 %T Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study %A Kela,Neta %A Eytam,Eleanor %A Katz,Adi %+ Shamoon College of Engineering, 84 Jabotinsky St, Ashdod, 77245, Israel, 972 088519309, neta.kela@gmail.com %K mHealth %K digital health %K instrumentality %K aesthetics %K symbolic value %K preference %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective: This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods: A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app. Results: As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03). Conclusions: Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value. %M 35234653 %R 10.2196/28697 %U https://humanfactors.jmir.org/2022/1/e28697 %U https://doi.org/10.2196/28697 %U http://www.ncbi.nlm.nih.gov/pubmed/35234653 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27146 %T Age- and Sex-Specific Differences in Multimorbidity Patterns and Temporal Trends on Assessing Hospital Discharge Records in Southwest China: Network-Based Study %A Wang,Liya %A Qiu,Hang %A Luo,Li %A Zhou,Li %+ School of Computer Science and Engineering, University of Electronic Science and Technology of China, No.2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, 611731, China, 86 28 61830278, qiuhang@uestc.edu.cn %K multimorbidity pattern %K temporal trend %K network analysis %K multimorbidity prevalence %K administrative data %K longitudinal study %K regional research %D 2022 %7 25.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Multimorbidity represents a global health challenge, which requires a more global understanding of multimorbidity patterns and trends. However, the majority of studies completed to date have often relied on self-reported conditions, and a simultaneous assessment of the entire spectrum of chronic disease co-occurrence, especially in developing regions, has not yet been performed. Objective: We attempted to provide a multidimensional approach to understand the full spectrum of chronic disease co-occurrence among general inpatients in southwest China, in order to investigate multimorbidity patterns and temporal trends, and assess their age and sex differences. Methods: We conducted a retrospective cohort analysis based on 8.8 million hospital discharge records of about 5.0 million individuals of all ages from 2015 to 2019 in a megacity in southwest China. We examined all chronic diagnoses using the ICD-10 (International Classification of Diseases, 10th revision) codes at 3 digits and focused on chronic diseases with ≥1% prevalence for each of the age and sex strata, which resulted in a total of 149 and 145 chronic diseases in males and females, respectively. We constructed multimorbidity networks in the general population based on sex and age, and used the cosine index to measure the co-occurrence of chronic diseases. Then, we divided the networks into communities and assessed their temporal trends. Results: The results showed complex interactions among chronic diseases, with more intensive connections among males and inpatients ≥40 years old. A total of 9 chronic diseases were simultaneously classified as central diseases, hubs, and bursts in the multimorbidity networks. Among them, 5 diseases were common to both males and females, including hypertension, chronic ischemic heart disease, cerebral infarction, other cerebrovascular diseases, and atherosclerosis. The earliest leaps (degree leaps ≥6) appeared at a disorder of glycoprotein metabolism that happened at 25-29 years in males, about 15 years earlier than in females. The number of chronic diseases in the community increased over time, but the new entrants did not replace the root of the community. Conclusions: Our multimorbidity network analysis identified specific differences in the co-occurrence of chronic diagnoses by sex and age, which could help in the design of clinical interventions for inpatient multimorbidity. %M 35212632 %R 10.2196/27146 %U https://www.jmir.org/2022/2/e27146 %U https://doi.org/10.2196/27146 %U http://www.ncbi.nlm.nih.gov/pubmed/35212632 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e26405 %T The Effects of Modified Intermittent Fasting in Psoriasis (MANGO): Protocol for a Two-Arm Pilot Randomized Controlled Open Cross-over Study %A Grine,Lynda %A Hilhorst,Niels %A Michels,Nathalie %A Abbeddou,Souheila %A De Henauw,Stefaan %A Lambert,Jo %+ Dermatology Research Unit, Department of Head and Skin, Ghent University, Medical Research Building 2, Entrance 38, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 9 332 5117, lynda.grine@ugent.be %K psoriasis %K leaky gut %K gut-skin axis %K dietary intervention %K intermittent fasting %D 2022 %7 23.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psoriasis is a complex disease associated with multiple comorbidities, including metabolic syndrome and leaky gut syndrome. Dietary lifestyle interventions have been reported to affect the disease in terms of lesional severity. It remains unclear how diets affect these comorbidities and the general health in psoriasis patients. Modified intermittent fasting (MIF) on 2 nonconsecutive days has shown beneficial effects on metabolic parameters. A significant advantage of MIF over the currently investigated dietary changes is its feasibility. Objective: Here, we aim to study the effects of MIF on skin, gut, and metabolic health in psoriasis patients. Methods: A 2-arm pilot randomized controlled open cross-over study will be performed in 24 patients with psoriasis. Patients will be randomized 1:1 to either start with 12 weeks of MIF and go on a subsequent regular diet for another 12 weeks or start with 12 weeks of regular diet and do subsequent MIF for 12 weeks. The following parameters will be assessed: demographics, disease phenotype, medical and familial history, psoriasis severity, dermatology-specific and general quality of life, nutritional and physical habits, mental and intestinal health, intestinal and cutaneous integrity, inflammatory and metabolic markers, and satisfaction. Results: A total of 24 participants have been enrolled in the study. The final visit is foreseen for June 2021. Conclusions: The aim is to uncover the effects of MIF on psoriasis severity and gut health integrity through clinical and molecular investigation. More precisely, we want to map the evolution of the different markers, such as psoriasis severity, permeability, and inflammation, in response to MIF as compared to a regular diet,. Understanding how dietary lifestyles can affect epithelial lineages, such as the skin and gut, will greatly improve our understanding of the development of psoriasis and may offer a nonpharmacological venue for treatments. Trial Registration: ClinicalTrials.gov NCT04418791; https://clinicaltrials.gov/ct2/show/NCT04418791 International Registered Report Identifier (IRRID): DERR1-10.2196/26405 %M 35195533 %R 10.2196/26405 %U https://www.researchprotocols.org/2022/2/e26405 %U https://doi.org/10.2196/26405 %U http://www.ncbi.nlm.nih.gov/pubmed/35195533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e34790 %T Online Health Information Seeking Behaviors Among Older Adults: Systematic Scoping Review %A Zhao,Yuxiang Chris %A Zhao,Mengyuan %A Song,Shijie %+ Business School, Hohai University, Fo-Cheng West Rd 8, Nanjing, 211000, China, 86 15951973800, ssong@hhu.edu.cn %K older adults %K online health information seeking %K health information behavior %K aging technology %K systematic scoping review %D 2022 %7 16.2.2022 %9 Review %J J Med Internet Res %G English %X Background: With the world’s population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults’ online health information seeking (OHIS) behavior is still underway. Objective: This systematic scoping review aims to understand older adults’ OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults’ OHIS? (3) What are the barriers to older adults’ OHIS? (4) How can we intervene and support older adults’ OHIS? Methods: A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication & Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions. Results: The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults’ OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults’ OHIS. Conclusions: Although OHIS has become increasingly common among older adults, the review reveals that older adults’ OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults’ OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults’ OHIS; (4) facilitating older adults’ OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults. %M 35171099 %R 10.2196/34790 %U https://www.jmir.org/2022/2/e34790 %U https://doi.org/10.2196/34790 %U http://www.ncbi.nlm.nih.gov/pubmed/35171099 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31448 %T Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk %A Kohlbrenner,Dario %A Clarenbach,Christian F %A Ivankay,Adam %A Zimmerli,Lukas %A Gross,Christoph S %A Kuhn,Manuel %A Brunschwiler,Thomas %+ Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 43 253 08 42, dario.kohlbrenner@usz.ch %K home monitoring %K digital health %K respiratory disease %K usability %K feasibility %K adherence %K disease management %K chronic disease %K patient monitoring %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Research integrating multisensory home-monitoring in respiratory disease is scarce. Therefore, we created a novel multisensory home-monitoring device tailored for long-term respiratory disease management (named the CAir-Desk). We hypothesize that recent technological accomplishments can be integrated into a multisensory participant-driven platform. We also believe that this platform could improve chronic disease management and be accessible to large groups at an acceptable cost. Objective: This study aimed to report on user adherence and acceptance as well as system functionality of the CAir-Desk in a sample of participants with stable chronic obstructive pulmonary disease (COPD) or asthma. Methods: We conducted an observational usability study. Participants took part in 4 weeks of home-monitoring with the CAir-Desk. The CAir-Desk recorded data from all participants on symptom burden, physical activity, spirometry, and environmental air quality; data on sputum production, and nocturnal cough were only recorded for participants who experienced symptoms. After the study period, participants reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. We used descriptive statistics and visualizations to display results. Results: Ten participants, 5 with COPD and 5 with asthma took part in this study. They completed symptom burden questionnaires on a median of 96% (25th percentile 14%, 75th percentile 96%), spirometry recordings on 55% (20%, 94%), wrist-worn physical activity recordings on 100% (97%, 100%), arm-worn physical activity recordings on 45% (13%, 63%), nocturnal cough recordings on 34% (9%, 54%), sputum recordings on 5% (3%, 12%), and environmental air quality recordings on 100% (99%, 100%) of the study days. The participants indicated that the measurements consumed a median of 13 (10, 15) min daily, and that they preferred the wrist-worn physical activity monitor to the arm-worn physical activity monitor. Conclusions: The CAir-Desk showed favorable technical performance and was well-accepted by our sample of participants with stable COPD and asthma. The obtained insights were used in a redesign of the CAir-Desk, which is currently applied in a randomized controlled trial including an interventional program. %M 35171107 %R 10.2196/31448 %U https://humanfactors.jmir.org/2022/1/e31448 %U https://doi.org/10.2196/31448 %U http://www.ncbi.nlm.nih.gov/pubmed/35171107 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31020 %T Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report %A García-Muñoz,Cristina %A Cortés-Vega,María-Dolores %A Hernández-Rodríguez,Juan-Carlos %A Fernández-Seguín,Lourdes M %A Escobio-Prieto,Isabel %A Casuso-Holgado,María Jesús %+ Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/ Avicena S/N, Seville, 41009, Spain, 34 954486528, mdcortes@us.es %K immersive virtual reality %K vestibular rehabilitation %K multiple sclerosis %K exergames %D 2022 %7 16.2.2022 %9 Case Report %J JMIR Serious Games %G English %X Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16% in the physical health area at T2; 33.56% in the mental health area at T2). The patient rated the usability of the system as 90%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. %M 34766551 %R 10.2196/31020 %U https://games.jmir.org/2022/1/e31020 %U https://doi.org/10.2196/31020 %U http://www.ncbi.nlm.nih.gov/pubmed/34766551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33103 %T Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Protocol for a Systematic Search and Evaluation of Mobile Apps %A Robinson,Billy %A Gong,Enying %A Oldenburg,Brian %A See,Katharine %+ Department of Respiratory Medicine, Northern Health, 185 Cooper Street, Epping, 3076, Australia, 61 416738886, billymed1994@gmail.com %K asthma %K mHealth %K mobile phone %K applications %K self-management %K chronic disease %K respiratory %K smartphone %K asthma app %D 2022 %7 9.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma is a chronic respiratory disorder that requires long-term pharmacotherapy and patient empowerment to manage the condition and recognize and respond to asthma exacerbations. Mobile health (mHealth) apps represent a potential medium through which patients can improve their ability to self-manage their asthma. Few studies have conducted a systematic evaluation of asthma mobile apps for quality and functionality using a validated tool. None of these reviews have systematically assessed these apps for their content and evaluated them against the available international best practice guidelines. Objective: The objective of this study is to conduct a systematic search and evaluation of adult-targeted asthma mHealth apps. As part of this review, the potential of an mHealth app to improve asthma self-management and the overall quality of the app will be evaluated using the Mobile App Rating Scale framework, and the quality of the information within an app will be evaluated using the current Global Initiative for Asthma guidelines as a reference. Methods: A stepwise methodological approach was taken in creating this review. First, the most recent Global Initiative for Asthma guidelines were independently reviewed by 2 authors to identify key recommendations that could be feasibly incorporated into an mHealth app. A previously developed asthma assessment framework was identified and was modified to suit our research and ensure that all of these identified recommendations were included. In total, 2 popular app stores were reviewed to identify potential mHealth apps. These apps were screened based on predefined inclusion and exclusion criteria. Suitable apps were then evaluated. Technical information was obtained from publicly available information. The next step was to perform an app quality assessment using the validated Mobile App Rating Scale framework to objectively determine the quality of an app. App functionality was assessed using the Intercontinental Medical Statistics Institute for Health Informatics Functionality Scoring System. Finally, the mHealth apps were assessed using our developed checklist. Results: Funding has been received for the project from the Respiratory Department at Northern Health, Victoria. Three reviewers have been recruited to systematically evaluate the apps. The results of this study are expected in 2022. Conclusions: To our knowledge, this review represents the first study to examine all mHealth apps available in Australia that are targeted to adults with asthma for their functionality, quality, and consistency with international best practice guidelines. Although this review will only be conducted on mHealth apps available in Australia, many apps are available worldwide; thus, this study should be largely generalizable to other English-speaking regions and users. The results of this review will help to fill gaps in the literature and assist clinicians in providing evidence-based advice to patients wishing to use mHealth apps as part of their asthma self-management. Trial Registration: PROSPERO 269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894 International Registered Report Identifier (IRRID): PRR1-10.2196/33103 %M 35138257 %R 10.2196/33103 %U https://www.researchprotocols.org/2022/2/e33103 %U https://doi.org/10.2196/33103 %U http://www.ncbi.nlm.nih.gov/pubmed/35138257 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30880 %T The Effect of Adjunct Telephone Support on Adherence and Outcomes of the Reboot Online Pain Management Program: Randomized Controlled Trial %A Gardner,Tania %A Schultz,Regina %A Haskelberg,Hila %A Newby,Jill M %A Wheatley,Jane %A Millard,Michael %A Faux,Steven G %A Shiner,Christine T %+ Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 406 Victoria St, Sydney, 2010, Australia, 61 0410449766, taniagardner@optusnet.com.au %K chronic pain %K online pain management %K telephone support %K clinician guidance %K adherence %K digital health %K eHealth %K internet interventions %K multidisciplinary %D 2022 %7 3.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear. Objective: The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone. Methods: A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)–compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected. Results: Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93%) into the course than those from the control group (35/45, 78%; χ21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91% vs 27/45, 60%, respectively; χ21=11.4; P=.001). Of the participants enrolled in the intervention group, 43% (19/44) completed the course, and of those in the control group, 31% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48%) and control groups (14/27, 52%; χ21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups. Conclusions: Telephone support improves participants’ registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167 %M 35113021 %R 10.2196/30880 %U https://www.jmir.org/2022/2/e30880 %U https://doi.org/10.2196/30880 %U http://www.ncbi.nlm.nih.gov/pubmed/35113021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30295 %T Use of a Smartphone App Versus Motivational Interviewing to Increase Walking Distance and Weight Loss in Overweight/Obese Adults With Peripheral Artery Disease: Pilot Randomized Trial %A Collins,Tracie %A Geana,Mugur %A Overton,Kathryn %A Benton,Mary %A Lu,Liuqiang %A Khan,Faarina %A Rohleder,Mason %A Ahluwalia,Jasjit %A Resnicow,Ken %A Zhu,Yiliang %+ College of Population Health, University of New Mexico, MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, United States, 1 505 272 4979, tccollins@salud.unm.edu %K mobile health %K smartphone app %K peripheral artery disease %K motivational interviewing %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking therapy improves functional outcomes in patients with peripheral artery disease (PAD). Less is known about the additive benefit of a dietary intervention. Objective: Our objectives were to develop a smartphone app and, as a pilot, explore its potential efficacy as compared to motivational interviewing (MI) to increase walking distance and promote weight loss in overweight/obese adults with PAD. Methods: We conducted a 3-month, 2-arm randomized pilot study at the University of Kansas. Inclusion criteria were BMI >27 kg/m2 and symptomatic PAD, defined by an ankle-brachial index <0.9. Patients were randomized into 2 groups: MI, delivered through in-person and telephone counseling, and app, a mobile smartphone app. Both interventions encouraged walking for exercise and healthy dietary habits (increasing fruits and vegetables and whole grains while reducing fat and sugary drinks). We assessed medical history at baseline. At baseline and 3 months, participants completed an assessment of 6-minute walking distance, weight, quality of life, exercise behaviors, and dietary habits. The primary outcome was 3-month change in walking distance. Secondary outcomes were changes in weight, quality of life, exercise behaviors, and dietary habits. We used a Wilcoxon rank-sum test to analyze the primary and secondary outcomes at 3 months within the MI and app groups and to compare the changes between the groups with adjustment for baseline. Results: We randomized 29 participants with a mean age of 66.03 (SD 8.12) years; 25 participants completed the trial. At baseline, mean walking distance among completers was 260.40 (SD 94.32) meters and 326.15 (SD 69.28) meters for MI and app participants, respectively. At 3 months, the mean walking distance was 298.67 (SD 101.20) meters and 331.19 (SD 58.63) meters for MI and app participants, respectively (group difference P=.03, adjusting for baseline). Increase in walking distance at 3 months was 40.5 meters (95% CI 6.77 to 61.34; P=.02) in MI group. At baseline, mean body weight was 253.10 (SD 59.45) lbs and 225.13 (SD 58.93) lbs for MI and app participants, respectively. At 3 months, mean body weight was 242.14 (SD 58.54) lbs and 223.44 (SD 59.54) lbs for MI and app, respectively (group difference P=.006, adjusting for baseline). Pre-post study decrease in weight was 10.1 lbs (95% CI –17.9 to –3.0) and 2.3 lbs (95% CI –3.4 to –0.7) in MI and app group, respectively. Comparing baseline to 3 months, there were no statistically significant differences in quality of life, exercise behaviors, or dietary habits. Conclusions: Our study demonstrates that MI can promote walking and weight loss in overweight/obese adults with PAD. The smartphone app showed a small weight loss but no statistically significant increase in walking distance. As this was a pilot study, future large-scale studies are needed to replicate the efficacy of MI to promote weight loss in overweight or obese adults with PAD. Trial Registration: ClinicalTrials.gov NCT03694652; https://clinicaltrials.gov/ct2/show/NCT03694652 %M 35113020 %R 10.2196/30295 %U https://formative.jmir.org/2022/2/e30295 %U https://doi.org/10.2196/30295 %U http://www.ncbi.nlm.nih.gov/pubmed/35113020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29837 %T Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review %A Gillam,Juliet %A Davies,Nathan %A Aworinde,Jesutofunmi %A Yorganci,Emel %A Anderson,Janet E %A Evans,Catherine %+ Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom, 44 7500 708 293, juliet.h.gillam@kcl.ac.uk %K telemedicine %K implementation science %K dementia %K long-term care %K systematic review %D 2022 %7 3.2.2022 %9 Review %J J Med Internet Res %G English %X Background: As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective: The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods: A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results: A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions: Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care. %M 35113029 %R 10.2196/29837 %U https://www.jmir.org/2022/2/e29837 %U https://doi.org/10.2196/29837 %U http://www.ncbi.nlm.nih.gov/pubmed/35113029 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e27355 %T Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study %A Hu,Lu %A Trinh-Shevrin,Chau %A Islam,Nadia %A Wu,Bei %A Cao,Shimin %A Freeman,Jincong %A Sevick,Mary Ann %+ Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyumc.org %K technology use %K Chinese immigrants %K type 2 diabetes %K mHealth %K health disparities %K immigrant health %K diabetes %K mobile health %K intervention %K smartphone %K immigrant %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. %M 35107426 %R 10.2196/27355 %U https://aging.jmir.org/2022/1/e27355 %U https://doi.org/10.2196/27355 %U http://www.ncbi.nlm.nih.gov/pubmed/35107426 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26308 %T The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study %A Wang,Zhuoxin %A Fan,Yanyan %A Lv,Hekai %A Deng,Shanshan %A Xie,Hui %A Zhang,Li %A Luo,Aijing %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600# Donghai Rd, Bengbu, Anhui Province, PRC, Bengbu, 233030, China, 86 18855202156, wfz.bbmc@foxmail.com %K online %K health information %K barriers to acquisition %K middle-aged patients with chronic diseases %K rural community %K chronic conditions %K chronic %K rural %K literacy %K information seeking %D 2022 %7 31.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China. Objective: In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet. Methods: Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants’ behavior during the web-based operational tasks. Results: A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91% (64/70) of the respondents could find health websites, and 93% (65/70) of the respondents could find information on treatment that they thought was the best, 35% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet. Conclusions: Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information. %M 35099401 %R 10.2196/26308 %U https://www.jmir.org/2022/1/e26308 %U https://doi.org/10.2196/26308 %U http://www.ncbi.nlm.nih.gov/pubmed/35099401 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31140 %T Social Media Platforms Listening Study on Atopic Dermatitis: Quantitative and Qualitative Findings %A Voillot,Paméla %A Riche,Brigitte %A Portafax,Michel %A Foulquié,Pierre %A Gedik,Anaïs %A Barbarot,Sébastien %A Misery,Laurent %A Héas,Stéphane %A Mebarki,Adel %A Texier,Nathalie %A Schück,Stéphane %+ Kap Code, 28 rue d'Enghien, Paris, 75010, France, 33 972605764, pamela.voillot@kapcode.fr %K atopic dermatitis %K Atopic Dermatitis Control Tool %K health-related quality of life %K social media use %K real world %K dermatology %K skin disease %K social media %K online health information %K online health %K health care %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Atopic dermatitis (AD) is a chronic, pruritic, inflammatory disease that occurs most frequently in children but also affects many adults. Social media have become key tools for finding and disseminating medical information. Objective: The aims of this study were to identify the main themes of discussion, the difficulties encountered by patients with respect to AD, the impact of the pathology on quality of life (QoL; physical, psychological, social, or financial), and to study the perception of patients regarding their treatment. Methods: A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experience with AD, their QoL, and their treatments. Messages related to AD discomfort posted between July 1, 2010, and October 23, 2020, were extracted from French-speaking publicly available online forums. Automatic and manual extractions were implemented to create a general corpus and 2 subcorpuses depending on the level of control of the disease. Results: A total of 33,115 messages associated with AD were included in the analysis corpus after extraction and cleaning. These messages were posted by 15,857 separate web users, most of them being women younger than 40 years. Tips to manage AD and everyday hygiene/treatments were among the most discussed topics for controlled AD subcorpus, while baby-related topics and therapeutic failure were among the most discussed topics for insufficiently controlled AD subcorpus. QoL was discussed in both subcorpuses with a higher proportion in the controlled AD subcorpus. Treatments and their perception were also discussed by web users. Conclusions: More than just emotional or peer support, patients with AD turn to online forums to discuss their health. Our findings show the need for an intersection between social media and health care and the importance of developing new approaches such as the Atopic Dermatitis Control Tool, which is a patient-related disease severity assessment tool focused on patients with AD. %M 35089160 %R 10.2196/31140 %U https://www.jmir.org/2022/1/e31140 %U https://doi.org/10.2196/31140 %U http://www.ncbi.nlm.nih.gov/pubmed/35089160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27759 %T Web Portals for Patients With Chronic Diseases: Scoping Review of the Functional Features and Theoretical Frameworks of Telerehabilitation Platforms %A Morimoto,Yuh %A Takahashi,Tetsuya %A Sawa,Ryuichi %A Saitoh,Masakazu %A Morisawa,Tomoyuki %A Kagiyama,Nobuyuki %A Kasai,Takatoshi %A Dinesen,Birthe %A Hollingdal,Malene %A Refsgaard,Jens %A Daida,Hiroyuki %+ Faculty of Health Science, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, 1138421, Japan, 81 338133111 ext 3900, daida@juntendo.ac.jp %K telerehabilitation %K web portal %K chronic disease %K monitoring/data tracking function %K patient-centered care %D 2022 %7 27.1.2022 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has required an increased need for rehabilitation activities applicable to patients with chronic diseases. Telerehabilitation has several advantages, including reducing clinic visits by patients vulnerable to infectious diseases. Digital platforms are often used to assist rehabilitation services for patients in remote settings. Although web portals for medical use have existed for years, the technology in telerehabilitation remains a novel method. Objective: This scoping review investigated the functional features and theoretical approaches of web portals developed for telerehabilitation in patients with chronic diseases. Methods: PubMed and Web of Science were reviewed to identify articles associated with telerehabilitation. Of the 477 nonduplicate articles reviewed, 35 involving 14 portals were retrieved for the scoping review. The functional features, targeted diseases, and theoretical approaches of these portals were studied. Results: The 14 portals targeted patients with chronic obstructive pulmonary disease, cardiovascular, osteoarthritis, multiple sclerosis, cystic fibrosis diseases, and stroke and breast cancer survivors. Monitoring/data tracking and communication functions were the most common, followed by exercise instructions and diary/self-report features. Several theoretical approaches, behavior change techniques, and motivational techniques were found to be utilized. Conclusions: The web portals could unify and display multiple types of data and effectively provide various types of information. Asynchronous correspondence was more favorable than synchronous, real-time interactions. Data acquisition often required assistance from other digital tools. Various functions with patient-centered principles, behavior change strategies, and motivational techniques were observed for better support shifting to a healthier lifestyle. These findings suggested that web portals for telerehabilitation not only provided entrance into rehabilitation programs but also reinforced participant-centered treatment, adherence to rehabilitation, and lifestyle changes over time. %M 35084355 %R 10.2196/27759 %U https://www.jmir.org/2022/1/e27759 %U https://doi.org/10.2196/27759 %U http://www.ncbi.nlm.nih.gov/pubmed/35084355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31754 %T Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study %A Ware,Patrick %A Shah,Amika %A Ross,Heather Joan %A Logan,Alexander Gordon %A Segal,Phillip %A Cafazzo,Joseph Antony %A Szacun-Shimizu,Katarzyna %A Resnick,Myles %A Vattaparambil,Tessy %A Seto,Emily %+ Centre for Global eHealth Innovation, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada, 1 (416) 340 4800 ext 4765, Patrick.Ware@uhn.ca %K telemonitoring %K telemedicine %K heart failure %K diabetes %K hypertension %K tertiary health care %K multiple chronic conditions %K mobile phone %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 %M 35080502 %R 10.2196/31754 %U https://www.jmir.org/2022/1/e31754 %U https://doi.org/10.2196/31754 %U http://www.ncbi.nlm.nih.gov/pubmed/35080502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e34616 %T Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic %A Lama,Yuki %A Davidoff,Amy J %A Vanderpool,Robin C %A Jensen,Roxanne E %+ Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, United States, 1 240 276 7588, roxanne.jensen@nih.gov %K cancer survivor %K Medicare %K telehealth %K COVID-19 %K availability %K use %K elderly %K older adults %K cancer %K sociodemographic %K internet %K communication %K population %K access %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53%) of cancer survivors reported using the internet for communication purposes, and 62% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28% vs 46%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29%, 31%, and 44%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53% vs 63%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers’ available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. %M 34978531 %R 10.2196/34616 %U https://www.jmir.org/2022/1/e34616 %U https://doi.org/10.2196/34616 %U http://www.ncbi.nlm.nih.gov/pubmed/34978531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32855 %T Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study %A Chen,Yu-Chi %A Cheng,Christina %A Osborne,Richard H %A Kayser,Lars %A Liu,Chieh-Yu %A Chang,Li-Chun %+ Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Section 2, Li-Nong Street, Beitou District, Taipei, 112, Taiwan, 886 228267093, ycchen2@nycu.edu.tw %K chronic illness %K eHealth literacy questionnaire %K eHLQ %K validation %K cultural adaptation %K eHealth %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users’ diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users’ knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective: This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods: The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results: The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions: Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs. %M 35044310 %R 10.2196/32855 %U https://www.jmir.org/2022/1/e32855 %U https://doi.org/10.2196/32855 %U http://www.ncbi.nlm.nih.gov/pubmed/35044310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29703 %T Adherence, Efficacy, and Safety of Wearable Technology–Assisted Combined Home-Based Exercise in Chinese Patients With Ankylosing Spondylitis: Randomized Pilot Controlled Clinical Trial %A Wang,Yiwen %A Liu,Xingkang %A Wang,Weimin %A Shi,Yanyun %A Ji,Xiaojian %A Hu,Lidong %A Wang,Lei %A Yin,Yiquan %A Xie,Siyuan %A Zhu,Jian %A Zhang,Jianglin %A Jiao,Wei %A Huang,Feng %+ Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China, 86 010 5549 9314, fhuang@301hospital.com.cn %K ankylosing spondylitis %K wearable technology %K home-based exercise %K combined exercise %K randomized controlled trial %K RCT %K exercise %K wearable %K photoplethysmography %K spondyloarthritis %D 2022 %7 18.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical practice guidelines recommend that exercise is essential in the self-management of ankylosing spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be difficult and patients may decline participation, whereas effective home-based exercise interventions that do not require regular medical center visits are likely to be more accessible for AS patients. Objective: The goal of the research was to investigate the adherence, efficacy, and safety of a wearable technology–assisted combined home-based exercise program in AS. Methods: This was a 16-week investigator-initiated, assessor-blinded, randomized, pilot controlled trial conducted at Chinese People’s Liberation Army General Hospital. We enrolled patients with AS who had no regular exercise habits and had been stable in drug treatment for the preceding month. Patients were randomly assigned (1:1) using a computer algorithm. An exercise program consisting of moderate-intensity aerobic exercise and functional exercise was given to the patients in the intervention group. The exercise intensity was controlled by a Mio FUSE Heart Rate Monitor wristband, which uses photoplethysmography to measure heart rate. Patients in the control group received usual care. The primary outcome was the difference in the Ankylosing Spondylitis Disease Activity Score (ASDAS). The secondary outcomes were patient global assessment (PGA), physician global assessment (PhGA), total pain, nocturnal pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BAS Functional Index (BASFI), BAS Metrology Index (BASMI), Spondyloarthritis International Society Health Index (ASAS HI), 36-item Short Form Survey (SF-36), maximal oxygen uptake (VO2) max, body composition, range of motion of joints, and muscle endurance tests. Retention rate, adherence rate, barriers to being active, and adverse events were also assessed. Results: A total of 77 patients were screened, of whom 55 (71%) patients were enrolled; 2% (1/55) withdrew without treatment after randomization. Patients were assigned to the intervention (n=26) or control group (n=28). The median adherence rate of the prescribed exercise protocol was 84.2% (IQR 48.7%-97.9%). For the primary outcome, between-group difference of ASDAS was significant, favoring the intervention (–0.2, 95% CI –0.4 to 0.02, P=.03). For the secondary outcomes, significant between-group differences at 16 weeks were detected in PGA, PhGA, total pain, BASDAI, BASDAI-fatigue, BASDAI–spinal pain, BASDAI–morning stiffness intensity, BASFI, and BASMI. Moreover, the frequency of difficulty in ASAS HI-motivation at 16 weeks was less in the intervention group (P=.03). Between-group difference for change from baseline were also detected in VO2 max, SF-36, back extensor endurance test, and the range of motion of cervical lateral flexion at 16 weeks. Lack of time, energy, and willpower were the most distinct barriers to being active. Incidences of adverse events were similar between groups (P=.11). Conclusions: Our pilot study suggests that this technology-assisted combined home-based exercise program can improve the clinical outcomes of patients with AS who have no exercise habit, with good adherence and safety profile. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024244; http://www.chictr.org.cn/showproj.aspx?proj=40176 %M 35040798 %R 10.2196/29703 %U https://www.jmir.org/2022/1/e29703 %U https://doi.org/10.2196/29703 %U http://www.ncbi.nlm.nih.gov/pubmed/35040798 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e33118 %T Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study %A Wu,Vivien Xi %A Dong,Yanhong %A Tan,Poh Choo %A Gan,Peiying %A Zhang,Di %A Chi,Yuchen %A Chao,Felicia Fang Ting %A Lu,Jinhua %A Teo,Boon Heng Dennis %A Tan,Yue Qian %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K eHealth %K self-management %K older adults %K chronic disease %K community care %K elderly %K community %K innovation %K development %K pilot %K evaluation %K health literacy %K empowerment %K feasibility %K engagement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic diseases may impact older adults’ health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. %M 35037882 %R 10.2196/33118 %U https://aging.jmir.org/2022/1/e33118 %U https://doi.org/10.2196/33118 %U http://www.ncbi.nlm.nih.gov/pubmed/35037882 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e31699 %T Decision-making for Parents of Children With Medical Complexities: Activity Theory Analysis %A Buchanan,Francine %A Lai,Claudia %A Cohen,Eyal %A Milo-Manson,Golda %A Shachak,Aviv %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 4326, buchanan.fr@gmail.com %K shared decision-making %K activity theory %K parental decision-making %K parenting %K participatory medicine %K pediatric %K caregiving %D 2022 %7 17.1.2022 %9 Original Paper %J J Particip Med %G English %X Background: Shared decision-making (SDM), a collaborative approach to reach decisional agreement, has been advocated as an ideal model of decision-making in the medical encounter. Frameworks for SDM have been developed largely from the clinical context of a competent adult patient facing a single medical problem, presented with multiple treatment options informed by a solid base of evidence. It is difficult to apply this model to the pediatric setting and children with medical complexity (CMC), specifically since parents of CMC often face a myriad of interconnected decisions with minimal evidence available on the multiple complex and co-existing chronic conditions. Thus, solutions that are developed based on the traditional model of SDM may not improve SDM practices for CMCs and may be a factor contributing to the low rate of SDM practiced with CMCs. Objective: The goal of our study was to address the gaps in the current approach to SDM for CMC by better understanding the decision-making activity among parents of CMCs and exploring what comprises their decision-making activity. Methods: We interviewed 12 participants using semistructured interviews based on activity theory. Participants identified as either a parent of a CMC or a CMC over the age of 18 years. Qualitative framework analysis and an activity theory framework were employed to understand the complexity of the decision-making process in context. Results: Parents of CMCs in our study made decisions based on a mental model of their child’s illness, informed by the activities of problem-solving, seeking understanding, obtaining tests and treatment, and caregiving. These findings suggest that the basis for parental choice and values, which are used in the decision-making activity, was developed by including activities that build concrete understanding and capture evidence to support their decisions. Conclusions: Our interviews with parents of CMCs suggest that we can address both the aims of each individual activity and the related outcomes (both intended and unintended) by viewing the decision-making activity as a combination of caregiving, problem-solving, and seeking activities. Clinicians could consider using this lens to focus decision-making discussions on integrating the child’s unique situation, the insights parents gain through their decision-making activity, and their clinical knowledge to enhance the understanding between parents and health care providers, beyond the narrow concept of parental values. %M 35037890 %R 10.2196/31699 %U https://jopm.jmir.org/2022/1/e31699 %U https://doi.org/10.2196/31699 %U http://www.ncbi.nlm.nih.gov/pubmed/35037890 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e31413 %T The Role of Carbohydrates in Irritable Bowel Syndrome: Protocol for a Randomized Controlled Trial Comparing Three Different Treatment Options %A Nybacka,Sanna %A Törnblom,Hans %A Simren,Magnus %A Störsrud,Stine %+ Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 13, Gothenburg, 413 46, Sweden, 46 031 7860000, sanna.nybacka@gu.se %K irritable bowel syndrome %K low FODMAP %K LCHF %K pharmacological treatment %K diet %K NICE diet %D 2022 %7 17.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although it is widely acknowledged that food intake can worsen symptoms in patients with irritable bowel syndrome (IBS), there is a lack of efficient treatments that can apply to all patients and subtypes of IBS. As IBS can manifest in different ways, it is likely that the most successful treatment option will differ among patients; therefore, this large, randomized controlled trial comparing 3 different treatment options for patients with IBS is highly warranted. Objective: This study aims to conduct a randomized controlled trial to evaluate the effectiveness of 3 different treatment options for patients with IBS. Methods: A total of 300 patients with IBS will be randomized (1:1:1) to receive one of the following three treatment options: a diet with low total carbohydrate content; a diet combining low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols and traditional dietary advice in IBS; and optimized medical treatment. The study will comprise a 10-day screening period, 28 days of intervention, and a 6-month follow-up for patients receiving dietary treatment. Questionnaires assessing both gastrointestinal and extraintestinal symptoms will be used as end points, as well as metabolomics, microbiota profiling, and immunological markers. Furthermore, qualitative methods will be used to evaluate the patients’ experiences regarding diet treatments. Results: Recruitment for this study began in January 2017. By May 2021, of the proposed 300 participants, 270 (90%) had been randomized, and 244 (81.3%) participants had finished the 4-week intervention. The study is still in progress, and the results are expected to be published in 2022. Conclusions: By collecting a wide range of data before, during, and after treatment in a large group of patients with IBS and diverse bowel habits, we will gain new insights into the predictors of response to treatment. That information can, in the future, be used to personalize treatment for the patient, based on the individual’s phenotype and IBS symptoms. In addition, the long-term effects of 2 different dietary treatments will be evaluated regarding their impact on gut microbiota and clinical laboratory tests and to ensure that they are safe, effective, and applicable for patients with IBS. Trial Registration: ClinicalTrials.gov NCT02970591; https://clinicaltrials.gov/ct2/show/NCT02970591 International Registered Report Identifier (IRRID): DERR1-10.2196/31413 %M 35037893 %R 10.2196/31413 %U https://www.researchprotocols.org/2022/1/e31413 %U https://doi.org/10.2196/31413 %U http://www.ncbi.nlm.nih.gov/pubmed/35037893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32362 %T Fine Detection of Human Motion During Activities of Daily Living as a Clinical Indicator for the Detection and Early Treatment of Chronic Diseases: The E-Mob Project %A Thivel,David %A Corteval,Alice %A Favreau,Jean-Marie %A Bergeret,Emmanuel %A Samalin,Ludovic %A Costes,Frédéric %A Toumani,Farouk %A Dualé,Christian %A Pereira,Bruno %A Eschalier,Alain %A Fearnbach,Nicole %A Duclos,Martine %A Tournadre,Anne %+ Clermont Auvergne University, 3 rue de la chabarde, Aubiere, 63170, France, 33 0770398975, david.thivel@uca.fr %K indicator %K fine body motion %K movement behaviors %K decomposition %K structuration %K sequencing %D 2022 %7 14.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X Methods to measure physical activity and sedentary behaviors typically quantify the amount of time devoted to these activities. Among patients with chronic diseases, these methods can provide interesting behavioral information, but generally do not capture detailed body motion and fine movement behaviors. Fine detection of motion may provide additional information about functional decline that is of clinical interest in chronic diseases. This perspective paper highlights the need for more developed and sophisticated tools to better identify and track the decomposition, structuration, and sequencing of the daily movements of humans. The primary goal is to provide a reliable and useful clinical diagnostic and predictive indicator of the stage and evolution of chronic diseases, in order to prevent related comorbidities and complications among patients. %M 35029537 %R 10.2196/32362 %U https://www.jmir.org/2022/1/e32362 %U https://doi.org/10.2196/32362 %U http://www.ncbi.nlm.nih.gov/pubmed/35029537 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25863 %T Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice %A Hyman,Antonia %A Stacy,Elizabeth %A Mohsin,Humaira %A Atkinson,Kaitlin %A Stewart,Kurtis %A Novak Lauscher,Helen %A Ho,Kendall %+ Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 3rd Floor (Blusson Spinal Cord Centre), 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048228757, kurtis.stewart@ubc.ca %K immigrants %K community-based participatory action research %K eHealth %K delivery of health care %K photovoice %K South Asian %K digital health %K mobile phone %D 2022 %7 13.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective: The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods: This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results: A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions: The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences. %M 35023842 %R 10.2196/25863 %U https://www.jmir.org/2022/1/e25863 %U https://doi.org/10.2196/25863 %U http://www.ncbi.nlm.nih.gov/pubmed/35023842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30026 %T Engagement Strategies to Improve Adherence and Retention in Web-Based Mindfulness Programs: Systematic Review %A Winter,Natalie %A Russell,Lahiru %A Ugalde,Anna %A White,Victoria %A Livingston,Patricia %+ Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 5227 1100, n.heynsbergh@deakin.edu.au %K chronic disease %K chronic illness %K digital health %K digital technology %K internet mindfulness %K mindfulness based stress reduction %K patient dropouts %K mobile phone %D 2022 %7 12.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Web-based mindfulness programs may be beneficial in improving the well-being outcomes of those living with chronic illnesses. Adherence to programs is a key indicator in improving outcomes; however, with the digitization of programs, it is necessary to enhance engagement and encourage people to return to digital health platforms. More information is needed on how engagement strategies have been used in web-based mindfulness programs to encourage adherence. Objective: The aim of this study is to develop a list of engagement strategies for web-based mindfulness programs and evaluate the impact of engagement strategies on adherence. Methods: A narrative systematic review was conducted across the MEDLINE Complete, CINAHL Complete, APA PsycINFO, and Embase databases and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Articles were screened using the population, intervention, comparator, and outcome framework. Adults aged >18 years with chronic health conditions were included in the study. Mindfulness interventions, including those in combination with mindfulness-based cognitive therapy, delivered on the web through the internet or smartphone technology were included. Interventions lasted at least 2 weeks. Studies with a randomized controlled trial design or a pilot randomized controlled trial design were included. Engagement strategies, including web-based program features and facilitator-led strategies, adherence, and retention, were included. Results: A total of 1265 articles were screened, of which 19 were relevant and were included in the review. On average, 70.98% (2258/3181) of the study participants were women with a mean age of 46 (SD 13) years. Most commonly, mindfulness programs were delivered to people living with mental health conditions (8/19, 42%). Of the 19 studies, 8 (42%) used only program features to encourage adherence, 5 (26%) used facilitator-led strategies, and 6 (32%) used a combination of the two. Encouraging program adherence was the most common engagement strategy used, which was used in 77% (10/13) of the facilitator-led studies and 57% (8/14) of the program feature studies. Nearly two-thirds (63%) of the studies provided a definition of adherence, which varied between 50% and 100% completion across studies. The overall mean participant compliance to the mindfulness programs was 56% (SD 15%). Most studies (10/19, 53%) had a long-term follow-up, with the most common follow-up period being 12 weeks after intervention (3/10, 30%). After the intervention, the mean retention was 78% (SD 15%). Conclusions: Engagement strategies in web-based mindfulness programs comprise reminders to use the program. Other features may be suitable for encouraging adherence to interventions, and a facilitator-led component may result in higher retention. There is variance in the way adherence is measured, and intervention lengths and follow-up periods are inconsistent. More thorough reporting and a standardized framework for measuring adherence are needed to more accurately assess adherence and engagement strategies. %M 35019851 %R 10.2196/30026 %U https://www.jmir.org/2022/1/e30026 %U https://doi.org/10.2196/30026 %U http://www.ncbi.nlm.nih.gov/pubmed/35019851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e22122 %T Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study %A Martínez Silvagnoli,Leia %A Shepherd,Caroline %A Pritchett,James %A Gardner,Jason %+ CMC Connect, McCann Health Medical Communications, Complete House, 19–21 King Edward Street, Macclesfield, SK10 1AQ, United Kingdom, 44 1625 62 4000, Caroline.Shepherd@connect-cmc.com %K biomedical research %K health literacy %K multiple sclerosis %K plain language summary %K psoriasis %K rheumatoid arthritis %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Plain language summaries (PLSs) are intended to provide readers with a clear, nontechnical, and easily understandable overview of medical and scientific literature; however, audience preferences for specific PLS formats have yet to be fully explored. Objective: This study aims to evaluate the preferred readability level and format for PLSs of medical research articles of different disease states via a web-based survey of audiences of different age groups. Methods: Articles describing phase III clinical trials published in top-level, peer-reviewed journals between May 2016 and May 2018 were identified for 3 chronic disease states representing a range of adult patient age groups: (1) psoriasis, a skin disease representative of younger patients; (2) multiple sclerosis (MS), a neurological disease representative of middle-aged patients; and (3) rheumatoid arthritis (RA), a painful joint disease representative of older patients. Four PLSs were developed for each research article, of which 3 were text-only summaries (written with high, medium, and low complexity) and 1 was an infographic. To evaluate each of the 4 PLS formats, a 20-question open survey (specific to one of the 3 diseases) was sent to a representative sample selected via UK-based patient association websites, Twitter, and Facebook patient groups. A weighted-average calculation was applied to respondents’ ranked preferences for each PLS format. Results: For all 3 articles, the weighted-average preference scores showed that infographic (psoriasis 2.91, MS 2.71, and RA 2.78) and medium-complexity text-based PLS (reading age 14-17 years, US Grade 9-11; psoriasis 2.90; MS 2.47; RA 2.77) were the two most preferred PLS formats. Conclusions: Audience preferences should be accounted for when preparing PLSs to accompany peer-reviewed original research articles. Oversimplified text can be viewed negatively, and graphical summaries or medium-complexity text-based summaries appear to be the most popular. Plain Language Summary: Patients and caregivers should have the chance to read about medical research in a format they can understand. However, we do not know much about the formats that people with different illnesses or ages prefer. Researchers wanted to find out more about this. They selected 3 medical articles about illnesses that affect different age groups: psoriasis (younger patients), multiple sclerosis (middle-aged patients), and rheumatoid arthritis (older patients). They created 4 summaries of each article. One was a graphical summary, and the other 3 were words-only summaries of high, medium, and low complexity. Then, the researchers posted surveys on UK patient group websites and Facebook patient groups to ask people what they thought of the summaries. The surveys were taken by 167 people. These people were patients with psoriasis, multiple sclerosis, or rheumatoid arthritis, or their caregivers. Most were women, and about half had a university degree. For each illness, most people preferred the graphical summary. Among the word-only summaries, most people preferred the medium-complexity wording written for a reading age of 14 to 17 years. People felt that the graphical and medium-complexity summaries were clear and concise, while the others used jargon or were too simple. Authors of medical articles should remember these results when writing summaries for patients. More research is needed about the preferences of other people, such as those with other illnesses. (See Multimedia Appendix 1 for the graphical summary of the plain language summary.) %M 35014966 %R 10.2196/22122 %U https://www.jmir.org/2022/1/e22122 %U https://doi.org/10.2196/22122 %U http://www.ncbi.nlm.nih.gov/pubmed/35014966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e22957 %T The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Huang,Ching-Chang %A Lee,Jen-Kuang %A Yu,Jiun-Yu %A Ho,Yi-Lwun %+ Department of Internal Medicine, National Taiwan University Hospital, #7, Chung-Shan South Road, Taipei, 100225, Taiwan, 886 2 23123456 ext 65524, ylho@ntu.edu.tw %K blood pressure %K variability %K telehealth %K hypertension %K cardiovascular disease %K chronic disease %K heart %K digital platform %K cohort %K management %K intervention %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. Objective: The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP. Methods: This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05%) patients who received home BP surveillance for ≥56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated. Results: Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2±9.2 to 133.7±10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8±3.4 to 7.3±3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3±2.5 to 5.9±2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95% CI 1.18-3.89). Conclusions: Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD. %M 35006089 %R 10.2196/22957 %U https://www.jmir.org/2022/1/e22957 %U https://doi.org/10.2196/22957 %U http://www.ncbi.nlm.nih.gov/pubmed/35006089 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e27689 %T A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach %A Rao,Nema %A Perdomo,Sophy %A Jonassaint,Charles %+ Center for Behavioral Health and Smart Technology, Department of Medicine, University of Pittsburgh, 230 McKee Pl Suite 600, Pittsburgh, PA, 15213, United States, 1 4125869850, cjonassaint@pitt.edu %K pain %K pain measurement %K chronic pain %K animations %K mobile apps %K human-centered design %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. %M 34994697 %R 10.2196/27689 %U https://humanfactors.jmir.org/2022/1/e27689 %U https://doi.org/10.2196/27689 %U http://www.ncbi.nlm.nih.gov/pubmed/34994697 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30077 %T Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review %A Paalimäki-Paakki,Karoliina %A Virtanen,Mari %A Henner,Anja %A Nieminen,Miika T %A Kääriäinen,Maria %+ Research Unit of Nursing Science and Health Management, University of Oulu, Aapistie 5 A, Oulu, 90220, Finland, 358 505365959, karoliina.paalimaki-paakki@oamk.fi %K mHealth %K mobile health %K eHealth %K digital health %K mobile apps %K smartphone apps %K web-based %K telemedicine %K chronic diseases %K noncommunicable diseases %K web-based interventions %K mobile phone %D 2022 %7 6.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective: This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods: Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results: Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions: This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling. %M 34989681 %R 10.2196/30077 %U https://www.jmir.org/2022/1/e30077 %U https://doi.org/10.2196/30077 %U http://www.ncbi.nlm.nih.gov/pubmed/34989681 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e32575 %T A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study %A Wang,Tianyu %A Stanforth,Philip R %A Fleming,R Y Declan %A Wolf Jr,J Stuart %A Stanforth,Dixie %A Tanaka,Hirofumi %+ Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, United States, 1 5122324801, htanaka@austin.utexas.edu %K mobile app %K prehabilitation %K perioperative care %K rehabilitation %K surgery %K perioperative %K elective surgery %K mobile health %K health applications %K health apps %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. Objective: This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. Methods: The app was developed using “Appy Pie,” a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non–team-member users. Results: We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. Conclusions: This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future. %M 34967752 %R 10.2196/32575 %U https://periop.jmir.org/2021/2/e32575 %U https://doi.org/10.2196/32575 %U http://www.ncbi.nlm.nih.gov/pubmed/34967752 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e28285 %T Remote Monitoring Systems for Patients With Chronic Diseases in Primary Health Care: Systematic Review %A Peyroteo,Mariana %A Ferreira,Inês Augusto %A Elvas,Luís Brito %A Ferreira,João Carlos %A Lapão,Luís Velez %+ Unidade de Investigação e Desenvolvimento em Engenharia Mecanica e Industrial, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Faculdade de Ciências e Tecnologia, Campus da Caparica, Setúbal, 2829-516, Portugal, 351 212 948 300, l.lapao@fct.unl.pt %K sensors %K wearables %K remote monitoring %K digital health %K primary health care %K chronic diseases %D 2021 %7 21.12.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. Objective: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. Methods: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. Results: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%). Conclusions: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way. %M 34932000 %R 10.2196/28285 %U https://mhealth.jmir.org/2021/12/e28285 %U https://doi.org/10.2196/28285 %U http://www.ncbi.nlm.nih.gov/pubmed/34932000 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e32161 %T Reliability of Commercial Voice Assistants’ Responses to Health-Related Questions in Noncommunicable Disease Management: Factorial Experiment Assessing Response Rate and Source of Information %A Bérubé,Caterina %A Kovacs,Zsolt Ferenc %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV G 214, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 633 8419, berubec@ethz.ch %K voice assistants %K conversational agents %K health literacy %K noncommunicable diseases %K mobile phone %K smart speaker %K smart display %K evaluation %K protocol %K assistant %K agent %K literacy %K audio %K health information %K management %K factorial %K information source %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Noncommunicable diseases (NCDs) constitute a burden on public health. These are best controlled through self-management practices, such as self-information. Fostering patients’ access to health-related information through efficient and accessible channels, such as commercial voice assistants (VAs), may support the patients’ ability to make health-related decisions and manage their chronic conditions. Objective: This study aims to evaluate the reliability of the most common VAs (ie, Amazon Alexa, Apple Siri, and Google Assistant) in responding to questions about management of the main NCD. Methods: We generated health-related questions based on frequently asked questions from health organization, government, medical nonprofit, and other recognized health-related websites about conditions associated with Alzheimer’s disease (AD), lung cancer (LCA), chronic obstructive pulmonary disease, diabetes mellitus (DM), cardiovascular disease, chronic kidney disease (CKD), and cerebrovascular accident (CVA). We then validated them with practicing medical specialists, selecting the 10 most frequent ones. Given the low average frequency of the AD-related questions, we excluded such questions. This resulted in a pool of 60 questions. We submitted the selected questions to VAs in a 3×3×6 fractional factorial design experiment with 3 developers (ie, Amazon, Apple, and Google), 3 modalities (ie, voice only, voice and display, display only), and 6 diseases. We assessed the rate of error-free voice responses and classified the web sources based on previous research (ie, expert, commercial, crowdsourced, or not stated). Results: Google showed the highest total response rate, followed by Amazon and Apple. Moreover, although Amazon and Apple showed a comparable response rate in both voice-and-display and voice-only modalities, Google showed a slightly higher response rate in voice only. The same pattern was observed for the rate of expert sources. When considering the response and expert source rate across diseases, we observed that although Google remained comparable, with a slight advantage for LCA and CKD, both Amazon and Apple showed the highest response rate for LCA. However, both Google and Apple showed most often expert sources for CVA, while Amazon did so for DM. Conclusions: Google showed the highest response rate and the highest rate of expert sources, leading to the conclusion that Google Assistant would be the most reliable tool in responding to questions about NCD management. However, the rate of expert sources differed across diseases. We urge health organizations to collaborate with Google, Amazon, and Apple to allow their VAs to consistently provide reliable answers to health-related questions on NCD management across the different diseases. %M 34932003 %R 10.2196/32161 %U https://www.jmir.org/2021/12/e32161 %U https://doi.org/10.2196/32161 %U http://www.ncbi.nlm.nih.gov/pubmed/34932003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e25498 %T The Impact of Patient Characteristics on Their Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study %A Tossaint-Schoenmakers,Rosian %A Kasteleyn,Marise %A Goedhart,Annelijn %A Versluis,Anke %A Talboom-Kamp,Esther %+ Saltro Diagnostic Centre, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 302361136, rtossaint@saltro.nl %K patient portal %K eHealth impact questionnaire %K laboratory test results %K self-efficacy %K usability %K age %K gender %K chronic disease %K education %K patient characteristics %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are promising tools to increase patient involvement and allow them to manage their health. To optimally facilitate patients, laboratory test results should be explained in easy language. Patient characteristics affect the usage of portals and the user satisfaction. However, limited research is available, specified for online communicating laboratory test results, on whether portal use and acceptance differ between groups. Objective: The aim of this study was to assess the effect of patient characteristics (gender, age, education, and chronic disease) on the self-efficacy and perceived usability of an online patient portal that communicates diagnostic test results. Methods: We used the online-administered eHealth impact questionnaire (eHIQ) to explore patients’ attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire and to answer questions regarding gender, age, education, and chronic disease. The subscale “information and presentation” of the eHIQ assessed the usability of the patient portal and the subscale “motivation and confidence to act” assessed self-efficacy to determine whether patients were motivated to act on the presented information. Age, gender, education, and chronic disease were the determinants to analyze the effect on usability and self-efficacy. Descriptive analyses were performed to explore patient characteristics, usability, and self-efficacy. Univariable and multivariable regression analyses were performed with age, gender, education, and chronic disease as determinants, and usability and self-efficacy as outcomes. Results: The questionnaire was completed by 748 respondents, of which 428 (57.2%) were female, 423 (56.6%) were highly educated, and 509 (68%) had no chronic disease. The mean age was 58.5 years (SD 16.4). Higher age, high education, and asthma or chronic obstructive pulmonary disease were significant determinants for decreased usability; respectively, b=-.094, 95% CI -1147 to 0.042 (P<.001); b=-2.512, 95% CI -4.791 to -0.232 (P=.03); and b=-3.630, 95% CI -6.545 to -0.715 (P=.02). High education was also a significant determinant for a lower self-efficacy (b=-3.521, 95% CI -6.469 to -0.572; P=.02). Other determinants were not significant. Conclusions: This study showed that the higher-educated users of a patient portal scored lower on usability and self-efficacy. Usability was also lower for older people and for patients with asthma or chronic obstructive pulmonary disease. The results portal is not tailored for different groups. Further research should investigate which factors from a patient’s perspective are essential to tailor the portal for different groups and how a result portal can be optimally integrated within the daily practice of a doctor. %M 34927593 %R 10.2196/25498 %U https://formative.jmir.org/2021/12/e25498 %U https://doi.org/10.2196/25498 %U http://www.ncbi.nlm.nih.gov/pubmed/34927593 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31878 %T Accuracy of Physical Assessment in Nursing for Cervical Spine Joint Pain and Stiffness: Pilot Study Protocol %A Soares,Bruno %A Fonseca,Raquel %A Fonseca,Patrícia %A Alves,Paulo %+ Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, 1327, Porto, 4169-005, Portugal, 351 933880937, brunomgsoares@gmail.com %K nursing process %K nursing assessment %K pain %K referred pain %K range of motion %K neck pain %K stomatognathic system %K viscerosomatic reflexes %K cervical spine dysfunction %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cervical spine dysfunction is a condition with high personal, social, and economic impact worldwide. Although its etiology is described as multifactorial, there is a need for further clarification. The literature has demonstrated the anatomical, physiological, and pathophysiological relationship among the cervical spine, temporomandibular joint, and visceral system. To guide and contribute to the accuracy of the physical assessment performed by nurses, we will study the influence of the stomatognathic system and viscerosomatic reflexes on pain and joint stiffness of the cervical spine. Objective: The aim of this study is to describe a pilot study protocol to investigate the influence of the stomatognathic system and viscerosomatic reflexes on cervical structures. Methods: A pilot study with a quasi-experimental design was conducted with 50 volunteers from the university population of the Universidade Católica Portuguesa-Porto. We studied the influence of changes in the usual intercuspation, the occlusal deprogramming, and the pressure stimulus of the reflex skin region of the ilium/colon in the cervical spine. This study was divided into 2 phases. In the first phase, we performed the kinematic and pain analysis during the passive mobilization of the upper cervical spine using the Motion Capture System at the Motion Capture Laboratory at UCP-Porto and the Visual Analog Scale. In the second phase, we evaluated the pain threshold on palpation of the erector neck muscles and the structures of the stomatognathic system using algometry. The influence of viscerosomatic reflexes on the structures of the stomatognathic system was also analyzed. Results: Selection and preparation of the data collection site, acquisition of materials, constitution of the sample group and data collection were completed. The analysis of the results is being carried out. Conclusions: The data from this study will allow for the detection of the possible influence of the stomatognathic system and viscerosomatic reflexes on pain and range of motion of the upper cervical spine, providing data for future randomized studies. We have also identified potential limitations of this study. International Registered Report Identifier (IRRID): RR1-10.2196/31878 %M 34927588 %R 10.2196/31878 %U https://www.researchprotocols.org/2021/12/e31878 %U https://doi.org/10.2196/31878 %U http://www.ncbi.nlm.nih.gov/pubmed/34927588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e22672 %T A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial %A Doyle,Julie %A Murphy,Emma %A Gavin,Shane %A Pascale,Alessandra %A Deparis,Stéphane %A Tommasi,Pierpaolo %A Smith,Suzanne %A Hannigan,Caoimhe %A Sillevis Smitt,Myriam %A van Leeuwen,Cora %A Lastra,Julia %A Galvin,Mary %A McAleer,Patricia %A Tompkins,Lorraine %A Jacobs,An %A M Marques,Marta %A Medina Maestro,Jaime %A Boyle,Gordon %A Dinsmore,John %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91 K584, Ireland, 353 429370497, julie.doyle@dkit.ie %K digital health %K aging %K multimorbidity %K chronic disease %K self-management %K integrated care %K longitudinal study %K engagement %K usability %K mobile phone %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 %M 34914612 %R 10.2196/22672 %U https://www.jmir.org/2021/12/e22672 %U https://doi.org/10.2196/22672 %U http://www.ncbi.nlm.nih.gov/pubmed/34914612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e22125 %T A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial %A Dinsmore,John %A Hannigan,Caoimhe %A Smith,Suzanne %A Murphy,Emma %A Kuiper,Janneke M L %A O'Byrne,Emma %A Galvin,Mary %A Jacobs,An %A Sillevis Smitt,Myriam %A van Leeuwen,Cora %A McAleer,Patricia %A Tompkins,Lorraine %A Brady,Anne-Marie %A McCarron,Mary %A Doyle,Julie %+ Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, GAS Building, 24 D'Olier Street, Dublin, D02 T283, Ireland, 353 18964155 ext 4155, dinsmorj@tcd.ie %K multimorbidity %K digital health %K chronic disease %K self-management %K older adults %K integrated care %K behaviour change %K mobile phone %K smart phone %K smart device %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ≥65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 %M 34914613 %R 10.2196/22125 %U https://www.researchprotocols.org/2021/12/e22125 %U https://doi.org/10.2196/22125 %U http://www.ncbi.nlm.nih.gov/pubmed/34914613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30291 %T Long-Term Effects of a Web-Based Low-FODMAP Diet Versus Probiotic Treatment for Irritable Bowel Syndrome, Including Shotgun Analyses of Microbiota: Randomized, Double-Crossover Clinical Trial %A Ankersen,Dorit Vedel %A Weimers,Petra %A Bennedsen,Mette %A Haaber,Anne Birgitte %A Fjordside,Eva Lund %A Beber,Moritz Emanuel %A Lieven,Christian %A Saboori,Sanaz %A Vad,Nicolai %A Rannem,Terje %A Marker,Dorte %A Paridaens,Kristine %A Frahm,Suzanne %A Jensen,Lisbeth %A Rosager Hansen,Malte %A Burisch,Johan %A Munkholm,Pia %+ Department of Gastroenterology, North Zealand University Hospital, Frederikssundsvej 30, Frederikssund, 3600, Denmark, 45 48292078, pia.munkholm@regionh.dk %K irritable bowel syndrome %K web-based low-FODMAP diet %K probiotics %K randomized trial %K web-based %K IBS %K symptom management %K treatment outcomes %K outcomes %K treatment %K microbiota %K microbiome %K gastroenterology %K mobile app %K mHealth %K eHealth %D 2021 %7 14.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The long-term management of irritable bowel syndrome (IBS) poses many challenges. In short-term studies, eHealth interventions have been demonstrated to be safe and practical for at-home monitoring of the effects of probiotic treatments and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). IBS has been linked to alterations in the microbiota. Objective: The aim of this study was to determine whether a web-based low-FODMAP diet (LFD) intervention and probiotic treatment were equally good at reducing IBS symptoms, and whether the response to treatments could be explained by patients’ microbiota. Methods: Adult IBS patients were enrolled in an open-label, randomized crossover trial (for nonresponders) with 1 year of follow-up using the web application IBS Constant Care (IBS CC). Patients were recruited from the outpatient clinic at the Department of Gastroenterology, North Zealand University Hospital, Denmark. Patients received either VSL#3 for 4 weeks (2 × 450 billion colony-forming units per day) or were placed on an LFD for 4 weeks. Patients responding to the LFD were reintroduced to foods high in FODMAPs, and probiotic responders received treatments whenever they experienced a flare-up of symptoms. Treatment response and symptom flare-ups were defined as a reduction or increase, respectively, of at least 50 points on the IBS Severity Scoring System (IBS-SSS). Web-based ward rounds were performed daily by the study investigator. Fecal microbiota were analyzed by shotgun metagenomic sequencing (at least 10 million 2 × 100 bp paired-end sequencing reads per sample). Results: A total of 34 IBS patients without comorbidities and 6 healthy controls were enrolled in the study. Taken from participating subjects, 180 fecal samples were analyzed for their microbiota composition. Out of 21 IBS patients, 12 (57%) responded to the LFD and 8 (38%) completed the reintroduction of FODMAPs. Out of 21 patients, 13 (62%) responded to their first treatment of VSL#3 and 7 (33%) responded to multiple VSL#3 treatments. A median of 3 (IQR 2.25-3.75) probiotic treatments were needed for sustained symptom control. LFD responders were reintroduced to a median of 14.50 (IQR 7.25-21.75) high-FODMAP items. No significant difference in the median reduction of IBS-SSS for LFD versus probiotic responders was observed, where for LFD it was –126.50 (IQR –196.75 to –76.75) and for VSL#3 it was –130.00 (IQR –211.00 to –70.50; P>.99). Responses to either of the two treatments were not able to be predicted using patients’ microbiota. Conclusions: The web-based LFD intervention and probiotic treatment were equally efficacious in managing IBS symptoms. The response to treatments could not be explained by the composition of the microbiota. The IBS CC web application was shown to be practical, safe, and useful for clinical decision making in the long-term management of IBS. Although this study was underpowered, findings from this study warrant further research in a larger sample of patients with IBS to confirm these long-term outcomes. Trial Registration: ClinicalTrials.gov NCT03586622; https://clinicaltrials.gov/ct2/show/NCT03586622 %M 34904950 %R 10.2196/30291 %U https://www.jmir.org/2021/12/e30291 %U https://doi.org/10.2196/30291 %U http://www.ncbi.nlm.nih.gov/pubmed/34904950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30151 %T One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial %A Bekkelund,Svein Ivar %A Müller,Kai Ivar %+ Department of Clinical Medicine, The Arctic University of Norway, Hansine Hansens veg 18, Tromsø, 9037, Norway, 47 90185090, svein-ivar.bekkelund@uit.no %K chronic headache %K remission %K video consultation %K telemedicine %K eHealth %K digital consultation %K consultation %K treatment %K follow-up %K RCT %K randomized controlled trial %D 2021 %7 13.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective: The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods: Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results: From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions: One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration: ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177 %M 34898455 %R 10.2196/30151 %U https://www.jmir.org/2021/12/e30151 %U https://doi.org/10.2196/30151 %U http://www.ncbi.nlm.nih.gov/pubmed/34898455 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26794 %T Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial %A Ali,Lilas %A Wallström,Sara %A Fors,Andreas %A Barenfeld,Emmelie %A Fredholm,Eva %A Fu,Michael %A Goudarzi,Mahboubeh %A Gyllensten,Hanna %A Lindström Kjellberg,Irma %A Swedberg,Karl %A Vanfleteren,Lowie E G W %A Ekman,Inger %+ Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden, 46 707587856, lilas.ali@gu.se %K chronic heart failure %K chronic obstructive pulmonary disease %K digital platform %K eHealth %K patient-centered care %K person-centered care %K randomized controlled trial %K telehealth %D 2021 %7 13.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective: The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods: A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention’s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results: No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions: PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration: ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817 %M 34898447 %R 10.2196/26794 %U https://www.jmir.org/2021/12/e26794 %U https://doi.org/10.2196/26794 %U http://www.ncbi.nlm.nih.gov/pubmed/34898447 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30092 %T Assessing Patient Engagement in Health Care: Proposal for a Modeling and Simulation Framework for Behavioral Analysis %A Alwasel,Athary %A Stergioulas,Lampros %A Fakhimi,Masoud %A Garn,Wolfgang %+ Surrey Business School, University of Surrey, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 1483 683048, a.alwasel@surrey.ac.uk %K modeling and simulation %K behavioral analysis %K patient engagement %K behavioral factors, health care %K human factors %K outcomes %K patient health %K health policy %K chronic diseases %K behavioral model %D 2021 %7 8.12.2021 %9 Proposal %J JMIR Res Protoc %G English %X Human behavior plays a vital role in health care effectiveness and system performance. Therefore, it is necessary to look carefully at the interactions within a system and how a system is affected by the behavioral responses and activities of its various components, particularly human components and actions. Modeling patients’ engagement behaviors can be valuable in many ways; for example, models can evaluate the effects of therapeutic interventions on health improvement, health care effectiveness, and desired outcomes of changing health lifestyles. Modeling and simulation (M&S) help us to understand the interactions within a whole system under defined conditions. M&S in patient behavior analysis involve models that attempt to identify certain human behaviors that most likely have an impact on health care operations and services. Our study’s overall aims are (1) to investigate the impacts of patients’ engagement and various human behavior patterns on health care effectiveness and the achievement of desired outcomes and (2) to construct and validate a framework for modeling patient engagement and implementing and supporting patient management best practices, health policy-making processes, and innovative interventions in health care. We intend to extract routinely collected data of different parameters from general patients diagnosed with chronic diseases, such as diabetes. Our plan is to design data sets and extract health data from a pool of >4 million patient records from different general practices in England. We will focus on the primary electronic medical records of patients with at least 1 chronic disease (>200,000 records). Simulation techniques will be used to study patient engagement and its impact on health care effectiveness and outcome measures. The study will integrate available approaches to develop a framework for modeling how patients’ behaviors affect health care activities and outcomes and to underline the characteristics and salient factors that operational management needs to be aware of when developing a behavioral model for assessing patient engagement. The M&S framework, which is under development, will consider patient behavior in context and the underlying factors of human behavior with the help of simulation techniques. The proposed framework will be validated and evaluated through a health care case study. We expect to identify leading factors that influence and affect patient engagement and associated behavioral activities and to illustrate the challenges and complexities of developing simulation models for conducting behavioral analyses within health care settings. Additionally, we will assess patients’ engagement behaviors in terms of achieving health care effectiveness and desired outcomes, and we will specifically evaluate the impacts of patient engagement activities on health care services, patient management styles, and the effectiveness of health interventions in terms of achieving the intended outcomes—improved health and patient satisfaction.International Registered Report Identifier (IRRID): PRR1-10.2196/30092 %M 34889774 %R 10.2196/30092 %U https://www.researchprotocols.org/2021/12/e30092 %U https://doi.org/10.2196/30092 %U http://www.ncbi.nlm.nih.gov/pubmed/34889774 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28021 %T Recruitment of Patients With Amyotrophic Lateral Sclerosis for Clinical Trials and Epidemiological Studies: Descriptive Study of the National ALS Registry’s Research Notification Mechanism %A Mehta,Paul %A Raymond,Jaime %A Han,Moon Kwon %A Larson,Theodore %A Berry,James D %A Paganoni,Sabrina %A Mitsumoto,Hiroshi %A Bedlack,Richard Stanley %A Horton,D Kevin %+ Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, United States, 1 770 488 0556, pum4@cdc.gov %K amyotrophic lateral sclerosis %K Lou Gehrig disease %K motor neuron disease %K clinical trials %K patient recruitment %K National ALS Registry %K research notification mechanism %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers face challenges in patient recruitment, especially for rare, fatal diseases such as amyotrophic lateral sclerosis (ALS). These challenges include obtaining sufficient statistical power as well as meeting eligibility requirements such as age, sex, and study proximity. Similarly, persons with ALS (PALS) face difficulty finding and enrolling in research studies for which they are eligible. Objective: The aim of this study was to describe how the federal Agency for Toxic Substances and Disease Registry’s (ATSDR) National ALS Registry is linking PALS to scientists who are conducting research, clinical trials, and epidemiological studies. Methods: Through the Registry’s online research notification mechanism (RNM), PALS can elect to be notified about new research opportunities. This mechanism allows researchers to upload a standardized application outlining their study design and objectives, and proof of Institutional Review Board approval. If the application is approved, ATSDR queries the Registry for PALS meeting the study’s specific eligibility criteria, and then distributes the researcher’s study material and contact information to PALS via email. PALS then need to contact the researcher directly to take part in any research. Such an approach allows ATSDR to protect the confidentiality of Registry enrollees. Results: From 2013 to 2019, a total of 46 institutions around the United States and abroad have leveraged this tool and over 600,000 emails have been sent, resulting in over 2000 patients conservatively recruited for clinical trials and epidemiological studies. Patients between the ages of 60 and 69 had the highest level of participation, whereas those between the ages of 18 and 39 and aged over 80 had the lowest. More males participated (4170/7030, 59.32%) than females (2860/7030, 40.68%). Conclusions: The National ALS Registry’s RNM benefits PALS by connecting them to appropriate ALS research. Simultaneously, the system benefits researchers by expediting recruitment, increasing sample size, and efficiently identifying PALS meeting specific eligibility requirements. As more researchers learn about and use this mechanism, both PALS and researchers can hasten research and expand trial options for PALS. %M 34878988 %R 10.2196/28021 %U https://www.jmir.org/2021/12/e28021 %U https://doi.org/10.2196/28021 %U http://www.ncbi.nlm.nih.gov/pubmed/34878988 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28678 %T Preferences for Using a Mobile App in Sickle Cell Disease Self-management: Descriptive Qualitative Study %A Mayo-Gamble,Tilicia L %A Quasie-Woode,Delores %A Cunningham-Erves,Jennifer %A Rollins,Margo %A Schlundt,David %A Bonnet,Kemberlee %A Murry,Velma McBride %+ Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Dr, PO Box 8015, Statesboro, GA, 30458, United States, 1 912 478 1249, tmayogamble@georgiasouthern.edu %K sickle cell disease %K digital technology %K rural %K mHealth app %K patient-centered technology %K mobile health %K health outcomes %K hematology %K mobile phone %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with sickle cell disease (SCD) and their caregivers may benefit from technology-based resources to improve disease self-management. Objective: This study explores the preferences regarding a mobile health (mHealth) app to facilitate self-management in adults with SCD and their caregivers living in urban and rural communities. Methods: Five community listening sessions were conducted in 2 urban and rural communities among adults with SCD and their caregivers (N=43). Each session comprised 4 to 15 participants. Participants were asked questions on methods of finding information about SCD self-care, satisfaction with current methods for finding SCD management information, support for SCD management, important features for development of an mHealth app, and areas of benefit for using an mHealth app for SCD self-management. An inductive-deductive content analysis approach was implemented to identify the critical themes. Results: Seven critical themes emerged, including the current methods for receiving self-management information, desired information, recommendations for communicating sickle cell self-management information, challenges of disease management, types of support received for disease management, barriers to and facilitators of using an mHealth app, and feature preferences for an mHealth app. In addition, we found that the participants were receptive to using mHealth apps in SCD self-management. Conclusions: This study expands our knowledge on the use of mHealth technology to reduce information access barriers pertaining to SCD. The findings can be used to develop a patient-centered, user-friendly mHealth app to facilitate disease self-management, thus increasing access to resources for families of patients with SCD residing in rural communities. %M 34851295 %R 10.2196/28678 %U https://formative.jmir.org/2021/11/e28678 %U https://doi.org/10.2196/28678 %U http://www.ncbi.nlm.nih.gov/pubmed/34851295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e32900 %T Developing the Total Health Profile, a Generalizable Unified Set of Multimorbidity Risk Scores Derived From Machine Learning for Broad Patient Populations: Retrospective Cohort Study %A Mahajan,Abhishaike %A Deonarine,Andrew %A Bernal,Axel %A Lyons,Genevieve %A Norgeot,Beau %+ Anthem Inc, 661 Bryant St, Palo Alto, CA, 94301, United States, 1 650 272 7314, beaunorgeot@gmail.com %K multimorbidity %K clinical risk score %K outcome research %K machine learning %K electronic health record %K clinical informatics %K morbidity %K risk %K outcome %K population data %K diagnostic %K demographic %K decision making %K cohort %K prediction %D 2021 %7 26.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Multimorbidity clinical risk scores allow clinicians to quickly assess their patients' health for decision making, often for recommendation to care management programs. However, these scores are limited by several issues: existing multimorbidity scores (1) are generally limited to one data group (eg, diagnoses, labs) and may be missing vital information, (2) are usually limited to specific demographic groups (eg, age), and (3) do not formally provide any granularity in the form of more nuanced multimorbidity risk scores to direct clinician attention. Objective: Using diagnosis, lab, prescription, procedure, and demographic data from electronic health records (EHRs), we developed a physiologically diverse and generalizable set of multimorbidity risk scores. Methods: Using EHR data from a nationwide cohort of patients, we developed the total health profile, a set of six integrated risk scores reflecting five distinct organ systems and overall health. We selected the occurrence of an inpatient hospital visitation over a 2-year follow-up window, attributable to specific organ systems, as our risk endpoint. Using a physician-curated set of features, we trained six machine learning models on 794,294 patients to predict the calibrated probability of the aforementioned endpoint, producing risk scores for heart, lung, neuro, kidney, and digestive functions and a sixth score for combined risk. We evaluated the scores using a held-out test cohort of 198,574 patients. Results: Study patients closely matched national census averages, with a median age of 41 years, a median income of $66,829, and racial averages by zip code of 73.8% White, 5.9% Asian, and 11.9% African American. All models were well calibrated and demonstrated strong performance with areas under the receiver operating curve (AUROCs) of 0.83 for the total health score (THS), 0.89 for heart, 0.86 for lung, 0.84 for neuro, 0.90 for kidney, and 0.83 for digestive functions. There was consistent performance of this scoring system across sexes, diverse patient ages, and zip code income levels. Each model learned to generate predictions by focusing on appropriate clinically relevant patient features, such as heart-related hospitalizations and chronic hypertension diagnosis for the heart model. The THS outperformed the other commonly used multimorbidity scoring systems, specifically the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) overall (AUROCs: THS=0.823, CCI=0.735, ECI=0.649) as well as for every age, sex, and income bracket. Performance improvements were most pronounced for middle-aged and lower-income subgroups. Ablation tests using only diagnosis, prescription, social determinants of health, and lab feature groups, while retaining procedure-related features, showed that the combination of feature groups has the best predictive performance, though only marginally better than the diagnosis-only model on at-risk groups. Conclusions: Massive retrospective EHR data sets have made it possible to use machine learning to build practical multimorbidity risk scores that are highly predictive, personalizable, intuitive to explain, and generalizable across diverse patient populations. %M 34842542 %R 10.2196/32900 %U https://www.jmir.org/2021/11/e32900 %U https://doi.org/10.2196/32900 %U http://www.ncbi.nlm.nih.gov/pubmed/34842542 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29693 %T Prevalence of Multimorbidity of Chronic Noncommunicable Diseases in Brazil: Population-Based Study %A Shi,Xin %A Lima,Simone Maria da Silva %A Mota,Caroline Maria de Miranda %A Lu,Ying %A Stafford,Randall S %A Pereira,Corintho Viana %+ Management Engineering Department, Universidade Federal de Pernambuco, Av Prof Moraes Rego, 1235, Cidade Universitaria, Recife, 50670-901, Brazil, 55 8138795574, caroline.mota@ufpe.br %K multimorbidity %K prevalence %K health care %K public health %K Brazil %K logistic regression %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multimorbidity is the co-occurrence of two or more chronic diseases. Objective: This study, based on self-reported medical diagnosis, aims to investigate the dynamic distribution of multimorbidity across sociodemographic levels and its impacts on health-related issues over 15 years in Brazil using national data. Methods: Data were analyzed using descriptive statistics, hypothesis tests, and logistic regression. The study sample comprised 679,572 adults (18-59 years of age) and 115,699 elderly people (≥60 years of age) from the two latest cross-sectional, multiple-cohort, national-based studies: the National Sample Household Survey (PNAD) of 1998, 2003, and 2008, and the Brazilian National Health Survey (PNS) of 2013. Results: Overall, the risk of multimorbidity in adults was 1.7 times higher in women (odds ratio [OR] 1.73, 95% CI 1.67-1.79) and 1.3 times higher among people without education (OR 1.34, 95% CI 1.28-1.41). Multiple chronic diseases considerably increased with age in Brazil, and people between 50 and 59 years old were about 12 times more likely to have multimorbidity than adults between 18 and 29 years of age (OR 11.89, 95% CI 11.27-12.55). Seniors with multimorbidity had more than twice the likelihood of receiving health assistance in community services or clinics (OR 2.16, 95% CI 2.02-2.31) and of being hospitalized (OR 2.37, 95% CI 2.21-2.56). The subjective well-being of adults with multimorbidity was often worse than people without multiple chronic diseases (OR=12.85, 95% CI: 12.07-13.68). These patterns were similar across all 4 cohorts analyzed and were relatively stable over 15 years. Conclusions: Our study shows little variation in the prevalence of the multimorbidity of chronic diseases in Brazil over time, but there are differences in the prevalence of multimorbidity across different social groups. It is hoped that the analysis of multimorbidity from the two latest Brazil national surveys will support policy making on epidemic prevention and management. %M 34842558 %R 10.2196/29693 %U https://publichealth.jmir.org/2021/11/e29693 %U https://doi.org/10.2196/29693 %U http://www.ncbi.nlm.nih.gov/pubmed/34842558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32327 %T A Quality-of-Life Evaluation Study Assessing Health-Related Quality of Life in Patients Receiving Medicinal Cannabis (the QUEST Initiative): Protocol for a Longitudinal Observational Study %A Tait,Margaret-Ann %A Costa,Daniel S J %A Campbell,Rachel %A Norman,Richard %A Schug,Stephan %A Rutherford,Claudia %+ School of Psychology, Faculty of Science, The University of Sydney, Level 6, Chris O’Brien Lifehouse (C39Z), University of Sydney, Sydney, 2006, Australia, 61 2 8627 1558, margaret-ann.tait@sydney.edu.au %K medicinal cannabis %K patient-reported outcomes %K quality of life %K chronic pain %K pain management %K mental health %K depression %K anxiety %K cannabis oil %D 2021 %7 24.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Evidence supports several countries introducing legislation to allow cannabis-based medicine as an adjunctive treatment for the symptomatic relief of chronic pain, chemotherapy-induced nausea, spasticity in multiple sclerosis (MS), epileptic seizures, depression, and anxiety. However, clinical trial participants do not represent the entire spectrum of disease and health status seen in patients currently accessing medicinal cannabis in practice. Objective: This study aims to collect real-world data to evaluate health-related quality of life in patients prescribed medicinal cannabis oil and describe any differences over time, from before starting therapy to after 3 and 12 months of therapy. Methods: Adult patients newly prescribed medicinal cannabis oil by authorized prescribers and under the Special Access Schemes across Australia will be screened for eligibility and invited to participate. A sample size of 2142 is required, with a 3-month follow-up. All participants will complete the EuroQol 5-Dimension; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30; Depression, Anxiety, and Stress Scale-21; Patients’ Global Impression of Change; Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form (SF) version 1.0: Sleep Disturbance 8b; and PROMIS SF Fatigue 13a questionnaires. Patients with chronic pain conditions will also complete the PROMIS SF version 1.0: Pain Intensity 3a and PROMIS SF version 1.0: Pain Interference 8a. Patients with movement disorders will also complete Quality of Life in Neurological Disorders (Neuro-QoL) SF version 1.0: Upper Extremity Function (Fine Motor and Activities of Daily Living) and if chorea is indicated, the Neuro-QoL SF version 2.0: Huntington’s Disease health-related Quality of LIFE-Chorea 6a. All questionnaires will be administered at baseline, 2 weeks (titration), monthly up to 3 months, and then every 2 months up to 1 year. Results: Recruitment commenced in November 2020. By June 2021, 1095 patients were screened for the study by 69 physicians in centers across 6 Australian states: Australian Capital Territory, New South Wales, Queensland, South Australia, Victoria, and Western Australia. Of the patients screened, 833 (39% of the target sample size) provided consent and completed baseline questionnaires. Results are expected to be published in 2022. Results of this study will show whether patient-reported outcomes improve in patients accessing prescribed medicinal cannabis from baseline to 3 months and whether any changes are maintained over a 12-month period. This study will also identify differences in improvements in patient-reported outcomes among patients with different chronic conditions (eg, chronic pain, MS, epilepsy, Parkinson disease, or cancer). Conclusions: This protocol contains detailed methods that will be used across multiple sites in Australia. The findings from this study have the potential to be integral to treatment assessment and recommendations for patients with chronic pain and other health indicators for accessing medicinal cannabis. Trial Registration: Australian New Zealand Clinical Trials Registry: ANZCTRN12621000063819; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380807&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/32327 %M 34821570 %R 10.2196/32327 %U https://www.researchprotocols.org/2021/11/e32327 %U https://doi.org/10.2196/32327 %U http://www.ncbi.nlm.nih.gov/pubmed/34821570 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30191 %T Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial %A Sarker,Mohammad Habibur Rahman %A Moriyama,Michiko %A Rashid,Harun Ur %A Rahman,Md Moshiur %A Chisti,Mohammod Jobayer %A Das,Sumon Kumar %A Jahan,Yasmin %A Saha,Samir Kumar %A Arifeen,Shams El %A Ahmed,Tahmeed %A Faruque,A S G %+ Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan, 81 09028602013, d185558@hiroshima-u.ac.jp %K chronic kidney disease %K campaign %K mHealth %K knowledge %K Bangladesh %D 2021 %7 19.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID): DERR1-10.2196/30191 %M 34806998 %R 10.2196/30191 %U https://www.researchprotocols.org/2021/11/e30191 %U https://doi.org/10.2196/30191 %U http://www.ncbi.nlm.nih.gov/pubmed/34806998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30394 %T Practice Effects of Mobile Tests of Cognition, Dexterity, and Mobility on Patients With Multiple Sclerosis: Data Analysis of a Smartphone-Based Observational Study %A Woelfle,Tim %A Pless,Silvan %A Wiencierz,Andrea %A Kappos,Ludwig %A Naegelin,Yvonne %A Lorscheider,Johannes %+ Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Spitalstrasse 2, Basel, 4056, Switzerland, 41 612652525, johannes.lorscheider@usb.ch %K multiple sclerosis %K digital biomarkers %K practice effects %K learning effects %K learning curves %K nonlinear mixed models %K quantile regression %K information processing speed %K symbol digit modalities test %K smartphones %K wearable electronic devices %K mobile phones %D 2021 %7 18.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphones and their built-in sensors allow for measuring functions in disease-related domains through mobile tests. This could improve disease characterization and monitoring, and could potentially support treatment decisions for multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. Practice effects can complicate the interpretation of both improvement over time by potentially exaggerating treatment effects and stability by masking deterioration. Objective: The aim of this study is to identify short-term learning and long-term practice effects in 6 active tests for cognition, dexterity, and mobility in user-scheduled, high-frequency smartphone-based testing. Methods: We analyzed data from 264 people with self-declared MS with a minimum of 5 weeks of follow-up and at least 5 repetitions per test in the Floodlight Open study, a self-enrollment study accessible by smartphone owners from 16 countries. The collected data are openly available to scientists. Using regression and bounded growth mixed models, we characterized practice effects for the following tests: electronic Symbol Digit Modalities Test (e-SDMT) for cognition; Finger Pinching and Draw a Shape for dexterity; and Two Minute Walk, U-Turn, and Static Balance for mobility. Results: Strong practice effects were found for e-SDMT (n=4824 trials), Finger Pinching (n=19,650), and Draw a Shape (n=19,019) with modeled boundary improvements of 40.8% (39.9%-41.6%), 86.2% (83.6%-88.7%), and 23.1% (20.9%-25.2%) over baseline, respectively. Half of the practice effect was reached after 11 repetitions for e-SDMT, 28 repetitions for Finger Pinching, and 17 repetitions for Draw a Shape; 90% was reached after 35, 94, and 56 repetitions, respectively. Although baseline performance levels were highly variable across participants, no significant differences between the short-term learning effects in low performers (5th and 25th percentile), median performers, and high performers (75th and 95th percentile) were found for e-SDMT up to the fifth trial (β=1.50-2.00). Only small differences were observed for Finger Pinching (β=1.25-2.5). For U-Turn (n=15,051) and Static Balance (n=16,797), only short-term learning effects could be observed, which ceased after a maximum of 5 trials. For Two Minute Walk (n=14,393), neither short-term learning nor long-term practice effects were observed. Conclusions: Smartphone-based tests are promising for monitoring the disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong long-term practice effects in cognitive and dexterity functions have to be accounted for to identify disease-related changes in these domains, especially in the context of personalized health and in studies without a comparator arm. In contrast, changes in mobility may be more easily interpreted because of the absence of long-term practice effects, even though short-term learning effects might have to be considered. %M 34792480 %R 10.2196/30394 %U https://www.jmir.org/2021/11/e30394 %U https://doi.org/10.2196/30394 %U http://www.ncbi.nlm.nih.gov/pubmed/34792480 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30572 %T Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial %A Jessen,Stian %A Mirkovic,Jelena %A Halvorsen Brendmo,Elanor %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital HF, Aker Sykehus, Trondheimsveien 23, Oslo, 0586, Norway, 47 9804 9759, stian.jessen@rr-research.no %K mHealth %K personal strengths %K gameful design %K gamification %K user engagement %K explorative %K feasibility %K usefulness %K usability %K design %K self-management %K chronic illness %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life. Objective: The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes. Methods: A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre– and post–psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data. Results: In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received. Conclusions: Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness in performing self-management and achieving mastery of their life. %M 34787580 %R 10.2196/30572 %U https://formative.jmir.org/2021/11/e30572 %U https://doi.org/10.2196/30572 %U http://www.ncbi.nlm.nih.gov/pubmed/34787580 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30259 %T Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study %A Widmann,Catherine N %A Wieberneit,Michelle %A Bieler,Luzie %A Bernsen,Sarah %A Gräfenkämper,Robin %A Brosseron,Frederic %A Schmeel,Carsten %A Tacik,Pawel %A Skowasch,Dirk %A Radbruch,Alexander %A Heneka,Michael T %+ Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Venusberg-Campus-1, Building 80, Bonn, 53127, Germany, 49 228 287 13093, catherine.widmann@ukbonn.de %K SARS-CoV-2 %K COVID-19 %K postacute COVID-19 syndrome %K cognition %K neuropsychology %K lung %K magnetic resonance imaging %D 2021 %7 11.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective: This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods: A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results: At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions: To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration: International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID): DERR1-10.2196/30259 %M 34559059 %R 10.2196/30259 %U https://www.researchprotocols.org/2021/11/e30259 %U https://doi.org/10.2196/30259 %U http://www.ncbi.nlm.nih.gov/pubmed/34559059 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27779 %T Text Message Analysis Using Machine Learning to Assess Predictors of Engagement With Mobile Health Chronic Disease Prevention Programs: Content Analysis %A Klimis,Harry %A Nothman,Joel %A Lu,Di %A Sun,Chao %A Cheung,N Wah %A Redfern,Julie %A Thiagalingam,Aravinda %A Chow,Clara K %+ Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Westmead, Australia, 61 88903125, harry.klimis@sydney.edu.au %K mHealth %K machine learning %K chronic disease %K cardiovascular %K text messaging %K SMS %K digital health %K mobile phone %K engagement %K prevention %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messages as a form of mobile health are increasingly being used to support individuals with chronic diseases in novel ways that leverage the mobility and capabilities of mobile phones. However, there are knowledge gaps in mobile health, including how to maximize engagement. Objective: This study aims to categorize program SMS text messages and participant replies using machine learning (ML) and to examine whether message characteristics are associated with premature program stopping and engagement. Methods: We assessed communication logs from SMS text message–based chronic disease prevention studies that encouraged 1-way (SupportMe/ITM) and 2-way (TEXTMEDS [Text Messages to Improve Medication Adherence and Secondary Prevention]) communication. Outgoing messages were manually categorized into 5 message intents (informative, instructional, motivational, supportive, and notification) and replies into 7 groups (stop, thanks, questions, reporting healthy, reporting struggle, general comment, and other). Grid search with 10-fold cross-validation was implemented to identify the best-performing ML models and evaluated using nested cross-validation. Regression models with interaction terms were used to compare the association of message intent with premature program stopping and engagement (replied at least 3 times and did not prematurely stop) in SupportMe/ITM and TEXTMEDS. Results: We analyzed 1550 messages and 4071 participant replies. Approximately 5.49% (145/2642) of participants responded with stop, and 11.7% (309/2642) of participants were engaged. Our optimal ML model correctly classified program message intent with 76.6% (95% CI 63.5%-89.8%) and replies with 77.8% (95% CI 74.1%-81.4%) balanced accuracy (average area under the curve was 0.95 and 0.96, respectively). Overall, supportive (odds ratio [OR] 0.53, 95% CI 0.35-0.81) messages were associated with reduced chance of stopping, as were informative messages in SupportMe/ITM (OR 0.35, 95% CI 0.20-0.60) but not in TEXTMEDS (for interaction, P<.001). Notification messages were associated with a higher chance of stopping in SupportMe/ITM (OR 5.76, 95% CI 3.66-9.06) but not TEXTMEDS (for interaction, P=.01). Overall, informative (OR 1.76, 95% CI 1.46-2.12) and instructional (OR 1.47, 95% CI 1.21-1.80) messages were associated with higher engagement but not motivational messages (OR 1.18, 95% CI 0.82-1.70; P=.37). For supportive messages, the association with engagement was opposite with SupportMe/ITM (OR 1.77, 95% CI 1.21-2.58) compared with TEXTMEDS (OR 0.77, 95% CI 0.60-0.98; for interaction, P<.001). Notification messages were associated with reduced engagement in SupportMe/ITM (OR 0.07, 95% CI 0.05-0.10) and TEXTMEDS (OR 0.28, 95% CI 0.20-0.39); however, the strength of the association was greater in SupportMe/ITM (for interaction P<.001). Conclusions: ML models enable monitoring and detailed characterization of program messages and participant replies. Outgoing message intent may influence premature program stopping and engagement, although the strength and direction of association appear to vary by program type. Future studies will need to examine whether modifying message characteristics can optimize engagement and whether this leads to behavior change. %M 34757324 %R 10.2196/27779 %U https://mhealth.jmir.org/2021/11/e27779 %U https://doi.org/10.2196/27779 %U http://www.ncbi.nlm.nih.gov/pubmed/34757324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28634 %T Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study %A Herkert,Cyrille %A Graat-Verboom,Lidwien %A Gilsing-Fernhout,Judith %A Schols,Manon %A Kemps,Hareld Marijn Clemens %+ Department of Cardiology, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, Eindhoven, 5631 BM, Netherlands, 31 408888220, cyrille.herkert@mmc.nl %K home-based exercise %K cardiac diseases %K pulmonary diseases %K comorbidities %K elderly %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50% (5/10) were men. Of the 10 participants, 9 (90%) completed the 8-week program. Median adherence to the exercise prescription was 75% (IQR 37%-88%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86%, IQR 51%-100%, and final 2 weeks: 57%, IQR 8%-75%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 %M 34751655 %R 10.2196/28634 %U https://formative.jmir.org/2021/11/e28634 %U https://doi.org/10.2196/28634 %U http://www.ncbi.nlm.nih.gov/pubmed/34751655 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30093 %T A Decision Support Tool for Allogeneic Hematopoietic Stem Cell Transplantation for Children With Sickle Cell Disease: Acceptability and Usability Study %A Veludhandi,Anirudh %A Ross,Diana %A Sinha,Cynthia B %A McCracken,Courtney %A Bakshi,Nitya %A Krishnamurti,Lakshmanan %+ School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 5671, lkrishn@emory.edu %K decision support tool %K sickle cell disease %K mobile application %K mHealth %K pediatrics %K transplant %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living with sickle cell disease (SCD) may benefit from a variety of disease-modifying therapies, including hydroxyurea, voxelotor, crizanlizumab, L-glutamine, and chronic blood transfusions. However, allogeneic hematopoietic stem cell transplantation (HCT) remains the only nonexperimental treatment with curative intent. As HCT outcomes can be influenced by the complex interaction of several risk factors, HCT can be a difficult decision for health care providers to make for their patients with SCD. Objective: The aim of this study is to determine the acceptability and usability of a prototype decision support tool for health care providers in decision-making about HCT for SCD, together with patients and their families. Methods: On the basis of published transplant registry data, we developed the Sickle Options Decision Support Tool for Children, which provides health care providers with personalized transplant survival and risk estimates for their patients to help them make informed decisions regarding their patients’ management of SCD. To evaluate the tool for its acceptability and usability, we conducted beta tests of the tool and surveys with physicians using the Ottawa Decision Support Framework and mobile health app usability questionnaire, respectively. Results: According to the mobile health app usability questionnaire survey findings, the overall usability of the tool was high (mean 6.15, SD 0.79; range 4.2-7). According to the Ottawa Decision Support Framework survey findings, acceptability of the presentation of information on the decision support tool was also high (mean 2.94, SD 0.63; range 2-4), but the acceptability regarding the amount of information was mixed (mean 2.59, SD 0.5; range 2-3). Most participants expressed that they would use the tool in their own patient consults (13/15, 87%) and suggested that the tool would ease the decision-making process regarding HCT (8/9, 89%). The 4 major emergent themes from the qualitative analysis of participant beta tests include user interface, data content, usefulness during a patient consult, and potential for a patient-focused decision aid. Most participants supported the idea of a patient-focused decision aid but recommended that it should include more background on HCT and a simplification of medical terminology. Conclusions: We report the development, acceptability, and usability of a prototype decision support tool app to provide individualized risk and survival estimates to patients interested in HCT in a patient consultation setting. We propose to finalize the tool by validating predictive analytics using a large data set of patients with SCD who have undergone HCT. Such a tool may be useful in promoting physician-patient collaboration in making shared decisions regarding HCT for SCD. Further incorporation of patient-specific measures, including the HCT comorbidity index and the quality of life after transplant, may improve the applicability of the decision support tool in a health care setting. %M 34709190 %R 10.2196/30093 %U https://formative.jmir.org/2021/10/e30093 %U https://doi.org/10.2196/30093 %U http://www.ncbi.nlm.nih.gov/pubmed/34709190 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e32856 %T Impact of the World Inflammatory Bowel Disease Day and Crohn’s and Colitis Awareness Week on Population Interest Between 2016 and 2020: Google Trends Analysis %A Silangcruz,Krixie %A Nishimura,Yoshito %A Czech,Torrey %A Kimura,Nobuhiko %A Hagiya,Hideharu %A Koyama,Toshihiro %A Otsuka,Fumio %+ University of Hawaii, 1356 Lusitana St, Honolulu, HI, United States, 1 808 586 2910, nishimura-yoshito@okayama-u.ac.jp %K inflammatory bowel disease %K ulcerative colitis %K Crohn disease %K google trends %K trend analysis %K online health information %K awareness %K chronic disease %K gastrointestinal %K trend %K impact %K public health %K United States %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: More than 6 million people are affected by inflammatory bowel disease (IBD) globally. The World IBD Day (WID, May 19) and Crohn’s and Colitis Awareness Week (CCAW, December 1-7) occur yearly as national health observances to raise public awareness of IBD, but their effects are unclear. Objective: The aim of this study was to analyze the relationship between WID or CCAW and the public health awareness on IBD represented by the Google search engine query data. Methods: This study evaluates the impact of WID and CCAW on the public awareness of IBD in the United States and worldwide from 2016 to 2020 by using the relative search volume of “IBD,” “ulcerative colitis,” and “Crohn’s disease” in Google Trends. To identify significant time points of trend changes (joinpoints), we performed joinpoint regression analysis. Results: No joinpoints were noted around the time of WID or CCAW during the study period in the search results of the United States. Worldwide, joinpoints were noted around WID in 2020 with the search for “IBD” and around CCAW in 2017 and 2019 with the search for “ulcerative colitis.” However, the extents of trend changes were modest without statistically significant increases. Conclusions: These results posed a question that WID and CCAW might not have worked as expected to raise public awareness of IBD. Additional studies are needed to precisely estimate the impact of health observances to raise the awareness of IBD. %M 37114197 %R 10.2196/32856 %U https://infodemiology.jmir.org/2021/1/e32856 %U https://doi.org/10.2196/32856 %U http://www.ncbi.nlm.nih.gov/pubmed/37114197 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e12262 %T Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study %A Abid,Leila %A Kammoun,Ikram %A Ben Halima,Manel %A Charfeddine,Salma %A Ben Slima,Hedi %A Drissa,Meriem %A Mzoughi,Khadija %A Mbarek,Dorra %A Riahi,Leila %A Antit,Saoussen %A Ben Halima,Afef %A Ouechtati,Wejdene %A Allouche,Emna %A Mechri,Mehdi %A Yousfi,Chedi %A Khorchani,Ali %A Abid,Omar %A Sammoud,Kais %A Ezzaouia,Khaled %A Gtif,Imen %A Ouali,Sana %A Triki,Feten %A Hamdi,Sonia %A Boudiche,Selim %A Chebbi,Marwa %A Hentati,Mouna %A Farah,Amani %A Triki,Habib %A Ghardallou,Houda %A Raddaoui,Haythem %A Zayed,Sofien %A Azaiez,Fares %A Omri,Fadwa %A Zouari,Akram %A Ben Ali,Zine %A Najjar,Aymen %A Thabet,Houssem %A Chaker,Mouna %A Mohamed,Samar %A Chouaieb,Marwa %A Ben Jemaa,Abdelhamid %A Tangour,Haythem %A Kammoun,Yassmine %A Bouhlel,Mahmoud %A Azaiez,Seifeddine %A Letaief,Rim %A Maskhi,Salah %A Amri,Aymen %A Naanaa,Hela %A Othmani,Raoudha %A Chahbani,Iheb %A Zargouni,Houcine %A Abid,Syrine %A Ayari,Mokdad %A ben Ameur,Ines %A Gasmi,Ali %A ben Halima,Nejeh %A Haouala,Habib %A Boughzela,Essia %A Zakhama,Lilia %A ben Youssef,Soraya %A Nasraoui,Wided %A Boujnah,Mohamed Rachid %A Barakett,Nadia %A Kraiem,Sondes %A Drissa,Habiba %A Ben Khalfallah,Ali %A Gamra,Habib %A Kachboura,Salem %A Bezdah,Leila %A Baccar,Hedi %A Milouchi,Sami %A Sdiri,Wissem %A Ben Omrane,Skander %A Abdesselem,Salem %A Kanoun,Alifa %A Hezbri,Karima %A Zannad,Faiez %A Mebazaa,Alexandre %A Kammoun,Samir %A Mourali,Mohamed Sami %A Addad,Faouzi %+ Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Residence Pergolas, Maison du coeur de la Tunisie Appartement 201, Rue du Lac Huron, Tunis, 1053, Tunisia, 216 22739092, addad.faouzi@planet.tn %K heart failure %K acute heart failure %K chronic heart failure %K diagnosis %K prognosis %K treatment %D 2021 %7 27.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). Objective: The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. Methods: A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. Results: At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. Conclusions: The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial Registration: ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID): DERR1-10.2196/12262 %M 34704958 %R 10.2196/12262 %U https://www.researchprotocols.org/2021/10/e12262 %U https://doi.org/10.2196/12262 %U http://www.ncbi.nlm.nih.gov/pubmed/34704958 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29273 %T Assessing the Feasibility of a Multicenter Transition Intervention Model Across Adolescent Secure Services in England (MOVING FORWARD): Protocol for a Feasibility Cluster Randomized Controlled Trial %A Livanou,Maria %A Lane,Rebecca %+ Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Penhryn Road, Kingston Upon Thames, KT1 2EE, United Kingdom, 44 07879056605, m.livanou@kingston.ac.uk %K transition %K intervention %K young people %K feasibility cluster randomized trial %K cluster randomized controlled trial %K secure hospitals %K outcomes %K adolescents %K patients %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young people moving from adolescent secure inpatient units to adult care in the United Kingdom have multiple and complex needs and are more likely to experience poor transition outcomes. Poorly managed transitions can lead to enduring use and dependency on mental health services. However, there is a lack of knowledge about the feasibility of transitional care models. Objective: This paper presents the protocol for a study that aims to test a feasibility cluster randomized controlled trial for young people transitioning from adolescent secure services to adult-oriented settings. The overarching aim of the MOVING FORWARD study is to provide a preliminary estimate of the effectiveness and cost-effectiveness of a new transition intervention model and to inform a future full-scale cluster randomized controlled trial. Methods: The design of the study is a 3-arm feasibility cluster randomized controlled trial comparing the MOVING FORWARD intervention against standard transition preparation conducted at 6 adolescent secure services, of which 4 units will receive the intervention and 2 will serve as controls. Eligible young people between 17-19 years, their parents/carers, and key workers will be invited to participate. Young people and parents/carers will be allocated to two conditions (young people alone and young people with a parent/carer) and will receive 4 transition preparation workshops across 6 months. Six adolescent secure hospitals will be randomly allocated, stratified by area and service type. Data will be collected at 3 time points: baseline (T0), 6-12 months postintervention (T1), and 18-24 months postbaseline (T2). Primary and secondary outcomes will be based on assessment measures and interviews conducted at T1 and T2. Results: A total of 13 young people and 17 staff members have contributed to the intervention design through online advisory groups on the design of the study and important themes for transition. We have also consulted members of the public (a steering group) including 2 young people who have transitioned to the community and 2 parents/carers. Common identified themes included appropriateness of module content and support during delayed transitions. The content of the intervention will be finalized during the first 6 months of the study. Participants will be recruited over the course of 6 months. An intraclass correlation coefficient will be calculated to inform the power of the sample size for a further large-scale trial. With a sample size of 50, we will be able to estimate a dropout rate of 80% (95% CI –11% to 11%). Conclusions: This research will provide practitioners and policy makers with an evidence-based framework of how training and familiarization with the prospective transitions can yield positive outcomes. This study will test whether a psychosocial intervention can be implemented in adolescent secure hospitals. The results will identify barriers and facilitators to the proposed intervention and will enable services to reflect on the quality of transitional care delivery. International Registered Report Identifier (IRRID): PRR1-10.2196/29273 %M 34677140 %R 10.2196/29273 %U https://www.researchprotocols.org/2021/10/e29273 %U https://doi.org/10.2196/29273 %U http://www.ncbi.nlm.nih.gov/pubmed/34677140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e22567 %T Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study %A Phanareth,Klaus %A Dam,Astrid Laura %A Hansen,Martin A B C %A Lindskrog,Signe %A Vingtoft,Søren %A Kayser,Lars %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 26822657, lk@sund.ku.dk %K COPD %K exacerbations %K patient-reported outcomes %K Epital Care Model %K early interventions %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate, and temperature with synchronous communication of health data may become a powerful solution as they enable health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model and organized a person-centered technology-assisted ecosystem to provide health services to COPD patients. Objective: The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions? Methods: Participants were recruited by convenience sampling from November 2013 to December 2015. The participants’ sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering 4 questions and sending 3 semiautomated measurements. Results: Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C, and 39 in D. The number of observed days was 31,801 days with 12,470 measurements, 1397 care notes, and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 months. Conclusions: The majority of COPD patients in risk factor group D can be managed virtually, and only 13% of those with severe exacerbations required hospitalization. Contact to the health care professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings. %M 34665151 %R 10.2196/22567 %U https://www.jmir.org/2021/10/e22567 %U https://doi.org/10.2196/22567 %U http://www.ncbi.nlm.nih.gov/pubmed/34665151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e19307 %T Examining the Trends in Online Health Information–Seeking Behavior About Chronic Obstructive Pulmonary Disease in Singapore: Analysis of Data From Google Trends and the Global Burden of Disease Study %A Fang,Yang %A Shepherd,Thomas A %A Smith,Helen E %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Clinical Sciences Building, Singapore, 308232, Singapore, 65 6513 8572, fang.yang@ntu.edu.sg %K online health information seeking %K infodemiology %K Google Trends %K Global Burden of Disease study %K chronic obstructive pulmonary disease %K respiratory health %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, and timely health care seeking is imperative for its prevention, early detection, and management. While online health information–seeking behavior (OHISB) is increasingly popular due to widespread internet connectivity, little is known about how OHISB for COPD has changed in comparison with the COPD disease burden, particularly at a country-specific level. Objective: This study aimed to examine the trends in OHISB for COPD and how that compared with the estimates of COPD disease burden in Singapore, a highly wired country with a steadily increasing COPD disease burden. Methods: To examine the trends in OHISB for COPD, we performed Prais-Winsten regression analyses on monthly search volume data for COPD from January 2004 to June 2020 downloaded from Google Trends. We then conducted cross-correlational analyses to examine the relationship between annualized search volume on COPD topics and estimates of COPD morbidity and mortality reported in the Global Burden of Disease study from 2004 to 2017. Results: From 2004 to 2020, the trend in COPD search volume was curvilinear (β=1.69, t194=6.64, P<.001), with a slope change around the end of 2006. There was a negative linear trend (β=–0.53, t33=–3.57, P=.001) from 2004 to 2006 and a positive linear trend (β=0.51, t159=7.43, P<.001) from 2007 to 2020. Cross-correlation analyses revealed positive associations between COPD search volume and COPD disease burden indicators: positive correlations between search volume and prevalence, incidence, years living with disability (YLD) at lag 0, and positive correlations between search volume and prevalence, YLD at lag 1. Conclusions: Google search volume on COPD increased from 2007 to 2020; this trend correlated with the upward trajectory of several COPD morbidity estimates, suggesting increasing engagement in OHISB for COPD in Singapore. These findings underscore the importance of making high-quality, web-based information accessible to the public, particularly COPD patients and their carers. %M 34661539 %R 10.2196/19307 %U https://www.jmir.org/2021/10/e19307 %U https://doi.org/10.2196/19307 %U http://www.ncbi.nlm.nih.gov/pubmed/34661539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e29064 %T Development of a Theoretically Informed Web-Based Mind-Body Wellness Intervention for Patients With Primary Biliary Cholangitis: Formative Study %A Watt,Makayla %A Spence,John C %A Tandon,Puneeta %+ University of Alberta, 130-University Campus, Edmonton, AB, T6G2X8, Canada, 1 780 492 9844, ptandon@ualberta.ca %K liver disease %K meditation %K yoga %K breathwork %K behavior theory %K COM-B model %K behaviour change wheel %K behaviour change taxonomy %K internet %K digital %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development. Objective: This study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC. Methods: The steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development. Results: Barriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator. Conclusions: The Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components. Trial Registration: ClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527 %M 34623317 %R 10.2196/29064 %U https://formative.jmir.org/2021/10/e29064 %U https://doi.org/10.2196/29064 %U http://www.ncbi.nlm.nih.gov/pubmed/34623317 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28873 %T Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study %A Ranjan,Yatharth %A Althobiani,Malik %A Jacob,Joseph %A Orini,Michele %A Dobson,Richard JB %A Porter,Joanna %A Hurst,John %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 02078480924, amos.folarin@kcl.ac.uk %K mHealth %K COVID-19 %K mobile health %K remote monitoring %K wearables %K internet of things %K lung diseases %K respiratory health %K mental health %K cardiopulmonary diseases %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 %M 34319235 %R 10.2196/28873 %U https://www.researchprotocols.org/2021/10/e28873 %U https://doi.org/10.2196/28873 %U http://www.ncbi.nlm.nih.gov/pubmed/34319235 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26314 %T Using a Constraint-Based Method to Identify Chronic Disease Patients Who Are Apt to Obtain Care Mostly Within a Given Health Care System: Retrospective Cohort Study %A Tong,Yao %A Liao,Zachary C %A Tarczy-Hornoch,Peter %A Luo,Gang %+ Department of Biomedical Informatics and Medical Education, University of Washington, UW Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K asthma %K chronic kidney disease %K chronic obstructive pulmonary disease %K data analysis %K diabetes mellitus %K emergency department %K health care system %K inpatients %K patient care management %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: For several major chronic diseases including asthma, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes, a state-of-the-art method to avert poor outcomes is to use predictive models to identify future high-cost patients for preemptive care management interventions. Frequently, an American patient obtains care from multiple health care systems, each managed by a distinct institution. As the patient’s medical data are spread across these health care systems, none has complete medical data for the patient. The task of building models to predict an individual patient’s cost is currently thought to be impractical with incomplete data, which limits the use of care management to improve outcomes. Recently, we developed a constraint-based method to identify patients who are apt to obtain care mostly within a given health care system. Our method was shown to work well for the cohort of all adult patients at the University of Washington Medicine for a 6-month follow-up period. It is unknown how well our method works for patients with various chronic diseases and over follow-up periods of different lengths, and subsequently, whether it is reasonable to perform this predictive modeling task on the subset of patients pinpointed by our method. Objective: To understand our method’s potential to enable this predictive modeling task on incomplete medical data, this study assesses our method’s performance at the University of Washington Medicine on 5 subgroups of adult patients with major chronic diseases and over follow-up periods of 2 different lengths. Methods: We used University of Washington Medicine data for all adult patients who obtained care at the University of Washington Medicine in 2018 and PreManage data containing usage information from all hospitals in Washington state in 2019. We evaluated our method’s performance over the follow-up periods of 6 months and 12 months on 5 patient subgroups separately—asthma, chronic kidney disease, type 1 diabetes, type 2 diabetes, and chronic obstructive pulmonary disease. Results: Our method identified 21.81% (3194/14,644) of University of Washington Medicine adult patients with asthma. Around 66.75% (797/1194) and 67.13% (1997/2975) of their emergency department visits and inpatient stays took place within the University of Washington Medicine system in the subsequent 6 months and in the subsequent 12 months, respectively, approximately double the corresponding percentage for all University of Washington Medicine adult patients with asthma. The performance for adult patients with chronic kidney disease, adult patients with chronic obstructive pulmonary disease, adult patients with type 1 diabetes, and adult patients with type 2 diabetes was reasonably similar to that for adult patients with asthma. Conclusions: For each of the 5 chronic diseases most relevant to care management, our method can pinpoint a reasonably large subset of patients who are apt to obtain care mostly within the University of Washington Medicine system. This opens the door to building models to predict an individual patient’s cost on incomplete data, which was formerly deemed impractical. International Registered Report Identifier (IRRID): RR2-10.2196/13783 %M 34617906 %R 10.2196/26314 %U https://formative.jmir.org/2021/10/e26314 %U https://doi.org/10.2196/26314 %U http://www.ncbi.nlm.nih.gov/pubmed/34617906 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32216 %T Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study %A Kvale,Gerd %A Frisk,Bente %A Jürgensen,Marte %A Børtveit,Tore %A Ødegaard-Olsen,Øystein Theodor %A Wilhelmsen-Langeland,Ane %A Aarli,Bernt Bøgvald %A Sandnes,Kristina %A Rykken,Sidsel %A Haugstvedt,Anne %A Hystad,Sigurd William %A Søfteland,Eirik %+ Division of Psychiatry, Haukeland University Hospital, PO Box 1400, Bergen, 5021, Norway, 47 55975000, gerd.kvale@helse-bergen.no %K COVID-19 %K chronic illnesses %K concentrated rehabilitation %K low back pain %K post–COVID-19 symptoms %K post–COVID-19 syndrome %K long COVID %K fatigue %K type 2 diabetes %K anxiety %K depression %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes. Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/32216 %M 34505838 %R 10.2196/32216 %U https://www.researchprotocols.org/2021/10/e32216 %U https://doi.org/10.2196/32216 %U http://www.ncbi.nlm.nih.gov/pubmed/34505838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30582 %T Pediatric Chronic Critical Illness: Protocol for a Scoping Review %A Zorko,David %A McNally,James Dayre %A Rochwerg,Bram %A Pinto,Neethi %A Couban,Rachel %A O’Hearn,Katie %A Choong,Karen %+ Department of Pediatrics, McMaster University, Room 3E20, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada, 1 905 521 2100 ext 76651, david.zorko@medportal.ca %K pediatrics %K critical care %K intensive care units %K chronic critical illness %K research design %D 2021 %7 1.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition. Objective: This study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies. Methods: We will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes. Results: The database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021. Conclusions: This scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review’s results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews. International Registered Report Identifier (IRRID): DERR1-10.2196/30582 %M 34596576 %R 10.2196/30582 %U https://www.researchprotocols.org/2021/10/e30582 %U https://doi.org/10.2196/30582 %U http://www.ncbi.nlm.nih.gov/pubmed/34596576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24005 %T Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study %A Spitzer,Kerry A %A Heineman,Brent %A Jewell,Marcella %A Moran,Michael %A Lindenauer,Peter K %+ Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, 3rd Fl, 3601 Main St, Springfield, MA, 01199, United States, 1 413 794 7909, kerry.spitzer@baystatehealth.org %K asthma %K social media %K Instagram %K social support %K digital storytelling %K young adult %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. Objective: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. Methods: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. Results: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study. Conclusions: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection. %M 34591019 %R 10.2196/24005 %U https://formative.jmir.org/2021/9/e24005 %U https://doi.org/10.2196/24005 %U http://www.ncbi.nlm.nih.gov/pubmed/34591019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e19794 %T Patients’ Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study %A Toonders,Suze Adriana Johanna %A van Westrienen,Paula Elisabeth %A Konings,Sophie %A Nieboer,Marianne E %A Veenhof,Cindy %A Pisters,Martijn F %+ Department of Health Innovation and Technology, Fontys University of Applied Sciences, Dominee Theodor Fliednerstraat 2, Eindhoven, 5600 AH, Netherlands, 31 641621939, s.a.j.toonders@umcutrecht.nl %K usability %K medically unexplained physical symptoms %K blended care %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Medically unexplained physical symptoms are physical symptoms, such as pain, fatigue, and dizziness, that persist for more than a few weeks and cannot be explained after adequate medical examination. Treatment for preventing the chronicity of symptoms is recommended. A promising approach is identifying patients who are at risk and subsequently offering a blended care intervention that focuses on promoting self-management while using eHealth as a supportive tool. When these interventions match with a patient’s expectations, their effectiveness grows. Objective: This study aimed to obtain more insights into usability from the patient perspective to improve future interventions. Methods: A mixed methods design (ie, the use of qualitative and quantitative data) was used. Through semistructured interviews, in-depth insights were gained into patients’ perspectives on usability. The analysis process was continuous and iterative. Data were synthesized and categorized into different themes. The System Usability Scale, which measures the usability of a system, was used to compare participants that found usability to be low, medium, or high. This study was approved by the Medical Ethical Committee Utrecht (approval number: 17-391/C). Results: Saturation was reached after interviewing 13 participants. The following four themes emerged from the interviews: motivations and expectations prior to participating in the program, the applicability of e-coaching, the role of health care professionals, and the integrated design of the blended approach. Conclusions: The successful implementation of integrated blended care interventions based on patients’ perspectives requires matching treatments to patients’ individual situations and motivations. Furthermore, personalizing the relative frequency of face-to-face appointments and e-coaching can improve usability. %M 34581674 %R 10.2196/19794 %U https://www.jmir.org/2021/9/e19794 %U https://doi.org/10.2196/19794 %U http://www.ncbi.nlm.nih.gov/pubmed/34581674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30274 %T Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups %A Van Herck,Maarten %A Goërtz,Yvonne M J %A Houben-Wilke,Sarah %A Machado,Felipe V C %A Meys,Roy %A Delbressine,Jeannet M %A Vaes,Anouk W %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits M E %A Hajian,Bita %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Janssen,Daisy J A %A Spruit,Martijn A %+ REVAL Rehabilitation Research Center, BIOMED Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan gebouw A, Diepenbeek, 3590, Belgium, 32 494758248, maarten.vanherck@uhasselt.be %K COVID-19 %K SARS-CoV-2 %K long COVID %K post-COVID-19 syndrome %K post-acute sequelae of COVID-19 %K fatigue %K post-viral fatigue %K pandemic %K online health %K mental health %K online support %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective: The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods: A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength–subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ≥36 points was used to qualify patients as having severe fatigue. Results: A total of 239 patients with polymerase chain reaction/computed tomography–confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: –2 points, IQR –7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue –1 point, IQR –3 to 0, P<.001; median change for mental fatigue 0 points, IQR –3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2%) and 164/239 (68.6%) of all patients had received care from at least one medical professional and one allied health care professional, respectively. Conclusions: Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 34494964 %R 10.2196/30274 %U https://www.jmir.org/2021/9/e30274 %U https://doi.org/10.2196/30274 %U http://www.ncbi.nlm.nih.gov/pubmed/34494964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29672 %T Efficacy of a Single-Session “Empowered Relief” Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic %A Ziadni,Maisa S %A Gonzalez-Castro,Lluvia %A Anderson,Steven %A Krishnamurthy,Parthasarathy %A Darnall,Beth D %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA, 94304, United States, 1 6507365494, mziadni@stanford.edu %K single-session %K empowered relief %K Zoom-delivered %K pain catastrophizing %K pain intensity %K randomized-controlled trial %K chronic pain %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy–pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas. Objective: The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment. Methods: We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%). Results: Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS −8.72, 42.25% reduction; WLC: PCS −2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. Conclusions: Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. Trial Registration: ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685 %M 34505832 %R 10.2196/29672 %U https://www.jmir.org/2021/9/e29672 %U https://doi.org/10.2196/29672 %U http://www.ncbi.nlm.nih.gov/pubmed/34505832 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28728 %T COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study %A Ricadat,Élise %A Béliard,Aude %A Citrini,Marie %A Craus,Yann %A Gabarro,Céline %A Mamzer,Marie-France %A Marques,Ana %A Sannié,Thomas %A Teixeira,Maria %A Tocilovac,Marko %A Velpry,Livia %A Villa,François %A Virole,Louise %A Lefève,Céline %+ Institut La Personne en Médecine, Université de Paris, 5 rue Thomas Mann, Paris, 75013, France, 33 0157275249, louise.virole@sciencespo.fr %K chronic illness %K care %K prevention %K vulnerability %K health democracy %K COVID %K qualitative study %K COVID-19 %K pandemic %K risk %D 2021 %7 9.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. Objective: This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d’expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients’ experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. Methods: The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient’s care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. Results: The protocol study has undergone a peer review by the French National Research Agency’s scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. Conclusions: Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. International Registered Report Identifier (IRRID): DERR1-10.2196/28728 %M 34460413 %R 10.2196/28728 %U https://www.researchprotocols.org/2021/9/e28728 %U https://doi.org/10.2196/28728 %U http://www.ncbi.nlm.nih.gov/pubmed/34460413 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30951 %T Web- and Mindfulness-Based Intervention to Prevent Chronic Pain After Cardiac Surgery: Protocol for a Pilot Randomized Controlled Trial %A Martorella,Geraldine %A Hanley,Adam W %A Pickett,Scott M %A Gelinas,Céline %+ Tallahassee Memorial Healthcare Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 8506446028, gmartorella@fsu.edu %K postoperative pain %K cardiac surgery %K chronic pain %K web-based %K mindfulness %K mobile phone %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiac surgery is a frequently performed procedure. However, pain after cardiac surgery may become chronic (lasting >3 months) in adults. Once discharged from the hospital, patients are at greater risk of developing chronic postsurgical pain (CPSP) and of prolonged opioid use, as they need to self-manage their pain. Psychological risk and protective factors such as pain-related catastrophic thoughts and pain acceptance determine their ability to cope and their use of opioids, which is crucial for self-management of pain. Studies on mindfulness-based cognitive therapy (MBCT) have multiplied their potential effects on pain acceptance and catastrophic thoughts. However, web-based MBCT for the prevention of CPSP has not yet been examined. Objective: The aim of this study is to pilot test a 4-week-long web-based MBCT intervention for adults following discharge from the hospital by assessing the acceptability or feasibility of the intervention and examining preliminary effects on pain intensity, pain interference with activities and opioid use, and pain acceptance and catastrophic thoughts in the 6 months following surgery. Methods: A double-blinded pilot randomized controlled trial will be used to assess a web-based MBCT intervention. Patients will be selected according to the following criteria: age ≥18 years; first-time elective cardiac surgery via a median sternotomy; worst pain in the past week score ≥4/10; ability to understand and complete questionnaires in English; and ability to use an electronic device such as a smartphone, computer, or tablet. After baseline measures, 32 participants will be randomized into two groups: one receiving both the brief, 4-week-long web-based MBCT intervention and usual care (experimental group) and the other receiving only one standardized, web-based educational session with weekly reminders and usual care (attention control group). Peer-reviewed competitive funding was received from Florida State University’s Council on Research & Creativity in January 2021, as well as research ethics approval from Florida State University's institutional review board. Results: Recruitment began in June 2021. Unfortunately, because of the current COVID-19 pandemic, recruitment is not progressing as expected. Recruitment strategies are constantly monitored and updated according to latest data and restrictions surrounding the pandemic. Conclusions: This research is significant because it targets the trajectory of CPSP, a leading cause of disability and opioid misuse. This is the first study to assess MBCT for the prevention of CPSP after cardiac surgery in the recovery phase. This approach is innovative because it promotes self-management of pain through the modulation of individual factors. If successful, the intervention could be expanded to numerous populations at risk of chronic pain. International Registered Report Identifier (IRRID): DERR1-10.2196/30951 %M 34459749 %R 10.2196/30951 %U https://www.researchprotocols.org/2021/8/e30951 %U https://doi.org/10.2196/30951 %U http://www.ncbi.nlm.nih.gov/pubmed/34459749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24181 %T Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach %A Lapão,Luís Velez %A Peyroteo,Mariana %A Maia,Melanie %A Seixas,Jorge %A Gregório,João %A Mira da Silva,Miguel %A Heleno,Bruno %A Correia,Jorge César %+ Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, Lisbon, 1349-008, Portugal, 351 213652600, luis.lapao@ihmt.unl.pt %K primary healthcare %K information systems %K telemedicine %K implementation %K design science research %K COVID-19 %K monitoring %K chronic disease %K elderly %K digital health %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient’s health related outcomes. %M 34313591 %R 10.2196/24181 %U https://www.jmir.org/2021/8/e24181 %U https://doi.org/10.2196/24181 %U http://www.ncbi.nlm.nih.gov/pubmed/34313591 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e26930 %T An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study %A Ledermann,Katharina %A Abou Khaled,Omar %A Caon,Maurizio %A Berger,Thomas %A Chabwine,Joelle N %A Wicht,Joachim %A Martin-Soelch,Chantal %+ Department of Consiliar and Liaison Psychiary, University Hospital Zurich, Culmannstrasse 8, Zurich, 8091, Switzerland, 41 0765330316, katharina.ledermann@hotmail.com %K chronic pain %K older adults %K mHealth %K online intervention %K self-management %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population. Objective: To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults. Methods: The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app. Results: Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022. Conclusions: Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/26930 %M 34435969 %R 10.2196/26930 %U https://www.researchprotocols.org/2021/8/e26930 %U https://doi.org/10.2196/26930 %U http://www.ncbi.nlm.nih.gov/pubmed/34435969 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e14552 %T Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study %A Morsa,Maxime %A Perrin,Amélie %A David,Valérie %A Rault,Gilles %A Le Roux,Enora %A Alberti,Corinne %A Gagnayre,Rémi %A Pougheon Bertrand,Dominique %+ The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, 74 rue Marcel Cachin, Bobigny, 93017, France, 33 177 194 691, maxime.morsa@univ-paris13.fr %K cystic fibrosis %K pulmonary exacerbation %K connected devices %K patient education %K self-management %D 2021 %7 18.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team. Objective: This qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users’ point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management. Methods: We have been conducting a multicenter pilot study involving 36 patients with CF aged ≥12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a “React to PEx” educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients’ personalized alert thresholds by reviewing the data collected during phase 1 and their patients’ clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients’ experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International). Results: The study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users’ experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care. Conclusions: This study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 International Registered Report Identifier (IRRID): DERR1-10.2196/14552 %M 34406124 %R 10.2196/14552 %U https://www.researchprotocols.org/2021/8/e14552 %U https://doi.org/10.2196/14552 %U http://www.ncbi.nlm.nih.gov/pubmed/34406124 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e30244 %T The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review %A Snyder,Natalie %A Wilson,Ria %A Finch,Lian %A Gallant,Brooklyn %A Landa,Chris %A Frankel,Daniel %A Brooks,Dina %A Packham,Tara %A Oliveira,Ana %+ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main St West, Hamilton, ON, L8S 1C7, Canada, 1 6477651525, ana.oliveira@westpark.org %K chronic respiratory disease %K COPD %K lung diseases %K occupational therapy %K pulmonary rehabilitation program %D 2021 %7 26.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic respiratory diseases are highly prevalent and compromise an individual’s ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual’s exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful “occupations,” improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines. Objective: The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs. Methods: The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic. Results: The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022. Conclusions: The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes. Trial Registration: OSF Registries ZH63W; https://osf.io/zh63w International Registered Report Identifier (IRRID): DERR1-10.2196/30244 %M 34309572 %R 10.2196/30244 %U https://www.researchprotocols.org/2021/7/e30244 %U https://doi.org/10.2196/30244 %U http://www.ncbi.nlm.nih.gov/pubmed/34309572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29013 %T Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial %A Fanning,Jason %A Brooks,Amber K %A Hsieh,Katherine L %A Kershner,Kyle %A Furlipa,Joy %A Nicklas,Barbara J %A Rejeski,W Jack %+ Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO Box 7868, Winston-Salem, NC, United States, 1 336 758 5042, fanninjt@wfu.edu %K aging %K physical activity %K sedentary behavior %K weight loss %K chronic pain %K mHealth %D 2021 %7 19.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. Objective: The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. Methods: The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. Results: Recruitment is ongoing as of January 2021. Conclusions: Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. Trial Registration: ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 International Registered Report Identifier (IRRID): PRR1-10.2196/29013 %M 34279241 %R 10.2196/29013 %U https://www.researchprotocols.org/2021/7/e29013 %U https://doi.org/10.2196/29013 %U http://www.ncbi.nlm.nih.gov/pubmed/34279241 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26053 %T Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial %A Cashin,Aidan G %A Lee,Hopin %A Bagg,Matthew K %A Wand,Benedict M %A O'Hagan,Edel %A Rizzo,Rodrigo R N %A Stanton,Tasha R %A Moseley,G Lorimer %A McAuley,James H %+ Prince of Wales Clinical School, University of New South Wales, 61-63 Botany St, Randwick, 2031, Australia, 61 293991806, a.cashin@neura.edu.au %K chronic low back pain %K mediation analysis %K mechanism evaluation %K protocol %D 2021 %7 2.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on individuals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence. Objective: This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation. Methods: We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses. Results: Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia. Conclusions: The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000610538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/26053 %M 34255720 %R 10.2196/26053 %U https://www.researchprotocols.org/2021/7/e26053 %U https://doi.org/10.2196/26053 %U http://www.ncbi.nlm.nih.gov/pubmed/34255720 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25043 %T Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study %A van der Haar,Sandra %A Hoevenaars,Femke P M %A van den Brink,Willem J %A van den Broek,Tim %A Timmer,Mariëlle %A Boorsma,André %A Doets,Esmée L %+ Wageningen Food & Biobased Research, Wageningen University & Research, Bornse Weilanden 9, Wageningen, 6708 WG, Netherlands, 31 0317 480171, sandra.vanderhaar@wur.nl %K personalized nutrition %K metabolic syndrome %K dietary behavior %K diet %K metabolic %K metabolic health %K dietary advice %K dietary feedback %K digital health %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 %M 34185002 %R 10.2196/25043 %U https://formative.jmir.org/2021/6/e25043/ %U https://doi.org/10.2196/25043 %U http://www.ncbi.nlm.nih.gov/pubmed/34185002 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e29122 %T The Development of a Digital Patient-Reported Outcome Measurement for Adults With Chronic Disease (The Parsley Symptom Index): Prospective Cohort Study %A Williams,Hants %A Steinberg,Sarah %A Berzin,Robin %+ School of Health Technology and Management, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 6502183789, hantsawilliams@gmail.com %K patient-reported outcomes %K PROMs %K chronic diseases %K symptom management %K Parsley Symptom Index %K Review of Symptoms %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The monitoring and management of chronic illness has always been a challenge. Patient-reported outcome measures (PROMs) can be powerful tools for monitoring symptoms and guiding treatment of chronic diseases, but the available PROM tools are either too broad or too disease specific for the needs of a primary care practice focused on longitudinal care. Objective: In this study we describe the development and preliminary validation of the Parsley Symptom Index (PSI). Methods: This prospective cohort study took place from January 5, 2018, to June 05, 2020, among a sample of 4621 adult patients at Parsley Health. After a review of literature, followed by binning and winnowing of potential items, a 45-item PROM that also served as a review of systems (ROS) was developed. The PSI was deployed and completed by patients via an online portal. Construct and face validity was performed by clinicians, tested on patients, and feasibility was measured by response rate, completion rate, and percentage of missing data. Results: The response rate for 12,175 collected PSIs was 93.72% (4331/4621) with a 100% item completion rate. A confirmatory factor analysis confirmed the model structure was satisfactory by a Comparative Fit Index of 0.943, Tucker–Lewis index of 0.938, and root mean square error of approximation of 0.028. Conclusions: A 45-item ROS-style PROM designed to capture chronic disease symptoms was developed, and preliminary validation suggests that the PSI can be deployed, completed, and helpful to both patients and clinicians. %M 33999007 %R 10.2196/29122 %U https://formative.jmir.org/2021/6/e29122 %U https://doi.org/10.2196/29122 %U http://www.ncbi.nlm.nih.gov/pubmed/33999007 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27526 %T Adaptation of a Live Video Mind–Body Program to a Web-Based Platform for English-Speaking Adults With Neurofibromatosis: Protocol for the NF-Web Study %A Lester,Ethan Gabriel %A Hopkins,Sarah Whitall %A Popok,Paula Jean %A Vranceanu,Ana-Maria %+ Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square,, 1st Floor, Suite 100, Boston, MA, 02114, United States, 1 617 724 4977, avranceanu@mgh.harvard.edu %K neurofibromatosis %K quality of life %K stress management %K mind–body %K asynchronous delivery %K resiliency %K mobile phone %D 2021 %7 10.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neurofibromatosis (NF) is a rare genetic condition associated with lower but modifiable quality of life (QoL). Although a virtual live video program (Relaxation Response Resiliency Program for Neurofibromatosis [3RP-NF]; efficacy randomized controlled trial underway) that we created has been made available, ongoing barriers impede some patients from engaging in this intervention. A necessary next step is to develop a stand-alone web-based intervention that reduces barriers to accessing NF-specific psychosocial care. Objective: First, we aim to develop a web-based platform (Neurofibromatosis-Web [NF-Web]) of our mind–body resiliency program (3RP-NF) through qualitative interviews with participants from an adult efficacy randomized controlled trial. Second, we aim to iteratively optimize the feasibility, acceptability, credibility, and satisfaction of the NF-Web platform through open pilot trials with participant exit interviews and explore quantitative outcomes within this sample. Here, we describe the protocol and study design, intervention, and analysis plan. Methods: For aim 1, we will invite completers from our efficacy trial to participate in qualitative interviews. We will use data from these interviews to adapt the content of the live video program for asynchronous delivery and understand how to create a user-friendly format for an engaging web platform. For aim 2, we will enroll eligible participants recruited for the efficacy trial who could not enroll because of treatment barriers. Eligible participants will complete QoL, depression, anxiety, pain, treatment satisfaction, and program credibility measures at baseline and posttest. Inclusion criteria are identical to those for the efficacy trial, including stress and coping difficulties (self-report), no change in antidepressant medication in the past 3 months, no psychotherapy in the past 3 months, no major upcoming surgeries in the next 12 months, English speaking, ability to complete questionnaires on the web and participate in live video interventions, and consent before participation. The primary outcomes are feasibility, treatment satisfaction, and credibility. The secondary outcomes include physical, psychological, social, and environmental QoL; depression; anxiety; pain intensity; and pain interference. We will enroll at least two group cohorts and iteratively refine the program based on participant feedback after each cohort completes the open pilot trial. Results: This trial is ongoing. We have completed the interviews (n=23) and analyzed the data to construct the website. Afterward, we will recruit our cohorts for the trial (approximately n=15/cohort; total=30). Recruitment will end by May 2021, with plans to analyze the data by October 2021. Conclusions: We will develop the first web platform for people with NF with difficulties managing stress and NF symptoms and report on feasibility and preliminary effects in improving QoL and psychosocial functioning. NF-Web has potential to extend the reach of our 3RP-NF intervention by removing barriers to care, including lack of trained providers, scheduling difficulties, and appearance concerns. International Registered Report Identifier (IRRID): DERR1-10.2196/27526 %M 34110294 %R 10.2196/27526 %U https://www.researchprotocols.org/2021/6/e27526 %U https://doi.org/10.2196/27526 %U http://www.ncbi.nlm.nih.gov/pubmed/34110294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e29365 %T Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study %A Costanza,Alessandra %A Chytas,Vasileios %A Piguet,Valérie %A Luthy,Christophe %A Mazzola,Viridiana %A Bondolfi,Guido %A Cedraschi,Christine %+ Department of Psychiatry, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland, 41 223795900, alessandra.costanza@unige.ch %K suicide %K suicidal behavior %K suicidal ideation %K suicide attempt %K chronic pain %K meaning in life %K protective factors %K risk factors %K mental health %D 2021 %7 4.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. Objective: There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one’s perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the “presence of” and “search for” constructs, in a group of patients with chronic pain and suicidal ideation. Methods: Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. Results: The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the “presence of” construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the “search for” construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The “presence of” and “search for” constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the “presence of” construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. Conclusions: The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain–induced deep moral suffering. %M 34003136 %R 10.2196/29365 %U https://formative.jmir.org/2021/6/e29365 %U https://doi.org/10.2196/29365 %U http://www.ncbi.nlm.nih.gov/pubmed/34003136 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27668 %T STAR Duodecim eHealth Tool to Recognize Chronic Disease Risk Factors and Change Unhealthy Lifestyle Choices Among the Long-Term Unemployed: Protocol for a Mixed Methods Validation Study %A Kuhlberg,Henna %A Kujala,Sari %A Hörhammer,Iiris %A Koskela,Tuomas %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 504488439, henna.kuhlberg@gmail.com %K eHealth %K risk assessment %K long-term unemployed %K expected age of death %K online intervention %K risk factors %K chronic illnesses %K primary prevention %K online health check %K long-term %K multimorbidity %K health care services %K examination %K evaluation %K lifestyle %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lifestyle choices and socioeconomic status have a significant impact on the expected onset of diseases, age of death, and risk factors concerning long-term illnesses and morbidity. STAR is an online health examination tool, which gives users a report that includes an evaluation of their life expectancy and an estimated risk for developing common long-term illnesses based on questions about health, characteristics, lifestyle, and quality of life. Objective: The goals of this study are to (1) review the capacity of STAR to recognize morbidity risks in comparison to a traditional nurse-led health examination and patient-reported health challenges; (2) evaluate the user experience and usability of STAR; and (3) assess the potential impact of STAR on the health confidence and motivation of patients to make healthier lifestyle choices. Methods: This mixed methods validation study will consist of a quantitative part (questionnaires) and a qualitative part (phone interviews and open-ended questions from the questionnaires). The participants will include 100 long-term unemployed individuals attending a health check for the unemployed. The participants will be recruited from three Finnish public health centers in Espoo, Hämeenlinna, and Tampere. At the health centers, the participants will use STAR and attend a nurse’s health check. Surveys with multiple-choice and open-ended questions will be collected from the participants, the nurse, and a study assistant. The questionnaires include questions about the participant’s background and health challenges from the patient and nurse points of view, as well as questions about how well the health challenges matched the STAR report. The questionnaires also gather data about user experience, health confidence, and usability of STAR. A study assistant will fill out an observer’s form containing questions about use time and possible problems encountered while using STAR. A sample of the unemployed participants will be interviewed by telephone subsequently. For the quantitative data, descriptive statistics and a reliability analysis will be performed, and mean sum scores will be computed for the study variables. Thematic analysis of the qualitative data will be performed. Results: This study was approved by the Ethics Committee of the Expert Responsibility Area of Tampere University Hospital in June 2020 (ETL Code R20067). Data collection will begin in June 2021 and will take approximately 3-6 months. Conclusions: Online health examinations can improve the effectiveness of primary prevention in health care by supporting efficient evidence-based morbidity risk estimation and motivating patients to change unhealthy behaviors. A multimethod approach is used to allow for assessment of the tool’s usefulness from the points of view of both professionals and patients. This study will further provide a rich understanding of how the tool can be used as part of routine health checks, and how and why the tool may or may not motivate users for making healthier lifestyle choices. International Registered Report Identifier (IRRID): PRR1-10.2196/27668 %M 34061041 %R 10.2196/27668 %U https://www.researchprotocols.org/2021/6/e27668 %U https://doi.org/10.2196/27668 %U http://www.ncbi.nlm.nih.gov/pubmed/34061041 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e18410 %T Physical Activity Together for People With Multiple Sclerosis and Their Care Partners: Protocol for a Feasibility Randomized Controlled Trial of a Dyadic Intervention %A Fakolade,Afolasade %A Cameron,Julie %A McKenna,Odessa %A Finlayson,Marcia L %A Freedman,Mark S %A Latimer-Cheung,Amy E %A Pilutti,Lara A %+ School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada, 1 613 533 6000 ext 77893, a.fakolade@queensu.ca %K multiple sclerosis %K advanced disability %K care partners %K physical activity %K dyadic intervention %K feasibility randomized controlled trial %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) is beneficial for all people; however, people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with advanced disabilities and their care partners. Objective: The objective of this study is to determine the feasibility of a dyadic PA intervention for people with advanced MS and their care partners. Methods: This study is a randomized controlled feasibility trial of a 12-week intervention, with 1:1 allocation into an immediate intervention condition or delayed control condition. A target of 20 people with MS–care partner dyads will be included. The outcomes will be indicators of process, resources, management, and scientific feasibility. Participant satisfaction with the intervention components will be evaluated using a satisfaction survey. The subjective experience of participation in the study will be explored using semistructured interviews. Results: The project is funded by the Consortium of Multiple Sclerosis Centers. This protocol was approved by the Ottawa Hospital Research Ethics Board (20190329-01H) and the University of Ottawa Research Ethics Board (H-09-19-4886). The study protocol was registered with ClinicalTrials.gov in February 2020. The findings of this feasibility trial will be disseminated through presentations at community events to engage the MS population in the interpretation of our results and in the next steps. The results will also be published in peer-reviewed journals and presented to the scientific community at national and international MS conferences. Conclusions: The data collected from this feasibility trial will be used to refine the intervention and materials in preparation for a pilot randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04267185; https://clinicaltrials.gov/ct2/show/NCT04267185. International Registered Report Identifier (IRRID): PRR1-10.2196/18410 %M 34061040 %R 10.2196/18410 %U https://www.researchprotocols.org/2021/6/e18410 %U https://doi.org/10.2196/18410 %U http://www.ncbi.nlm.nih.gov/pubmed/34061040 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e22533 %T Treatment of Barth Syndrome by Cardiolipin Manipulation (CARDIOMAN) With Bezafibrate: Protocol for a Randomized Placebo-Controlled Pilot Trial Conducted in the Nationally Commissioned Barth Syndrome Service %A Dabner,Lucy %A Pieles,Guido E %A Steward,Colin G %A Hamilton-Shield,Julian P %A Ness,Andrew R %A Rogers,Chris A %A Bucciarelli-Ducci,Chiara %A Greenwood,Rosemary %A Ellis,Lucy %A Sheehan,Karen %A Reeves,Barnaby C %+ Bristol Trials Centre (Clinical Trials and Evaluation Unit), Bristol Medical School, University of Bristol, Upper Maudlin St, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW, United Kingdom, 44 (0)1173422374, lucy.dabner@bristol.ac.uk %K randomized controlled trial %K Barth syndrome %K cardiomyopathies %K inherited cardiomyopathy %K bezafibrate %K placebo controlled %K rare disease %K resveratrol %K cardiomyopathy %K metabolism %K lipid %K genetic diseases %K x-linked %K genes %K mitochondrial %K controlled clinical trial %K placebos %K mitochondrial diseases %K metabolic diseases %K lipid metabolism %K lipid metabolism disorders %K cross-over studies %D 2021 %7 31.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Barth syndrome is a rare, life-threatening, X-linked recessive genetic disease that predominantly affects young males and is caused by abnormal mitochondrial lipid metabolism. Currently, there is no definitive treatment for Barth syndrome other than interventions to ameliorate acute symptoms, such as heart failure, cardiac arrhythmias, neutropenia, and severe muscle fatigue. Previous mechanistic studies have identified the lipid-lowering drug bezafibrate as a promising potential treatment; however, to date, no human trials have been performed in this population. Objective: The aim of this study is to determine whether bezafibrate (and resveratrol in vitro) will increase mitochondrial biogenesis and potentially modify the cellular ratio of monolysocardiolipin (MLCL) to tetralinoleoyl-cardiolipin (L4-CL), ameliorating the disease phenotype in those living with the disease. Methods: The CARDIOMAN (Cardiolipin Manipulation) study is a UK single-center, double-blinded, randomized, placebo-controlled crossover study investigating the efficacy of bezafibrate in participants with Barth syndrome. Treatment was administered in two 15-week phases with a minimum washout period of 1 month between the phases where no treatment was administered. The primary outcome is peak oxygen consumption (VO2 peak). Secondary outcomes include MLCL/L4-CL ratio and CL profile in blood cells, amino acid expression, phosphocreatine to adenosine triphosphate ratio in cardiac muscle and skeletal muscle oxidative function on phosphorus-31 magnetic resonance spectroscopy, quality of life using the Pediatric Quality of Life Inventory questionnaire, absolute neutrophil count, cardiac function and rhythm profiles at rest and during exercise, and mitochondrial organization and function assessments. Outcomes were assessed at baseline and during the final week of each treatment phase. Results: A total of 12 patients were scheduled to participate across three consecutive research clinics between March and April 2019. In total, 11 participants were recruited, and the follow-up was completed in January 2020. Data analysis is ongoing, with publication expected in 2021. Conclusions: This trial was approved by the United Kingdom National Research Ethics Service Committee and the Medicines and Healthcare products Regulatory Agency. The feasibility of the CARDIOMAN study will help to inform the future conduct of randomized controlled trials in rare disease populations as well as testing the efficacy of bezafibrate as a potential treatment for the disease and advancing the mechanistic understanding of Barth syndrome. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 58006579; https://www.isrctn.com/ISRCTN58006579 International Registered Report Identifier (IRRID): DERR1-10.2196/22533 %M 34057417 %R 10.2196/22533 %U https://www.researchprotocols.org/2021/5/e22533 %U https://doi.org/10.2196/22533 %U http://www.ncbi.nlm.nih.gov/pubmed/34057417 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e14321 %T Web-Based Peer Support Interventions for Adults Living With Chronic Conditions: Scoping Review %A Hossain,Saima N %A Jaglal,Susan B %A Shepherd,John %A Perrier,Laure %A Tomasone,Jennifer R %A Sweet,Shane N %A Luong,Dorothy %A Allin,Sonya %A Nelson,Michelle L A %A Guilcher,Sara J T %A Munce,Sarah E P %+ Toronto Rehabilitation Institute - Rumsey Centre, University Health Network, 345 Rumsey Road, Toronto, ON, M4G 1R7, Canada, 1 416 597 3422 ext 5313, sarah.munce@uhn.ca %K online %K peer support %K self-management %K chronic conditions %K scoping review %D 2021 %7 25.5.2021 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. Objective: The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. Methods: This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results. Results: After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment. Conclusions: There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs. %M 34032572 %R 10.2196/14321 %U https://rehab.jmir.org/2021/2/e14321 %U https://doi.org/10.2196/14321 %U http://www.ncbi.nlm.nih.gov/pubmed/34032572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25966 %T Interprofessional Medication Adherence Program for Patients With Diabetic Kidney Disease: Protocol for a Randomized Controlled and Qualitative Study (PANDIA-IRIS) %A Bandiera,Carole %A Dotta-Celio,Jennifer %A Locatelli,Isabella %A Nobre,Dina %A Wuerzner,Grégoire %A Pruijm,Menno %A Lamine,Faiza %A Burnier,Michel %A Zanchi,Anne %A Schneider,Marie Paule %+ School of Pharmaceutical Sciences, University of Geneva, Rue Michel Servet 1, Geneva, 1211, Switzerland, 41 22 379 53 16, Marie.Schneider@unige.ch %K medication adherence %K patient compliance %K diabetes mellitus %K diabetes complications %K diabetic nephropathies %K chronic kidney disease %K kidney failure %K renal insufficiency %K electronic monitoring %K interprofessional program %D 2021 %7 19.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite effective treatments, more than 30% of patients with diabetes will present with diabetic kidney disease (DKD) at some point. Patients with DKD are among the most complex as their care is multifactorial and involves different groups of health care providers. Suboptimal adherence to polypharmacy is frequent and contributes to poor outcomes. As self-management is one of the keys to clinical success, structured medication adherence programs are crucial. The PANDIA-IRIS (patients diabétiques et insuffisants rénaux: un programme interdisciplinaire de soutien à l’adhésion thérapeutique) study is based on a routine medication adherence program led by pharmacists. Objective: The aim of this study is to define the impact of the duration of this medication adherence program on long-term adherence and clinical outcomes in patients with DKD. Methods: This monocentric adherence program consists of short, repeated motivational interviews focused on patients’ medication behaviors combined with the use of electronic monitors containing patients’ medications. When patients open the electronic monitor cap to take their medication, the date and hour at each opening are registered. In total, 73 patients are randomized as 1:1 in 2 parallel groups; the adherence program will last 6 months in the first group versus 12 months in the second group. After the intervention phases, patients continue using their electronic monitors for a total of 24 months but without receiving feedback. Electronic monitors and pill counts are used to assess medication adherence. Persistence and implementation will be described using Kaplan-Meier curves and generalized estimating equation multimodeling, respectively. Longitudinal adherence will be presented as the product of persistence and implementation and modelized by generalized estimating equation multimodeling. The evolution of the ADVANCE (Action in Diabetes and Vascular disease: Preterax and Diamicron Modified-Release Controlled Evaluation) and UKPDS (United Kingdom Prospective Diabetes Study) clinical scores based on medication adherence will be analyzed with generalized estimating equation multimodeling. Patients’ satisfaction with this study will be assessed through qualitative interviews, which will be transcribed verbatim, coded, and analyzed for the main themes. Results: This study was approved by the local ethics committee (Vaud, Switzerland) in November 2015. Since then, 2 amendments to the protocol have been approved in June 2017 and October 2019. Patients’ recruitment began in April 2016 and ended in October 2020. This study was introduced to all consecutive eligible patients (n=275). Among them, 73 accepted to participate (26.5%) and 202 (73.5%) refused. Data collection is ongoing and data analysis is planned for 2022. Conclusions: The PANDIA-IRIS study will provide crucial information about the impact of the medication adherence program on the adherence and clinical outcomes of patients with DKD. Monitoring medication adherence during the postintervention phase is innovative and will shed light on the duration of the intervention on medication adherence. Trial Registration: Clinicaltrials.gov NCT04190251_PANDIA IRIS; https://clinicaltrials.gov/ct2/show/NCT04190251 International Registered Report Identifier (IRRID): DERR1-10.2196/25966 %M 33739292 %R 10.2196/25966 %U https://www.researchprotocols.org/2021/3/e25966 %U https://doi.org/10.2196/25966 %U http://www.ncbi.nlm.nih.gov/pubmed/33739292 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25309 %T Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study %A Biondi,Andrea %A Laiou,Petroula %A Bruno,Elisa %A Viana,Pedro F %A Schreuder,Martijn %A Hart,William %A Nurse,Ewan %A Pal,Deb K %A Richardson,Mark P %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, United Kingdom, 44 7753986485, andrea.2.biondi@kcl.ac.uk %K epilepsy %K EEG %K electroencephalography %K brain ictogenicity %K wearables %K seizure prediction %K brain %K seizures %K mobile technology %D 2021 %7 19.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy. Objective: EEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk. Methods: A total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King’s College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk. Results: The EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022. Conclusions: With the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence. International Registered Report Identifier (IRRID): PRR1-10.2196/25309 %M 33739290 %R 10.2196/25309 %U https://www.researchprotocols.org/2021/3/e25309 %U https://doi.org/10.2196/25309 %U http://www.ncbi.nlm.nih.gov/pubmed/33739290 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24589 %T Mobile Health Crowdsensing (MHCS) Intervention on Chronic Disease Awareness: Protocol for a Systematic Review %A Tokosi,Temitope Oluwaseyi %A Twum-Darko,Michael %+ Graduate Centre for Management, Faculty of Business and Management Sciences, Cape Peninsula University of Technology, Keizersgracht Street, District Six Campus, Cape Town, 8000, South Africa, 27 76 047 1328, toksymoore@gmail.com %K mHealth %K crowdsensing %K chronic diseases %K awareness %K mobile phone %D 2021 %7 19.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health crowdsensing (MHCS) involves the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information, or patient observation and provision of care). MHCS technologies (eg, smartphones) have sensory capabilities, such as GPS, voice, light, and camera, to collect, analyze, and share user-centered data (explicit and implicit). The current literature indicates no scientific study related to MHCS interventions for chronic diseases. The proposed systematic review will examine the impact of MHCS interventions on chronic disease awareness. Objective: The objectives of this study are to identify and describe various MHCS intervention strategies applied to chronic disease awareness. Methods: Literature from various databases, such as MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials, will be examined. Trial registers, reports, grey literature, and unpublished academic theses will also be included. All mobile technologies, such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities, will be included. MHCS will be the primary intervention strategy. The search strategy will include keywords such as mHealth, crowdsensing, and awareness among other medical subject heading terms. Articles published from January 1, 1945, to December 31, 2019, will be eligible for inclusion. The authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by an independent party not involved in the study. The authors will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the chi-square test of homogeneity on Cochrane Q test, and quantified using the I2 statistic. Results: The preliminary search query found 1 paper. Further literature search commenced in mid-March 2021 and is to be concluded in April 2021. The proposed systematic review protocol has been registered in PROSPERO (The International Prospective Register of Systematic Reviews; no. CRD42020161435). Furthermore, the use of search data extraction and capturing in Review Manager version 5.3 (Cochrane) commenced in January 2021 and ended in February 2021. Further literature search will begin in mid-March 2021 and will be concluded in April 2021. The final stages will include analyses and writing, which are anticipated to start and be completed in May 2021. Conclusions: The knowledge derived from this study will inform health care stakeholders—including researchers, policy makers, investors, health professionals, technologists, and engineers—of the impact of MHCS interventions on chronic disease awareness. International Registered Report Identifier (IRRID): PRR1-10.2196/24589 %M 33739288 %R 10.2196/24589 %U https://www.researchprotocols.org/2021/3/e24589 %U https://doi.org/10.2196/24589 %U http://www.ncbi.nlm.nih.gov/pubmed/33739288 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25941 %T Transition of Renal Patients Using AlloSure Into Community Kidney Care (TRACK): Protocol for Long-Term Allograft Surveillance in Renal Transplant Recipients %A Dale,Bethany L %A Bose,Subhasish %A Kuo,Sheng %A Burns,Alana %A Daou,Pierre %A Short,Jenna %A Miles,Jake %+ CareDx, 1 Tower Place, 9th Floor, Brisbane, CA, 94080, United States, 1 9293635937, jmiles@caredx.com %K donor-derived cell free DNA (dd-cfDNA) %K molecular inflammation %K molecular injury %K acute rejection %K allograft injury %K allograft surveillance %K renal transplant %K renal %K transplant %K injury %K graft rejection %K kidney %K kidney disease %K transplantation %D 2021 %7 15.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with end-stage kidney disease require complex and expensive medical management. Kidney transplantation remains the treatment of choice for end-stage kidney disease and is considered superior to all other modalities of renal replacement therapy or dialysis. However, access to kidney transplant is limited by critical supply and demand, making it extremely important to ensure longevity of transplanted kidneys. This is prevented through lifelong immunosuppression, with caution not to overly suppress the immune system, resulting in toxicity and harm. Transition of care to community nephrologists after initial kidney transplantation and monitoring at a transplant center is an important process to ensure delivery of effective and patient-centric care closer to home. Once transplanted, laborious surveillance of the immune system and monitoring for potential rejection and injury are undertaken through an armamentarium of screening modalities. Posttransplant surveillance for kidney function and injury remains key to follow-up care. While kidney function, quantified by estimated glomerular filtration rate and serum creatinine, and kidney injury, measured by proteinuria and hematuria, are standard biomarkers used to monitor injury and rejection posttransplant, they have recently been demonstrated to be inferior in performance to that of AlloSure (CareDx Inc, Brisbane, CA) circulating donor-derived, cell-free DNA (dd-cfDNA). Objective: The outcomes and methods of monitoring renal transplant recipients posttransplant have remained stagnant over the past 15 years. The aim of this study is to consider intensive surveillance using AlloSure dd-cfDNA in an actively managed protocol, assessing whether it increases long-term allograft survival in kidney transplant recipients compared with current standard clinical care in community nephrology. Methods: The study protocol will acquire data from a phase IV observational trial to assess a cohort of renal transplant patients managed using AlloSure dd-cfDNA and patient care managers versus 1000 propensity-matched historic controls using United Network for Organ Sharing U.S. Scientific Registry of Transplant Recipients data. Data will be managed in a centralized electronic data server. The primary outcome will be superior allograft survival, as a composite of return to dialysis, retransplant, death due to allograft failure, and death with a functional graft (infection, malignancy, and cardiovascular death). The secondary endpoints will assess improved kidney function through decline in estimated glomerular filtration rate and immune activity through development of donor-specific antibodies. Results: The total sample is anticipated to be 3500 (2500 patients managed with AlloSure dd-cfDNA and 1000 propensity-matched controls). Active enrollment began in November 2020. Conclusions: Based on a significant literature base, we believe implementing the surveillance of dd-cfDNA in the kidney transplant population will have a positive impact on graft survival. Through early identification of rejection and facilitating timely intervention, prolongation of allograft survival versus those not managed by dd-cfDNA surveillance protocol should be superior. International Registered Report Identifier (IRRID): PRR1-10.2196/25941 %M 33720033 %R 10.2196/25941 %U https://www.researchprotocols.org/2021/3/e25941 %U https://doi.org/10.2196/25941 %U http://www.ncbi.nlm.nih.gov/pubmed/33720033 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e25121 %T Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States %A op den Buijs,Jorn %A Pijl,Marten %A Landgraf,Andreas %+ Philips Research, High Tech Campus 34, Eindhoven, 5656 AE, Netherlands, 31 631926890, jorn.op.den.buijs@philips.com %K emergency hospital transport %K predictive modeling %K personal emergency response system %K population health management %K emergency transport %K emergency response system %K emergency response %K health management %D 2021 %7 8.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective: The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods: Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results: German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions: Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use. %M 33682679 %R 10.2196/25121 %U https://medinform.jmir.org/2021/3/e25121 %U https://doi.org/10.2196/25121 %U http://www.ncbi.nlm.nih.gov/pubmed/33682679 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25619 %T A Value-Based Comparison of the Management of Ambulatory Respiratory Diseases in Walk-in Clinics, Primary Care Practices, and Emergency Departments: Protocol for a Multicenter Prospective Cohort Study %A Berthelot,Simon %A Breton,Mylaine %A Guertin,Jason Robert %A Archambault,Patrick Michel %A Berger Pelletier,Elyse %A Blouin,Danielle %A Borgundvaag,Bjug %A Duhoux,Arnaud %A Harvey Labbé,Laurie %A Laberge,Maude %A Lachapelle,Philippe %A Lapointe-Shaw,Lauren %A Layani,Géraldine %A Lefebvre,Gabrielle %A Mallet,Myriam %A Matthews,Deborah %A McBrien,Kerry %A McLeod,Shelley %A Mercier,Eric %A Messier,Alexandre %A Moore,Lynne %A Morris,Judy %A Morris,Kathleen %A Ovens,Howard %A Pageau,Paul %A Paquette,Jean-Sébastien %A Perry,Jeffrey %A Schull,Michael %A Simon,Mathieu %A Simonyan,David %A Stelfox,Henry Thomas %A Talbot,Denis %A Vaillancourt,Samuel %+ Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, QC, G1V 4G2, Canada, 1 418 525 4444 ext 46095, simon.berthelot@fmed.ulaval.ca %K emergency department %K primary care %K walk-in clinic %K health economics %K quality of care %K patient preferences %K patient-reported outcomes %K outcome assessment, health care %D 2021 %7 22.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. Results: Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. Conclusions: The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative. International Registered Report Identifier (IRRID): PRR1-10.2196/25619 %M 33616548 %R 10.2196/25619 %U https://www.researchprotocols.org/2021/2/e25619 %U https://doi.org/10.2196/25619 %U http://www.ncbi.nlm.nih.gov/pubmed/33616548 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25175 %T A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Mahoney,Jane E %A Brown,Randall T %A Landucci,Gina %A Pe-Romashko,Klaren %A Cody,Olivia J %A Gustafson Jr,David H %A Shah,Dhavan V %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering, 4th Fl, 1513 University Avenue, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K eHealth %K telemedicine %K aged %K geriatrics %K multiple chronic conditions %K depression %K social support %K quality of life %K primary care %K health expenditures %K mobile phone %D 2021 %7 19.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective: This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods: In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results: Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions: With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration: ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID): DERR1-10.2196/25175 %M 33605887 %R 10.2196/25175 %U http://www.researchprotocols.org/2021/2/e25175/ %U https://doi.org/10.2196/25175 %U http://www.ncbi.nlm.nih.gov/pubmed/33605887 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23960 %T Developmental Assets of Adolescents and Young Adults With Chronic Illness and Comorbid Depression: Qualitative Study Using YouTube %A Zheng,Katherine %A George,Maureen %A Roehlkepartain,Eugene %A Santelli,John %A Bruzzese,Jean-Marie %A Smaldone,Arlene %+ The Feinberg School of Medicine, Center for Education in Health Sciences, Northwestern University, 633 N Saint Clair St, 20th Floor, Chicago, IL, 60605, United States, 1 6032036736, katzheng1@gmail.com %K adolescent development %K chronic disease %K depression %K developmental assets %K positive youth development %K YouTube %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Developmental assets provide a framework for optimizing development among adolescents but have not been studied in adolescents with chronic illness and comorbid depression, which is a group at risk for poor health outcomes. YouTube postings provide valuable insights to understand this understudied population. Objective: This study aims to explore asset development from the perspectives of adolescents and young adults (AYAs) with chronic illness and comorbid depression. Methods: YouTube was searched using 12 chronic illnesses (eg, diabetes) coupled with “depression” as keywords. Videos were included if they were uploaded by AYAs aged between 11 and 29 years and discussed living with chronic illness and depression during adolescence. Video transcripts were coded deductively for 40 internal and external assets that constitute the Developmental Assets Framework. Categories not captured by deductive coding were identified using conventional content analysis. Categories and their respective assets were labeled as being discussed either negatively or positively. Results: In total, 31 videos from 16 AYAs met the inclusion criteria. A total of 7 asset categories, support, constructive use of time, boundaries and expectations (external assets), identity, commitment to learning, positive values, and social competence (internal assets), reflecting 25 (13 internal; 12 external) assets, were discussed. Internal assets, particularly relating to identity, were commonly discussed by AYAs either in a negative way or fluctuated between positive and negative perspectives. Conclusions: In this sample of AYAs with chronic illness and comorbid depression, internal assets were commonly discussed in a negative way. Future research is needed to better understand how assets develop and if the Developmental Assets Framework adequately represents the experiences of this population. %M 33591288 %R 10.2196/23960 %U http://mental.jmir.org/2021/2/e23960/ %U https://doi.org/10.2196/23960 %U http://www.ncbi.nlm.nih.gov/pubmed/33591288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22220 %T A Web-Based Self-Management Support Prototype for Adults With Chronic Kidney Disease (My Kidneys My Health): Co-Design and Usability Testing %A Donald,Maoliosa %A Beanlands,Heather %A Straus,Sharon E %A Smekal,Michelle %A Gil,Sarah %A Elliott,Meghan J %A Herrington,Gwen %A Harwood,Lori %A Waldvogel,Blair %A Delgado,Maria %A Sparkes,Dwight %A Tong,Allison %A Grill,Allan %A Novak,Marta %A James,Matthew Thomas %A Brimble,K Scott %A Samuel,Susan %A Tu,Karen %A Farragher,Janine %A Hemmelgarn,Brenda R %+ Faculty of Medicine and Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Edmonton, AB, T6G 2B7, Canada, 1 780 492 9728, Brenda.Hemmelgarn@albertahealthservices.ca %K chronic kidney disease %K knowledge-to-action framework %K integrated knowledge translation %K patient engagement %K patient-oriented research %K self-management %K web-based intervention %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those who care for them. Self-management has been shown to slow CKD progression and improve the quality of life of individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed, web-based tool for CKD self-management that can be individualized to a patient’s unique situation, priorities, and preferences. We addressed this gap using an integrated knowledge translation method and patient engagement principles. Objective: The aim of this study is to conduct systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (nondialysis and nontransplant) and their caregivers to enhance self-management support. Methods: A multistep, iterative system development cycle was used to co-design and test the My Kidneys My Health prototype. The 3-step process included creating website features and content using 2 sequential focus groups with patients with CKD and caregivers, heuristic testing using the 10 heuristic principles by Nielsen, and usability testing through in-person 60-minute interviews with patients with CKD and their caregivers. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. Results: In step 1, 18 participants (14 patients and 4 caregivers) attended one of the 2 sequential focus groups. The participants provided specific suggestions for simplifying navigation as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. A total of 5 reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Furthermore, 5 participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean system usability score of 90 out of 100. Conclusions: The My Kidneys My Health prototype is a systematically developed, multifaceted, web-based CKD self-management support tool guided by the theory and preferences of patients with CKD and their caregivers. The website is user friendly and provides features that improve user experience by tailoring the content and resources to their needs. A feasibility study will provide insights into the acceptability of and engagement with the prototype and identify preliminary patient-reported outcomes (eg, self-efficacy) as well as potential factors related to implementation. This work is relevant given the shift to virtual care during the current pandemic times and provides patients with support when in-person care is restricted. %M 33560245 %R 10.2196/22220 %U https://formative.jmir.org/2021/2/e22220 %U https://doi.org/10.2196/22220 %U http://www.ncbi.nlm.nih.gov/pubmed/33560245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18732 %T Prevailing Outcome Themes Reported by People With Degenerative Cervical Myelopathy: Focus Group Study %A Khan,Danyal Zaman %A Fitzpatrick,Siobhan Mairead %A Hilton,Bryn %A McNair,Angus GK %A Sarewitz,Ellen %A Davies,Benjamin Marshall %A Kotter,Mark RN %A , %+ Academic Neurosurgery Department, University of Cambridge, Box 167, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Cambridge, United Kingdom, 44 122 333 6946, mrk25@cam.ac.uk %K cervical %K myelopathy %K spondylosis %K spondylotic %K stenosis %K disc herniation %K ossification posterior longitudinal ligament %K qualitative %K thematic analysis %K core outcomes set %K consensus %K Delphi %K patient perspectives %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) arises when arthritic changes of the cervical spine cause compression and a progressive injury to the spinal cord. It is common and potentially disabling. People with DCM have among the lowest quality of life scores (Short Form Health Survey–36 item [SF-36]) of chronic disease, although the drivers of the imapact of DCM are not entirely understood. DCM research faces a number of challenges, including the heterogeneous reporting of study data. The AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) project is an international consensus process that aims to improve research efficiency through formation of a core outcome set (COS). A key part of COS development process is organizing outcomes into domains that represent key aspects of the disease. To facilitate this, we sought to qualitatively explore the context and impact of patient-reported outcomes in DCM on study participants. Objective: The goal of the research was to qualitatively explore the patient-reported outcomes in DCM to improve understanding of patient perspective and assist the organization of outcomes into domains for the consensus process. Methods: Focus group sessions were hosted in collaboration with Myelopathy.org, a charity and support group for people with DCM. A 40-minute session was audiorecorded and transcribed verbatim. Two authors familiarized themselves with the data and then performed data coding independently. Codes were grouped into themes and a thematic analysis was performed guided by Braun and Clarke’s 6-phase approach. The themes were subsequently reviewed with an independent stakeholder with DCM, assisting in the process of capturing the true context and importance of themes. Results: Five people with DCM (3 men and 2 women) participated in the focus group session. The median age was 53 years, and the median score on the modified Japanese Orthopaedic Association scale was 11 (interquartile range 9.5-11.5), indicating the participants had moderate to severe DCM. A total of 54 codes were reviewed and grouped into 10 potential themes that captured the impact of the disability on people with DCM: acceptance of symptoms, anticipatory anxiety, coping mechanisms/resilience, feelings of helplessness, financial consequences, lack of recognition, mental health impact, loss of life control, social reclusiveness and isolation, and social stigma. Conclusions: This qualitative analysis of the perspectives of people with DCM has highlighted a number of prevailing themes currently unmeasured in clinical research or care. The determinants of low quality of life in DCM are currently unknown, and these findings provide a novel and so far, unique perspective. Continued inclusion of online communities and use of targeted digital software will be important in establishing a consensus-based COS for patients with DCM that is inclusive of all relevant stakeholders including people with DCM. %M 33533719 %R 10.2196/18732 %U https://formative.jmir.org/2021/2/e18732 %U https://doi.org/10.2196/18732 %U http://www.ncbi.nlm.nih.gov/pubmed/33533719 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e20615 %T Tui Na for Chronic Nonspecific Low Back Pain: Protocol for a Systematic Review and Meta-analysis %A Yang,Juan %A Brault,Jeffrey S %A Jensen,Mark A %A Do,Alexander %A Ma,Qingyu %A Zhou,Xuan %A Shen,Longbin %A Zhao,Canghuan %A Cheong,Kwok Chee Philip %A He,Kejie %A Guo,Yu %A Chen,Zhuoming %A Tang,Shujie %A Tang,Yong %A Tan,Celia Ia Choo %A Chen,Jiaxu %A Bauer,Brent A. %+ Division of General Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 5072842511, Bauer.Brent@mayo.edu %K Tui na %K Tuina %K low back pain %K protocol %K systematic review %D 2021 %7 27.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic nonspecific low back pain (CNLBP) is one of the most common complex pain conditions, and it is strongly associated with high rates of disability. Even though several studies on Tui na for CNLBP have been reported, to our knowledge there has been no systematic review of the currently available publications. Objective: This study aims to develop a protocol for a systematic review and meta-analysis that will evaluate the effectiveness and safety of Tui na therapy for patients with CNLBP. Methods: An electronic literature search of PubMed, Embase, MEDLINE, Cochrane Library, Springer, Scopus, World Health Organization International Clinical Trials Registry Platform, Physiotherapy Evidence Database (PEDro), Clarivate Analytics, and Chinese biomedical databases (the China National Knowledge Infrastructure, Wan-fang database, Chinese Scientific Journals Database, and Chinese Biomedical Literature Databases) will be conducted. Studies will be screened by two reviewers independently based on titles and abstracts, followed by a full-text reading with eligibility criteria. Randomized controlled trials involving Tui na for patients with CNLBP will be reviewed. The primary outcomes of the study are improvement of pain, analgesic medication reduction, improvement of functional disability, and degree of satisfaction with the intervention. A secondary outcome is any adverse event of Tui na intervention. Methodological quality and risk of bias will be assessed with the Cochrane Collaboration Risk of Bias Tool. If studies are sufficient, a meta-analysis of the effectiveness will be performed. If possible, we will evaluate publication bias using funnel plots. If substantial heterogeneity between studies is present, and there are sufficient studies, subgroup analyses will be conducted to explain the study findings. Results: The review database searches will be initiated in December 2020, with findings expected by January 2021. Conclusions: This protocol will establish a framework of a high-quality literature synthesis on the impact of Tui na treatment in patients with CNLBP. The proposed review will determine whether Tui na is effective and safe for CNLBP patients. Trial Registration: PROSPERO CRD42020166731; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=166731 International Registered Report Identifier (IRRID): PRR1-10.2196/20615 %M 33502327 %R 10.2196/20615 %U http://www.researchprotocols.org/2021/1/e20615/ %U https://doi.org/10.2196/20615 %U http://www.ncbi.nlm.nih.gov/pubmed/33502327 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25291 %T Self-Administered Behavioral Skills–Based At-Home Virtual Reality Therapy for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial %A Garcia,Laura M %A Darnall,Beth D %A Krishnamurthy,Parthasarathy %A Mackey,Ian G %A Sackman,Josh %A Louis,Robert G %A Maddox,Todd %A Birckhead,Brandon J %+ Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Pacific Theaters Building, Suite 800 116 N. Robertson Blvd., Los Angeles, CA, 90048, United States, 1 818 850 0814, bbirckhead@appliedvr.io %K chronic pain %K virtual reality %K behavioral medicine %K behavioral health %K pain treatment %K randomized controlled trial %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is one of the most common and debilitating health conditions. Treatments for chronic low back pain typically focus on biomedical treatment approaches. While psychosocial treatments exist, multiple barriers prevent broad access. There is a significant unmet need for integrative, easily accessible, non-opioid solutions for chronic pain. Virtual reality (VR) is an immersive technology allowing innovation in the delivery of behavioral pain treatments. Behavioral skills-based VR is effective at facilitating pain management and reducing pain-related concerns. Continued research on these emerging approaches is needed. Objective: In this randomized controlled trial, we seek to test the efficacy of a self-administered behavioral skills-based VR program as a nonpharmacological home-based pain management treatment for people with chronic low back pain (cLBP). Methods: We will randomize 180 individuals with cLBP to 1 of 2 VR programs: (1) EaseVRx (8-week skills-based VR program); or (2) Sham VR (control condition). All participants will receive a VR headset to minimize any biases related to the technology’s novelty. The Sham VR group had 2D neutral content in a 3D theater-like environment. Our primary outcome is average pain intensity and pain-related interference with activity, stress, mood, and sleep. Our secondary outcomes include patient-reported physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, health utilization, medication use, and user satisfaction. We hypothesize superiority for the skills-based VR program in all of these measures compared to the control condition. Team statisticians blinded to treatment assignment will assess outcomes up to 6 months posttreatment using an approach suitable for the longitudinal nature of the data. Results: The study was approved by the Western Institutional Review Board on July 2, 2020. The protocol (NCT04415177) was registered on May 27, 2020. Recruitment for this study was completed in July 2020, and data collection will remain active until March 2021. In total, 186 participants were recruited. Multiple manuscripts will be generated from this study. The primary manuscript will be submitted for publication in the winter of 2020. Conclusions: Effectively delivering behavioral treatments in VR could overcome barriers to care and provide scalable solutions to chronic pain’s societal burden. Our study could help shape future research and development of these innovative approaches. Trial Registration: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID): RR1-10.2196/25291 %M 33464215 %R 10.2196/25291 %U https://www.researchprotocols.org/2021/1/e25291 %U https://doi.org/10.2196/25291 %U http://www.ncbi.nlm.nih.gov/pubmed/33464215 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e16774 %T Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions %A Tighe,Sarah A %A Ball,Kylie %A Kensing,Finn %A Kayser,Lars %A Rawstorn,Jonathan C %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia, 61 92468383 ext 95590, stighe@deakin.edu.au %K noncommunicable diseases %K chronic disease %K web-based intervention %K mobile health %K self-management %K health behavior %K mobile phone %D 2020 %7 28.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. Objective: This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. Methods: A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. Results: A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. Conclusions: Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care. %M 33112239 %R 10.2196/16774 %U http://www.jmir.org/2020/10/e16774/ %U https://doi.org/10.2196/16774 %U http://www.ncbi.nlm.nih.gov/pubmed/33112239 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e18687 %T Mapping Behavioral Health Serious Game Interventions for Adults With Chronic Illness: Scoping Review %A Thomas,Teresa Hagan %A Sivakumar,Varshini %A Babichenko,Dmitriy %A Grieve,Victoria L B %A Klem,Mary Lou %+ School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, United States, 1 4126243799, t.thomas@pitt.edu %K review %K chronic disease %K behavioral sciences %K video games %D 2020 %7 30.7.2020 %9 Review %J JMIR Serious Games %G English %X Background: Serious games for health are increasingly being used to address health outcomes in patients with chronic illnesses. These studies vary in their study designs, patient populations, frameworks, outcome variables, and degree of specificity of the serious game intervention. Objective: This scoping review aims to clarify the conceptual features of the existing research related to serious games designed to improve cognitive and behavioral outcomes in adults with chronic illness. Methods: We applied the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for scoping reviews (PRISMA-ScR) methodology, including an a priori research question. We searched 4 electronic databases to identify articles published through November 2019. Inclusion criteria encompassed (1) adults 18 years or older; (2) patients with a diagnosis of chronic illness; (3) a serious game intervention; and (4) defined patient outcomes that assess patients’ behavioral, cognitive, or health outcomes. Results: Of the 3305 articles identified, 38 were included in the review. We charted and analyzed the theoretical frameworks, key concepts, and outcome variables of these studies with summaries of features across articles. The majority of studies used a randomized controlled trial design (23/38, 61%), included a custom serious game intervention (22/38, 58%), and lacked a theoretical framework (25/38, 66%). Common outcome variables included quality of life (16/38, 42%), mood (15/38, 39%), cognitive function (13/38, 34%), symptoms (12/38, 32%), and physical activity (9/38, 24%). Key differences between studies included whether or not serious games aimed to train versus teach patients, be widely accessible versus tailored interventions, or replace versus complement current treatments. Conclusions: This scoping review defines the current landscape of research in serious games for health research targeting behavioral and cognitive outcomes in adults with chronic disease. Studies have addressed a variety of patient populations and diverse patient outcomes. Researchers wanting to build on the current research should integrate theoretical frameworks into the design of the intervention and trial to more clearly articulate the active ingredients and mechanisms of serious games. %M 32729836 %R 10.2196/18687 %U http://games.jmir.org/2020/3/e18687/ %U https://doi.org/10.2196/18687 %U http://www.ncbi.nlm.nih.gov/pubmed/32729836 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e16372 %T Summarizing Complex Graphical Models of Multiple Chronic Conditions Using the Second Eigenvalue of Graph Laplacian: Algorithm Development and Validation %A Faruqui,Syed Hasib Akhter %A Alaeddini,Adel %A Chang,Mike C %A Shirinkam,Sara %A Jaramillo,Carlos %A NajafiRad,Peyman %A Wang,Jing %A Pugh,Mary Jo %+ Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, United States, 1 210 458 8747, adel.alaeddini@utsa.edu %K graphical models %K graph summarization %K graph Laplacian %K disease network %K multiple chronic conditions %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: It is important but challenging to understand the interactions of multiple chronic conditions (MCC) and how they develop over time in patients and populations. Clinical data on MCC can now be represented using graphical models to study their interaction and identify the path toward the development of MCC. However, the current graphical models representing MCC are often complex and difficult to analyze. Therefore, it is necessary to develop improved methods for generating these models. Objective: This study aimed to summarize the complex graphical models of MCC interactions to improve comprehension and aid analysis. Methods: We examined the emergence of 5 chronic medical conditions (ie, traumatic brain injury [TBI], posttraumatic stress disorder [PTSD], depression [Depr], substance abuse [SuAb], and back pain [BaPa]) over 5 years among 257,633 veteran patients. We developed 3 algorithms that utilize the second eigenvalue of the graph Laplacian to summarize the complex graphical models of MCC by removing less significant edges. The first algorithm learns a sparse probabilistic graphical model of MCC interactions directly from the data. The second algorithm summarizes an existing probabilistic graphical model of MCC interactions when a supporting data set is available. The third algorithm, which is a variation of the second algorithm, summarizes the existing graphical model of MCC interactions with no supporting data. Finally, we examined the coappearance of the 100 most common terms in the literature of MCC to validate the performance of the proposed model. Results: The proposed summarization algorithms demonstrate considerable performance in extracting major connections among MCC without reducing the predictive accuracy of the resulting graphical models. For the model learned directly from the data, the area under the curve (AUC) performance for predicting TBI, PTSD, BaPa, SuAb, and Depr, respectively, during the next 4 years is as follows—year 2: 79.91%, 84.04%, 78.83%, 82.50%, and 81.47%; year 3: 76.23%, 80.61%, 73.51%, 79.84%, and 77.13%; year 4: 72.38%, 78.22%, 72.96%, 77.92%, and 72.65%; and year 5: 69.51%, 76.15%, 73.04%, 76.72%, and 69.99%, respectively. This demonstrates an overall 12.07% increase in the cumulative sum of AUC in comparison with the classic multilevel temporal Bayesian network. Conclusions: Using graph summarization can improve the interpretability and the predictive power of the complex graphical models of MCC. %M 32554376 %R 10.2196/16372 %U http://medinform.jmir.org/2020/6/e16372/ %U https://doi.org/10.2196/16372 %U http://www.ncbi.nlm.nih.gov/pubmed/32554376 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 4 %P e17642 %T Using Natural Language Processing Techniques to Provide Personalized Educational Materials for Chronic Disease Patients in China: Development and Assessment of a Knowledge-Based Health Recommender System %A Wang,Zheyu %A Huang,Haoce %A Cui,Liping %A Chen,Juan %A An,Jiye %A Duan,Huilong %A Ge,Huiqing %A Deng,Ning %+ Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Yuquan Campus, Hangzhou, China, 86 571 2295 2693, zju.dengning@gmail.com %K health education %K ontology %K natural language processing %K chronic disease %K recommender system %D 2020 %7 23.4.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health education emerged as an important intervention for improving the awareness and self-management abilities of chronic disease patients. The development of information technologies has changed the form of patient educational materials from traditional paper materials to electronic materials. To date, the amount of patient educational materials on the internet is tremendous, with variable quality, which makes it hard to identify the most valuable materials by individuals lacking medical backgrounds. Objective: The aim of this study was to develop a health recommender system to provide appropriate educational materials for chronic disease patients in China and evaluate the effect of this system. Methods: A knowledge-based recommender system was implemented using ontology and several natural language processing (NLP) techniques. The development process was divided into 3 stages. In stage 1, an ontology was constructed to describe patient characteristics contained in the data. In stage 2, an algorithm was designed and implemented to generate recommendations based on the ontology. Patient data and educational materials were mapped to the ontology and converted into vectors of the same length, and then recommendations were generated according to similarity between these vectors. In stage 3, the ontology and algorithm were incorporated into an mHealth system for practical use. Keyword extraction algorithms and pretrained word embeddings were used to preprocess educational materials. Three strategies were proposed to improve the performance of keyword extraction. System evaluation was based on a manually assembled test collection for 50 patients and 100 educational documents. Recommendation performance was assessed using the macro precision of top-ranked documents and the overall mean average precision (MAP). Results: The constructed ontology contained 40 classes, 31 object properties, 67 data properties, and 32 individuals. A total of 80 SWRL rules were defined to implement the semantic logic of mapping patient original data to the ontology vector space. The recommender system was implemented as a separate Web service connected with patients' smartphones. According to the evaluation results, our system can achieve a macro precision up to 0.970 for the top 1 recommendation and an overall MAP score up to 0.628. Conclusions: This study demonstrated that a knowledge-based health recommender system has the potential to accurately recommend educational materials to chronic disease patients. Traditional NLP techniques combined with improvement strategies for specific language and domain proved to be effective for improving system performance. One direction for future work is to explore the effect of such systems from the perspective of patients in a practical setting. %M 32324148 %R 10.2196/17642 %U http://medinform.jmir.org/2020/4/e17642/ %U https://doi.org/10.2196/17642 %U http://www.ncbi.nlm.nih.gov/pubmed/32324148 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e14483 %T Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Development of a Tool by Adapted Delphi Procedure %A Falck,Leandra %A Zoller,Marco %A Rosemann,Thomas %A Martínez-González,Nahara Anani %A Chmiel,Corinne %+ Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland, 41 44 255 98 55, Leandra.Falck@usz.ch %K monitoring of chronic diseases %K indicators %K primary care %K electronic medical record %K diabetes mellitus type 2 %K arterial hypertension %K asthma %K osteoarthritis %K chronic heart failure %D 2020 %7 25.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Long-term care for patients with chronic diseases poses a huge challenge in primary care. There are deficits in care, especially regarding monitoring and creating structured follow-ups. Appropriate electronic medical records (EMR) could support this, but so far, no generic evidence-based template exists. Objective: The aim of this study is to develop an evidence-based standardized, generic template that improves the monitoring of patients with chronic conditions in primary care by means of an EMR. Methods: We used an adapted Delphi procedure to evaluate a structured set of evidence-based monitoring indicators for 5 highly prevalent chronic diseases (ie, diabetes mellitus type 2, asthma, arterial hypertension, chronic heart failure, and osteoarthritis). We assessed the indicators’ utility in practice and summarized them into a user-friendly layout. Results: This multistep procedure resulted in a monitoring tool consisting of condensed sets of indicators, which were divided into sublayers to maximize ergonomics. A cockpit serves as an overview of fixed goals and a set of procedures to facilitate disease management. An additional tab contains information on nondisease-specific indicators such as allergies and vital signs. Conclusions: Our generic template systematically integrates the existing scientific evidence for the standardized long-term monitoring of chronic conditions. It contains a user-friendly and clinically sensible layout. This template can improve the care for patients with chronic diseases when using EMRs in primary care. %M 32209535 %R 10.2196/14483 %U http://medinform.jmir.org/2020/3/e14483/ %U https://doi.org/10.2196/14483 %U http://www.ncbi.nlm.nih.gov/pubmed/32209535 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 1 %P e13029 %T Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey %A Volpicelli Leonard,Kathryn %A Robertson,Courtney %A Bhowmick,Amrita %A Herbert,Leslie Beth %+ Health Union LLC, 1 International Plaza Dr, #550, Philadelphia, PA, , United States, 1 4849859715, Kate.Leonard@health-union.com %K treatment effectiveness %K patient satisfaction %K migraine %K multiple sclerosis %K rheumatoid arthritis %D 2020 %7 6.3.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to improved adherence. However, how patients perceive effectiveness is poorly understood. Objective: The aim of this study was to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions. Methods: We conducted a descriptive study using a cross-sectional survey design. We administered a Web-based survey to participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Patients were recruited from established online communities of Health Union. Descriptive statistics, correlations, and comparison tests were used to examine outcomes. Results: Data were collected from 1820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (1644/1820, 90.33%), >40 years old (1462/1820, 80.33%), and diagnosed >5 years ago (1189/1820, 65.33%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r=0.90, P<.01). Overall, three temporal factors were positively correlated with satisfaction or perceived effectiveness: time on current medication (satisfaction rs=0.22, P<.01; effectiveness rs=0.25, P<.01), time since diagnosis (satisfaction rs=0.07, P<.01; effectiveness rs=0.09, P<.01), and time on treatment (effectiveness rs=0.08, P<.01). Conclusions: Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between time and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients regarding treatment. Clinicians may be better prepared to elicit patient beliefs, which influence medication adherence, for people diagnosed with chronic health conditions. %M 32141836 %R 10.2196/13029 %U http://www.i-jmr.org/2020/1/e13029/ %U https://doi.org/10.2196/13029 %U http://www.ncbi.nlm.nih.gov/pubmed/32141836