Internet-enabled Tablet Research Articles

Virtual assessment protocols for Timed-Up-and-Go, 5-repetition Chair Rise, and 1-minute Sit-to-Stand tests in community-dwelling older adults: Investigating feasibility, reliability, and validity

ObjectiveTo 1) develop and evaluate virtual assessment protocols for the Timed-Up-and-Go (TUG) usual and fast-pace, Chair Rise-5 repetition, and the 1-minute Sit-to-Stand (1MSTS) tests, and 2) examine their feasibility, reliability, and validity. DesignThis was a prospective cohort study, where participants engaged in up to two virtual assessments and data was collected prospectively for one year. SettingAssessments took place in participants’ homes in the community. Toolkits were delivered that included the required equipment and internet-enabled tablet. ParticipantsParticipants included a random sample of adults ≥65 years old who could walk 10m without assistance from another person and communicate in English. Main outcome measuresFalls and healthcare utilization data were collected for one year after initial assessments. Descriptive data were used to examine feasibility; intra-class correlation and Pearson's/Spearman's correlation and AUCs were used to evaluate reliability and validity, respectively. ResultsSixty participants (mean age 76.6 ±5.6; 53% female) completed visit 1 and 52 completed visit 2. Technology issues were relatively common, yet no safety incidents occurred. All the virtual mobility tests demonstrated excellent test-retest (ICCs=0.86 to 0.95) and inter-rater (ICC=0.98 to 0.99) reliability. The tests had weak-to-moderate correlations with measures of physical function (r=-0.14 to -0.43) and physical activity (r=-0.19 to 0.32). Fifty-seven total falls were recorded by 28 participants (46%) over 1 year. The virtual mobility tests did not have adequate accuracy for predicting falls (AUCs = 0.53 to 0.59), specialist (AUCs=0.48-0.60), family doctor (AUCs=0.48-0.59), or rehabilitation professional visits (AUCs=0.65-0.67), or hospitalizations (AUCs=0.56-0.63). ConclusionResults support the feasibility and reliability of virtual administration of the TUG usual and fast-pace, Chair Rise, and 1MSTS. Clinicians and researchers can use the included manuals to conduct these tests virtually. Future research should examine the clinical utility of these tests for remote monitoring and mobility assessment.

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities.

The coronavirus disease 2019 pandemic accelerated the adoption of telehealth technologies. Persistent disparities in telecommunication devices, internet connectivity, and digital literacy, however, undermine the potential for telemedicine to reduce barriers to health care access. Health systems may have a role in addressing these structural inequities. We describe the operationalization and feasibility of an internet-enabled tablet loaner program at a freestanding children's hospital. Between October 2020 and October 2021, pediatricians enrolled families through ambulatory clinics at an academic urban freestanding children's hospital. Eligibility criteria included difficulty accessing virtual care due to lack of stable internet or device. Tablets featured an unlimited data package, access to the patient portal, and virtual visit platform. A private technology company managed device configuration and distribution. To characterize program impact, we compared the proportion of completed clinical encounters during the intervention compared with a preintervention period (March 2020-October 2020) and conducted a qualitative survey with program participants. Participant and visit characteristics were obtained from the electronic medical record and summarized with descriptive statistics. A total of 111 families participated in the tablet loaner program, the majority of whom were Hispanic (51.4%) and black, non-Hispanic (26.1%), and publicly insured (64.9%). Between the preintervention and intervention periods, there was a significant increase in completed video- and phone-based virtual visits (75.3 vs. 79.1%, p = 0.038). The proportion of video-based only visits increased from 82.9 to 88.9%. p < 0.001. Families reported that the tablet improved the patient's ability to receive medical care (93.7%) and was easy to use (93.9%). The tablet loaner initiative was associated with an improvement in markers of virtual visit engagement and health care experience. Efforts to expand telemedicine equity must consider technological access and digital literacy as well as broad coalitions across industry, government, and community organizations.

Abstract A028: Exploring age and race/ethnic associations with the multiple dimensions of pain among cancer patients receiving home hospice care

Abstract Aim: Racial disparities in pain are well known, but most hospice studies included few underrepresented minority patients, which limits understanding of pain disparities among cancer patients receiving hospice care. Our study purpose was to explore age and racial/ethnic associations with the sensory, affective, evaluative, and temporal dimensions of cancer pain in the hospice setting. Methods: We analyzed control group data from a stepped-wedge randomized control trial of the PAINRelieveIt app. 150 home hospice patients with a variety of cancers (mean age 68.0±14.6 years, 52% female, 44% White, 37% Black, 19% Hispanic) completed PAINReportIt, an electronic McGill Pain Questionnaire, on an internet-enabled tablet at baseline and 1 week later. We compared racial/ethnic groups for age (ANOVA) and gender (Chi square) differences. We also conducted regression analyses of baseline and posttest sensory pain (current pain intensity [0-10], worst pain intensity [0-10], Pain Rating Index[PRI]-Sensory), affective pain (PRI-Affective [0-14), evaluative pain (PRI-Evaluative), and pain pattern scores, adjusting for age, and comparing Black and Hispanic with White groups. Results: Gender was relatively balanced across the racial/ethnic groups (p=.54). There was significant difference among groups in mean age (p=.01; Black: 64.1±12.1, Hispanic: 66.5±16.6, White: 71.9±14.8). Baseline current and worst pain intensity were moderate and severe respectively across Black (4.7±2.9; 7.1±1.9), Hispanic (5.4±2.6; 7.7±2.1), and White (4.4±2.7; 6.7±2.6) groups (p&amp;gt;.05). Posttest current and worst pain intensity remained moderate and severe across Black (4.6±2.8; 6.5±2.3), Hispanic (4.7±2.4; 6.5±2.2) and White (4.0±2.4 and 5.9±2.4) groups (p&amp;gt;.05). Baseline values were not significantly different across racial/ethnic groups for PRI-Sensory, PRI-Evaluative, and pain pattern. Baseline PRI-Affective scores differed significantly among Black (1.8±2.0), Hispanic (3.8±3.9) and White (3.1±2.6) groups (p=.003). Higher baseline pain values for all variables except current pain were associated with younger age (p≤.02) and the Black group had significantly lower PRI-Affective (p=.001). Posttest, higher current pain and worst pain were associated with younger age (p=.04). Other pain variables were not associated with age or race/ethnicity (p&amp;gt;.05). Conclusions: Patients with advanced cancer, regardless of race or ethnicity, reported clinically important current and worst pain intensity suggesting the need for better pain control in the hospice setting. Younger patients reported more intense pain than older patients. Younger patients reported more intense pain than older patients. The significantly lower affective contribution to pain among Black patients at baseline represents a novel finding that warrants additional research. Insufficient pain control remained consistent across racial/ethnic groups in usual hospice care. The racial/ethnic disparities commonly observed in pain management was not evident in this sample. Citation Format: Jeronda C. Jenkins, Dottington Fullwood, Yingwei Yao, Diana Wilkie, Miriam O. Ezenwa. Exploring age and race/ethnic associations with the multiple dimensions of pain among cancer patients receiving home hospice care [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A028.

Implementation of an Online Glaucoma-Specific Quality of Life Computerized Adaptive Test System in a US Glaucoma Hospital

PurposeThe feasibility of implementing a computerized adaptive test (CAT) system in routine clinical care in ophthalmology has not been assessed. We evaluated the implementation of a glaucoma-specific CAT (GlauCAT) in outpatients at Massachusetts Eye and Ear Institute.MethodsIn this implementation study (July 2020–April 2021), 216 adults (mean ± SD age 64.8 ± 15.3 years; 56.0% women) completed six adaptive GlauCAT quality of life (QOL) tests on an internet-enabled tablet at the clinic. A real-time printable report summarizing domain scores was shared with physicians prior to consultation. The implementation was evaluated using Proctor's outcomes: acceptability (patient satisfaction); appropriateness (independent complete rate [%]); feasibility (acceptance rate [%]; completion time); and fidelity (percentage of patients discussing GlauCAT results with their physician). Physician barriers/facilitators were explored using open-ended questions.ResultsPatients’ mean ± SD satisfaction score was 3.5 ± 0.5 of 4, with >95% of patients willing to recommend it to others. Of the 216 (89.2%) patients accepting to participate, 173 (80%) completed GlauCAT independently. Patients took 8 minutes and 5 seconds (median) to complete all 6 GlauCAT tests. Almost two-thirds (n = 136/216) of the patients reported discussing their GlauCAT results with their doctor. Physicians described the GlauCAT summary report as helpful and user-friendly, although lack of time and uncertainty about how to action information were reported.ConclusionsPilot implementation of six GlauCAT QOL tests in glaucoma outpatient clinics was feasible and acceptable. Integration of GlauCAT with electronic medical records (EMRs) and evaluation of long-term implementation outcomes are needed.Translational RelevanceGlauCAT's multiple outcomes and low test-taking burden makes it attractive for measuring glaucoma-specific QOL in routine clinical care.

Technology-supported home monitoring in heart failure patients

Abstract Background Digital health promises to enhance the prevailing episodic models of chronic heart failure (HF) care. Purpose We aimed to test the hypothesis that digital home monitoring with centralised specialist support for remote management of HF and major vascular comorbidities is more effective in optimising medical therapy and improving patients' quality of life than digital home monitoring alone. Methods and results In a two-armed partially blinded parallel randomised controlled trial, seven sites in the United Kingdom recruited a total of 202 adults with HF (71.3 years SD 11.1; mean left ventricular ejection fraction 32.9% SD 15.4). Participants were selected for being at high risk of adverse outcomes or high potential to benefit from remote management. Participants in both study arms were given an internet-enabled tablet computer, Bluetooth-enabled blood pressure monitor and weighing scales for health monitoring. After a run-in period, participants randomized to intervention received additional regular feedback to support self-management and their primary care doctors received instructions on blood investigations and pharmacological treatment. The primary outcome was the use of recommended medical therapy, for chronic HF and major comorbidities, measured as a composite opportunity score. Co-primary outcome was change in physical score of Minnesota Living with Heart failure questionnaire. At the end of the trial, the weighted opportunity score was 0.54 (CI 95% 0.46, 0.62) in the control group and 0.61 (CI 95% 0.52, 0.70) in the intervention arm (p for mean difference=0.25). Physical well-being of participants did not differ significantly between the groups either (p=0.55). Conclusions Central provision of tailored specialist management in a multimorbid HF population was feasible. However, there was no strong evidence for improvement in use of evidence-based therapies nor health-related quality of life. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) Health Services Research and Delivery; NIHR Career Development Fellowship

"No Waiting" in the "Waiting Room": The Self-rooming Patient Pilot Study.

Introduction: Although patient timeliness and appointment flow are highly important for patients and practices, the impact of technology on improving these aspects of healthcare delivery are not widely studied. We evaluated the satisfaction and acceptability of using a handheld internet-enabled tablet computer (the Mobile Patient Communicator (MPC)) that uses interactive maps, and visual and written instructions to direct patients from waiting rooms to exam rooms independently of medical personnel.Methods: At the time of appointment check-in, eligible patients attending their healthcare appointments at a family medicine practice received the MPC that provided them an online orientation about its use and function. The MPC directed patients to their assigned exam rooms. Patients completed pre-/post-visit surveys. We used Wilcoxon rank-sum tests for numeric variables and Fisher’s exact tests for categorical variables.Results: Among 200 participated patients, the median level of satisfaction was 9 (1=not at all, 10= very much satisfied), 177 (91%) were successful in finding their room, and 147 (76%) thought the device should be used in the future. Prior to using the MPC, patients ≥65 years old were less comfortable with using the device (median 7 vs. 9; P=0.001), expected to have more problems operating the device (yes 6% vs. 1%; P=0.002), and were less likely to use a computer daily (yes 51% vs. 91%; P<0.001) vs. <65 years old. After using the MPC, patients ≥65 years old were less satisfied with using the device (median 8 vs. 10; P=0.001) but were more likely to watch the video on the device (yes 70% vs. 54%; P=0.04) vs. <65 years old. Conclusion: The pilot results show evidence that using this technology for self-rooming by patients is highly acceptable regardless of age and sex. The findings also indicate this technology was helpful in delivering health care-related information before face-to-face appointments.

Patients and Caregivers Rate the PAINReportIt Wireless Internet-Enabled Tablet as a Method for Reporting Pain During End-of-Life Cancer Care.

In several studies, investigators have successfully used an internet-enabled PAINReportIt tablet to allow patients to report their pain to clinicians in real-time, but it is unknown how acceptable this technology is to patients and caregivers when used in their homes. The aims of this study were to examine computer use acceptability scores of patients with end-stage cancer in hospice and their caregivers and to compare the scores for differences by age, gender, race, and computer use experience. Immediately after using the tablet, 234 hospice patients and 231 caregivers independently completed the Computer Acceptability Scale (maximum scores of 14 for patients and 9 for caregivers). The mean (SD) Computer Acceptability score was 12.2 (1.9) for patients and 8.5 (0.9) for caregivers. Computer Acceptability scores were significantly associated with age and with previous computer use for both patients and caregivers. This technology was highly acceptable to patients and caregivers for reporting pain in real time to their hospice nurses. Findings provide encouraging results that are worthy of serious consideration for patients who are in end stages of illness, including older persons and those with minimal computer experience. Increasing availability of technology can provide innovative methods for improving care provided to patients facing significant cancer-related pain even at the end of life.

Home monitoring with IT-supported specialist management versus home monitoring alone in patients with heart failure: Design and baseline results of the SUPPORT-HF 2 randomized trial

SUPPORT-HF 2 tests the hypothesis that home monitoring with information technology-supported specialist management is more effective in optimizing medical therapy than is home monitoring alone for patients with heart failure. The study was designed as a 2-armed partially blinded parallel randomized controlled trial. Seven sites in the United Kingdom (UK) recruited a total of 202 adults with heart failure at high risk of adverse outcomes and with potential to benefit from remote management (mean age 73 years, 28% female, median left ventricular ejection fraction 37%). Both arms are given a home monitoring and communication kit (Internet-enabled tablet computer, Bluetooth-enabled blood pressure and heart rate monitor, and weighing scale). For each participant, an individualized plan for treatment of heart failure and major comorbidities is developed before randomization. Participants randomized to intervention receive regular feedback to support self-management, and their physicians receive advice on blood investigations and pharmacological treatment from a central specialist heart failure team. Participants in the control arm use the same monitoring system but with no central medical management support. The primary outcome is the use of recommended medical therapy, defined as treatment consistent with the guidelines for management of patients with chronic heart failure, and will be measured as a composite opportunity score. The trial data collection ended in October 2017, and results will be reported in 2019. ISRCTN86212709. Preliminary experience suggests that central provision of tailored specialist management using commercially available low-cost monitoring and computing devices, enhanced by customized applications, is feasible.

Promoting deceased organ and tissue donation registration in family physician waiting rooms (RegisterNow-1 trial): study protocol for a pragmatic, stepped-wedge, cluster randomized controlled registry

BackgroundThere is a worldwide shortage of organs available for transplant, leading to preventable mortality associated with end-stage organ disease. While most citizens in many countries with an intent-to-donate “opt-in” system support organ donation, registration rates remain low. In Canada, most Canadians support organ donation but less than 25% in most provinces have registered their desire to donate their organs when they die. The family physician office is a promising yet underused setting in which to promote organ donor registration and address known barriers and enablers to registering for deceased organ and tissue donation. We developed a protocol to evaluate an intervention to promote registration for organ and tissue donation in family physician waiting rooms.Methods/designThis protocol describes a planned, stepped-wedge, cluster randomized registry trial in six family physician offices in Ontario, Canada to evaluate the effectiveness of reception staff providing patients with a pamphlet that addresses barriers and enablers to registration including a description of how to register for organ donation. An Internet-enabled tablet will also be provided in waiting rooms so that interested patients can register while waiting for their appointments. Family physicians and reception staff will be provided with training and/or materials to support any conversations about organ donation with their patients. Following a 2-week control period, the six offices will cross sequentially into the intervention arm in randomized sequence at 2-week intervals until all offices deliver the intervention. The primary outcome will be the proportion of patients visiting the office who are registered organ donors 7 days following their office visit. We will evaluate this outcome using routinely collected registry data from provincial administrative databases. A post-trial qualitative evaluation process will assess the experiences of reception staff and family physicians with the intervention and the stepped-wedge trial design.DiscussionPromoting registration for organ donation in family physician offices is a potentially useful strategy for increasing registration for organ donation. Increased registration may ultimately help to increase the number of organs available for transplant. The results of this trial will provide important preliminary data on the effectiveness of using family physician offices to promote registration for organ donation.Trial registrationClinicalTrials.gov, ID: NCT03213171. Registered on 11 July 2017.

Pain Intensity and Misconceptions Among Hospice Patients With Cancer and Their Caregivers: Status After 2 Decades.

There is little evidence about barriers to pain management or their relationships with pain outcomes of hospice patients with cancer. The purpose of the study was to determine the barriers reported by hospice patients with cancer and their caregivers and the relationships with demographic characteristics and the patients' pain. In this cross-sectional study, we used selected baseline data from an ongoing randomized clinical trial of patient and lay caregiver dyads receiving home-level hospice care. Participants used an Internet-enabled tablet to complete the valid, reliable measures of pain intensity, pain management barriers (Barriers Questionnaire 13 items [BQ-13]), and demographic characteristics. The responses indicate that the 2 areas of highest concern (mean scores >3) to both patients and caregivers were "pain means disease progression" and "constipation." Additionally, 3 other areas of highest concern (mean scores >3) to caregivers were "addiction" pain medicine causing "one to do embarrassing things" and "confusion." The mean BQ-13 scores ranged from 0.2 to 4.9 and averaged 2.6 ± 0.9 for the patients and ranged from 0.5 to 4.7 and averaged 2.7 ± 0.9 for the caregivers. Mean barrier scores remain high and were not different between patients and their caregivers or significantly related to the patients' pain intensity. However, there were differences in race, ethnic, and hospice setting in the barrier scores. Patients with Hispanic heritage reported higher barrier scores than non-Hispanic patients. Together, these findings not only support prior research findings but also contribute new insights about pain intensity and pain barriers that are relevant to hospices serving minorities with cancer.

Creating connections - the development of a mobile-health monitoring system for heart failure: Qualitative findings from a usability cohort study.

ObjectiveThere is significant interest in the role of digital health technology in enabling optimal monitoring of heart failure patients. To harness this potential, it is vital to account for users’ capacity and preferences in the development of technological solutions. We adopted an iterative approach focussed on learning from users’ interactions with a mobile-health monitoring system.MethodsWe used a participatory mixed methods research approach to develop and evaluate a mobile-health monitoring system. Fifty-eight heart failure patients were recruited from three health care settings in the UK and provided with Internet-enabled tablet computers that were wirelessly linked to sensor devices for blood pressure, heart rate and weight monitoring. One to two home visits were conducted with a subgroup of 29 participants to evaluate the usability of the system over a median follow-up period of six months. The thematic analysis of observational data and 45 interviews was informed by the domestication of technology theory.ResultsOur findings indicate that digital health technologies need to create and extend connections with health professionals, be incorporated into users’ daily routines, and be personalised according to users’ technological competencies and interest in assuming a proactive or more passive role in monitoring their condition.ConclusionsUsers' patterns of engagement with health technology changes over time and varies according to their need and capacity to use the technology. Incorporating diverse user experiences in the development and maintenance of mobile-health systems is likely to increase the extent of successful uptake and impacts on outcomes for patients and providers.

A user-centred home monitoring and self-management system for patients with heart failure: a multicentre cohort study.

Previous generations of home monitoring systems have had limited usability. We aimed to develop and evaluate a user-centred and adaptive system for health monitoring and self-management support in patients with heart failure. Patients with heart failure were recruited from three UK centres and provided with Internet-enabled tablet computers that were wirelessly linked with sensor devices for blood pressure, heart rate, and weight monitoring. Patient observations, interviews, and concurrent analyses of the automatically collected data from their monitoring devices were used to increase the usability of the system. Of the 52 participants (median age 77 years, median follow-up 6 months [interquartile range, IQR, 3.6-9.2]), 24 (46%) had no, or very limited prior, experience with digital technologies. It took participants about 1.5 min to complete the daily monitoring tasks, and the rate of failed attempts in completing tasks was <5%. After 45 weeks of observation, participants still used the system on 4.5 days per week (confidence interval 3.2-5.7 days). Of the 46 patients who could complete the final survey, 93% considered the monitoring system as easy to use and 38% asked to keep the system for self-management support after the study was completed. We developed a user-centred home monitoring system that enabled a wide range of heart failure patients, with differing degrees of IT literacy, to monitor their health status regularly. Despite no active medical intervention, patients felt that they benefited from the reassurance and sense of connectivity that the monitoring system provided.