Mobile Health System Research Articles

Enhancing System Acceptance through User-Centred Design: Integrating Patient Generated Wellness Data.

Gestational diabetes mellitus (GDM) is a condition that appears during pregnancy and is expected to be a temporary one. While patients are encouraged to manage it themselves, research findings indicate that GDM may negatively affect the foetus; in addition, there is an increased risk of women with GDM subsequently developing Type 2 diabetes. To alleviate the risks, women with GDM are advised to maintain a record of their diet and blood glucose levels and to attend regular clinical reviews. Rather than using a paper diary, women with GDM can maintain a record of their blood glucose level readings and other relevant data using a wellness mobile application (app). However, such apps are developed for general use and may not meet the specific needs of clinical staff (physicians, dietitians, obstetricians and midwives) involved in managing GDM; for example, an app may record glucose readings but not the details of a meal taken before or after the glucose reading. Second, the apps do not permanently store the data generated by the patient and do not support the transfer of these data to a clinical system or information portal. The mobile health (mHealth) system designed and developed in this research allows one to integrate different types of user generated wellness data into a centralised database. A user-centered design (UCD) approach informed by the technology acceptance model (TAM) was adopted. This paper investigates and evaluates the effectiveness of the approach with regard to facilitating system acceptance and future adoption through an early focus on enhancing system usefulness and ease of use. The functional system requirements of the proposed system were refined through a series of interviews with the perspective of clinical users; ease-of-use and usability issues were resolved through ‘think aloud’ sessions with clinicians and GDM patients.

Validation of a Musculoskeletal Digital Assessment Routing Tool: Protocol for a Pilot Randomized Crossover Noninferiority Trial.

BackgroundMusculoskeletal conditions account for 16% of global disability, resulting in a negative effect on millions of patients and an increasing demand for health care use. Digital technologies to improve health care outcomes and efficiency are considered a priority; however, innovations are rarely tested with sufficient rigor in clinical trials, which is the gold standard for clinical proof of safety and efficacy. We have developed a new musculoskeletal digital assessment routing tool (DART) that allows users to self-assess and be directed to the right care. DART requires validation in a real-world setting before implementation.ObjectiveThis pilot study aims to assess the feasibility of a future trial by exploring the key aspects of trial methodology, assessing the procedures, and collecting exploratory data to inform the design of a definitive randomized crossover noninferiority trial to assess DART safety and effectiveness.MethodsWe will collect data from 76 adults with a musculoskeletal condition presenting to general practitioners within a National Health Service (NHS) in England. Participants will complete both a DART assessment and a physiotherapist-led triage, with the order determined by randomization. The primary analysis will involve an absolute agreement intraclass correlation (A,1) estimate with 95% CI between DART and the clinician for assessment outcomes signposting to condition management pathways. Data will be collected to allow the analysis of participant recruitment and retention, randomization, allocation concealment, blinding, data collection process, and bias. In addition, the impact of trial burden and potential barriers to intervention delivery will be considered. The DART user satisfaction will be measured using the system usability scale.ResultsA UK NHS ethics submission was done during June 2021 and is pending approval; recruitment will commence in early 2022, with data collection anticipated to last for 3 months. The results will be reported in a follow-up paper in 2022.ConclusionsThis study will inform the design of a randomized controlled crossover noninferiority study that will provide evidence concerning mobile health DART system clinical signposting in an NHS setting before real-world implementation. Success should produce evidence of a safe, effective system with good usability, potentially facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This rigorous approach to mobile health system testing could be used as a guide for other developers of similar applications.Trial RegistrationClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029International Registered Report Identifier (IRRID)PRR1-10.2196/31541

Adaptive Goals and Reinforcement Timing to Increase Physical Activity in Adults: A Factorial Randomized Trial

Potent lifestyle interventions to increase moderate-to-vigorous physical activity are urgently needed for population-level chronic disease prevention. This trial tested the independent and joint effects of a mobile health system automating adaptive goal setting and immediate financial reinforcement for increasing daily walking among insufficiently active adults. Participants were randomized into a 2 (adaptive versus static goal setting) X 2 (immediate versus delayed financial incentive timing) condition factorial trial to increase walking. Participants (N=512 adults) were recruited between 2016 and 2018 and were 64.5% female, aged 18-60 years, 18.8% Hispanic, 6.1% African American, and 83% White. Principles of reinforcement and behavioral economics directed intervention design. Participants wore accelerometers daily (133,876 day-level observations) that remotely measured moderate-to-vigorous physical activity bout minutes of ≥3 minutes/day for 1 year. Primary outcomes were between-condition differences in (1) engaging ≥1 bout of moderate-to-vigorous physical activity on each day and (2) on days with ≥1 bout, daily total moderate-to-vigorous physical activity minutes. Mixed-effects hurdle models tested treatment group X phase (time) interactions using an intent-to-treat approach in 2021. Engaging in any ambulatory moderate-to-vigorous physical activity was greater for Adaptive than for Static Goal groups (OR=2.34, 95% CI=2.10, 2.60 vs OR=1.66, 95% CI=1.50, 1.84; p<0.001) and for Immediate than for Static Reinforcement groups (OR=2.16 95% CI=1.94, 2.40 vs OR=1.77, 95% CI=1.59, 1.97; p<0.01). The Immediate Reinforcement group increased by 16.54 moderate-to-vigorous physical activity minutes/day, whereas the Delayed Reinforcement group increased by 9.91 minutes/day (p<0.001). The combined Adaptive Goals+Immediate Reinforcement group increased by 16.52 moderate-to-vigorous physical activity minutes/day, significantly more than that of either Delayed Reinforcement group. This study offers automated and scalable-behavior change strategies for increasing walking among adults most at-risk for chronic diseases attributed to sedentary lifestyles. This study is registered at www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02717663).

Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development.

BackgroundThe proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development.ObjectiveDespite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems.MethodsTapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development.ResultsThe contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact.ConclusionsSystem designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.

Mobile Health Systems Affordability in India: Perspectives of Stakeholders

Purpose: The purpose of this study were to identify stakeholder perspective for achieving affordable and cost-effective system outcomes and what describes success associated with mHealth systems in India. This study identifies stakeholder views on (a) fundamental conditions for initiating mobile health (mHealth) systems and (b) desirable outcomes regarding affordable and cost-effectiveness of successful mHealth systems. Design/Methodology/Approach: This qualitative study uses existing models of affordability and used an inductive approach to organise emerging codes as per a priori themes. Data were collected from direct observations and 17 in-depth interviews both online and offline involving stakeholder, namely healthcare professionals, technology entrepreneurs and software developers working on health information and mHealth systems. Findings: Findings illustrated people’s need and unwillingness, lack of application infrastructure, ecosystem development, governmental policies, and training and support as factors influencing successful mHealth systems in India. Originality/Value: Earlier studies were less adequate in explaining mHealth systems affordability and cost-effectiveness from the perspective of stakeholder. The current study attempts to provide fundamental conditions and desirable outcomes that are considered to be valuable for developing mHealth systems. This makes healthcare providers with information of what needs to be considered for developing mHealth systems.

Usability Testing of a mHealth System for Swallowing Therapy in Patients Following Stroke

Purpose The objective of this study was to evaluate the usability of a mobile health (mHealth) system designed for dysphagia exercise in persons with a history of stroke. Method Five participants with a history of stroke were recruited from a tertiary health center and assessed for their ability to use and interact with the system. After being introduced to the technology, participants were asked to independently complete five tasks, one at a time. Assistance was available when required or requested. Usability was evaluated with respect to effectiveness, efficiency, and user satisfaction when completing the prespecified goals. Results Four men and one woman between the ages of 50 and 83 years ( M = 65.4) completed the usability testing. Time from stroke onset varied from 1 month to 2.5 years. Additional poststroke challenges related to the usability of the mHealth system included reduced range of motion or mobility, vision, and short-term memory difficulties. Independent success (system effectiveness) varied in this user subgroup, and the research clinician or the family member was required to adjust the level and type of support they provided (system efficiency). All participants reported satisfaction with the use of the system. Conclusion Usability of and satisfaction with this mHealth system and others like it can be achieved in individuals who have had a stroke, either as an independent user or as a patient–caregiver dyad.

Cryptanalysis of Two Signature Schemes for IoT and Mobile Health Systems

Cryptanalysis of Two Signature Schemes for IoT and Mobile Health Systems

Impact of a Mobile Health System on the Suppression of Schistosoma haematobium in Chad

ABSTRACT.This study determined the contribution of a mobile health (M-health) system to the treatment of Schistosoma haematobium in a region of Chad where S. haematobium is endemic. M-health involves the use of a mobile phone for health care. The study compared the prevalence of schistosomiasis in an area with an M-health system, newly installed in 2014, with an area without an adequate health infrastructure. Data were gathered after the M-health system had been running for 3 years. We took urine samples from children age 1 to 15 years, for a total of 200 children in a village in the M-health area and 200 in a village in a non-M-health area. Urine was checked for urinary schistosomiasis by using dipsticks for microhematuria and, in cases of positive dipstick results, microscopy was used to detect eggs. Comparison between the areas allowed us to assess the effectiveness of the installed M-health system after 3 years of operation. Based on dipstick outcomes, the non-M-health area had an infection rate of 51.5% compared with 29% in the M-health area. Microscopy results in non-M-health and M-health were 27.5% and 21%, respectively. The dipstick result difference between M-health and non-M-health areas was statistically significant. Dipsticks were more reliable than microscopy for the detection of schistosomiasis, especially in areas without qualified personnel. Based on these results, M-health proved its ability to reduce the infection rate of urogenital schistosomiasis, and the implementation of M-health shows great promise in areas where this disease is endemic and where no mass drug administration is provided.

SMARTPHONE APPLICATIONS FOR CONTACT TRACING IN COVID-19 EPIDEMIC: A SYSTEMATIC REVIEW

The great spread of the COVID-19 Pandemic and its effect on lifestyle around the world has led countries and organizations to accelerate the design or use of mobile health systems and applications to tackle and monitor the outbreak. Digital contact tracing applications have been proposed to automatically warning individuals at risk of infection and exposure. This systematic analysis discusses the various types of mechanisms and systems used in applications for digital contact tracing including Centralized, Decentralized, or Hybrid, in addition to, the used communication technologies such as Bluetooth, GPS, WiFi, and others, with a focus on user privacy and the efficiency of dealing with the extracted data. Four databases were scanned (IEEE Xplore, ScienceDirect, Web of Science, and PubMed) between 2015 and 2020. To review the collected 636 papers, precise exclusion criteria and selection strategies were applied. Only seven papers have been thoroughly analyzed and included in this study. The results in all papers have been presented to identify gaps and issues to supply an overview of the main aspects that need to be included and resolved in mobile applications that will be built to effectively restrict the spread of this pandemic and preserve full user privacy.

Co-design in mHealth Systems Development: Insights From a Systematic Literature Review

Mobile health (mHealth) systems hold great potential for supporting users in self-managing disease and engaging in a healthier life. However, given the mobile context and the multiple factors that affect a person’s health, designing mHealth systems involves much complexity and a range of pitfalls. To overcome these pitfalls, scholars have called on system designers to employ a co-design approach; that is, to involve stakeholders in all phases of the design process. However, the literature on how, when, and why designers use co-design in mHealth remains scant. To address this gap, we systematically reviewed 61 studies that co-designed mHealth systems. Our results show that co-designing mHealth systems constitutes a fragmented and rapidly evolving research field with only limited overlaps and a strong focus on the early design phases (i.e., pre-design, generative). Thereby, the co-designed artifacts cover various application contexts in disease management (e.g., heart disease, diabetes) and health promotion (e.g., physical activity, nutrition) and a diverse group of involved users, healthcare professionals, and system designers. Finally, guided by Sanders and Stappers’ (2014) co-design framework, we provide a concise overview of the most widely used methods in the different co-design phases.

Agent-Based Autonomic Semantic Context-Aware Platform for Smart Health Monitoring and Disease Detection

Abstract Nowadays, mobile applications have been widely used in various health and social domains. While there are large number of smart devices that connect and transmit their context data in free manner, these mobile applications have limitations regarding the increasing number of heterogeneous context data sent by devices, conducting the problem of identifying user-centric situations and providing services in real-time. Many smart mobile health systems were proposed to ensure context-aware personal health monitoring and diseases detection, while most of them are failed to ensure a right level of dynamicity and enough flexibility for assisting users everywhere, anytime, through widespread sensors and mobile devices. In fact, it becomes necessary to rethink a new way to minimize the response time combining competitive agents with semantic-based situation reasoning strategy. In this paper, we introduce a novel agent-based platform with three-layered ontology for the semantic description and parallel management of services selection approach dedicated to context-aware health mobile applications. In addition, we propose an innovative parallel services discovery and optimal selection process, which involved a set of filtered and classified semantic health multipath according to user’s context and preferences with consistent mobility of users and limited resources (low battery, processing capabilities, memory and others). Experimental results show the effectiveness of the proposed approach as it includes the semantic service information on cooperative agents. In addition, the proposed approach ensures fast response time and prolongs the continuity of the mobile application.

Interruption of cancer screening services due to COVID-19 pandemic: lessons from previous disasters.

To review the scientific literature seeking lessons for the COVID-19 era that could be learned from previous health services interruptions that affected the delivery of cancer screening services. A systematic search was conducted up to April 17, 2020, with no restrictions on language or dates and resulted in 385 articles. Two researchers independently assessed the list and discussed any disagreements. Once a consensus was achieved for each paper, those selected were included in the review. Eleven articles were included. Three studies were based in Japan, two in the United States, one in South Korea, one in Denmark, and the remaining four offered a global perspective on interruptions in health services due to natural or human-caused disasters. No articles covered an interruption due to a pandemic. The main themes identified in the reviewed studies were coordination, communication, resource availability and patient follow-up. Lessons learned applied to the context of COVID-19 are that coordination involving partners across the health sector is essential to optimize resources and resume services, making them more resilient while preparing for future interruptions. Communication with the general population about how COVID-19 has affected cancer screening, measures taken to mitigate it and safely re-establish screening services is recommended. Use of mobile health systems to reach patients who are not accessing services and the application of resource-stratified guidelines are important considerations. More research is needed to explore best strategies for suspending, resuming and sustaining cancer screening programs, and preparedness for future disruptions, adapted to diverse health care systems.

Home Monitoring System for Comprehensive Geriatric Assessment in Patient's Dwelling: System Design and UX Evaluation.

Population aging threatens the sustainability of welfare systems since it is not accompanied by an extended healthy and independent period in the last years of life. The Comprehensive Geriatric Assessment (CGA) has been shown to be efficient in maintaining the healthy period at the end of the life. Frailty monitoring is typically carried out for an average period of 6 months in clinical settings, while more regular monitoring could prevent the transition to disability. We present the design process of a system for frailty home monitoring based on an adapted CGA and the rationale behind its User eXperience (UX) design. The resulting home monitoring system consists of two devices based on ultrasound sensors, a weight scale, and a mobile application for managing the devices, administering CGA-related questionnaires, and providing alerts. Older users may encounter barriers in their usage of technology. For this reason, usability and acceptability are critical for health monitoring systems addressed to geriatric patients. In the design of our system, we have followed a user-centered process, involving geriatricians and older frail patients by means of co-creation methods. In the iterative process of design and usability testing, we have identified the most effective way of conducting the home-based CGA, not just by replicating the dialogue between the physician and the patient, but by adapting the design to the possibilities and limitations of mobile health for this segment of users. The usability evaluation, carried out with 14 older adults, has proved the feasibility of users older than 70 effectively using our monitoring system, additionally showing an intention over 80% for using the system. It has also provided some insights and recommendations for the design of mobile health systems for older users.

Proof-of-concept trial results of the HeartMan mobile personal health system for self-management in congestive heart failure

This study tested the effectiveness of HeartMan—a mobile personal health system offering decisional support for management of congestive heart failure (CHF)—on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the intervention group only. No significant intervention effects were observed for HRQoL, self-care confidence, illness perception and exercise capacity. Overall, results of this proof-of-concept trial suggest that the HeartMan personal health system significantly improved mental and sexual health and self-care behaviour in CHF patients. These observations were in contrast to the lack of intervention effects on HRQoL, illness perception and exercise capacity.

The Impact of the Digital Health Interventions in Curbing COVID-19 in Zimbabwe

Amid ongoing research about, Digital Health Interventions (DHI) in Zimbabwe, is the largely overlooked impact of DHI to mitigate the spread of COVID-19. To contribute towards filling this knowledge gap, the study seeks to examine the DHI strategies that have been adopted to curb the inimical effects of COVID-19 in Zimbabwe. DHI such as telemedicine, use of social media, Electronic Medical Records (EMRs), Mobile Health (mHealth), and Healthcare Information Systems (HIS) have been disposed to curtail the spread of COVID-19. The limitations and hurdles crippling DHI are discussed extensively. This study adopts a qualitative research design, comprising personal and targeted interviews and documentary review. Preliminary findings are that DHIs are effectively working for employing routine and innovative forms of Information and Communications Technology (ICT) to address health needs. However, the research noted that various factors such as corruption lack of funding, shortage of qualified workforce and medical expertise, and weak healthcare infrastructure are militating against robust deployment of DHIs. This study includes measures that can be adopted to address these challenges.

Usability Assessment of the Rehabilitation Lower-limb Orthopedic Assistive Device by Service Members and Veterans With Lower Limb Loss.

Telehealth is an increasingly common approach to improve healthcare delivery, especially within the Veterans Health Administration and Department of Defense (DoD). Telehealth has diminished many challenges to direct access for clinical follow-up; however, the use of mobile telehealth for specialty rehabilitative care is emerging and is referred to as telerehabilitation. As early adopters of telehealth, the Veterans Affairs and DoD have supported collaborated efforts for programs designed to increase the access and quality of rehabilitative care while improving the functional ability of our service members (SMs) and veterans with lower limb amputation (LLA). The DoD and Veterans Health Administration collaborated on a Mobile Device Outcomes-based Rehabilitation Program (MDORP) to help injured SMs and veterans with LLA. The MDORP project utilized a mobile health system called the Rehabilitative Lower Limb Orthopedic Accommodating Device (ReLOAD) to assess walking quality. The ReLOAD system includes real-time auditory biofeedback to notify the user of their most prominent gait deviation and then recommends exercises that address specific balance and strength impairments. The purpose of this study was to describe the responses to a postintervention survey evaluating the feasibility and usability of ReLOAD completed by SMs and veterans with LLA who used the system for 5 months. A link to an anonymous usability survey was emailed to all participants who completed MDORP. The survey was modeled after the System Usability Scale, with agreeableness to items rated on a 5-point Likert-style questionnaire in addition to open feedback. Data visualization of Likert-style questionnaires was conducted using ggplot2 and reshape2 statistical packages and was analyzed using R. We obtained institutional review board approval through both Miami Veterans Affairs Healthcare System and Walter Reed National Military Medical Center. The majority of participants reported that they would use the system again for home rehabilitation (65%) and that auditory biofeedback helped them walk better (59%). Participants also suggested that future work should include a greater variety of exercise options and the use of smart phones for the ReLOAD application in addition to the iPad tablet. The participants provided positive and constructive feedback that will enhance the value and usability of telerehabilitation interventions like the ReLOAD system for future users.

Voice Disorder Recognition and Analysis Using Knowledge Engineering Techniques

Nowadays, the use of mobile application is most important thing in the healthcare sector is increasing rapidly. Mobile technologies not only for communication for multimedia content (e.g. clinical audio-visual notes and medical records) but also promising solutions for people who desire the identification, monitoring, and treatment of their health conditions anywhere and at any time. Mobile E-healthcare systems can contribute to make patient care faster, better, and cheaper. Several pathological conditions can benefit from the use of mobile technologies. In this paper we focus on dysphonia, an alteration of the voice quality that affects about one person in three at least once in his/her lifetime. Voice disorders are rapidly spreading, although they are often underestimated. Mobile health systems can be an easy and fast support to voice pathology detection. The identification of an algorithm that discriminates between pathological and healthy voices with more accuracy is necessary to realize a valid and precise mobile health system. . This technique is evaluated by based on experimental results deep neural networks with machine learning approach to provide an accuracy of 99.89% in detecting voice. In this field to detect any abnormal structure and analysis without human intervention in health care sector to enhance the utility of well beginning system.

Mobile Health (mHealth) in the Developing World: Two Decades of Progress or Retrogression

Mobile healthcare, or mHealth, is one of the key pillars of information and communication technologies for healthcare that consists of telemedicine, telehealth, eHealth, and mHealth. In the past two decades, mobile health has become a transformative concept for healthcare delivery innovations on a global scale. The success was based on the market-driven strategies that utilised the advances in mobile communications, computing, and sensor technologies, especially in recent years. Those market-driven mobile health systems were also closely associated with the global proliferation of smartphones, and based on the correlated usage principle of the smartphone applications for healthcare and wellbeing. However, the global commercial success of the smartphone-based mHealth model was not widely translated into successful scaled-up and tangible healthcare benefits, especially in low- and-middle income countries, compared to the consumer mobile health markets. The numerous healthcare challenges in the developing world remained largely untackled by the existing mobile health systems and models. The much-hyped transformative benefits of these systems remain largely unfulfilled. For two decades since the inception of this concept, the majority of the population in resource-limited healthcare settings still remain in poorer health and live in worsened conditions, with limited if any access to basic healthcare services. The much-hyped mobile health services that promised transforming these fragile and limited healthcare conditions, did not come to wider fruition globally. The COVID-19 pandemic, with its devastating human and economic impact worsened this status. An overview of the origin and the basic principles of mobile health, its current landscape and status in the developing world is presented. The impact of the smartphone-centric model that dominated the landscape of mobile health systems in these countries is discussed, and a critical view on the limitation of this mobile health model adopted widely in these settings is provided.

Self-adaptive and secure mechanism for IoT based multimedia services: a survey

With the advent of internet of things (IoT) and IoT multimedia services in real-time applications, including smart healthcare, smart home, and smart connected transportation, IoT multimedia systems have significantly enhanced the lifestyle. However, the increased number of connected heterogeneous IoT multimedia devices have resulted in several vulnerabilities and cyberattacks. The existing multimedia in IoT multimedia security solutions are insufficient for detecting such complex attacks and require a self-adaptive security mechanism that can monitor the changing environment and detect, mitigate, plan, and prevent future prospective attacks in real time. In this study, we conduct a study of several self-adaptive security approaches for IoT multimedia and analyze them based on critical, security metrics to determine their level of support and the achieved satisfaction for IoT multimedia services. The evaluation results show significant insights, challenges, and concerns in the existing approaches, which can provide vital information for the development of future IoT multimedia security research. We propose a self-adaptive security model for IoT multimedia and discuss a case utilizing a mobile e-health system, where we use an adaptation model (using monitor-analyze-plan-execute over a shared knowledge adaptation loop) to determine the adaptation requirement based on the confidence level of several security factors. The adaptation requirement depicts that adaptation is required for stabilizing the security factors in a continuous context-changing sustainable e-health IoT multimedia environment.

Electromyography-Driven Exergaming in Wheelchairs on a Mobile Platform: Bench and Pilot Testing of the WOW-Mobile Fitness System.

BackgroundImplementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements.ObjectiveThis study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system.MethodsWe developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire.ResultsBench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53% of that time (39%-59%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5.ConclusionsMobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility.