Self-monitoring Tools Research Articles

Development of Low-cost Thermal Imaging System as a Preliminary Screening Instrument

Abstract Thermography is a technique that offers high portability and poses absolutely no risk to the patient. Home monitoring of temperature has helped in the early diagnosis of foot ulcers in diabetic subjects. It is observed that the cost of a camera increases with the resolution, due to the enhancements made in the computation power, computer-based algorithms, and processing software. A need for an inexpensive, portable and easily usable self-monitoring tool for frequent examination and communication was achieved by developing this low-cost thermal imaging system. In this work, a low-cost, light-weight, and user-friendly thermal camera has been developed that can be used as a preliminary diagnostic tool for a wide range of applications such as skin cancer detection, monitoring thyroid disorders, identifying diabetic foot ulcers and fever screening. The device can be easily accessible and affordable to local clinics and homes, thereby making thermal imaging as a viable option for detection of abnormalities in temperature distribution over the human body in a non-contact and pain-free manner.

Development of Mobile Self-Monitoring Tool Prototype Based on User-Centered Design

This study aims to develop a mobile application prototype for self-monitoring. Exercising self-regulated learning is considered as one of the ways that can help students achieve their learning goals. One of the key components of self-regulated learning is self-monitoring, in which students could monitor their learning process. To make students get used to monitoring skill, a web-based application called self-monitoring tool was developed. User research was carried out by evaluating the existing web-based application via an interview. Findings from the interview were analyzed and used as requirements to develop the mobile application. By taking into account usability components and design principles, an interactive prototype of a mobile self-monitoring tool was designed for both student and instructor roles.

Implementing Experience Sampling Technology for Functional Analysis in Family Medicine - A Design Thinking Approach.

BackgroundA paradigm shift in health care from illness to wellbeing requires new assessment technologies and intervention strategies. Self-monitoring tools based on the Experience Sampling Method (ESM) might provide a solution. They enable patients to monitor both vulnerability and resilience in daily life. Although ESM solutions are extensively used in research, a translation from science into daily clinical practice is needed.ObjectiveTo investigate the redesign process of an existing platform for ESM data collection for detailed functional analysis and disease management used by psychological assistants to the general practitioner (PAGPs) in family medicine.MethodsThe experience-sampling platform was reconceptualized according to the design thinking framework in three phases. PAGPs were closely involved in co-creation sessions. In the ‘understand’ phase, knowledge about end-users’ characteristics and current eHealth use was collected (nominal group technique – 2 sessions with N = 15). In the ‘explore’ phase, the key needs concerning the platform content and functionalities were evaluated and prioritized (empathy mapping – 1 session with N = 5, moderated user testing – 1 session with N = 4). In the ‘materialize’ phase, the adjusted version of the platform was tested in daily clinical practice (4 months with N = 4). The whole process was extensively logged, analyzed using content analysis, and discussed with an interprofessional project group.ResultsIn the ‘understand’ phase, PAGPs emphasized the variability in symptoms reported by patients. Therefore, moment-to-moment assessment of mood and behavior in a daily life context could be valuable. In the ‘explore’ phase, (motivational) functionalities, technological performance and instructions turned out to be important user requirements and could be improved. In the ‘materialize’ phase, PAGPs encountered barriers to implement the experience-sampling platform. They were insufficiently facilitated by the regional primary care group and general practitioners.ConclusionThe redesign process in co-creation yielded meaningful insights into the needs, desires and daily routines in family medicine. Severe barriers were encountered related to the use and uptake of the experience-sampling platform in settings where health care professionals lack the time, knowledge and skills. Future research should focus on the applicability of this platform in family medicine and incorporate patient experiences.

Experiences of a Web-Based Quality of Life Self-Monitoring Tool for Individuals With Bipolar Disorder: A Qualitative Exploration.

BackgroundSelf-monitoring of symptoms is a cornerstone of psychological interventions in bipolar disorder (BD), but individuals with lived experience also value tracking holistic outcomes, such as quality of life (QoL). Importantly, self-monitoring is not always experienced positively by people with BD and may have lower than expected rates of engagement. Therefore, before progressing into QoL tracking tools, it is important to explore user perspectives to identify possible risks and benefits, optimal methods to support engagement, and possible avenues to integrate QoL self-monitoring practices into clinical work.ObjectiveThis study aimed to conduct a qualitative exploration of how individuals with BD engaged with a Web-based version of a BD-specific QoL self-monitoring instrument, the QoL tool.MethodsA total of 43 individuals with BD engaged with a self-management intervention with an optional Web-based QoL self-assessment tool as part of an overarching mixed method study. Individuals were later interviewed about personal experiences of engagement with the intervention, including experiences of gauging their own QoL. A thematic analysis was used to identify salient aspects of the experience of QoL self-monitoring in BD.ResultsIn total, 4 categories describing people’s experiences of QoL self-monitoring were identified: (1) breadth of QoL monitoring, (2) highlighting the positive, (3) connecting self-monitoring to action, and (4) self-directed patterns of use.ConclusionsThe findings of this research generate novel insights into ways in which individuals with BD experience the Web-based QoL self-assessment tool. The value of tracking the breadth of domains was an overarching aspect, facilitating the identification of both areas of strength and life domains in need of intervention. Importantly, monitoring QoL appeared to have an inherently therapeutic quality, through validating flourishing areas and reinforcing self-management efforts. This contrasts the evidence suggesting that symptom tracking may be distressing because of its focus on negative experiences and positions QoL as a valuable adjunctive target of observation in BD. Flexibility and personalization of use of the QoL tool were key to engagement, informing considerations for health care providers wishing to support self-monitoring and future research into Web- or mobile phone–based apps.

Presymptomatic Retinal Sensitivity Changes in Intermediate Age-Related Macular Degeneration Associated With New Retinal Fluid.

PurposeTo determine whether change in retinal sensitivity in areas with subretinal or intraretinal fluid secondary to age-related macular degeneration (AMD) precedes visual symptoms. If confirmed, retinal sensitivity testing could be used for home monitoring in AMD.MethodsIndividuals with intermediate AMD enrolled in a longitudinal study were seen every 6 months and underwent best-corrected visual acuity testing (BCVA), spectral domain–optical coherence tomography (SD-OCT), and microperimetry. Asymptomatic individuals who developed incidental, reading center–determined retinal fluid detected on SD-OCT were identified. The point-wise sensitivity (PWS) at the time of fluid detection was compared with 6 and 12 months prior.ResultsFourteen of 161 individuals developed fluid without symptoms. PWS over fluid areas at detection was reduced compared with 6 (difference −2.04 dB, P < 0.001) and 12 months (−2.27 dB, P < 0.001) prior. PWS over fluid areas was reduced compared with perifluid areas (difference −1.02 dB, P = 0.03), peripheral areas (−1.51 dB, P < 0.001), nonprogressed fellow eyes (−1.49 dB, P = 0.006), and nonprogressed age-matched intermediate AMD eyes (−2.29 dB, P = 0.001). No difference in BCVA was observed in eyes developing fluid compared to eyes that do not develop fluid (P = 0.76).ConclusionsRetinal areas with fluid on SD-OCT had a corresponding reduction in retinal sensitivity at the time of fluid detection compared with 6 and 12 months prior, in asymptomatic intermediate AMD without change in BCVA.Translational RelevanceDevelopment of self-monitoring tools to detect changes in retinal sensitivity may be helpful for early detection of retinal fluid suggestive of progression to neovascular AMD before acuity is affected.

Toward Digital Self-monitoring of Multiple Sclerosis: Investigating First Experiences, Needs, and Wishes of People with MS.

Digital self-monitoring, such as through smartphone applications (apps) or activity trackers, could be applied to monitor the health of people with multiple sclerosis (MS). This self-monitoring could facilitate personalized therapies and self-management of MS. The acceptance of digital self-monitoring tools by patients depends on them being able and willing to use these tools in their daily lives. In-depth interviews were conducted with seven adults with MS before and after participation in a study in which they used an activity tracker and an MS-specific smartphone app for 4 weeks. We inquired about experiences with the tools in daily life and needs and wishes regarding further development and implementation of digital self-monitoring for people with MS. The smartphone app and the activity tracker increased respondents' awareness of their physical status and stimulated them to act on the data. Challenges, such as confrontation with their MS and difficulties with data interpretation, were discussed. The respondents desired 1) adaptation of digital self-monitoring tools to a patient's personal situation, 2) guidance to increase the value of the data, and 3) integration of digital self-monitoring into treatment plans. These findings show that patients can provide detailed descriptions of their daily life experiences with new technologies. Mapping these experiences could help in better aligning the development and implementation of digital self-monitoring tools, in this case smartphones and activity trackers, with the needs and wishes of people with MS.

Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-management.

Heart failure affects 6.5 million Americans, with 1 million hospitalizations annually, a 22% readmission rate, and $31 billion in health care costs. Palliative care decreases symptom burden, readmissions, and costs. Many elderly patients have difficulty recognizing and reporting heart failure symptoms to their providers in a timely manner. Self-management tools with color-coded zones (green = "all clear," yellow = "caution," red = "take action") help patients recognize and respond to heart failure symptoms and reduce readmissions. The purpose of this quality improvement project was to develop, implement, and evaluate a low-literacy zone tool for heart failure self-management with home-based palliative care patients. An interdisciplinary palliative care team developed this zone tool. Health literacy was prescreened with the Newest Vital Sign instrument. Nurses provided the zone tool to patients and caregivers and instructed them in use of this tool for daily self-monitoring. In postimplementation surveys, participants rated the zone tool as easy to understand and helpful in recognizing and reporting symptoms. This project demonstrated feasibility of a new zone tool for heart failure self-management, resulting in a practice change for this home-based palliative care program. The interdisciplinary team eventually developed similar zone tools for cancer, cirrhosis, chronic obstructive pulmonary disease, dementia, and frailty self-management.

Understanding User Reactions and Interactions With an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Evaluation.

Purpose Internet-based interventions have the potential to reduce the disparity in access to psychological therapy that people with tinnitus currently experience. One example is the Tinnitus E-Programme, which, although freely available online, has not yet been formally evaluated. The purpose of this study was to evaluate past, current, and new users' reactions and interactions with the Tinnitus E-Programme. Method Study 1 used an online survey to gather past and current users' reactions to, and interactions with, the intervention (n = 27). Study 2 used interviews and a relaxation log to assess how new users implemented the skills they learned into their everyday lives (n = 13). Results Generally, users expressed positive views on the intervention content and design features. Users particularly valued the education about tinnitus and its management and the relaxation skills training, and use of these components was high. In contrast, user reactions to self-monitoring tools, an online support forum, and therapist support were mixed, and use was lower. Implementation was limited by instances of poor usability and accessibility, user engagement, and adherence to relaxation goals. Users' perceptions of the intervention's credibility and relevance and beliefs regarding a negative impact on their tinnitus influenced engagement. Users in both studies identified several benefits gained, including functional and emotional management, self-efficacy for managing and coping with tinnitus, understanding tinnitus and its management, social support, and acceptance of tinnitus. Conclusion Findings suggest that the intervention was acceptable to its target group but also highlighted some areas for improvement. These findings will be used to inform further optimization work.

Co-Design of a Mobile Health App for Heart Failure: Perspectives from the Team.

Using a Design Thinking and co-design methodology, hospital staff and consumers developed a novel mobile health app for heart failure self-management. Various stakeholders engaged in three development stages: interviews, design workshops and prototype iterations. Eleven of 18 co-design team members reflected on the co-design process and design outcomes. A total of 144 data points were collected: 96 about the co-design process and 48 about the design outcomes. Successes and failures reflect the strengths and weaknesses of operationalising co- design in practice. Overall, participants were surprised the design outcomes were achieved. The app was considered a supportive tool for meaningful self-monitoring and patients believed the app would be applicable to their situations. Our findings suggest that local co-design can be achieved through meaningful partnerships, and managing stakeholders was key to the projectâĂŹs success.

Modifiable factors associated with weight regain after bariatric surgery: a scoping review

Background: Although bariatric surgery is the most effective treatment for severe obesity, weight regain may still occur. While non-modifiable factors associated with weight regain have been explored, modifiable factors responsible for weight regain are understudied. This scoping review aimed to identify modifiable behaviors associated with weight regain after bariatric surgery. Methods: A systematic search was conducted in Medline, Google Scholar, Cochrane, National Collaborating Centre for Methods and Tools (NCCMT) and Practice-based Evidence in Nutrition (PEN) which included articles published between January 1990 and February 2 2017, for studies examining “weight regain” after bariatric surgery. A total of 293 citations were retrieved. Eligible articles must have examined modifiable factors and addressed weight regain, or a long-term post-operative phase in which weight regain may occur. After removing duplicates, 22 studies were included for thematic analysis. Results: Key modifiable factors associated with weight regain were identified and categorized under the following themes: poor dietary adherence (e.g. excessive calorie, carbohydrate, and alcohol intake), maladaptive eating behaviors (e.g. grazing, binging), lack of on-going follow-up with the bariatric team and insufficient physical activity. Conclusions: Health professionals and self-monitoring tools for patients who have undergone bariatric surgery may benefit from these findings to direct their education and interventions to target behavior change.

Modifiable factors associated with weight regain after bariatric surgery: a scoping review.

Background:Although bariatric surgery is the most effective treatment for severe obesity, weight regain may still occur. While non-modifiable factors associated with weight regain have been explored, modifiable factors responsible for weight regain are understudied. This scoping review aimed to identify modifiable behaviors associated with weight regain after bariatric surgery. Methods:A systematic search was conducted in Medline, Google Scholar, Cochrane, National Collaborating Centre for Methods and Tools (NCCMT) and Practice-based Evidence in Nutrition (PEN) which included articles published between January 1990 and February 2 2017, for studies examining "weight regain" after bariatric surgery. A total of 293 citations were retrieved. Eligible articles must have examined modifiable factors and addressed weight regain, or a long-term post-operative phase in which weight regain may occur.After removing duplicates, 22 studies were included for thematic analysis. Results:Key modifiable factors associated with weight regain were identified and categorized under the following themes: poor dietary adherence (e.g. excessive calorie, carbohydrate, and alcohol intake), maladaptive eating behaviors (e.g. grazing, binging), lack of on-going follow-up with the bariatric team and insufficient physical activity. Conclusions: Health professionals and self-monitoring tools for patients who have undergone bariatric surgery may benefit from these findings to direct their education and interventions to target behavior change.

Mobile health tools for the management of chronic respiratory diseases.

The market of mobile health (mHealth) technology is rapidly evolving, making new mobile technologies potentially available for healthcare systems. Patient empowerment through self-monitoring of symptoms, shared decision making with the physician, and easily accessible education are importantfeatures extending the reach of mHealth technology beyond traditional care. Two digital distribution platforms (Apple App Store and Google Play Store) were searched for currently available mobile applications (apps) for patients with chronic respiratory diseases (CRDs). A new index (score ranging from 0 to 10) was developed to assess the potential of apps as a tool to empower patients through mobile technology (based on self-monitoring, personalized feedback, and patient education app features). One hundred and twelve apps were retained for analysis and could be classified in 5 categories: Asthma (n=71), COPD (n=15), Asthma and COPD (n=15), Rhinitis and Asthma (n=5), and Rhinosinusitis (n=6). Eighty percent were developed by medical technology companies compared to 18% by medical doctors and 2% by pharmaceutical companies. Two-thirds of apps allow disease self-monitoring, whereas over half of apps provide patient feedback through graphs. Sixty percent of apps contain easily accessible patient education material. Only three percent of apps reach a score of ≥7 on the newly designed patient empowerment index. A variety of apps are available for patients with CRDs of which only few were developed by or jointly with medical doctors. The majority of these apps include self-monitoring tools, but only few also provide personalized feedback, which is needed to adopt these apps into daily care.

Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial

IntroductionObesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals’ utilisation of evidence-based...

Mobile Phone App for Self-Monitoring of Eating Rhythm: Field Experiment.

BackgroundTemporal aspects of eating are an integral part of healthy eating, and regular eating has been associated with good diet quality and more successful weight control. Unfortunately, irregular eating is becoming more common. Self-monitoring of behavior has been found to be an efficient behavioral change technique, but the solution should be simple enough to ensure long-lasting adherence.ObjectiveThis study aimed to explore the influence of self-monitoring of daily eating pattern with mobile phone app on eating rhythm, eating behavior tendencies, and the underlying motives and attitudes related to eating.MethodsA mobile phone app, Button, was developed for effortless self-monitoring of eating rhythm. The feasibility of the app was tested in a 30-day intervention. The participants (N=74) recorded their eating occasions during the intervention by pressing a button in the app widget.ResultsThe average interval between meals increased (96 [SD 24] min during the first 10 days vs 109.1[SD 36.4] during the last 10 days) and the number of daily eating occasions decreased (4.9 [SD 0.9] during the first 10 days vs 4.4 [SD 0.9] during the last 10 days). The tendencies for cognitive restraint, emotional eating, and uncontrolled eating increased. Eating-related attitudes and motives remained largely unchanged.ConclusionsThese results indicate that a simple self-monitoring tool is able to draw a user’s attention to eating and is a potential tool to aid people to change their eating rhythm.

A Mobile Phone-Based Self-Monitoring Tool for Perioperative Gastric Cancer Patients With Incentive Spirometer: Randomized Controlled Trial.

BackgroundAn incentive spirometer (IS) is a medical device used to help patients improve the functioning of their lungs. It is provided to patients who have had any surgery that might jeopardize respiratory function. An incentive spirometer plays a key role in the prevention of postoperative complications, and the appropriate use of an IS is especially well known for the prevention of respiratory complications. However, IS utilization depends on the patient’s engagement, and information and communication technology (ICT) can help in this area.ObjectiveThis study aimed to determine the effect of mobile ICT on the usage of an IS (Go-breath) app by postoperative patients after general anesthesia.MethodsFor this study, we recruited patients from April to May 2018, who used the Go-breath app at a single tertiary hospital in South Korea. The patients were randomly classified into either a test or control group. The main function of the Go-breath app was to allow for self-reporting and frequency monitoring of IS use, deep breathing, and active coughing in real time. The Go-breath app was identical for both the test and control groups, except for the presence of the alarm function. The test group heard an alarm every 60 min from 9 am to 9 pm for 2 days. For the test group alone, a dashboard was established in the nurse’s station through which a nurse could rapidly assess the performance of multiple patients. To evaluate the number of performances per group, we constructed an incentive spirometer index (ISI).ResultsA total of 44 patients were recruited, and 42 of them completed the study protocol. ISI in the test group was 20.2 points higher than that in the control group (113.5 points in the test group and 93.2 points in the control group, P=.22). The system usability scale generally showed almost the same score in the 2 groups (79.3 points in the test group and 79.4 points in the control group, P=.94). We observed that the performance rates of IS count, active coughing, and deep breathing were also higher in the test group but with no statistically significant difference between the groups. For the usefulness “yes or no” question, over 90% (38/42) of patients answered “yes” and wanted more functional options and information.ConclusionsThe use of the Go-breath app resulted in considerable differences between the test group and control group but with no statistically significant differences.Trial RegistrationClinicalTrials.gov NCT03569332; https://clinicaltrials.gov/ct2/show/NCT03569332 (Archived by WebCite at http://www.webcitation.org/74ihKmQIX).

Patients' experiences with a behaviour change intervention to enhance physical activity in primary care: A mixed methods study.

ObjectiveTo explore the experiences of patients at risk for cardiovascular disease in primary care with the Activate intervention in relation to their success in increasing their physical activity.MethodsA convergent mixed methods study was conducted, parallel to a cluster-randomised controlled trial in primary care, using a questionnaire and semi-structured interviews. Questionnaires from 67 patients were analysed, and semi-structured interviews of 22 patients were thematically analysed. Experiences of patients who had objectively increased their physical activity (responders) were compared to those who had not (non-responders). Objective success was analysed in relation to self-perceived success.ResultsThe questionnaire and interview data corresponded, and no substantial differences among responders and non-responders emerged. Participating in the intervention increased patients’ awareness of their physical activity and their physical activity level. Key components of the intervention were the subsequent support of nurses with whom patients’ have a trustful relationship and the use of self-monitoring tools. Patients highly valued jointly setting goals, planning actions, receiving feedback and review on their goal attainment and jointly solving problems. Nurses’ support, the use of self-monitoring tools, and involving others incentivised patients to increase their physical activity. Internal circumstances and external circumstances challenged patients’ engagement in increasing and maintaining their physical activity.ConclusionPatients experienced the Activate intervention as valuable to increase and maintain their physical activity, irrespective of their objective change in physical activity. The findings enable the understanding of the effectiveness of the intervention and implementation in primary care.Trial registrationClinicalTrials.gov NCT02725203.

Type 2 Diabetes Mobile Application for Supporting for Clinical Treatment: Case Development Report

As clinical treatments for type-2 diabetes patients using mobile application on smartphones have become more widely practiced, the technology has enabled patients to easily control and monitor their blood sugar levels themselves. Although, the technology development provides more options to improve type-2 diabetes treatment, not all applications developed are suitable for the real treatment as there might be different situations and treatments for different cases.Research questions occurred while attempting to develop a diabetes mobile application as a supportive learning and self-monitoring tool. These research questions are the followings: How are patients enabled to use the diabetes mobile application effectively? And what are necessary functions of the mobile application for diabetes? The objective of this research are (1) to analysis, design, and development of a type-2 diabetes mobile application (T2DM) (2) to test the application.The method starts with collecting users’ requirements from diabetes experts, type-2 diabetes patients and their relatives for using the type-2 diabetes literacy-learning tool. Five qualified diabetes experts and five pairs of diabetes patients with their relatives were investigated for gathering users’ requirements that lead to necessary functions for the development. After the T2DM is completely developed, 18 medical staffs and 20 diabetes patients and patient relatives tested the T2DM by using the application.Conclusion: When designing the more effective T2DM, developing of necessary functions by users’ involvement ensures that requirements were analyzed and tested. It has been found that the nutrition function is the most significant piece of information for the T2DM, and also the key point of the development. At the same time, the functions for blood sugar recording and information sending are the most supportive and helpful functions for users.

The Effects of Dietary Mobile Apps on Nutritional Outcomes in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis

BackgroundDietary interventions are effective prevention and treatment strategies for chronic diseases; however, they require extensive commitment, time, and resources. Dietary mobile applications (apps) have gained popularity and are thus being incorporated into dietary management. ObjectiveThe aim of this review is to assess the effects of the use of dietary mobile apps on nutritional outcomes in adults with chronic diseases. MethodsA systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using MEDLINE, PubMed, Embase, and CINAHL databases. The protocol was registered on PROSPERO. Intervention studies evaluating the nutritional outcomes of dietary apps, published in English between January 1, 2007 and November 15, 2017 were included. The methodological quality of included articles was assessed via the Academy of Nutrition and Dietetics’ Quality Criteria Checklist: Primary Research. Heterogeneity was confirmed using the I2 index and a random-effects meta-analysis was performed for randomized controlled trials. Estimates of the pooled mean difference were calculated for app usage compared to no app usage. Main outcomes measureNutritional outcomes, categorized as food-/nutrition-related, anthropometric measurements, pertinent clinical/biochemical data, and nutrition-focused physical findings, were extracted from the included intervention studies. ResultsUpon completion of the searches, 18,649 articles were identified, and data were extracted from 22 articles. Pooled estimates showed a significantly greater decrease in weight (–2.45 kg, 95% CI –3.33 to –1.58 kg; P<0.001; I2=96.2%, 95% CI 95% to 97%), waist circumference (–2.54 cm, 95% CI –3.34 to –1.73 cm; P<0.001; I2=88.3%, 95% CI 67% to 96%), and energy intake (–149.52 kcal, 95% CI –215.78 to –83.27 kcal; P<0.001; I2=0% CI 0% to 90%) when an app was used compared to control. ConclusionsThe findings of this systematic review and meta-analysis indicate that dietary mobile apps are effective self-monitoring tools, and that their use results in positive effects on measured nutritional outcomes in chronic diseases, especially weight loss.

Study protocol of the self-monitoring activity program: Effects of activity on incident dementia

IntroductionNumerous studies have focused on nonpharmacological interventions on cognitive function and the effects of cognitive function on daily living. However, effects of behavior change techniques that promote physical, cognitive, and social activities on cognitive function and incident dementia in the elderly are yet to be elucidated. In this study, we aimed to design a single-blind, randomized controlled trial to study dementia prevention effects of behavior change techniques, using an accelerometer and a newly developed daily activity booklet in community-living older adults. MethodsThe study cohort comprised 5390 individuals aged 65 years and older who were randomized into one of the following three groups: accelerometer group (n = 1508), accelerometer and daily activity booklet group (n = 1180), or a control group (n = 2702; vs. accelerometer group [n = 1509] vs. accelerometer and daily activity booklet group [n = 1193]). Incident dementia was diagnosed based on the Japanese Health Insurance System data. The participants without dementia at baseline, who are diagnosed with dementia over a 36-month follow-up period, are considered to have incident dementia. The participants of the accelerometer group were asked to wear the accelerometer everyday and visit a site having data readers to download the accelerometer data every month. The subjects of the booklet group were requested to not only wear the accelerometer but also record the physical, cognitive, and social activities. The participants receive a feedback report from the data of the accelerometer and booklet. DiscussionThe study has the potential to provide the first evidence of effectiveness of the self-monitoring tools in incident dementia. In case our trial results suggest a delayed dementia onset upon self-monitoring interventions, the study protocol will provide a cost-effective and safe method for maintaining a healthy cognitive aging.

The Use and Effects of Electronic Health Tools for Patient Self-Monitoring and Reporting of Outcomes Following Medication Use: Systematic Review.

BackgroundElectronic health (eHealth) tools are becoming increasingly popular for helping patients’ self-manage chronic conditions. Little research, however, has examined the effect of patients using eHealth tools to self-report their medication management and use. Similarly, there is little evidence showing how eHealth tools might prompt patients and health care providers to make appropriate changes to medication use.ObjectiveThe objective of this systematic review was to determine the impact of patients’ use of eHealth tools on self-reporting adverse effects and symptoms that promote changes to medication use. Related secondary outcomes were also evaluated.MethodsMEDLINE, EMBASE, and CINAHL were searched from January 1, 2000, to April 25, 2018. Reference lists of relevant systematic reviews and included articles from the literature search were also screened to identify relevant studies. Title, abstract, and full-text review as well as data extraction and risk of bias assessment were performed independently by 2 reviewers. Due to high heterogeneity, results were not meta-analyzed and instead presented as a narrative synthesis.ResultsA total of 14 studies, including 13 randomized controlled trials (RCTs) and 1 open-label intervention, were included, from which 11 unique eHealth tools were identified. In addition, 14 RCTs found statistically significant increases in positive medication changes as a result of using eHealth tools, as did the single open-label study. Moreover, 8 RCTs found improvement in patient symptoms following eHealth tool use, especially in adolescent asthma patients. Furthermore, 3 RCTs showed that eHealth tools might improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of eHealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behavior, health service utilization, adverse effects, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy.ConclusionsEvidence suggests that the use of eHealth tools may improve patient symptoms and lead to medication changes. Patients generally found eHealth tools useful in improving communication with health care providers. Moreover, health-related outcomes among frequent eHealth tool users improved in comparison with individuals who did not use eHealth tools frequently. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how eHealth tools can be used to effectively manage use of medications to improve medication management and patient outcomes.