Training Apps Research Articles

RETRACTED: Music education: Which is more effective – Traditional learning or the introduction of modern technologies to increase student motivation?

The introduction of mobile technologies and platforms in music education improves the efficiency of the educational process and can influence the motivation of students in higher educational institutions. The purpose of this study was to compare the effectiveness of the traditional educational program and the program with the introduction of interactive music services, as well as to identify the impact of the introduction of specialized applications in the vocal training process on student motivation. The study relies on two vocal training apps: Yousician and Voice Training: Learn To Sing. A total of 322 students from three Chinese educational institutions took part in the experiment. The effectiveness of the use of mobile applications in the context of teaching students vocal skills and increasing their motivation for learning was established. It is worth noting that the Voice Training: Learn To Sing application has shown itself to be more effective, which can be explained by the clear specialization of this software, while Yousician was created not only to teach learners to sing but also to play musical instruments, which is what most of the app functionality is devoted to. There was an increase in the motivation of students from groups B and C when using interactive mobile environments by 24.8 % and 38.8 %, respectively. It was also shown that high rates of student motivation were ensured by the introduction of modern interactive environments in vocal training. This study can help in shaping the experience of using modern technologies in the context of rising student motivation.

Factors Associated With the Experience of Cognitive Training Apps for the Prevention of Dementia: Cross-sectional Study Using an Extended Health Belief Model.

BackgroundThe prevalence and economic burden of dementia are increasing dramatically. Using information communication technology to improve cognitive functions is proven to be effective and holds the potential to serve as a new and efficient method for the prevention of dementia.ObjectiveThe aim of this study was to identify factors associated with the experience of mobile apps for cognitive training in middle-aged adults. We evaluated the relationships between the experience of cognitive training apps and structural variables using an extended health belief model.MethodsAn online survey was conducted on South Korean participants aged 40 to 64 years (N=320). General characteristics and dementia knowledge were measured along with the health belief model constructs. Statistical analysis and logistic regression analysis were performed.ResultsHigher dementia knowledge (odds ratio [OR] 1.164, P=.02), higher perceived benefit (OR 1.373, P<.001), female gender (OR 0.499, P=.04), and family history of dementia (OR 1.933, P=.04) were significantly associated with the experience of cognitive training apps for the prevention of dementia.ConclusionsThis study may serve as a theoretical basis for the development of intervention strategies to increase the use of cognitive training apps for the prevention of dementia.

Improvement in executive function for older adults through smartphone apps: a randomized clinical trial comparing language learning and brain training

ABSTRACT Bilingualism has been linked to improved executive function and delayed onset of dementia, but it is unknown whether similar benefits can be obtained later in life through deliberate intervention. Given the logistical hurdles of second language acquisition in a randomized trial for older adults, few interventional studies have been done thus far. However, recently developed smartphone apps offer a convenient means to acquire skills in a second language and can be compared with brain training apps specifically designed to improve executive function. In a randomized clinical trial, 76 adults aged 65–75 were assigned to either 16 weeks of Spanish learning using the app Duolingo 30 minutes a day, an equivalent amount of brain training using the app BrainHQ, or a waitlist control condition. Executive function was assessed before and after the intervention with preregistered (NCT03638882) tests previously linked to better performance in bilinguals. For two of the primary measures: incongruent Stroop color naming and 2-back accuracy, Duolingo provided equivalent benefits as BrainHQ compared to a control group. On reaction time for N-back and Simon tests, the BrainHQ group alone experienced strong gains over the other two groups. Duolingo was rated as more enjoyable. These results suggest that app-based language learning may provide some similar benefits as brain training in improving executive function in seniors but has less impact on processing speed. However, future advancements in app design may optimize not only the acquisition of the target language but also the side benefits of the language learning experience.

The Impact of a Gameful Breathing Training Visualization on Intrinsic Experiential Value, Perceived Effectiveness, and Engagement Intentions: Between-Subject Online Experiment.

BackgroundSlow-paced breathing has been shown to be positively associated with psychological and physiological health. In practice, however, there is little long-term engagement with breathing training, as shown by the usage statistics of breathing training apps. New research suggests that gameful smartphone-delivered breathing training may address this challenge.ObjectiveThis study assesses the impact of breathing training, guided by a gameful visualization, on perceived experiential and instrumental values and the intention to engage in such training.MethodsA between-subject online experiment with 170 participants was conducted, and one-way multiple analysis of variance and two-tailed t test analyses were used to test for any difference in intrinsic experiential value, perceived effectiveness, and the intention to engage in either a breathing training with a gameful or a nongameful guidance visualization. Moreover, prior experience in gaming and meditation practices were assessed as moderator variables for a preliminary analysis.ResultsThe intrinsic experiential value for the gameful visualization was found to be significantly higher compared to the nongameful visualization (P=.001), but there was no difference in either perceived effectiveness (P=.50) or the intention to engage (P=.44). The preliminary analysis of the influence of meditation and gaming experience on the outcomes indicates that people with more meditation experience yielded higher intrinsic experiential values from using the gameful visualization than people with no or little meditation experience (P=.03). This analysis did not find any additional evidence of gaming time or meditation experience impacting the outcomes.ConclusionsThe gameful visualization was found to increase the intrinsic experiential value of the breathing training without decreasing the perceived effectiveness. However, there were no differences in intentions to engage in both breathing training conditions. Furthermore, gaming and meditation experiences seem to have no or only a small positive moderating effect on the relationship between the gameful visualization and the intrinsic experiential value. Future longitudinal field studies are required to assess the impact of gameful breathing training on actual behavior, that is, long-term engagement and outcomes.

Exploring User Needs in the Development of a Virtual Reality-Based Advanced Life Support Training Platform: Exploratory Usability Study.

BackgroundTraditional methods of delivering Advanced Life Support (ALS) training and reaccreditation are resource-intensive and costly. Interactive simulations and gameplay using virtual reality (VR) technology can complement traditional training processes as a cost-effective, engaging, and flexible training tool.ObjectiveThis exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms.MethodsSemistructured interviews were conducted with experienced clinicians (n=10, median age=40.9 years) following a single playthrough of the application. All clinicians have been directly involved in the delivery of ALS training in both clinical and educational settings (median years of ALS experience=12.4; all had minimal or no VR experience). Interviews were supplemented with an assessment of usability (using heuristic evaluation) and presence.ResultsThe ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles.ConclusionsThis study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities.

User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study

BackgroundSwallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits.ObjectiveThe aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties.MethodsA total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews).ResultsThe quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience.ConclusionsTo the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.

Global, economic and technological trends in human resource management development

Background: A manager is the one who is responsible for accomplishing the tasks of the organization and who directs the efforts of the organization's employees for this purpose. In this paper, we will focus on one of the functions of management - the function of personnel management and on some trends that the 21st century has brought. Objectives: of this paper is to explore and identify innovative ways and trends, global, economic and technological shifts in human resource management. Methods/approach.: We have studied the experience that exists for effective and innovative use of freelancers, social networks and internet applications. We brought them in contact with a number of macroeconomic agents and set out directions and outlines for further research. Results: In close collaboration with line managers, HR managers have been helping employers to find, hire, dismiss, administer and evaluate employees. However, there are trends in personnel management that substantially change perceptions of how well employers are coping with their HR tasks. Conclusion: HR department's style and methods are constantly changing. Because of this, many employers are re-examining the organization of their HR functions. These types of HR centres carry out their activities through intranets (centralized networks) or centralized call centres; Feedback, jokes, and game-specific targeting coincide with many new training apps, and websites such as Knack, Gild, and True Office allow an employer to incorporate game features in training, performance evaluation and recruitment.).

ASSESSMENT OF PALLIATIVE CARE TRAINING NEEDS FOR CERTIFIED NURSING ASSISTANTS

It is unknown whether certified nursing assistants (CNAs) receive up-to-date palliative care training through continuing education. Also unclear is whether existing trainings cover the issues that CNAs encounter at work or are tailored to CNAs’ learning styles and preferences. This study aimed to assess the palliative care training needs of CNAs working at skilled nursing facilities (SNFs) in northern Illinois. CNAs (n=127) from 6 SNFs completed an online survey regarding palliative care training experience, perceived needs for palliative care training, and demographic and work-related information. The majority of the participants were female (88%) and White (58%) or African American (20%). On average, participants were 34 years old and worked for 8 years in the field. Four out of five preferred a training 90 minutes or shorter. Approximately one half preferred in-person training, and the rest preferred a hybrid (32%) or online delivery (19%). Discussions and videos were most preferred in training, while quizzes and mobile apps were least preferred. CNAs who worked longer in the field were less likely to have received training than their counterparts. The least-trained areas included utilizing advance directives and discussing death with patients. The most needed training areas were talking to a patient who wants to hasten death and addressing the complex needs of dying patients. The results indicate a relative deficiency of palliative care training among CNAs who have worked longer in the field. Training areas needing more attention include advance directives, discussing death with patients, and the complex needs of dying patients.

Computerized Training for Neuroplasticity and Cognitive Improvement

The research area of brain plasticity studies indicates that individuals can train and improve their cognitive abilities throughout life. In addition, more and more computerized training tools are presented in recent studies. The purpose of this study is to represent studies of the last decade in the field of cognitive training with the use of Information and Communication Tech-nologies, to record the cognitive improvement techniques used, as well as to evaluate the effectiveness of these intervention programs. As indicated by the literature review, computer-based tools, mobile training apps and video games could be used in intervention studies for cognitive improve-ment. In addition, cognitive training techniques seem to be significantly ef-fective for the cognitive improvement of healthy or cognitive impaired in-dividuals.

Spatial task solving on tablets: analysing mental and physical rotation processes of 12–13-year olds

Spatial skill assessment and training are promising fields of application for tablets, as touch-based interaction can prime and support mental transformations of spatial knowledge. We report on a study with 49 secondary school students who used our iPad app to solve mental and physical rotation tasks. During physical rotation, students were able to rotate 3D stimuli using touch interaction. Results show specific similarities (e.g., regarding angular disparity effects) as well as differences between mental and physical conditions, such as for task success, mental effort, efficiency; all to the advantage of the physical condition. 12–13-year olds can benefit from these advantages without previous task training, whereas previous research showed this to be different for younger students. In a second step, our analysis compares low and high achievers regarding physical rotation behaviour and motivational variables, including expected success. The results lay grounds for constructing individualized, tablet-based training apps for spatial skills.

FROM COMPUTER LITERACY TO DIGITAL TRANSFORMATION OF EDUCATION

The publishing of the 300th issue of the INFO magazine coincided with the approval of the Passport of the National Digital Economy Program. One of the Program' task is the development of the promising Digital Educational and Methodological Complexes (DEMC) that should transform the informatics’ classes at the public school. This event is considered as a step to the digital transformation of the Russian school. Digital transformation is considered as harnessing digital technologies to increase the productivity and value of an enterprise. Digital transformation of education is considered as the controlled and/or spontaneous process of the transformation of the content, methods and organizational forms of educational activities, which is aimed at improving the quality of schools in a rapidly developing digital environment to meet the requirements of the digital economy. The development of Digital Educational and Methodological Complexes, smart simulation and training apps and virtual laboratories provided by the Passport of the National Digital Economy Program for the implementation of general secondary and vocational education programs for areas of “Mathematics”, “Informatics” and “Technology” is аn important step towards the digital transformation of education. The DEMC for informatics curriculum that will be created under the Digital Economy Program has to predetermine the formation of digital literacy of the younger generation in the next decade. The features of the promising DEMC for informatics, which the author would like to see in it, are discussed.

Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review.

BackgroundBreast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient’s home.ObjectiveThis systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients.MethodsWe searched in a systematic way all the full-text articles from the PubMed and Embase databases.ResultsWe found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention.ConclusionsThese results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients.

Visuospatial Executive Functions are Improved by Brief Brain Training in Young Rugby Players - Evidence of Far Transfer Test Effects: A Pilot Study

Brain training apps are becoming increasingly popular for at home use and as an adjunct to more traditional therapies. There is uncertainty about whether the effects of brain training transfer to real-world cognition, or performance on other cognitive assessment tests, or is specific only to the brain training app. Executive functions (EF’s) are higher-order cognitive processes important for activities of everyday living and autonomous goal-directed behaviour [1]. EF’s are associated with frontal brain networks that are susceptible to injury after head trauma and concussion so it is important to know whether these functions can be trained after a short training period (transfer effects beyond gains on app play), to general cognitive ability but findings so far have been mixed. The present study investigated efficacy of brief computerised brain training to in producing far-transfer effects to performance on standardised clinical tests of cognition in young rugby players with mixed concussion history, over a 4-week period. Athletes cognitive ability was assessed at baseline and after the training period on standardised tests to establish whether there were transfer effects. The putative relationship between concussion frequency and severity on baseline cognitive performance was also investigated. Results showed effective transfer effects from initial training to selective visuospatial executive functions. There was also a decline over the training period in non-verbal strategy initiation, although ability remained at average levels. Players showed no cognitive deficits at baseline, but correlational analyses and MR results indicated that concussion frequency, not severity, was a significant predictor of some visuospatial executive function scores at baseline. These preliminary findings hold promise for full scale studies investigating efficacy of brief brain training and association between sport-related concussion and cognition.

Identifying and improving adherence to the gluten-free diet in people with coeliac disease.

Coeliac disease (CD) is an autoimmune gastrointestinal disorder whereby the ingestion of gluten, a storage protein found in wheat, barley and rye, causes damage to intestinal mucosa with resultant malabsorption, increased risk of anaemia and osteoporosis. Worldwide estimates suggest 1% of the population have CD. With no cure, the only treatment is a gluten-free diet (GFD). Adhering to a GFD can be very challenging; it requires knowledge, motivation and modified behaviours. Assessing adherence to a GFD is methodologically challenging. This review aims to provide an overview of the literature reporting adherence to a GFD in people with CD and the methodological challenges encountered. From six studies it has been reported that rates of adherence to a GFD range between 45 and 90% in patients of different ethnicities with CD. GF dietary adherence can be influenced by age at diagnosis, coexisting depression, symptoms on ingestion of gluten, nutrition counselling, knowledge of GF foods, understanding of food labels, cost and availability of GF foods, receiving GF foods on prescription and membership of a coeliac society. To date only five intervention studies in adults with CD have been undertaken to improve GF dietary adherence. These have included dietary and psychological counselling, and the use of online training programmes, apps, text messages and telephonic clinics. Future interventions should include people of all ethnicities, consider patient convenience and the cost-effectiveness for the healthcare environment.

Heart Rate Variability and Cognitive Bias Feedback Interventions to Prevent Post-deployment PTSD: Results from a Randomized Controlled Trial.

There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed. This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretation (CBM-I), and control. The hypothesis was that pre-deployment resilience training would result in lower post-deployment PTSD symptoms compared with control. Army National Guard soldiers (n = 342) were enrolled in the Warriors Achieving Resilience (WAR) study and analyzed. The outcome was PTSD symptom severity using the PTSD Checklist - Military version (PCL) measured at pre-deployment, 3- and 12-month post-deployment. Due to the repeated measures for each participant and cluster randomization at the company level, generalized linear mixed models were used for the analysis. This study was approved by the Army Human Research Protection Office, Central Arkansas Veterans Healthcare System Institutional Review Board (IRB), and Southeast Louisiana Veterans Health Care System IRB. Overall, there was no significant intervention effect. However, there were significant intervention effects for subgroups of soldiers. For example, at 3-months post-deployment, the HRVB arm had significantly lower PCL scores than the control arm for soldiers with no previous combat zone exposure who were age 30 and older and for soldiers with previous combat zone exposure who were 45 and older (unadjusted effect size -0.97 and -1.03, respectively). A significant difference between the CBM-I and control arms was found for soldiers without previous combat zone exposure between ages 23 and 42 (unadjusted effect size -0.41). Similarly, at 12-months post-deployment, the HRVB arm had significantly lower PCL scores in older soldiers. Pre-deployment resilience training was acceptable and feasible and resulted in lower post-deployment PTSD symptom scores in subgroups of older soldiers compared with controls. Strengths of the study included cluster randomization at the company level, use of iPod device to deliver the resilience intervention throughout the deployment cycle, and minimal disruption of pre-deployment training by using self-paced resilience training. Weaknesses included self-report app use, study personnel not able to contact soldiers during deployment, and in general a low level of PTSD symptom severity throughout the study. In future studies, it would important for the study team and/or military personnel implementing the resilience training to be in frequent contact with participants to ensure proper use of the resilience training apps.

Review of Auditory Training Mobile Apps for Adults With Hearing Loss

Purpose The purpose of this article was to describe currently available mobile auditory training apps and to assist clinicians in the selection and future use of apps for their clients. Method Two ...

The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials.

The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.

Skills Training via Smartphone App for University Students with Excessive Alcohol Consumption: a Randomized Controlled Trial

PurposeUniversity students in a study on estimated blood alcohol concentration (eBAC) feedback apps were offered participation in a second study, if reporting continued excessive consumption at 6-week follow-up. This study evaluated the effects on excessive alcohol consumption of offering access to an additional skills training app.MethodA total of 186 students with excessive alcohol consumption were randomized to an intervention group or a wait list group. Both groups completed online follow-ups regarding alcohol consumption after 6 and 12 weeks. Wait list participants were given access to the intervention at 6-week follow-up. Assessment-only controls (n = 144) with excessive alcohol consumption from the ongoing study were used for comparison.ResultsThe proportion of participants with excessive alcohol consumption declined in both intervention and wait list groups compared to controls at first (p < 0.001) and second follow-ups (p = 0.054). Secondary analyses showed reductions for the intervention group in quantity of drinking at first follow-up (−4.76, 95% CI [−6.67, −2.85], Z = −2.09, p = 0.037) and in frequency of drinking at both follow-ups (−0.83, 95% CI [−1.14, −0.52], Z = −2.04, p = 0.041; −0.89, 95% CI [−1.16, −0.62], Z = −2.12, p = 0.034). The odds ratio for not having excessive alcohol consumption among men in the intervention group compared to male controls was 2.68, 95% CI [1.37, 5.25] (Z = 2.88, p = 0.004); the figure for women was 1.71, 95% CI [1.11, 2.64] (Z = 2.41, p = 0.016).ConclusionSkills training apps have potential for reducing excessive alcohol use among university students. Future research is still needed to disentangle effects of app use from emailed feedback on excessive alcohol consumption and study participation.Trial RegistrationNCT02064998

The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial.

BackgroundMobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes.ObjectiveThe objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression.MethodsParticipants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant’s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed.ResultsWe randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04).ConclusionsMobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In particular, an app that is designed to engage cognitive correlates of depression had the strongest effect on depressed mood in this sample. This study suggests that mobile apps reach many people and are useful for more moderate levels of depression.ClinicalTrialClinicaltrials.gov NCT00540865; https://www.clinicaltrials.gov/ct2/show/NCT00540865 (Archived by WebCite at http://www.webcitation.org/6mj8IPqQr)

Democratizing Neurorehabilitation: How Accessible are Low-Cost Mobile-Gaming Technologies for Self-Rehabilitation of Arm Disability in Stroke?

Motor-training software on tablets or smartphones (Apps) offer a low-cost, widely-available solution to supplement arm physiotherapy after stroke. We assessed the proportions of hemiplegic stroke patients who, with their plegic hand, could meaningfully engage with mobile-gaming devices using a range of standard control-methods, as well as by using a novel wireless grip-controller, adapted for neurodisability. We screened all newly-diagnosed hemiplegic stroke patients presenting to a stroke centre over 6 months. Subjects were compared on their ability to control a tablet or smartphone cursor using: finger-swipe, tap, joystick, screen-tilt, and an adapted handgrip. Cursor control was graded as: no movement (0); less than full-range movement (1); full-range movement (2); directed movement (3). In total, we screened 345 patients, of which 87 satisfied recruitment criteria and completed testing. The commonest reason for exclusion was cognitive impairment. Using conventional controls, the proportion of patients able to direct cursor movement was 38–48%; and to move it full-range was 55–67% (controller comparison: p>0.1). By comparison, handgrip enabled directed control in 75%, and full-range movement in 93% (controller comparison: p<0.001). This difference between controllers was most apparent amongst severely-disabled subjects, with 0% achieving directed or full-range control with conventional controls, compared to 58% and 83% achieving these two levels of movement, respectively, with handgrip. In conclusion, hand, or arm, training Apps played on conventional mobile devices are likely to be accessible only to mildly-disabled stroke patients. Technological adaptations such as grip-control can enable more severely affected subjects to engage with self-training software.