Using Digital Health Technology to Optimise Older People’s Pain Self-Management Capabilities: A Mixed Methods Study (The DigiTech Pain Project)

Background Arthritic pain is a major cause of illness and disability among older people. As the use of smartphones and apps increases in the lives of older people, there is an opportunity to explore the role of these apps in helping older people better manage their arthritic pain. Aim To explore the feasibility and acceptability of older people using an arthritic pain selfmanagement app to improve their pain symptoms. Methods A parallel convergent, mixed methods design underpinned by Bandura’s Self-Efficacy Theory and the Technology Acceptance Model 2; comprising of the following five studies: (i) Study 1a: an integrative review; (ii) Study 1b: a systematic review; (iii) Study 2a: a phase I feasibility study of pre–post-test design; (iv) Study 2b: a qualitative sub-study involving participants of study; and (v) Study 3: a qualitative interview study with primary care and allied health clinicians. The data from these studies was integrated to answer the project’s research questions. Results Study 1a revealed paucity of evidence on use of apps for older people’s pain selfmanagement. Study 1b indicated that few publicly available pain self-management apps are based on robust evidence. Eighteen older people were recruited into Study 2a, 80% via snowballing. Over 59% of participants were provided face-to-face app download and use training, none had used a pain self-management app in the past. Telephone-based survey and interview data collection was found to be acceptable to older people. Almost 90% of study 2a participants (n=16) took part in study 2b sharing their experiences of using the intervention app. Following four themes emerged: (i) Apps are valuable selfmanagement tool, but they do have the potential for harm; (ii) pain self-management apps need to be strictly relevant to the user; (iii) Clinicians’ involvement is crucial; and (iv) pain self-management apps must be designed with the end user in mind. Study 3 recruited seventeen (n=17) primary care and allied health clinicians who shared their perceptions and attitudes regarding app use by their older patients for pain self-management. Four themes emerged: (i) self-management apps are a potentially useful tool but require careful consideration; (ii) clinicians’ involvement is crucial yet potentially onerous; (iii) no single app is right for every older person; and (iv) patient data access is beneficial but caution is needed for real-time data access. Meta-inference of the data from all five studies indicated that an app intervention involving older people was both feasible and acceptable, with the following caveats: snowballing recruitment may be required; and access to app download and use training is an important element to implement into the study design. Older people and primary care clinicians were keen to engage with pain self-management apps; however, they wanted these apps to offer high level usefulness, adaptability and information sharing features. Future pain self-management apps need to be underpinned by robust evidence, while providing appropriate support and resources to clinicians. Conclusion While older people and their clinicians welcomed the opportunity to use pain self-management apps, their engagement ought to be supported by systems level policies, and high-quality apps. Collaboration among clinicians, older people, researchers and app developers ought to be considered when developing, researching and integrating pain self-management apps

Framework to Evaluate Emerging Systems Designed to Health Field

In recent years, several information and communication technology systems have emerged as tools to improve sleep quality. Research reveals that poor sleep quality may produce irritability and deficits in performance, concentration, and learning ability in the short term, and is associated with chronic disease in the long term. ICT proposals range from the old Polysomnography (PSG) to innovative systems, such as wearable devices, smartphone applications, and suites of sensors embedded in the users’ environment. Since these technological developments concern a health issue, they have raised important questions regarding their reliability and the level of rigor of the evaluations to which they are submitted. We found that some of the emerging systems that we studied, do not meet the requirements that health science demands to be accepted as clinical tools. The rationale behind this apparent weakness is explained with arguments from the field of evaluations for health interventions and evaluation of technological developments. We propose a framework to evaluate this kind of systems through appropriate scientific methods that provide valuable information to the research. These methods must be performed while designs mature and the feasibility of rigorous evaluations became appropriate

Meeting them where they are: Using the Internet to deliver behavioral medicine interventions for pain

Pharmacological and interventional pain medicine treatments are emphasized in the routine treatment of chronic pain despite strong evidence for the efficacy and safety of behavioral approaches. Most medical professionals have not incorporated behavioral pain treatments into their practices. Internet-based interventions have the potential to increase clinical use of these treatments. We discuss the strengths and weaknesses of current Internet-based behavioral pain management interventions, focusing on three broad intervention categories: therapist-guided interventions, unguided (automated) interventions, and pain-relevant applications for mobile platforms. Examples of each category are discussed, revealing a high degree of variation in approaches, user interfaces, and components as well as variability in the degree to which these interventions have been subjected to empirical testing. Finally, we highlight key issues for research and clinical implementation, with the goal of advancing this field so that it can meet its potential to increase access to evidence-based behavioral medicine treatments for chronic pain

Implementing the Latvian Early Intervention Program (LAT-EIP) for Patients With Schizophrenia Spectrum First-Episode Psychosis : Study Protocol

Funding Information: The study authors thank all of the psychiatrists at Daugavpils Psychoneurological Hospital for their involvement in the practical aspects for realizing the LAT-EIP. Thanks to the Latvian Psychiatric Association for professional support in developing the program. We also thank the State Employment Agency for the collaboration contract to provide the program with a vocational specialist. All study authors want to express their appreciation to the patients and their families for being involved in the study. Publisher Copyright: © Copyright © 2019 Berze, Civcisa, Krone, Kvartalovs, Kikuste, Sapele, Lazovika and Rancans.Background: Patients with first-episode psychosis are mainly young people in the active phase of their social and professional lives, and psychosis is a serious disruption of normal life with high risk of disability. Integrated biopsychosocial early intervention treatment is crucial for patients with first-time psychosis episode. The purpose of this trial is to adapt the first early intervention program for patients with first-time non-affective psychosis in Latvia, and to investigate whether it is possible to integrate this kind of treatment approach in the frame of existing services and whether it provides better outcomes for patients than existing services. Design/Methods: The study has a nonrandomized controlled design in a real-life environment. Participants are all consecutive patients presenting in the psychiatric emergency room with first-time non-affective schizophrenia spectrum psychosis episode (ICD criteria F23, F20) from a catchment area of 262,541 inhabitants, with urban and rural regions. The Latvian Early Intervention Program is a 6-month program developed from existing treatment guidelines and recommendations and adapted to a low-resource environment, integrated in an existing outpatient unit. This study aimed to test the hypothesis that the patients who received intervention have milder symptoms, higher functioning, and better adherence to outpatient treatment. The study primary aims are: 1) to establish and examine in practice the adapted early intervention for patients with first schizophrenia spectrum psychosis; 2) compare clinical and functional outcomes (including occupation, housing, and social relationships) between intervention treatment and standard treatment; and 3) compare the number of rehospitalizations, adherence to outpatient treatment, and assigned disability. Secondary aims are: 1) to compare full recovery status in both treatment groups at 12 months follow-up and 2) to develop recommendations for establishing early intervention programs in limited resource settings. Discussion/Conclusions: Across the world, there is wide inequality in the availably and accessibility to early intervention treatment. This study will increase our knowledge in early intervention treatment approach and outcomes for patients with schizophrenia spectrum first psychosis episode in real-life working clinical practices. We hope to provide theoretical and practical aspects to develop strategies for early intervention service implementation in limited resource mental healthcare settings.Peer reviewe

Tinnitus Guidelines and Their Evidence Base

Evidence-based medicine (EBM) is generally accepted as the gold standard for high-quality medicine and, thus, for managing patients with tinnitus. EBM integrates the best available scientific information with clinical experience and patient values to guide decision-making about clinical management. To help health care providers and clinicians, the available evidence is commonly translated into medical or clinical guidelines based on a consensus. These involve a systematic review of the literature and meta-analytic aggregation of research findings followed by the formulation of clinical recommendations. However, this approach also has limitations, which include a lack of consideration of individual patient characteristics, the susceptibility of guideline recommendations to material and immaterial conflicts of interest of guideline authors and long latencies till new knowledge is implemented in guidelines. A further important aspect in interpreting the existing literature is that the absence of evidence is not evidence of absence. These circumstances could result in the decoupling of recommendations and their supporting evidence, which becomes evident when guidelines from different countries differ in their recommendations. This opinion paper will discuss how these weaknesses can be addressed in tinnitus

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer-and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN),for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed

Managing Fatigue with Technology for Individuals with Multiple Sclerosis

OBJECTIVE: The purpose of this study was to investigate whether the use of a mobile health application (mHealth app) in conjunction with energy conservation management techniques will result in a decrease in fatigue for adults with multiple sclerosis. METHOD: Using a quantitative, exploratory, pre-posttest design, we examined outcomes associated with the use of the mHealth app, Pace My Day, by seven participants during one chosen task over two weeks. The app reinforced the use of energy conservation management techniques during the chosen task. Outcome measures included Modified Fatigue Impact Scale (MFIS) and Canadian Occupational Performance Measure (COPM). RESULTS: There was a significant decrease in the MFIS scores indicating a decrease in fatigue over the two-week period t (6) =5.75, p=0.001. Additionally, there was a significant increase in satisfaction with performance of the chosen task as measured by the COPM over the two-week period t (6) =-3.359, p=0.015. CONCLUSION: The use of a mHealth app to support energy conservation management education was found to significantly reduce levels of fatigue and increase self-perceived performance and satisfaction with task execution