Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland

Background: A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce.Objective: The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs.Methods: Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis).Results: There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI –8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI –2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, PConclusions: High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families.</p

Reusable data visualization patterns for clinical practice

Among clinical psychologists involved in guided internet-facilitated interventions, there is an overarching need to understand patients symptom development and learn about patients need for treatment support. Data visualizations is a technique for managing enormous amounts of data and extract useful information, and is often used in developing digital tool support for decision-making. Although there exists numerous data visualisation and analytical reasoning techniques available through interactive visual interfaces, it is a challenge to develop visualizations that are relevant and suitable in a healthcare context, and can be used in clinical practice in a meaningful way. For this purpose it is necessary to identify actual needs of healthcare professionals and develop reusable data visualization components according to these needs. In this paper we present a study of decision support needs of psychologists involved in online internet-facilitated cognitive behavioural therapy. Based on these needs, we provide a library of reusable visual components using a model-based approach. The visual components are featured with mechanisms for investigating data using various levels of abstraction and causal analysis

Differences in health, participation and life satisfaction outcomes in adults following paediatric- versus adult-sustained spinal cord injury

Study design: Cross-sectional. Objectives: To compare differences in self-reported health status, participation and life satisfaction outcomes between adults with a spinal cord injury (SCI) sustained during paediatric (P) versus adulthood (A) years. Setting: Ontario, Canada. Methods: Secondary analysis of data from the Study of Health and Activity in People with SCI (SHAPE-SCI). Eighty-seven participants who sustained an SCI prior to age 19 (M +/- s.d. = 24.1 +/- 14.0 years postinjury (YPI)) were matched for lesion level (C2-L5), severity (complete/incomplete), gender, age, education and ethnicity with 87 participants who sustained an SCI at >= age 19 years (M-YPI = 12.8 +/- 10.0). Results: Those with a paediatric SCI reported significantly less pain, fewer visits to the physician in the past year, greater functional independence, social participation, occupational participation and minutes per day of moderate-to-heavy physical activity than those who sustained an SCI in adulthood. No significant differences were found for the measures of depression, perceived health status or life satisfaction (P>0.05). With the exception of moderate-to-heavy physical activity and visits to the physician in the past year, between-group differences were independent of YPI. Conclusions: Regardless of time since injury, people who sustained a paediatric SCI reported better health and greater participation than those injured in adulthood. Nevertheless, both groups scored well below able-bodied normative values for all measures. The results highlight the importance of a comprehensive life-course approach to SCI rehabilitation, irrespective of age at the time of injury

Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art

Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations