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      Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review

      review-article
      , MSc, MD 1 , 2 , , , MD, PhD 3 , 4 , , PhD 5 , , PhD 5 , , MD, PhD 6 , , MD, PhD 7
      (Reviewer), (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      mobile health, self-management, arthritis, telemedicine, musculoskeletal diseases

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          Abstract

          Background

          Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps.

          Objective

          This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods.

          Methods

          A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed.

          Results

          Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures.

          Conclusions

          The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients’ willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory.

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          Most cited references41

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          The well-built clinical question: a key to evidence-based decisions

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            The taxonomy of telemedicine.

            The purpose of this article is to present a taxonomy for telemedicine. The field has markedly grown, with an increasing number of applications, a variety of technologies, and newly introduced terminology. A taxonomy would serve to bring conceptual clarity to this burgeoning set of alternatives to in-person healthcare delivery. The article starts with a brief discussion of the importance of taxonomy as an information management strategy to improve knowledge sharing, facilitate research and policy initiatives, and provide some guidance for the orderly development of telemedicine. We provide a conceptual context for the proliferation of related concepts, such as telehealth, e-health, and m-health, as well as a classification of the content of these concepts. Our main concern is to develop an explicit taxonomy of telemedicine and to demonstrate how it can be used to provide definitive information about the true effects of telemedicine in terms of cost, quality, and access. Taxonomy development and refinement is an iterative process. If this initial attempt at classification proves useful, subject matter experts could enhance the development and proliferation of telemedicine by testing, revising, and verifying this taxonomy.
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              A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial

              Background Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited. Objective The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program. Methods A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels. Results Of the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen’s d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen’s d=0.74, P=.003), acceptance of pain (Cohen’s d=0.54, P=.02), and functioning and symptom levels (Cohen’s d=0.75, P=.001). Conclusions The results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation. Trial Registration Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY)
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                November 2019
                26 November 2019
                : 7
                : 11
                : e14730
                Affiliations
                [1 ] Department of Rheumatology Nantes University Hospital Nantes France
                [2 ] INSERM UMR 1238 Nantes University of Medicine Nantes France
                [3 ] INSERM UMR S1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique Sorbonne Université Paris France
                [4 ] Rheumatology department Pitié Salpêtrière Hospital AP-HP Paris France
                [5 ] Bibliothèque interuniversitaire de Santé Paris Descartes University Paris France
                [6 ] Department of rheumatology Sorbonne Université, INSERM CRSA Saint-Antoine AP-HP, Saint Antoine Hospital Paris France
                [7 ] Department of Inflammation Biology, School of Immunology and Microbial Sciences Faculty of Life Sciences & Medicine King’s College London Paris France
                Author notes
                Corresponding Author: Aurélie Najm aurelie.najm@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-6008-503X
                https://orcid.org/0000-0002-4528-310X
                https://orcid.org/0000-0001-6614-5657
                https://orcid.org/0000-0002-0552-5864
                https://orcid.org/0000-0001-8252-7815
                https://orcid.org/0000-0001-6847-3726
                Article
                v7i11e14730
                10.2196/14730
                6904900
                31769758
                5a879d70-d39f-4865-8fb1-6ad026733efc
                ©Aurélie Najm, Laure Gossec, Catherine Weill, David Benoist, Francis Berenbaum, Elena Nikiphorou. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 26.11.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 16 May 2019
                : 2 July 2019
                : 26 July 2019
                : 30 July 2019
                Categories
                Review
                Review

                mobile health,self-management,arthritis,telemedicine,musculoskeletal diseases

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