JMIR mHealth和uHealth

基于数字生物标志物的研究:系统综述的范围综述

2022 - 10 - 24 - t11:30:21内

传感器和数字设备已经彻底改变了行为和生理数据的测量、收集和存储，导致了新的术语数字生物标志物。目的:本研究旨在调查涉及数字生物标志物的随机对照试验的系统评价(SRs)所涵盖的临床证据范围。这次范围评估是根据PRISMA-ScR(范围评估系统评估和元分析扩展的首选报告项目)指南组织的。由于搜索仅限于英文出版物，数字生物标志物的全文sr包括涉及人群的随机对照试验，并报告了参与者健康状况的变化。PubMed和Cochrane图书馆的检索时间限制在2019年和2020年。分别采用世界卫生组织的疾病分类系统(《国际疾病分类，第11版》)、健康干预措施分类(《国际健康干预措施分类》)和身体功能分类(《国际功能、残疾和健康分类》[ICF])对人群、干预措施和结果进行分类。结果:符合纳入标准的sr共有31例。大多数sr研究的患者有循环系统疾病(19/ 31,61%)和呼吸系统疾病(9/ 31,29%)。大多数流行的干预措施集中在体力活动行为(16/ 31,52%)和心律转换(4/ 31,13%)。照顾自己的健康(体育活动; 15/31, 48%), walking (12/31, 39%), heart rhythm functions (8/31, 26%), and mortality (7/31, 23%) were the most commonly reported outcomes. In total, 16 physiological and behavioral data groups were identified using the ICF tool, such as looking after one’s health (physical activity; 14/31, 45%), walking (11/31, 36%), heart rhythm (7/31, 23%), and weight maintenance functions (7/31, 23%). Various digital devices were also studied to collect these data in the included reviews, such as smart glasses, smartwatches, smart bracelets, smart shoes, and smart socks for measuring heart functions, gait pattern functions, and temperature. A substantial number (24/31, 77%) of digital biomarkers were used as interventions. Moreover, wearables (22/31, 71%) were the most common types of digital devices. Position sensors (21/31, 68%) and heart rate sensors and pulse rate sensors (12/31, 39%) were the most prevalent types of sensors used to acquire behavioral and physiological data in the SRs. Conclusions: In recent years, the clinical evidence concerning digital biomarkers has been systematically reviewed in a wide range of study populations, interventions, digital devices, and sensor technologies, with the dominance of physical activity and cardiac monitors. We used the World Health Organization’s ICF tool for classifying behavioral and physiological data, which seemed to be an applicable tool to categorize the broad scope of digital biomarkers identified in this review. To understand the clinical value of digital biomarkers, the strength and quality of the evidence on their health consequences need to be systematically evaluated.

使用特定步数智能手机应用程序对体力活动和减肥的长期影响:随机对照临床试验

2022 - 10 - 24 - t11:30:03内

一些关于使用智能手机应用程序促进减肥的研究表明，有减肥效果，但没有增加身体活动。然而，迄今为止，智能手机应用程序对减肥和增加体育锻炼的长期影响还没有得到严格的检验。这项研究的目的是评估使用智能手机应用程序是否会增加身体活动和减轻体重。在这项平行随机临床试验中，2018年4月至2019年6月期间招募的参与者按等比例随机分为智能手机应用程序组(n=55)或对照组(n=54)。使用意向治疗方法分析了2019年12月至2021年11月的数据。在干预前，两组都进行了一次长达一小时的减肥指导和增加体育活动的讲座。两组参与者都被要求在干预开始后每天至少醒来一次后立即称体重。为了保持或增强动力，两组参与者每月都会收到电子邮件，建议他们如何减肥和增加体育锻炼。智能手机应用程序组的参与者被要求每天至少打开一次应用程序，以查看他们的步数和排名。主要终点为每日加速计测量的体力活动(步数)，次要终点为体重。 Since there was a significant difference in the wear time of the accelerometer depending on the intervention period (P<.001), the number of steps and moderate-to-vigorous physical activity were also evaluated per wear time. Results: The mean age of the 109 participants in this study was 47 (SD 8) years. At baseline, the mean daily total steps were 7259 (SD 3256) steps per day for the smartphone app group and 8243 (SD 2815) steps per day for the control group. The difference in the step count per wear time between preintervention and postintervention was significantly different between the app group and the control group (average difference [95% CI], 65 [30 to 101] steps per hour vs –9 [–56 to 39] steps per hour; P=.042). The weight loss was –2.2 kg (SD –3.1%) in the smartphone app group and –2.2 kg (SD –3.1%) in the control group, with no significant difference between the groups. In addition, when divided into weekdays (Monday through Friday) and weekends (Saturday and Sunday), there was a significant interaction between step counts (P=.004) and MVPA (P=.003) during the intervention, with the app group showing higher interaction on weekends than the control group. Conclusions: In this trial, the group with the smartphone app intervention showed increased physical activity, especially on weekends. However, this increased physical activity did not lead to increased weight loss. Trial Registration: University Hospital Medical Information Network UMIN000033397; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037956

智能手机方法评估健康年轻人身体活动的测量特性:系统综述

2022 - 10 - 21 - t10:30:02内

体育活动不足是几种慢性疾病的一个可预防的危险因素，也是全球疾病负担不断增加的背后驱动力之一。最近的证据表明，使用移动智能手机应用程序进行干预可以显著提高身体活动(PA)水平。然而，使用应用程序的准确性和可靠性尚不清楚。我们综述的目的是确定使用移动应用程序测量年轻人PA水平的准确性和可靠性。我们在PRISMA(系统评价和元分析首选报告项目)的指导下进行了系统评价。2007 - 2020年发表的研究来源于8个数据库:ovid MEDLINE、Embase (Elsevier)、Cochrane Library (Wiley)、PsychINFO (EBSCOhost)、CINAHL (EBSCOhost)、Web of Science (Clarivate)、SPORTDiscus (EBSCOhost)和IEEE Xplore数字图书馆数据库。研究对象是10-24岁、没有慢性疾病的年轻人，他们评估了一款移动应用程序测量PA的能力。主要结果包括测量方法的效度、信度和响应性。重复筛选进行资格、数据提取和评估偏倚风险。结果报告为系统综述。 The main physical activity measures evaluated for each study were the following: total PA time (min/day or min/week), total moderate to vigorous PA per week, daily step count, intensity measure (heart rate), and frequency measure (days per week). Results: Of the 149 identified studies, 5 met the inclusion criteria (322 participants, 176 female; mean age 14, SD 3 years). A total of 3 studies measured criterion validity and compared PA measured via apps against PA measured via an Actigraph accelerometer. The 2 studies that reported on construct validity identified a significant difference between self-reported PA and the objective measure. Only 1 of the 5 apps examined was available to the public, and although this app was highly accepted by young people, the app recorded PA to be significantly different to participants’ self-reported PA. Conclusions: Overall, few studies assess the reliability, validity, and responsiveness of mobile apps to measure PA in healthy young people, with studies typically only reporting on one measurement property. Of the 3 studies that measured validity, all concluded that mobile phones were acceptable and valid tools. More research is needed into the validity and reliability of smartphone apps to measure PA levels in this population as well as in populations with other characteristics, including other age groups and those with chronic diseases. Trial Registration: PROSPERO CRD42019122242; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=122242

更正:血液系统恶性肿瘤患者的智能手机应用程序:内容的系统回顾和评估

2022 - 10 - 13 - t13:00:34内

法国应用商店中的心理健康手机应用:功能和质量评估研究

2022 - 10 - 12 - t10:45:03内

大约有8亿人(占世界人口的11%)受到精神健康问题的影响。COVID-19大流行加剧了问题，引发了福祉的下降，焦虑、抑郁和压力等状况的发病率急剧上升。手机应用商店中大约有2万个心理健康应用。然而，在文献中还没有发现对法语心理健康应用程序的重要评估，大约有3亿人使用法语。本研究旨在回顾目前在法国苹果应用商店和谷歌Play Store上可用的心理健康手机应用程序，并使用移动应用程序评级量表-法语(MARS-F)评估它们的质量。方法:于2022年6月10日至2022年6月17日在法国苹果应用商店和谷歌Play Store上对心理健康应用进行筛查。9名心理健康专业人士使用MARS-F评估了12个应用程序的候选名单。组内相关性用于评价评分者之间的一致性。计算每个部分和项目的平均(SD)分数及其分布。Soutien psy avec Mon Sherpa(平均3.85,SD 0.48)、Evoluno(平均3.54,SD 0.72)和Teale(平均3.53,SD 0.87)获得了火星- f质量的最高分。 Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS – journal de l’humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. Conclusions: Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users.

客观推式睡眠反馈对日常生活中习惯性睡眠行为和瞬间症状的影响:使用医疗物联网系统的移动健康干预试验

2022 - 10 - 06 - t10:45:04内

背景:睡眠有益于身心健康。一些移动和可穿戴的睡眠跟踪设备已经被开发出来，个性化的睡眠反馈是这些设备中最常见的功能。到目前为止，还没有研究实施客观的推送式反馈信息，并调查接受睡眠反馈时习惯性睡眠行为和日常症状的特征。我们进行了一项移动健康干预试验，以检查发送客观的推送式睡眠反馈是否会改变日本办公室职员自我报告的情绪、身体症状和睡眠行为。方法:共31名上班族(平均年龄42.3岁，标准差7.9岁;男女比例21:10)于2020年11月30日至12月19日参加了一项2组干预试验。参与者被要求使用智能手机应用程序每天5次表明他们的瞬间情绪和身体症状(抑郁情绪、焦虑、压力、嗜睡、疲劳和颈部和肩部僵硬)。此外，每天下班后对日常工作表现进行一次评估。他们被随机分配到反馈组或对照组，分别在每天早上在应用程序上收到或没有收到关于他们睡眠状态的消息。所有参与者都在非惯用手腕上佩戴活动监测器，通过监测器，客观的睡眠数据被记录在服务器上的网络上。根据服务器上估计的睡眠数据，生成个性化的睡眠反馈信息，并使用应用程序发送给反馈组的参与者。这些过程是完全自动化的。 Results: Using hierarchical statistical models, we examined the differences in the statistical properties of sleep variables (sleep duration and midpoint of sleep) and daily work performance over the trial period. Group differences in the diurnal slopes for mood and physical symptoms were examined using a linear mixed effect model. We found a significant group difference among within-individual residuals at the midpoint of sleep (expected a posteriori for the difference: −15, 95% credible interval −26 to −4 min), suggesting more stable sleep timing in the feedback group. However, there were no significant group differences in daily work performance. We also found significant group differences in the diurnal slopes for sleepiness (P<.001), fatigue (P=.002), and neck and shoulder stiffness (P<.001), which was largely due to better scores in the feedback group at wake-up time relative to those in the control group. Conclusions: This is the first mobile health study to demonstrate that objective push-type sleep feedback improves sleep timing of and physical symptoms in healthy office workers. Future research should incorporate specific behavioral instructions intended to improve sleep habits and examine the effectiveness of these instructions.

电子健康日记运动补充多发性硬化症患者的纵向评估:嵌套观察研究

2022 - 10 - 05 - t10:15:02内

背景:电子健康日记有望补充前瞻性健康研究中的标准化调查，但充满了许多方法上的挑战。目的:本研究旨在调查参与者特征和其他与多发性硬化症患者对电子健康日记活动反应相关的因素，确定自由文本日记条目中反复出现的主题，并评估与调查收集的信息相比，结构化日记条目关于当前症状和药物摄入的附加价值。数据由瑞士多发性硬化症登记处在嵌套的电子健康日记活动中收集，并在瑞士多发性硬化症登记处定期半年随访调查中作为比较。将活动参与者的特征与非参与者的特征进行描述性比较。使用语言查询和单词计数2015软件(Pennebaker集团公司)和描述性关键词分析日记内容。使用Jaccard指数检查结构化日记数据与健康相关生活质量、症状和药物摄入量的随访数据之间的相似性。结果:活动参与者(n=134;日记记录:n=815)的女性更多，不是全职工作，没有更高的教育程度，有更严重的步态障碍，并且比符合条件的非参与者(中位年龄47岁，IQR 38-55岁;n = 524)。日记自由文本条目(n=632; participants: n=100) most often contained references to the following standard Linguistic Inquiry and Word Count word categories: negative emotion (193/632, 30.5%), body parts or body functioning (191/632, 30.2%), health (94/632, 14.9%), or work (67/632, 10.6%). Analogously, the most frequently mentioned keywords (diary entries: n=526; participants: n=93) were “good,” “day,” and “work.” Similarities between diary data and follow-up survey data, collected 14 months apart (median), were high for health-related quality of life and stable for slow-changing symptoms such as fatigue or gait disorder. Similarities were also comparatively high for drugs requiring a regular application, including interferon beta-1a (Avonex) and glatiramer acetate (Copaxone), and for modern oral therapies such as fingolimod (Gilenya) and teriflunomide (Aubagio). Conclusions: Diary campaign participation seemed dependent on time availability and symptom burden and was enhanced by reminder emails. Electronic health diaries are a meaningful complement to regular structured surveys and can provide more detailed information regarding medication use and symptoms. However, they should ideally be embedded into promotional activities or tied to concrete research study tasks to enhance regular and long-term participation.

间歇性禁食应用程序的保留、禁食模式和减肥:大规模、52周观察性研究

2022 - 10 - 04 - t10:45:49内

间歇性禁食(IF)是一种越来越受欢迎的饮食控制方法，它关注的是进食的时间，而不是热量摄入的数量和内容。IF从业者通常寻求改善他们的体重和其他健康因素。数以百万计的从业者已经转向专门设计的移动应用程序来帮助他们跟踪和坚持禁食，并监测体重和其他生物特征的变化。本研究旨在量化两款IF手机应用的用户留存率、断食模式和减肥情况。我们还试图描述和建模初始BMI、禁食量、体重跟踪频率和其他与留存率和体重变化相关的人口统计数据。我们收集了2018年至2020年LIFE禁食追踪器和LIFE Extend应用程序的成年用户(18-100岁)的身高、体重、禁食和人口统计数据。根据记录的禁食时间和用户统计数据，对最多52周的留存率进行了量化。提供身高和至少2个体重读数，并且第一次快速和体重记录是同期的用户被纳入减肥分析。禁食被量化为延长禁食时间(EFH;禁食时超过12小时)平均每天(EFH每天)。 Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. Results: A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ≥40 kg/m² lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m². EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R²=0.334) with starting BMI and EFH per day as the most significant predictors. Conclusions: IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more.

抑郁症状严重程度与日常生活步态特征之间的关联，从现实世界环境中的长期加速信号得出:回顾性分析

2022 - 10 - 04 - t10:15:26内

背景:步态是抑郁症的重要表现。然而，日常行走的步态特征及其与抑郁症的关系尚未得到充分探索。目的:本研究的目的是探索抑郁症症状严重程度与日常生活步态特征之间的联系，这些特征来源于真实世界环境中的加速度信号。我们使用两组动态数据集(N=71和N=215)，分别由可穿戴设备和手机收集加速度信号。我们提取了12个日常生活步态特征来描述步态节奏和力量在长期内的分布和变化。采用Spearman系数和线性混合效应模型探讨日常生活步态特征与抑郁症症状严重程度之间的关系，抑郁症症状严重程度由15项老年抑郁症量表(GDS-15)和8项患者健康问卷(PHQ-8)自报告问卷测量。使用似然比(LR)检验来测试日常生活步态特征是否可以提供相对于实验室步态特征的额外信息。结果:在两个数据集中，抑郁症状严重程度越高，高性能步行(步行速度较快的分段)的步态节奏越低。具有长期日常生活步态特征的线性回归模型(R²=0.30)拟合抑郁评分显著优于仅具有实验室步态特征的模型(R²=0.06) (LR检验P=.001)。这项研究表明，可穿戴设备和手机都可以捕捉到日常生活走路特征与抑郁症状严重程度之间的显著联系。 The daily-life gait patterns could provide additional information for predicting depression symptom severity relative to laboratory walking. These findings may contribute to developing clinical tools to remotely monitor mental health in real-world settings.

设计、开发、评估和实现智能手机交付的基于规则的会话代理(DISCOVER):概念框架的开发

2022 - 10 - 04 - t10:15:02内

背景:会话代理(ca)，也称为聊天机器人，是一种通过使用预定的基于规则的响应或人工智能算法来模拟人类对话的计算机程序。它们越来越多地用于医疗保健，尤其是通过智能手机。目前还没有一个概念性框架来指导医疗保健领域基于智能手机、基于规则的ca的开发。为了填补这一空白，我们建议为其设计、开发、评估和实施提供结构化和量身定制的指导。本研究的目的是为设计、评估和实施智能手机提供的、基于规则的、面向目标的和基于文本的医疗保健ca开发一个概念框架。方法:我们遵循Jabareen基于扎根理论方法的方法来开发这个概念框架。我们进行了2项文献综述，重点是医疗保健ca和开发移动医疗干预的概念框架。我们对从文献综述中检索到的信息进行识别、命名、分类、集成和综合，以开发概念框架。然后，我们通过开发CA并在可行性研究中测试它来应用这个框架。设计、开发、评估和实现智能手机交付、基于规则的会话代理(DISCOVER)概念框架包括8个迭代步骤，分为3个阶段，如下:设计，包括定义目标、创建身份、组建团队和选择交付接口; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations—user-centered design and privacy and security—that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. Conclusions: Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns. Trial Registration: