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A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial. 针对心血管疾病成人的双模式家庭心脏康复计划：单臂远程临床试验。
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-10-01 DOI: 10.2196/59098
Tim Bilbrey, Jenny Martin, Wen Zhou, Changhao Bai, Nitin Vaswani, Rishab Shah, Sara Chokshi, Xi Chen, Satjit Bhusri, Samantha Niemi, Hongdao Meng, Zhen Lei
<p><strong>Background: </strong>Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD.</p><p><strong>Objective: </strong>We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD.</p><p><strong>Methods: </strong>This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ≥40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables.</p><p><strong>Results: </strong>In total, 162 met the inclusion criteria and 75 (46.3%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49%; White: n=46, 61%). Heart failure was the most common diagnosis (37/75, 49%). In total, 62/75 (83%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95% CI 1.1-4.3) and 2.2 (SD 9.09) points (95% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported.</p><p><strong>Conclusions: </strong>The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence th
背景：心脏康复（CR）是针对心血管疾病（CVD）患者的一种安全有效的干预措施。然而，大多数符合条件的患者并没有完成心脏康复治疗。越来越多的证据表明，家庭心脏康复（HBCR）项目的有效性和安全性与传统的中心项目不相上下。需要开展更多研究，探索向心血管疾病患者提供 HBCR 项目的不同方法：本研究旨在评估数字 HBCR 项目（RecoveryPlus.Health，RPH-D）的可行性和影响，该项目整合了远程医疗和移动医疗模式，对患有心血管疾病（CVD）的成年人的功能锻炼能力、静息心率和生活质量均有影响：这项为期 12 周的前瞻性单臂远程临床试验采用受试者内设计。我们在 2023 年 5 月至 8 月间从社区招募了符合 CR 诊断条件（稳定型心绞痛、心肌梗死、心力衰竭等）的成年心血管疾病患者（40 岁以上）。所有转诊至德克萨斯州罗阿诺克市 RPH 诊所的入组患者均被纳入其中。护理团队通过两种方式为研究参与者提供与指南相一致的 CR 服务：1）通过视频会议进行同步远程医疗运动训练；2）异步移动医疗虚拟辅导应用程序（RPH App）。基线入组调查、电子健康记录 (EHR) 和应用程序日志数据用于提取个人特征、护理流程和远程保健/移动保健参与数据。可行性通过项目完成率和 CR 服务使用率来衡量。疗效通过 12 周计划前后 6 分钟步行测试 (6MWT)、静息心率和生活质量 (SF-12) 的变化来衡量。采用配对 t 检验来检测干预前后结果变量的变化：共有 162 人符合纳入标准，其中 75 人（46.3%）同意并加入。参与者的平均年龄为 64.24 岁（标准差 10.30）；37 人（49%）为男性，46 人（61%）为白人。心力衰竭是最常见的诊断（49%）。共有 62 人（83%）完成了为期 12 周的研究，其中 62 人（83%）使用了远程医疗模式，平均完成了 9.63 次（标清 3.33 次）疗程，59 人（79%）使用了移动医疗模式，平均完成了 10.97 次（标清 11.70 次）疗程。干预后，50 名（81%）参与者的 6MWT 有所改善，平均改善 40.0 米（95% CI，25.6 至 57.1）。SF-12 身体和心理综合评分平均分别提高了 2.7 分（95% CI，1.1 至 4.3）和 2.2 分（95% CI，0.1 至 4.5）。静息心率没有变化，也没有与运动相关的不良事件报告：RecoveryPlus.Health数字HBCR计划在一组全国招募的心血管疾病患者中显示出可行性和有效性。这些研究结果进一步证明，远程医疗和移动医疗双模式 HBCR 计划可能是一种很有前景的方法，可以克服美国在提高 CR 普及率方面的一些主要障碍：临床试验：ClinicalTrials.gov NCT05804500。
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引用次数: 0
Patient Engagement in a Mobile App-Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial. 患者参与基于移动应用程序的全髋关节或膝关节置换术康复计划：随机对照试验的二次数据分析。
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-10-01 DOI: 10.2196/57635
Qingling Wang, Regina Lai-Tong Lee, Sharyn Hunter, Aiyong Zhu, Sally Wai-Chi Chan
<p><strong>Background: </strong>Health care professionals use mobile apps to support patients' rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients.</p><p><strong>Objective: </strong>This study aimed to investigate patient engagement in a mobile app-based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics.</p><p><strong>Methods: </strong>Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])-based program to support patients' rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants' posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics.</p><p><strong>Results: </strong>The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95% CI 1.98-15.35; χ<sup>2</sup><sub>1</sub>=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95% CI 0.45-5.48; χ<sup>2</sup><sub>1</sub>=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy.</p><p><strong>Conclusions: </strong>Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the de
背景：医疗保健专业人员使用移动应用程序来支持全髋关节或膝关节置换术后患者的康复。了解患者在此类移动医疗干预中的参与度有助于调整这些干预措施，为患者提供更好的支持：本研究旨在调查患者参与基于移动应用程序的关节置换术康复计划的情况，并调查患者参与情况与其特征之间的关联：从一项随机对照试验实验组的42名参与者中提取数据，该试验使用基于手机应用（微信[腾讯控股有限公司]）的程序来支持全髋关节或膝关节置换术后患者的康复。主要结果是参与者访问该程序并完成推荐康复任务的天数。次要结果包括参与者在讨论区发帖的数据、参与者发送的信息、访问程序组件的情况以及阅读和分享程序内容的情况。研究人员使用广义线性模型分析了患者参与度与个人特征之间的关联：在康复日记中，参与者平均每周有 5.2 天（标准差为 2 天）访问该计划，平均每周有 6.5 天（标准差为 0.8 天）完成建议的康复任务。大多数参与者（31/42，74%）在论坛上发帖，平均发帖 18.1 个（标准差 21.2 个）。大多数参与者（37/42，88%）向医护人员发送信息，平均发送 14 条（标准差 15.9）。共访问了 525 次节目内容。计划内容共被阅读 898 次，分享 82 次。广义线性模型显示，两个主要结果，即参与者访问程序的天数（B=6.46，95% CI 1.98-15.35；χ21=11.1，P=.001）和完成康复任务的天数（B=2.65，95% CI 0.45-5.48；χ21=5.7，P=.02），均与高中或以上学历正相关。此外，在论坛上发帖的数量与与家人同住、高中或以上学历、接受全膝关节置换术、合并症以及自我效能感得分呈正相关，但与年龄呈负相关。参与者发送信息的数量与高中或以上学历、合并症和自我效能感得分呈正相关：结论：患者参与移动关节置换康复训练与他们的教育水平、同居状况、年龄、手术类型、是否有合并症以及自我效能感有关。项目开发人员在设计移动关节成形术康复项目时，可考虑这些特征并采用家庭参与等策略，以提高患者对此类干预措施的参与度：澳大利亚新西兰临床试验注册中心 ACTRN12621000867897; https://tinyurl.com/mtdw25fp。
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引用次数: 0
Raw Photoplethysmography as an Enhancement for Research-Grade Wearable Activity Monitors. 将原始光敏血压计作为研究级可穿戴活动监测器的增强功能
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-27 DOI: 10.2196/57158
Paul R Hibbing, Maryam Misal Khan

Wearable monitors continue to play a critical role in scientific assessments of physical activity. Recently, research-grade monitors have begun providing raw data from photoplethysmography (PPG) alongside standard raw data from inertial sensors (accelerometers and gyroscopes). Raw PPG enables granular and transparent estimation of cardiovascular parameters such as heart rate, thus presenting a valuable alternative to standard PPG methodologies (most of which rely on consumer-grade monitors that provide only coarse output from proprietary algorithms). The implications for physical activity assessment are tremendous, since it is now feasible to monitor granular and concurrent trends in both movement and cardiovascular physiology using a single noninvasive device. However, new users must also be aware of challenges and limitations that accompany the use of raw PPG data. This viewpoint paper therefore orients new users to the opportunities and challenges of raw PPG data by presenting its mechanics, pitfalls, and availability, as well as its parallels and synergies with inertial sensors. This includes discussion of specific applications to the prediction of energy expenditure, activity type, and 24-hour movement behaviors, with an emphasis on areas in which raw PPG data may help resolve known issues with inertial sensing (eg, measurement during cycling activities). We also discuss how the impact of raw PPG data can be maximized through the use of open-source tools when developing and disseminating new methods, similar to current standards for raw accelerometer and gyroscope data. Collectively, our comments show the strong potential of raw PPG data to enhance the use of research-grade wearable activity monitors in science over the coming years.

可穿戴监测仪在体育锻炼的科学评估中继续发挥着至关重要的作用。最近，研究级监测仪开始提供光电血压计（PPG）的原始数据以及惯性传感器（加速度计和陀螺仪）的标准原始数据。原始 PPG 可以对心率等心血管参数进行精细、透明的估算，因此是标准 PPG 方法（其中大部分依赖于只能提供专有算法粗略输出的消费级监护仪）的重要替代品。这对体力活动评估的影响是巨大的，因为现在只需使用一台无创设备，就能同时监测运动和心血管生理的细微变化趋势。不过，新用户也必须了解使用原始 PPG 数据所面临的挑战和限制。因此，本观点文件通过介绍原始 PPG 数据的力学原理、隐患、可用性及其与惯性传感器的相似性和协同性，让新用户了解原始 PPG 数据带来的机遇和挑战。这包括讨论能量消耗、活动类型和 24 小时运动行为预测的具体应用，重点是原始 PPG 数据可能有助于解决惯性传感已知问题的领域（例如，骑自行车活动期间的测量）。我们还讨论了在开发和传播新方法时，如何通过使用开源工具（类似于当前的原始加速度计和陀螺仪数据标准）最大限度地发挥原始 PPG 数据的影响。总之，我们的评论表明，原始 PPG 数据具有强大的潜力，可在未来几年内提高科研级可穿戴活动监测器在科学领域的应用。
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引用次数: 0
Controlled and Real-Life Investigation of Optical Tracking Sensors in Smart Glasses for Monitoring Eating Behavior Using Deep Learning: Cross-Sectional Study. 利用深度学习对智能眼镜中用于监测进食行为的光学跟踪传感器进行受控和实际调查：横断面研究。
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-26 DOI: 10.2196/59469
Simon Stankoski, Ivana Kiprijanovska, Martin Gjoreski, Filip Panchevski, Borjan Sazdov, Bojan Sofronievski, Andrew Cleal, Mohsen Fatoorechi, Charles Nduka, Hristijan Gjoreski
<p><strong>Background: </strong>The increasing prevalence of obesity necessitates innovative approaches to better understand this health crisis, particularly given its strong connection to chronic diseases such as diabetes, cancer, and cardiovascular conditions. Monitoring dietary behavior is crucial for designing effective interventions that help decrease obesity prevalence and promote healthy lifestyles. However, traditional dietary tracking methods are limited by participant burden and recall bias. Exploring microlevel eating activities, such as meal duration and chewing frequency, in addition to eating episodes, is crucial due to their substantial relation to obesity and disease risk.</p><p><strong>Objective: </strong>The primary objective of the study was to develop an accurate and noninvasive system for automatically monitoring eating and chewing activities using sensor-equipped smart glasses. The system distinguishes chewing from other facial activities, such as speaking and teeth clenching. The secondary objective was to evaluate the system's performance on unseen test users using a combination of laboratory-controlled and real-life user studies. Unlike state-of-the-art studies that focus on detecting full eating episodes, our approach provides a more granular analysis by specifically detecting chewing segments within each eating episode.</p><p><strong>Methods: </strong>The study uses OCO optical sensors embedded in smart glasses to monitor facial muscle activations related to eating and chewing activities. The sensors measure relative movements on the skin's surface in 2 dimensions (X and Y). Data from these sensors are analyzed using deep learning (DL) to distinguish chewing from other facial activities. To address the temporal dependence between chewing events in real life, we integrate a hidden Markov model as an additional component that analyzes the output from the DL model.</p><p><strong>Results: </strong>Statistical tests of mean sensor activations revealed statistically significant differences across all 6 comparison pairs (P<.001) involving 2 sensors (cheeks and temple) and 3 facial activities (eating, clenching, and speaking). These results demonstrate the sensitivity of the sensor data. Furthermore, the convolutional long short-term memory model, which is a combination of convolutional and long short-term memory neural networks, emerged as the best-performing DL model for chewing detection. In controlled laboratory settings, the model achieved an F<sub>1</sub>-score of 0.91, demonstrating robust performance. In real-life scenarios, the system demonstrated high precision (0.95) and recall (0.82) for detecting eating segments. The chewing rates and the number of chews evaluated in the real-life study showed consistency with expected real-life eating behaviors.</p><p><strong>Conclusions: </strong>The study represents a substantial advancement in dietary monitoring and health technology. By providing a reliable and noninvasive met
背景：肥胖症的发病率越来越高，有必要采用创新方法来更好地了解这一健康危机，特别是考虑到肥胖症与糖尿病、癌症和心血管疾病等慢性疾病的密切联系。监测饮食行为对于设计有效的干预措施，帮助降低肥胖患病率和促进健康的生活方式至关重要。然而，传统的饮食跟踪方法受到参与者负担和回忆偏差的限制。除了进食事件外，探索微观层面的进食活动（如进餐时间和咀嚼频率）也至关重要，因为它们与肥胖和疾病风险有很大关系：本研究的主要目的是开发一种精确的无创系统，利用配备传感器的智能眼镜自动监测进食和咀嚼活动。该系统可将咀嚼与其他面部活动（如说话和牙齿紧咬）区分开来。次要目标是通过实验室对照研究和真实用户研究相结合的方法，评估该系统对未见过的测试用户的性能。与专注于检测完整进食情节的先进研究不同，我们的方法通过专门检测每个进食情节中的咀嚼片段，提供了更精细的分析：本研究使用嵌入在智能眼镜中的 OCO 光学传感器来监测与进食和咀嚼活动相关的面部肌肉活动。传感器从两个维度（X 和 Y）测量皮肤表面的相对运动。利用深度学习（DL）对这些传感器的数据进行分析，以区分咀嚼和其他面部活动。为了解决现实生活中咀嚼事件之间的时间依赖性问题，我们集成了一个隐马尔可夫模型，作为分析深度学习模型输出的附加组件：结果：对传感器平均激活度的统计测试表明，在所有 6 对对比中，传感器平均激活度的差异都具有统计学意义（P1-score 为 0.91，显示了强大的性能。在真实场景中，该系统检测进食片段的精确度（0.95）和召回率（0.82）都很高。实际研究中评估的咀嚼率和咀嚼次数与预期的实际进食行为一致：这项研究代表了饮食监测和健康技术的重大进步。通过提供一种可靠的非侵入性方法来跟踪饮食行为，它有可能彻底改变饮食数据的收集和使用方式。这将带来更有效的健康干预措施，并让人们更好地了解影响饮食习惯的因素及其对健康的影响。
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引用次数: 0
The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review. 针对青少年行为问题使用非商业性以家长为中心的移动医疗干预措施：系统回顾
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-24 DOI: 10.2196/51273
Katherine I Magnuson, Kexin Li, Grace Beuley, Stacy R Ryan-Pettes
<p><strong>Background: </strong>The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies.</p><p><strong>Objective: </strong>This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs.</p><p><strong>Methods: </strong>This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features.</p><p><strong>Results: </strong>Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents.</p><p><strong>Conclusions: </strong>Although features and techniques were referenced, only a few of the stud
背景：青少年使用药物的比例高得惊人，尽管有证据表明，有效的父母养育方式可以调节青少年使用药物的治疗效果，但目前的治疗方案缺乏以父母为中心的干预措施。通过移动医疗（mHealth）可以减轻家长干预的可及性和其他障碍；然而，很少有移动医疗平台通过实施家长行为培训策略来针对青少年的药物使用行为：本研究旨在回顾目前实证文献中的移动医疗平台，这些平台旨在通过父母行为培训技术提高父母的育儿效率。考虑到针对青少年药物使用的父母行为疗法与针对青少年药物使用的父母行为疗法有重叠之处，本研究将目标扩展到了针对青少年行为问题的移动医疗平台。总之，进行系统综述的目的是为涉及药物使用的青少年家长开发移动医疗应用程序提供信息，提高可访问性，并更好地满足家长的需求：本系统综述采用 PRISMA（系统综述和元分析首选报告项目）方法，在多个数据库中筛选相关文章。对每项研究的相关性和纳入性进行了评估。对每项研究的人口统计学、传递媒介、干预状态（作为独立治疗或作为治疗的增强）、使用的移动设备、针对的心理健康状况、干预类型、基本干预理论、设计中应用的行为改变理论、行为改变技术、家长培训技术、青少年结果、家长结果、可视化设计、内容和特征进行了审查：结果：总共纳入了 11 项研究。几乎所有的研究（9/11，82%）都以女性照顾者为主要样本。大多数研究（6/11，55%）都结合了社会学习理论。只有少数研究（2/11，18%）讨论了嵌入式行为改变理论，而所有研究（11/11，100%）都使用了至少一种行为改变技巧来鼓励父母改变行为。许多研究（7/11，64%）为最终用户量身定制了设计特点。在各种家长行为训练技巧中，几乎所有的研究（10/11，91%）都包含了加强亲子关系的技巧。对治疗结果的初步评估表明，以家长为目标的移动医疗干预措施具有积极影响。在报告治疗效果时，青少年的效果大小从 Cohen d=0.38 到 Cohen d=1.58，家长的效果大小从 Cohen d=0.13 到 Cohen d=2.59：结论：尽管研究中提到了一些特征和技术，但只有少数研究提供了与行为改变理论（2/11，18%）、视觉设计（2/11，18%）以及将针对家长的干预措施转化为移动医疗平台相关的具体信息。这些信息对移动医疗应用程序的开发非常有用。青少年和家长的初步结果令人鼓舞，但随着研究数量的增加，未来的研究应考虑进行荟萃分析，以确定综合统计结果。
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引用次数: 0
Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review. 评估撒哈拉以南非洲社区保健工作者采用移动保健技术改善孕产妇保健服务的情况：系统回顾。
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-24 DOI: 10.2196/55819
Chiyembekezo Kachimanga, Haules Robbins Zaniku, Titus Henry Divala, Johannes C F Ket, Joia S Mukherjee, Daniel Palazuelos, Alexandra V Kulinkina, Ibukun-Oluwa Omolade Abejirinde, Thomas van den Akker

Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA).

Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach.

Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes.

Results: Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive.

Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs.

Trial registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364.

背景在撒哈拉以南非洲地区（SSA），社区卫生工作人员使用移动医疗（mHealth）对提高孕产妇保健服务使用率的影响方面的信息有限：本系统性综述涉及两个目标：评估撒哈拉以南非洲地区社区保健员使用移动医疗对产前护理 (ANC) 使用、设施内分娩和产后护理 (PNC) 使用的影响；使用社会技术系统方法确定旨在提高撒哈拉以南非洲地区产前护理 (ANC) 使用、设施内分娩和产后护理 (PNC) 使用的项目中社区保健员使用移动医疗的促进因素和障碍：我们在 6 个数据库（MEDLINE、CINAHL、Web of Science、Embase、Scopus 和 Africa Index Medicus）中搜索了从开始到 2022 年 9 月的文章，并从 Google Scholar 中找到了其他文章。文章筛选后，由两名独立审稿人使用 Covidence 软件（Veritas Health Innovation Ltd）进行标题和摘要筛选、全文筛选和数据提取。此外，我们还对纳入文章的参考文献列表进行了人工筛选。最后，我们对结果进行了叙述性综合：在检索到的 2594 条记录中，有 10 项（0.39%）研究（n=22，0.85% 篇文章）符合纳入标准并进行了数据提取。这些研究发表于 2012 年至 2022 年，分布在 6 个国家。在报告产前检查结果的研究中，43%（3/7）的研究报告称，保健工作者使用移动医疗提高了产前检查的使用率。同样，在报告设施内分娩情况的研究中，89%（8/9）的研究表明，由于保健医生使用了移动医疗，设施内分娩情况有所改善。此外，在有关新生儿护理的研究中，75%（3/4）的研究表明，新生儿护理的使用与保健工作者使用移动保健服务有关。许多研究报告了解决与支持移动医疗的社区保健工作者的社会环境有关的因素的重要性，包括社区对社区保健工作者的看法、信任、关系、数字扫盲、培训、指导和监督、技能、社区保健工作者计划的所有权以及提供激励措施。只有极少数研究报告了项目目标和文化是如何影响社区保健工作者使用移动医疗的。提供免费的设备、配件和互联网连接，同时解决连接、电力、移动医疗软件的易用性以及设备维护支持等方面的持续挑战，使支持移动医疗的保健医生项目得以蓬勃发展。结论：在 SSA，保健医生使用移动医疗与 ANC 使用、设施内分娩和 PNC 使用的增加有关。识别并解决使用移动医疗的社会和技术障碍对于确保移动医疗项目的成功至关重要：PERCORO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364.
{"title":"Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review.","authors":"Chiyembekezo Kachimanga, Haules Robbins Zaniku, Titus Henry Divala, Johannes C F Ket, Joia S Mukherjee, Daniel Palazuelos, Alexandra V Kulinkina, Ibukun-Oluwa Omolade Abejirinde, Thomas van den Akker","doi":"10.2196/55819","DOIUrl":"10.2196/55819","url":null,"abstract":"<p><strong>Background: </strong>Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA).</p><p><strong>Objective: </strong>This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach.</p><p><strong>Methods: </strong>We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes.</p><p><strong>Results: </strong>Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive.</p><p><strong>Conclusions: </strong>mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs.</p><p><strong>Trial registration: </strong>PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"12 ","pages":"e55819"},"PeriodicalIF":5.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment 基于移动应用程序评分量表的儿童和青少年眼科护理应用程序评估：内容分析与质量评估
IF 5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-13 DOI: 10.2196/53805
Ming Liu, Xiaoqian Wu, Ziyu Li, Dongmei Tan, Cheng Huang
Background: In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies. Objective: This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores. Methods: A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale. Results: This study included 29 apps, of which 17 (59%) were developed by commercial organizations and 12 (41%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62%), eye exercises (16/29, 55%), and eye-care education (16/29, 55%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner. Conclusions: In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users’ needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control.
背景：中国儿童青少年近视现状十分严峻。医疗资源的匮乏和护眼意识的淡薄阻碍了近视防控工作的开展。然而，手机应用程序为解决这些问题提供了有效途径。由于中国的健康应用程序市场尚不成熟，因此开展一项评估护眼应用程序质量的研究以促进制定更好的护眼服务策略就显得尤为重要。研究目的本研究旨在评估中国应用程序商店中针对儿童和青少年的护眼应用程序的质量、功能、医学证据和专业背景。方法：对 iOS 和 Android 应用程序进行系统检索：对 iOS 和 Android 应用程序商店进行系统搜索，以确定针对儿童和青少年的护眼应用程序。对应用程序的一般特征、开发背景和功能特点进行了描述。两名独立研究人员使用移动应用程序评分量表完成了应用程序的质量评估。研究结果本研究包括 29 款应用程序，其中 17 款（59%）由商业机构开发，12 款（41%）的设计具有相关科学依据。这些应用程序的主要内置功能包括自我测试（18/29，62%）、眼保健操（16/29，55%）和护眼教育（16/29，55%）。护眼应用程序总体质量的平均值为 3.49（标准差为 0.33），得分范围在 2.89 至 4.39 之间。移动应用评分量表的总分与各分量表得分呈显著正相关（r=0.81-0.91；P<.001）。此外，尽管大多数应用程序都提供了基本的护眼功能，但也存在一些不足之处。例如，只有少数应用程序是在医疗组织或专业眼科医生的参与下开发的，而且大多数应用程序的更新频率较低，不能及时提供最新的护眼信息和技术。结论总体而言，中国应用程序商店中的儿童和青少年护眼应用程序质量较好。这些应用在一定程度上满足了用户的护眼服务需求，但仍存在医疗背景不足、用户参与度低、更新不及时等问题。为了进一步提高护眼类应用的效果，应加强与医疗机构和专业眼科医生的合作，增强应用的科学性和权威性。同时，应增加互动功能和定期更新，提高用户参与度和应用程序的延续性。本研究为今后开发或改进护眼应用程序提供了参考，有助于促进近视防控工作。
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引用次数: 0
Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study 改善员工健康状况的数字行为指导干预的实际效果：回顾性观察研究
IF 5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-10 DOI: 10.2196/50356
Amani Fadzlina Abdul Aziz, Tiffanie Ong
Background: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. Objective: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. Methods: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Results: Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=–0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=–11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. Conclusions: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors. Trial Registration:
背景：慢性非传染性疾病（NCDs）在全球范围内造成了严重的残疾和过早死亡，中低收入国家的负担尤为沉重。鉴于非传染性疾病对员工绩效和工作效率的负面影响，利益相关者越来越需要找到有效的工作场所解决方案，以改善员工的健康状况。随着大流行后工作场所变得更加分散，数字化行为指导为管理员工的慢性病风险因素提供了一种可扩展、个性化和具有成本效益的方法。研究目的本研究旨在回顾性评估数字化行为指导项目对印度尼西亚员工健康状况逐年变化的影响。研究方法这项对二次健康数据进行的回顾性真实世界探索分析追踪了一家印尼公司的774名员工，他们在2021年至2022年期间完成了公司资助的健康检查，并获得了Naluri（Naluri Hidup Sdn Bhd）的访问权限，这是一个提供数字行为健康指导和自助工具的整体数字治疗平台。参与者被回顾性地分为接受主动辅导者（177 人）、被动辅导者（108 人）和未接受辅导者（489 人）。采用线性混合效应模型评估 3 个员工组的健康结果的逐年变化，并通过事后分析评估两个时间点之间的组内差异和随访时的组间差异。结果显示在体重、体重指数、血红蛋白 A1c、低密度脂蛋白、总胆固醇、收缩压和舒张压方面发现了明显的时间×组间交互效应。事后配对比较显示，在2021年至2022年期间，主动辅导组员工的血红蛋白A1c（平均差[Mdiff]=-0.14，P=.008）、高密度脂蛋白（Mdiff=+2.14，P<.001）和总胆固醇（Mdiff=-11.45，P<.001）均有显著改善，而其他两组员工在这两个时间点的多个健康结果均有所恶化。在随访中，2021 年至 2022 年期间接受积极辅导的员工的体重（P<.001）、体重指数（P=.001）、低密度脂蛋白（P=.045）和总胆固醇（P<.001）均显著低于无辅导组。结论：本研究展示了支持使用工作场所数字化行为指导改善员工健康状况的实际结果和意义。鉴于东南亚地区非传染性疾病的负担日益加重，我们的研究结果强调了工作场所数字健康干预在预防和管理慢性疾病风险因素方面所能发挥的作用。试验注册：
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引用次数: 0
The Impact of Air Pollution Information on Individuals’ Exercise Behavior: Empirical Study Using Wearable and Mobile Devices Data 空气污染信息对个人锻炼行为的影响：使用可穿戴设备和移动设备数据的实证研究
IF 5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-10 DOI: 10.2196/55207
Yang Yang, Khim-Yong Goh, Hock Hai Teo, Sharon Swee-Lin Tan
Background: Physical exercise and exposure to air pollution have counteracting effects on individuals’ health outcomes. Knowledge on individuals’ real-time exercise behavior response to different pollution information sources remains inadequate. Objective: This study aims to examine the extent to which individuals avoid polluted air during exercise activities in response to different air pollution information sources. Methods: We used data on individuals’ exercise behaviors captured by wearable and mobile devices in 83 Chinese cities over a 2-year time span. In our data set, 35.99% (5896/16,379) of individuals were female and 64% (10,483/16,379) were male, and their ages predominantly ranged from 18 to 50 years. We further augmented the exercise behavior data with air pollution information that included city-hourly level measures of the Air Quality Index and particulate matter 2.5 concentration (in µg/m3), and weather data that include city-hourly level measures of air temperature (ºC), dew point (ºC), wind speed (m/s), and wind direction (degrees). We used a linear panel fixed effect model to estimate individuals’ exercise-aversion behaviors (ie, running exercise distance at individual-hour, city-hour, or city-day levels) and conducted robustness checks using the endogenous treatment effect model and regression discontinuity method. We examined if alternative air pollution information sources could moderate (ie, substitute or complement) the role of mainstream air pollution indicators. Results: Our results show that individuals exhibit a reduction of running exercise behaviors by about 0.50 km (or 7.5%; P<.001) during instances of moderate to severe air pollution, and there is no evidence of reduced distances in instances of light air pollution. Furthermore, individuals’ exercise-aversion behaviors in response to mainstream air pollution information are heightened by different alternative information sources, such as social connections and social media user-generated content about air pollution. Conclusions: Our results highlight the complementary role of different alternative information sources of air pollution in inducing individuals’ aversion behaviors and the importance of using different information channels to increase public awareness beyond official air pollution alerts.
背景：体育锻炼和暴露于空气污染会对个人的健康产生反作用。有关个人对不同污染信息源的实时运动行为反应的知识仍然不足。研究目的本研究旨在探讨个体在运动过程中根据不同的空气污染信息源避开污染空气的程度。研究方法我们使用了通过可穿戴设备和移动设备获取的中国 83 个城市两年内的个人运动行为数据。在我们的数据集中，35.99%（5896/16379）的个体为女性，64%（10483/16379）的个体为男性，年龄主要介于 18 岁至 50 岁之间。我们还利用空气污染信息（包括城市每小时的空气质量指数和颗粒物 2.5 浓度（单位：µg/m3））和天气数据（包括城市每小时的气温（ ºC）、露点（ ºC）、风速（米/秒）和风向（度））进一步增强了运动行为数据。我们使用线性面板固定效应模型来估计个人的运动厌恶行为（即个人小时、城市小时或城市日级别的跑步运动距离），并使用内生处理效应模型和回归不连续法进行稳健性检验。我们研究了其他空气污染信息源是否可以缓和（即替代或补充）主流空气污染指标的作用。结果我们的结果表明，在中度到重度空气污染的情况下，个人的跑步锻炼行为减少了约 0.50 公里（或 7.5%；P<.001），而在轻度空气污染的情况下，没有证据表明跑步距离会减少。此外，不同的替代信息来源，如社会关系和社交媒体用户生成的有关空气污染的内容，也会增强个人对主流空气污染信息的厌恶运动行为。结论：我们的研究结果凸显了不同的空气污染替代信息源在诱导个人厌恶行为方面的互补作用，以及在官方空气污染警报之外利用不同信息渠道提高公众意识的重要性。
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引用次数: 0
Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial. 基于移动医疗的膝骨关节炎患者运动干预 re.flex 的疗效：试点随机对照试验。
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
JMIR mHealth and uHealth
Pub Date : 2024-09-09 DOI: 10.2196/54356
Valerie Dieter, Pia Janssen, Inga Krauss
<p><strong>Background: </strong>Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply.</p><p><strong>Objective: </strong>This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis.</p><p><strong>Methods: </strong>This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately.</p><p><strong>Results: </strong>A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m<sup>2</sup>). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions.</p><p><strong>Conclusions: </strong>Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-
背景：国际指南建议将运动疗法作为膝关节骨性关节炎患者的核心治疗方法。然而，建议与医疗实践之间存在巨大差距。数字运动应用程序有望帮助解决这一供应不足的问题：本研究旨在评估一种为期 12 周、基于应用程序的全自动运动干预措施的疗效，该干预措施可使用或不使用支撑型护膝，对膝关节骨性关节炎患者的健康相关结果、表现指标和坚持性均有影响：这项封闭式用户组试验的参与者包括中度至重度单髁疼痛性膝关节骨关节炎患者。以 1:1:2 的比例随机分为干预组（IG）和对照组（CG），前者包含两个子组（基于应用程序的训练 [IG A]、基于应用程序的训练和支持性膝关节支架 [IG AB]）。干预措施包括为期 12 周的家庭锻炼计划，每周 3 次。运动指导通过应用程序进行，并使用放置在受影响膝关节下方和上方的两个加速度计进行监测。CG参与者不接受任何研究干预，但可利用常规护理。骨关节炎特异性疼痛（膝关节损伤和骨关节炎结果评分）被定义为主要结果，次要结果包括所有其他膝关节损伤和骨关节炎结果评分分量表、一般健康相关生活质量（退伍军人兰德12项健康调查）、心理测量（如运动自我效能）、表现测量（力量和姿势控制）以及对坚持性和安全性的监测。结果在基线和 12 周后进行评估。对于 IG A 和 IG AB 与 CG 的联合比较，采用基线调整后的协方差分析计算干预效果，并按协议方法进行。对每种 IG 分别进行了分组分析：共纳入 61 名参与者（IG：n=30，49%；CG：n=31，51%；男性：n=31，51%；女性：n=30，49%；平均年龄 62.9 岁，SD 8.5 岁；平均体重指数 27.7，SD 4.5 kg/m2）。分析表明，IG 在减轻疼痛方面的效果具有统计学意义（结论：IG 对膝关节骨性关节炎患者有明显的疗效：与对照组相比，膝关节骨性关节炎患者在接受为期12周的基于传感器辅助应用程序的运动干预后，无论是否使用额外的护膝，都能在缓解疼痛、改善身体功能以及其他骨性关节炎特定问题方面获得有临床意义的治疗效果：试验注册：德国临床试验注册中心（DRKS）DRKS00023269；https://drks.de/search/de/trial/DRKS00023269。
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