Background: Total knee arthroplasty (TKA) is commonly performed to manage end-stage knee osteoarthritis, yet postsurgical recovery varies significantly among patients. Lifestyle modification and rehabilitation interventions play a critical role in optimizing outcomes. While telerehabilitation has shown promise in enhancing accessibility and compliance, its role in supporting lifestyle behavior change alongside supervised sensorimotor training remains underexplored.
Objective: This study aimed to evaluate the effects of a home-based lifestyle modification program delivered through web-based telerehabilitation monitoring in addition to supervised sensorimotor training, in improving physical function, pain, balance, quality of life (QOL), and adherence in patients undergoing TKA.
Methods: A single-blinded randomized controlled trial was conducted among 52 participants undergoing primary TKA, who were randomly assigned to either the intervention group (IG) (supervised sensorimotor training plus a telerehabilitation-supported lifestyle modification program) or the control group (CG) (supervised sensorimotor training alone and a traditional home exercise plan). The intervention lasted 22 weeks, and participants were assessed at baseline (presurgery), 14 weeks, and 22 weeks postsurgery. Outcome measures included joint position sense (JPS), musculoskeletal ultrasound of the rectus femoris muscle, Berg Balance Scale, knee function using the Knee Injury and Osteoarthritis Outcome Score, and QOL via EuroQol 5-dimension 5-level questionnaire.
Results: Significant improvements were observed in the IG across all outcomes compared with the CG. Notably, the IG showed greater improvements in musculoskeletal ultrasound thickness. JPS showed superior accuracy in the experimental group (baseline [3.2 degrees] to 22 wk postsurgery [0.05 degrees]) compared with the CG (baseline [3.1 degrees] to 22 wk postsurgery [1.8 degrees]), with significant improvements noted (P=.001, Cohen d=3.1 vs 0.7), Knee Injury and Osteoarthritis Outcome Score subscales (pain, symptoms, activities of daily living, sport, and QOL), and JPS (mean absolute error 0.05 vs 1.8 degrees). Berg Balance Scale demonstrated significant gains in balance for the experimental group (baseline [34] to 22 wk postsurgery [53]) relative to the CG (baseline [37] to 22 wk postsurgery [48]), with substantial differences observed (P=.001, Cohen d=1.8 vs 0.4). The EuroQol 5-dimension 5-level questionnaire health-related QOL scores were markedly higher for the experimental group (baseline [45.4] to 22 wk postsurgery [88.1]) compared with the CG (baseline [42.8] to 22 wk postsurgery [70.9]), indicating substantial gains in overall health status (P=.001, Cohen d=2.4 vs 1.3). The IG also reported higher compliance, with 81.8% (18/22) achieving over 90% adherence compared with 68.18% (15/22) in the CG.
Conclusions:
Background: Engagement with digital mental health interventions is often measured as a summary-level variable and remains underresearched despite its importance for meaningful symptom change. This study deepens understanding of engagement in a digital eating disorder intervention, recovery record, by measuring engagement with unique components of the app, on 2 different devices (phone and watch), and at a summary level.
Objective: This study described and modeled how individuals engaged with the app across a variety of measures of engagement and identified baseline predictors of engagement.
Methods: Participants with current binge-eating behavior were recruited as part of the Binge Eating Genetics Initiative study to use a digital eating disorder intervention for 4 weeks. Demographic and severity of illness variables were captured in the baseline survey at enrollment, and engagement data were captured through both an iPhone and Apple Watch version of the intervention. Engagement was characterized by log type (urge, behavior, mood, or meal), device type (logs on phone or watch), and overall usage (total logs) and averaged each week for 4 weeks. Descriptives were tabulated for demographic and engagement variables, and multilevel growth models were conducted for each measure of engagement with baseline characteristics and time as predictors.
Results: Participants (N=893) self-reported as primarily White (743/871, 85%), non-Hispanic (801/893, 90%), females (772/893, 87%) with a mean age of 29.6 (SD 7.4) years and mean current BMI of 32.5 (SD 9.8) kg/m2 and used the app for a mean of 24 days. Most logs were captured on phones (217,143/225,927; 96%), and mood logs were the most used app component (174,818/282,136; 62% of logs). All measures of engagement declined over time, as illustrated by the visualizations, but each measure of engagement illustrated unique participant trajectories over time. Time was a significant negative predictor in every multilevel model. Sex and ethnicity were also significant predictors across several measures of engagement, with female and Hispanic participants demonstrating greater engagement than male and non-Hispanic counterparts. Other baseline characteristics (age, current BMI, and binge episodes in the past 28 days) were significant predictors of 1 measure of engagement each.
Conclusions: This study highlighted that engagement is far more complex and nuanced than is typically described in research, and that specific components and mode of delivery may have unique engagement profiles and predictors. Future work would benefit from developing early engagement models informed by baseline characteristics to predict intervention outcomes, thereby tailoring digital eating disorder interventions at the individual level.
Background: Adverse events (AEs) related to cancer treatment represent a valuable source of information that can be used to adjust therapy for individual patients. The NIH developed the Common Terminology Criteria for Adverse Events (CTCAE), a comprehensive standardized terminology for healthcare providers to consistently report AEs during patient visits. mHealth technologies, in principle, also allow AEs to be self-reported by patients in-between visits; however, the terminology poses challenges for them, both in selecting the correct symptom to report and in rating its severity. NIH developed the Patient-Reported Outcomes (PRO)-CTACE as the patient-oriented companion of the CTCAE. However, it shows some weaknesses in completeness and precision when used for continuous home patient monitoring and for decision support.
Objective: The aim of this work is to propose a new terminology for reporting AEs, which is easy for patients to use while also being clinically meaningful for healthcare providers, and easily exploitable by decision support systems. Moreover, we aim to demonstrate its implementation and validation within the CAPABLE EU project.
Methods: The development of the new terminology starts from the CTCAE, which includes a comprehensive list of signs and symptoms along with guidance for accurately grading their severity. Through a multi-step, participatory approach involving both patients and healthcare providers, we reduced and adapted the AE list for patient-oriented applications. During the CAPABLE project, the proposed terminology was integrated in a mobile app and evaluated within a clinical pilot study involving 86 patients who were monitored through the app for at least 6 months, and a control cohort of 133 patients monitored using standard care practices.
Results: The final terminology includes 124 AEs, 49 expressed as "present/absent", and 77 associated with four description levels. A mapping between the description levels and the original CTCAE grades enables running the decision support system embedded in the CAPABLE app. The pilot study demonstrated that the majority of the patients used the symptoms reporting functionality, sharing also 24 unique AEs that are not present in the PRO-CTCAE. Symptoms reported using the proposed terminology allowed the enactment of the clinical practice guidelines included in the CAPABLE decision support tool, triggering 11 distinct recommendations.
Conclusions: The results obtained from the clinical study support our claim regarding the need for a novel terminology for the self-reporting of AEs, characterized by ease of use, completeness, and clinical meaningfulness. Finally, by mapping our terminology to the CTCAE, we demonstrated that it is possible to exploit self-reported data to trigger decision support rules consistent with clinical practice guidelines.
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Background: Work engagement is an important determinant of workers' well-being. According to the job demands-resources model, personal resources are one of the key antecedents of work engagement. Enhancing personal resources leads to improved work engagement. Furthermore, reflecting positively on one's achievements at work may enhance personal resources. Hence, there is a need for a simple, self-guided tool such as a smartphone app that can be used by employees to record and reflect on their work accomplishments.
Objective: This study aimed to evaluate the effect of a smartphone-based diary (ie, Work Engagement Diary) that promotes positive reflection in daily working life on work engagement among Japanese workers in a randomized controlled trial.
Methods: Six hundred Japanese workers who met the inclusion criteria were randomly allocated to either the intervention group or the wait-list control group (300 participants each) via a web survey company. Participants in the intervention group kept the Work Engagement Diary for 2 weeks, whereby they were required to set a weekly goal at the beginning of the week and fill in their work achievements at the end of the day. Those in the waitlist control group did not receive any interventions until they completed a follow-up survey. Work engagement was assessed at preintervention (T1), postintervention (T2), and 3 weeks after intervention (T3) in both groups.
Results: A mixed model for repeated measures conditional growth model analysis using intention-to-treat revealed a significant improvement in work engagement for the intervention group compared to the wait-list control group throughout the study period (P=.04). Effect sizes were small in work engagement for T1 versus T2 (Cohen d=0.11 [95% CI -0.06 to 0.28]) and for T1 versus T3 (Cohen d=0.12 [95% CI -0.06 to 0.28]).
Conclusions: This randomized controlled trial demonstrated that our newly developed smartphone-based positive reflection diary at work effectively improved work engagement among Japanese workers. Future research needs to clarify longer-term intervention effects and detailed mechanisms of the intervention effects.
Background: Carbohydrate counting (CC) is vital for individuals living with type 1 diabetes mellitus (T1DM); yet, formal training is often lacking in many contexts. To bridge this gap, the parents of a person living with diabetes and a team at the Geneva University Hospital (HUG) developed WebDia, a free-access app that helps patients with T1DM assess meal carbohydrates and make informed decisions regarding insulin dosage. In the context of Peru, where dietary patterns and meal compositions may differ, customizing WebDia to suit the components of the Peruvian diet becomes particularly relevant.
Objective: This study aimed to customize WebDia according to the composition of the Peruvian diet to facilitate CC, and to provide training to health care workers (HCWs), children and adolescents living with T1DM, and their caregivers in the proficient use of WebDia-Mundi (new version of the Swiss app WebDia adapted to other geographic contexts).
Methods: A dietitian compiled a database of Peruvian foods and their carbohydrate content. This was reviewed by a Swiss nurse specialized in diabetes, a Peruvian pediatric endocrinologist, and 2 researchers. Validation was conducted with a small group of children and adolescents living with T1DM and their caregivers. Subsequently, a 3-day workshop was held in 3 Peruvian regions for HCW and children and adolescents living with T1DM. The first 2 days were a training course for HCW to gain knowledge in T1DM and learn CC skills. This was followed by a 1-day workshop involving HCW, children and adolescents living with T1DM, and their caregivers. At the end of the workshop and 3 months later, an evaluation was performed to assess the app's usability, glycated hemoglobin, quality of life, and knowledge perception for children and adolescents living with T1DM and their caregivers. Furthermore, changes in knowledge among HCWs and overall workshop satisfaction were measured.
Results: WebDia-Mundi was customized for the Peruvian context in 2022-2023. The training was attended by 25 HCWs, 25 children and adolescents living with T1DM, and 31 caregivers. Following the training, HCWs exhibited a significant 3.5-point increase in their knowledge of T1DM, while achieving positive results regarding the usability of WebDia-Mundi. Children and adolescents living with T1DM and their caregivers also reported a favorable perception of the ease of use and functionality of WebDia-Mundi, which enhanced their CC skills.
Conclusions: This study underscores the importance of collaboration among multidisciplinary teams and the involvement of individuals with T1DM. Adapting mobile health solutions to new contexts and sharing experiences can help standardize this process.
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