A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study

Abstract

Background Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient’s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire–9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire–9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966

Validation of the Mobile App Version of the EQ-5D-5L Quality of Life Questionnaire Against the Gold Standard Paper-Based Version: Randomized Crossover Study

“…Furthermore, Bellamy et al [32] found high correlations between a paper-based and mobile-based scores for osteoarthritis. Different studies [11,33,34] showed a similar response to a questionnaire requested via an app and a paper-based version. These results support the validity of the EQ-5D-5L mobile app questionnaire used in this study in healthy volunteers.…”

“…Older people are often less comfortable using mobile apps, and information about quality of life may be even more relevant for this group [40]. Another recommendation is to determine the use of the mobile app in long-term monitoring; for example, as a follow-up tool during or after treatment [11,31,34].…”

“…Therefore, a patient can be monitored effortlessly by the physician or researcher, and the patient does not have to make separate appointments with the physician or researcher. From a data perspective, the benefits of completing questionnaires via a smartphone app include easy to retrieve data, reliable data, and prevention of data loss due to backup systems [11]. Before a mobile questionnaire app can be deployed in a clinical setting, it is essential that this new method is validated against the traditional method [12].…”

Lifestyle interventions after colorectal cancer surgery using a mobile digital device: A study protocol for a randomized controlled trial

“…[27,28] On the other hand, health-related applications on smart phones are repeatedly reported to be efficient in communicating between medical providers and patients. [16][17][18][19] In a recent study, a mobile application was found to be an effective tool for increasing physical activity in breast cancer survivors. [17] The authors of that report tested the efficacy of the "Walkon" application which we will also test in our present trial to obtain daily step counts and also application-based questionnaire responses to evaluate patient distress.…”

An Overview of Telehealth in Total Joint Arthroplasty

“…Online electronic questionnaires can be used for the assessment of patient-reported outcome measures (PROMs). It has been reported that the app versions of questionnaires have shown a high level of association with the paper-based questionnaires, making their use in clinical practice and for telemedicine visits feasible [21].…”