Just-in-time adaptive intervention to promote fluid consumption in patients with kidney stones.

Abstract

Objective: Kidney stones are painful and costly. Prevention guidelines emphasize a simple behavior change: increasing fluid intake and urine output. Unfortunately, adherence to those prevention guidelines is limited, and patients report forgetting or not being thirsty enough. This study evaluated the acceptability of using semiautomated tracking of fluid consumption to trigger just-in-time reminders to drink and increase the experienced automaticity of fluid intake. Method: In a single-group trial, participants with a history of kidney stones (n ϭ 31) used the sip IT digital tools (H2OPal connected water bottle, H2OPal mobile app for self-tracking, Fitbit smartwatch app for gesture detection) for 3 months. Results: The semiautomated monitoring system detected 46,654 drinking events. From baseline to 1-month follow-up, the experienced automaticity of fluid intake increased significantly (d ϭ 0.50) and remained elevated at 3-month follow-up (d ϭ 0.64). A major barrier to adherence (lack of thirst) decreased from baseline to follow-ups. Retention rates and participant feedback indicated that this digital tool was acceptable to patients. Conclusion: Semiautomated tracking of fluid consumption can be used to trigger just-in-time reminders. Based on this demonstration, the sip IT tools are ready for testing in a rigorous Phase II trial to evaluate efficacy for increasing fluid consumption and urine output as recommended for preventing the recurrence of kidney stones.

Monitoring fluid intake by commercially available smart water bottles

“…To determine summative liquid intake and ensure proper daily hydration, it is more important to have an accurate volume intake detection throughout the whole day (24 h), rather than of each sip. However, to determine just-in-time intervention prompts, there is a need for each sip to have a low error, as done in the study by Conroy et al 2 . If a sip is not recorded or is poorly recorded, it is crucial that the bottle can balance out the volume in the next recordings.…”

“…High fluid intake is recommended for patients at risk of recurring stone formation. Therefore, monitoring fluid intake is a useful way to determine if adequate fluid has been consumed 1 , 2 . There are many reports in the literature of attempts to create systems or devices that can aide in tracking and managing fluid intake 3 .…”

“…Since then, HidrateSpark has developed new bottles with different sensors. The H2OPal has been used in other research studies to track and promote fluid intake, but there is no specific study to validate its performance 2 , 10 . Plecher et al compared several commercial bottles in terms of functionality for seniors and available information online, however they did not perform any validation on their accuracy 11 .…”

Update – 2022 Canadian Urological Association guideline: Evaluation and medical management of the kidney stone patient

“…48 Recent studies assessing smart technology including smart water bottles and associated digital applications have shown the accuracy of these technologies to measure fluid intake, however the impact on urine output may be similar to counseling. [56][57][58] A systematic review showed that most interventions can improve fluid intake by approximately 500mL, with the most effective strategies being instruction, and self-monitoring using urine dipstick or 24-hour urine volume. 59 Counseling regarding fluid intake should clearly state the risk reduction associated with increased fluid intake, explore barriers to fluid consumption such as occupational barriers, taste factors related to water, and urinary voiding difficulties such as overactive bladder and bladder outlet obstruction.…”

Dynamical Outcome Modeling of Fragmented Intensive Longitudinal Data

“…That is, using sensors in the system to collect person-level data in addition to the EMAs provides the opportunity for adaptation and triggerring the support dynamically (Spruijt-Metz and Nilsen, 2014). These three features that represent the ability of JITAIs to detect and deliver support at the right "moment" has led them to be implemented in various health related concerns such as physical activity (Hardeman et al, 2019), stress management (Sarker et al, 2016), fluid consumption (Conroy et al, 2020), weight loss (Forman et al, 2019), sun protection (Huh et al, 2021), addiction (S. P. Goldstein et al, 2017), and smoking cessation (McClernon and Choudhury, 2013) among others.…”