Use of mHealth Technology for Patient-Reported Outcomes in Community-Dwelling Adults with Acquired Brain Injuries: A Scoping Review

Abstract

The purpose of our scoping review was to describe the current use of mHealth technology for long-term assessment of patient-reported outcomes in community-dwelling individuals with acquired brain injury (ABI). Following PRISMA guidelines, we conducted a scoping review of literature meeting these criteria: (1) civilians or military veterans, all ages; (2) self-reported or caregiver-reported outcomes assessed via mobile device in the community (not exclusively clinic/hospital); (3) published in English; (4) published in 2015–2019. We searched Ovid MEDLINE(R) < 1946 to 16 August 2019, MEDLINE InProcess, EPub, Embase, and PsycINFO databases for articles. Thirteen manuscripts representing 12 distinct studies were organized by type of ABI [traumatic brain injury (TBI) and stroke] to extract outcomes, mHealth technology used, design, and inclusion of ecological momentary assessment (EMA). Outcomes included post-concussive, depressive, and affective symptoms, fatigue, daily activities, stroke risk factors, and cognitive exertion. Overall, collecting patient-reported outcomes via mHealth was feasible and acceptable in the chronic ABI population. Studies consistently showed advantage for using EMA despite variability in EMA timing/schedules. To ensure best clinical measurement, research on post-ABI outcomes should consider EMA designs (versus single time-point assessments) that provide the best timing schedules for their respective aims and outcomes and that leverage mHealth for data collection.

Feasibility and Pilot Testing of Mobile Health Apps to Supplement 2 Healthy Lifestyle Interventions in Chronic Traumatic Brain Injury

“…However, based on our study results, pushing daily content through an mHealth app may be too frequent and repetitive and further work is needed to integrate multiple mHealth components into a single platform. Participants in our study were less compliant, on average, than those in previous studies examining mHealth technology in TBI populations (where compliance ranged from 50% to 83%), though no previous study included daily content for longer than 8 weeks (and ours engaged participants for 42 weeks) 22. Consistent with previous studies, however, we noted that many participants never used the apps or discontinued them almost immediately after starting 22,23.…”

Smartphone and mHealth Use After Stroke: Results From a Pilot Survey

“…These problems may contribute to providers feeling hesitant about recommending apps. Furthermore, there is insufficient evidence for making definitive recommendations for the use of mHealth apps after stroke (Juengst et al, 2021). Research teams and practitioners have an important opportunity to vet popular existing apps in the marketplaces as they are already being used by the public to support life after stroke.…”

“…Selecting the right mHealth app and integrating it successfully into everyday life can be inherently complex leaving room for training and coaching in this process by a knowledgeable and skilled provider. This requirement poses a significant role for occupational therapists to identify quality mHealth apps, educate clients on mHealth apps that are available, train clients on how to adjust accessibility features, and coach clients on how to implement them into their daily routine to support self-management (Juengst et al, 2021).…”

Rasch Analysis of the Behavioral Assessment Screening Tool (BAST) in Chronic Traumatic Brain Injury

“…Future work will examine the BAST using Multidimensional Rasch Analysis to improve the measure further [4]. Additionally, single time point assessment of neurobehavioral symptoms has known limitations with regard to recall bias and notable within person variability [13,12,29], which may also account for unmodeled noise in symptom reporting. We recommend that the BAST be used for repeated measurement in clinical surveillance of chronic neurobehavioral symptoms after TBI, to identify potential neurobehavioral issues early in their development, rather than as a diagnostic tool or absolute indicator of symptom severity.…”