Kim Ben Yb, Lee Joon
Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
JMIR Mhealth Uhealth. 2017 May 23;5(5):e69. doi: 10.2196/mhealth.7141.
The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions.
We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions.
We used the Arksey and O'Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model.
A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers.
Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies.
具备功能大幅提升（如传感器、计算能力、交互性）的智能手机和平板电脑的出现，改变了移动健康干预支持老年人慢性病管理的方式。婴儿潮一代已开始广泛采用智能设备，并表示希望将技术融入其慢性病护理中。尽管智能设备在研究中得到了积极应用，但对于基于智能设备的干预措施的范围、特点和种类，人们了解甚少。
我们进行了一项范围综述，以（1）了解基于智能设备的研究活动的性质、范围和种类，（2）确定当前研究的局限性和知识差距，（3）推荐未来的研究方向。
我们使用阿克斯和奥马利框架进行范围综述。我们使用与移动健康、慢性病和老年人相关的搜索词，从MEDLINE、Embase、CINAHL和科学引文索引数据库中识别相关研究。入选研究使用了智能设备，对老年人进行了抽样，且发表于2010年或之后。排除标准为仅依赖短信（短消息服务，SMS）或交互式语音应答、问卷电子版的验证、术后监测以及可用性评估。我们查阅了参考文献。我们绘制了定量数据，并使用主题综合法分析了定性研究。为了整理和总结数据，我们使用了慢性病护理模型。
共有51篇文章符合纳入标准。2014年研究活动急剧增加（17/51，33%），且实验前设计占主导（16/50，32%）。糖尿病（16/46，35%）和心力衰竭管理（9/46，20%）是研究最频繁的领域。我们发现慢性病内部和之间在生物特征数据收集和患者报告结局测量方面存在多样性和异质性。在各项研究中，我们发现了8种自我管理支持策略和4种支持决策过程的不同沟通渠道。特别是，自我监测（38/40，95%）、自动反馈（15/40，38%）和患者教育（13/40，38%）被普遍用作自我管理支持策略。在实施决策支持策略的23项研究中，有10项研究（43%）将临床决策下放给了患者。对患者结局的影响与使用手机的研究一致。心力衰竭和哮喘患者报告生活质量有所改善。定性分析得出了促进老年人采用技术的2个主题和障碍的3个主题。
当前研究的局限性包括缺乏老年学重点、实验前设计占主导、研究范围狭窄、对参与者的支持不足以及临床结局证据不足。对未来研究的建议包括为基于智能设备的项目提供证据、将患者生成的数据用于先进的数据挖掘技术、验证患者决策支持系统以及通过创新技术扩大移动健康实践。
