Pulantara I Wayan, Parmanto Bambang, Germain Anne
Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States.
Sleep and Chronobiology Laboratories, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
JMIR Hum Factors. 2018 May 17;5(2):e21. doi: 10.2196/humanfactors.8905.
Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this "Just in Time Adaptive Intervention" for insomnia-an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools-can significantly improve patient access and clinician delivery of evidence-based insomnia treatments.
This study aims to develop and assess the usability of a Just in Time Adaptive Intervention application platform called iREST ("interactive Resilience Enhancing Sleep Tactics") for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians.
The development of iREST was based on the Iterative and Incremental Development software development model. Requirement analysis was based on the case study's description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the Just in Time Adaptive Intervention architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns.
The iREST app was developed from the mobile logical architecture of Just in Time Adaptive Intervention. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean 12.23, SD 8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as "highly usable", achieving a mean System Usability Score score of 85.74 (SD 12.37), which translates to an adjective rating of "Excellent". The participants also gave high scores on "ease of use and learnability" with an average score of 4.33 (SD 0.65) on a scale of 1 to 5.
iREST provides a feasible platform for the implementation of Just in Time Adaptive Intervention in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based Just in Time Adaptive Intervention is not only feasible, but also works effectively.
健康睡眠是身心健康的基本组成部分。然而，失眠是一种普遍存在的睡眠障碍，会损害身体机能、工作效率和健康。因此，开发有效的失眠治疗方法对社会和个人健康具有重大影响。失眠的认知行为疗法（CBTI）是推荐的一线治疗方法，但目前患者获得该治疗的机会有限，因为治疗必须在专业睡眠诊所进行，而这类诊所中训练有素的临床医生数量不足。基于智能手机的干预措施为改善CBTI的提供方式提供了一种有前景的手段。此外，诸如实时监测与评估、个性化、干预措施的动态调整以及情境感知等新特性可以增强治疗的个性化程度和有效性，并降低相关成本。最终，这种针对失眠的“即时自适应干预”——一种患者和临床医生都能接受的、基于移动健康（mHealth）平台和工具的干预方法——可以显著改善患者获得循证失眠治疗的机会以及临床医生提供治疗的便利性。
本研究旨在开发并评估一款名为iREST（“交互式增强恢复力睡眠策略”）的即时自适应干预应用平台在行为性失眠干预中的可用性。患者和临床医生均可使用iREST。
iREST的开发基于迭代增量式软件开发模型。需求分析基于案例研究的描述、工作流程和需求、临床医生的意见，以及之前进行的BBTI军事研究/即时自适应干预架构的实施情况。为评估iREST移动健康工具的可用性，开展了一项试点可用性研究。此外，本研究还探讨了使用现成的可穿戴设备来补充对患者睡眠模式主观评估的可行性。
iREST应用程序是根据即时自适应干预的移动逻辑架构开发的。它由一个跨平台智能手机应用程序、一个临床医生门户以及该应用程序与门户之间的安全双向通信平台组成。可用性研究涵盖了19名年龄在18至60岁之间的现役军人和退伍军人。基于应用程序内问卷调查的描述性统计表明，平均而言，在两年多的时间里，每天有12个（平均12.23个，标准差8.96）不同的设备访问临床医生门户，而该应用程序被评为“高度可用”，系统可用性平均得分为85.74（标准差12.37），换算成形容词评级为“优秀”。参与者在“易用性和易学性”方面也给出了高分，在1至5分的量表上平均得分为4.33（标准差0.65）。
iREST为在基于移动健康的远程干预环境中实施即时自适应干预提供了一个可行的平台。该系统被评为高度可用，其跨平台特性使其能够在高度分化的智能手机市场中轻松实现。使用可穿戴设备来追踪睡眠很有前景；然而，这项技术的准确性还需要进一步提高。最终，iREST表明基于移动健康的即时自适应干预不仅可行，而且有效。
