scholarly journals Mobile Behavioral Therapy for Headache: Pilot Study (Preprint)

2018 ◽  
Author(s):  
Adam Kirell ◽  
Rebecca Shingleton
Keyword(s):  
Mobile Health ◽  
Relaxation Training ◽  
Medical Condition ◽  
Behavioral Therapy ◽  
Mobile App ◽  
Headache Frequency ◽  
Intervention Period ◽  
Headache Diary ◽  
Daily Headache ◽  
Training Exercises

BACKGROUND Frequently recurring tension headaches, migraines, and orofacial pain affect over 2.4 billion people worldwide, representing the second most prevalent medical condition in the world. In-office behavioral therapy (ie, relaxation and mindfulness exercises) has been shown to be one of the most effective treatment options for these patients. However, it has been underutilized due to stigma, cost, and accessibility. Mobile health apps may be one way to provide accessible, lower cost care in a nonstigmatized environment. As a result, apps are becoming an increasingly popular method for delivering behavioral therapy interventions and may provide an effective means to reach this population. OBJECTIVE The aim of this study was to assess the feasibility and acceptability of delivering a clinically validated behavioral therapy for migraine/headaches through a mobile app. METHODS Twenty-one migraine or headache sufferers met the criteria for severe migraine disability determined by the MIDAS test. Participants completed a two-week baseline period in which they kept a daily headache diary through the Halo app. They then began a four-week intervention period. During this period they were instructed to complete ten minutes of relaxation training exercises provided by the app each day, as well as monitor headaches via the daily headache diary. Relaxation training exercises consisted of various breathing techniques, progressive muscle relaxation, and mindfulness. Headache frequency was tracked throughout the intervention period, and further assessments, such as an in-person interview and posttreatment MIDAS test, were completed at the end of the four-week intervention period. RESULTS Analysis of data showed that there were significant differences between baseline scores (Headache Frequency Average=11.47/mo, MIDAS average=25.4) and postintervention follow-up (Headache Frequency Average=6.63/mo, MIDAS average=11.7, Frequency P<.01, MIDAS P<.01). Postintervention interviews revealed that more than 90% of the participants felt that the Halo beta app was easy to use and provided a benefit to the user. More than 85% of participants enjoyed using a daily headache diary and felt it gave them greater insights into their condition. More than 90% of the patients felt that the relaxation training had helped reduce the frequency of their headaches or headache related disability. CONCLUSIONS We found that mindfulness and relaxation-based interventions administered through the Halo beta app was a feasible and acceptable treatment for people suffering from frequently recurring headaches and migraines or disability associated with headaches and migraines. The pilot demonstrated the potential feasibility and usability of a mobile health app in delivering behavioral therapy for headache and migraine as an adjunct or alternative to in-office behavioral therapy for headache and migraine.

Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial

Cephalalgia ◽  
2021 ◽  
pp. 033310242110335
Author(s):  
Brooke L Reidy ◽  
James Peugh ◽  
Andrew D Hershey ◽  
Christopher S Coffey ◽  
Leigh A Chamberlin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Treatment Response ◽  
Active Treatment ◽  
Behavioral Therapy ◽  
Headache Frequency ◽  
Migraine Prevention ◽  
Prevention Study ◽  
Treatment Models ◽  
Daily Headache

Objective Identify preventive medication treatment response trajectories among youth participating in the Childhood and Adolescent Migraine Prevention study. Methods Data were evaluated from 328 youth (ages 8–17). Childhood and Adolescent Migraine Prevention study participants completed headache diaries during a 28-day baseline period and a 168-day active treatment period during which youth took amitriptyline, topiramate, or placebo. Daily headache occurrence trajectories were established across baseline and active treatment periods using longitudinal hierarchical linear modeling. We tested potential treatment group differences. We also compared final models to trajectory findings from a clinical trial of cognitive behavioral therapy plus amitriptyline for youth with chronic migraine to test for reproducibility. Results Daily headache occurrence showed stability across baseline. Active treatment models revealed decreases in headache frequency that were most notable early in the trial period. Baseline and active treatment models did not differ by treatment group and replicated trajectory cognitive behavioral therapy plus amitriptyline trial findings. Conclusions Replicating headache frequency trajectories across clinical trials provides strong evidence that youth can improve quickly. Given no effect for medication, we need to better understand what drives this clinically meaningful improvement. Results also suggest an expected trajectory of treatment response for use in designing and determining endpoints for future clinical trials. Trial Registration. ClinicalTrials.gov Identifier: NCT01581281

Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10022-10022
Author(s):  
Joseph Greer ◽  
Jamie M. Jacobs ◽  
Nicole Pensak ◽  
James MacDonald ◽  
Charn-Xin Fuh ◽  
...  
Keyword(s):  
Health Education ◽  
Cognitive Behavioral Therapy ◽  
Mobile Health ◽  
Education Program ◽  
Behavioral Therapy ◽  
Mobile App ◽  
Anxiety Symptoms ◽  
Health Education Program ◽  
Incurable Cancer ◽  
Anxiety Depression

10022 Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients with incurable cancer. Methods: From 2/15 to 8/16, 145 patients with incurable cancers (e.g., advanced lung, breast, GI/GU, sarcoma, melanoma) who screened positive for at least mild anxiety symptoms (Hospital Anxiety & Depression Scale-Anxiety subscale, HADS-A > 7) were randomized 1:1 at two cancer centers to receive either the CBT mobile app for anxiety or a mobile health education program (control), delivered via tablet computers. The CBT app included 7 modules teaching skills to relax the body, reduce worry, stay present-focused, improve communication, and plan/pace activities, which patients completed over 12 weeks. To assess anxiety, mood, and QOL, we administered the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Scale (CGI), HADS, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. General linear models were used to assess the effect of the intervention on patient outcomes over time. Results: The sample was predominantly female (73.8%) and white (91.7%), with a mean age of 56.45 ( SD= 11.30) years. Both study groups reported significant improvements in anxiety, depression, and QOL from baseline to post-assessment (all p-values≤002), with no differences in the improved outcomes between groups. Secondary analyses showed interaction effects on anxiety between the intervention and baseline HAM-A scores. Among patients with higher baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A ( p= .043), CGI ( p= .048), and HADS-A ( p= .001) compared to the health education control group. Conclusions: Patients with incurable cancer who received either a CBT mobile app intervention or mobile health education program reported improvements in anxiety, depression, and QOL. However, the CBT mobile app had better outcomes than health education for patients with higher baseline anxiety. Clinical trial information: NCT02286466.

Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 175-175 ◽  
Author(s):  
Joseph Greer ◽  
Jamie M. Jacobs ◽  
Nicole Pensak ◽  
James J MacDonald ◽  
Charn-Xin Fuh ◽  
...  
Keyword(s):  
Health Education ◽  
Cognitive Behavioral Therapy ◽  
Mobile Health ◽  
Education Program ◽  
Behavioral Therapy ◽  
Mobile App ◽  
Anxiety Symptoms ◽  
Health Education Program ◽  
Incurable Cancer ◽  
Anxiety Depression

175 Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients with incurable cancer. Methods: From 2/15 to 8/16, 145 patients with incurable cancers (e.g., advanced lung, breast, GI/GU, sarcoma, melanoma) who screened positive for at least mild anxiety symptoms (Hospital Anxiety & Depression Scale-Anxiety subscale, HADS-A > 7) were randomized 1:1 at two cancer centers to receive either the CBT mobile app for anxiety or a mobile health education program (control), delivered via tablet computers. The CBT app consisted of 7 modules teaching skills to relax the body, reduce worry, stay present-focused, improve communication, and plan/pace activities, which patients completed over 12 weeks. To assess anxiety, mood, and QOL, we administered the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Scale (CGI), HADS, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. General linear models were used to assess the effect of the intervention on patient outcomes over time. Results: The sample was predominantly female (73.8%) and white (91.7%), with a mean age of 56.45 ( SD= 11.30) years. Both study groups reported significant improvements in anxiety, depression, and QOL from baseline to post-assessment (all p-values < .002), with no differences in the improved outcomes between groups. Secondary analyses revealed interaction effects on anxiety between the intervention and baseline HAM-A scores. Among patients with higher baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A ( p= .043), CGI ( p= .048), and HADS-A ( p= .001) compared to the health education control group. Conclusions: Patients with incurable cancer who received either a CBT mobile app intervention or mobile health education program reported improvements in anxiety, depression, and QOL. However, the CBT mobile app had better outcomes than health education for patients with higher baseline anxiety. Clinical trial information: NCT02286466.

A comparison of mobile health platforms developed for depression and anxiety available for research or commercial purposes: A systematic review of the literature and app store review (Preprint)

2021 ◽  
Author(s):  
Qiao Ying Leong ◽  
Shreya Sridhar ◽  
Agata Blasiak ◽  
Xavier Tadeo ◽  
Geck Hong Yeo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mobile Health ◽  
Behavioral Therapy ◽  
Mobile App ◽  
Commercial Use ◽  
App Store ◽  
Current State ◽  
Real World Evidence ◽  
Key Characteristics ◽  
Common Purpose

BACKGROUND Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. OBJECTIVE This study aimed to characterize the current state of mHealth platforms designed for anxiety and/or depression that are available for research, commercial use or both. METHODS A systematic review was conducted using a two-pronged approach. (i) A systematic literature search of PubMed, EMBASE, CINAHL and PsycINFO was conducted to identify platforms available for research purposes. (ii) A simultaneous search of two major mobile app stores – Apple App Store and Google Play Store – to identify commercially available platforms. Key characteristics of the mHealth platforms such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, regulatory information were synthesized. RESULTS The literature and app stores searches yielded 169 and 179 mHealth platforms respectively. Most platforms developed for research purposes were designed for depression (n=113) whereas the app stores search reported a higher number of platforms were developed for anxiety (n=58 and n=27 for Android and iOS operating systems, respectively). The most common purpose of platforms in both searches was treatment (n=122 and n=129 for the literature and app stores searches, respectively). In regard to the types of intervention, cognitive behavioral therapy and referral to care/counselling emerged as the most popular options offered by the platforms identified in the literature and app stores searches, respectively. Most platforms from both searches did not have a specific target age group. Additionally, most platforms found in the app stores lacked clinical and real-world evidence, while only small number of platforms found in published research were available commercially. CONCLUSIONS A considerable number of mHealth platforms designed for anxiety and/or depression are available for research, commercial use or both. Characteristics of these mHealth platforms vary greatly. Future effort should focus on accessing the quality – utility, safety and effectiveness – of the existing platforms and providing developers, from both commercial and research sectors alike, a reporting guideline for their platform description as well as a regulatory framework to facilitate the development, validation and deployment of effective mHealth platforms. CLINICALTRIAL CRD42020193956

Daily Headache Diary Improves Diagnosis

2011 ◽  
Vol 39 (11) ◽  
pp. 28-29
Author(s):  
DAMIAN McNAMARA
Keyword(s):  
Headache Diary ◽  
Daily Headache

Comparing patient and parent recall of 90-day and 30-day migraine disability using elements of the PedMIDAS and an Internet headache diary

Cephalalgia ◽  
2013 ◽  
Vol 34 (4) ◽  
pp. 298-306 ◽  
Author(s):  
Geoffrey L Heyer ◽  
Sara Q Perkins ◽  
Sean C Rose ◽  
Shawn C Aylward ◽  
JoEllen M Lee
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Parent Report ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Patient Age ◽  
Recall Accuracy ◽  
Pediatric Migraine ◽  
Patient Âgé ◽  
Headache Diary

Aim The aim of this article is to compare 90-day and 30-day recall of Pediatric Migraine Disability Assessment (PedMIDAS) elements and headache frequency against daily entries from an Internet headache diary among pediatric patients and their parents. Methods In a prospective cohort study, patients aged 10–18 years with episodic migraine or probable migraine completed a 90-day Internet-based headache diary that incorporated PedMIDAS questions. Following the 90-day diary period, patients and parents completed modified PedMIDAS instruments to assess 90-day and 30-day recall. Intraclass correlation coefficients (ICC) were calculated to measure recall reliability. The Kruskal-Wallis and Jonckheere-Terpstra tests were used to explore recall accuracy as it relates to each participant’s self-reported confidence in recall and to patient age. Results Fifty-two subjects completed 90 consecutive diary entries. Comparing 30-day to 90-day recall of PedMIDAS elements, ICC scores improved by 26.2% (patients) and 17.5% (parents). Patients had better recall than their parents for all study measures. Self-reported confidence in recall and patient age had limited and inconsistent effects on recall accuracy. Conclusion The optimal recall interval to assess migraine disability must balance recall accuracy with generalizability across a range of headache frequencies. When compared to daily diary entries, recall accuracy of PedMIDAS elements and headache frequency improves at 30 days compared to 90 days. Parent report of migraine disability should not be used as a replacement for patient report.

scholarly journals Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study (Preprint)

2020 ◽  
Author(s):  
Kyungmi Chung ◽  
Seoyoung Kim ◽  
Eun Lee ◽  
Jin Young Park
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Sleep Problems ◽  
Mobile App ◽  
Community Dwelling ◽  
Intervention Period ◽  
Post Intervention ◽  
Subjective Sleep Quality ◽  
Subjective Sleep ◽  
Self Help

BACKGROUND As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. OBJECTIVE The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. METHODS During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. RESULTS Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, <i>P</i>&lt;.001) and memory complaints (40/40; ρ=.46, <i>P</i>=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; <i>t</i><sub>8</sub>=3.74, <i>P</i>=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. CONCLUSIONS This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.

scholarly journals Patient-Centric Structural Determinants of Adherence Rates Among Asthma Populations: Exploring the Potential of Patient Activation and Encouragement Tool TRUSTR to Improve Adherence

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Asim Zia ◽  
Arthur Brassart ◽  
Sheila Thomas ◽  
Fen Ye ◽  
Judith Stephenson ◽  
...  
Keyword(s):  
Clinical Data ◽  
Mobile Health ◽  
Medical Condition ◽  
Total Effect ◽  
Adherence Rate ◽  
Administrative Claims ◽  
Structural Determinants ◽  
Health Apps ◽  
Mobile Health Apps ◽  
Patient Centric

Background: Lack of adherence with prescribed medications among the asthma populations exacerbates health outcomes and increases social and economic costs. Objectives: The proposed study aims to model patient-centric structural determinants of adherence rates among asthma patients and explore the potential of mobile health apps such as the TRUSTR platform to improve adherence using its power of monetary and non-monetary chatbotting and non-monetary nudges. Following specific hypotheses are tested: (1) Patient attributes, such as their age and medical condition, have significant effect on their adherence with the prescribed treatment plans. (2) Behavioral nudging with rewards and engagement via mobile health apps will increase adherence rates. Methods: The patient population (N= 37 359) consists of commercially insured patients with asthma who have been identified from administrative claims in the HealthCore Integrated Research Database (HIRD) between April 1, 2018 and March 31, 2019. Two Structural Equation Models (SEMs) are estimated to quantify direct, indirect and total effect sizes of age and medical condition on proportion of days covered (PDC) and medical possession ratio (MPR), mediated by patient medical and pharmacy visits. Fourteen additional SEMs were estimated to lateralize TRUSTR findings and conduct sensitivity analysis. Results: HIRD data reveal mean adherence rate of 59% (standard deviation (SD) 29%) for PDC and 58% for MPR (SD 36%). Key structural findings from SEMs derived from the HIRD dataset indicate that each additional year in the age of the patient has a positive total effect on the adherence rate. Patients with poor medical condition are likely to have lower adherence rate, but this direct effect is countered by mediating variables. Further, each additional reward and higher engagement with a mobile app is likely to have a positive total effect on increasing the adherence rate. Conclusions: HIRD data reveal mean adherence rate of 59% (SD 29%), providing the evidence for the opportunity to increase adherence rate by around 40%. Statistical modeling results reveal structural determinants, such as the opportunity to nudge, are higher among younger patients, as they have higher probability of being non-adherent. Methodologically, lateralization approach demonstrates the potential to capture real-world evidence beyond clinical data and merge it with clinical data.

scholarly journals Patient testing of a mobile health app and review of educational materials designed for gout patient self-management (Preprint)

2018 ◽  
Author(s):  
Amy Danh Nguyen ◽  
Lauren J Frensham ◽  
Michael XC Wong ◽  
Sylvain MM Meslin ◽  
Paige Martin ◽  
...  
Keyword(s):  
Uric Acid ◽  
Mobile Health ◽  
Elevated Serum ◽  
Chronic Arthritis ◽  
Mobile App ◽  
Self Management ◽  
Educational Materials ◽  
Future Health ◽  
Mobile Health Applications ◽  
App Design

BACKGROUND Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Effective uric acid-lowering therapies exist, however adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health applications (apps) have been used in self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. OBJECTIVE This study aimed to design an effective gout self-management app by collecting feedback from gout patients. METHODS Two mixed-methods studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app. Six interviews and one focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for two weeks. Following the trial, patients participated in an interview about their experiences using the app. RESULTS Patients viewed the gout educational material positively, appreciating the combined use of video, text and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive, with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. CONCLUSIONS These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app’s presentation and usability, and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated to self-management apps for chronic diseases that require monitoring of pathological values, medication adherence and/or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients.

scholarly journals Rewriting One Patient’s Story of Disrupted Sleep

2019 ◽  
pp. 161-172
Author(s):  
Samantha Domingo ◽  
Michelle L. Drerup
Keyword(s):  
Social Support ◽  
Treatment Adherence ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Cognitive Restructuring ◽  
Sleep Hygiene ◽  
Sleep Restriction ◽  
Insomnia Disorder

This chapter covers treatment options for individuals with chronic insomnia disorder. We describe the effectiveness of cognitive behavioral therapy for insomnia (CBT-i) and various modalities of delivery of the treatment. CBT-i is an alternative treatment for insomnia that has been demonstrated to be as successful as pharmacological therapies in the short term, and more effective in the long term. CBT-i comprises sleep restriction, stimulus control, relaxation training, sleep hygiene, and cognitive restructuring. The authors examine group CBT-i as a way to increase social support and enhance treatment adherence. Computerized CBT-i is a newer option to provide increased access to this treatment.

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