LitCovid-sentences  

PMC:7275133 / 1530-36953 JSONTXT 11 Projects

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Id Subject Object Predicate Lexical cue
T13 0-12 Sentence denotes Introduction
T14 13-166 Sentence denotes As our world has become upended with the arrival of COVID-19, the way in which healthcare will be provided in the future is likely to change drastically.
T15 167-349 Sentence denotes This pandemic is a big wake-up call for limiting in-person visits, especially during the flu season that put vulnerable patients at undo risk coming into the office for routine care.
T16 350-528 Sentence denotes We have had the technology to perform telemedicine visits for years, but patients’ hesitancy and poor insurance reimbursement have always been barriers for widespread acceptance.
T17 529-688 Sentence denotes In the wake of the COVID-19 pandemic, most primary care and specialty offices transitioned to a telemedicine-focused approach within a matter of days to weeks.
T18 689-852 Sentence denotes In response, the Centers for Medicare & Medicaid Services (CMS) relaxed many requirements for Medicare patients and the states followed suit for Medicaid patients.
T19 853-1032 Sentence denotes Insurance companies also loosened restrictions giving healthcare providers increased flexibility to provide care for their patients from the comfort and safety of their own homes.
T20 1033-1257 Sentence denotes 2020 will be the ultimate testing ground for various telehealth services and remote monitoring applications, and it is the hope of the authors that recent changes in access and reimbursement will remain in place permanently.
T21 1258-1440 Sentence denotes To meet the needs of this growing market, new technologies including wearable devices will play an important role in providing real-time data to objectively monitor patients at home.
T22 1441-1635 Sentence denotes These devices will be especially important for improving the health and control of chronically ill patients and for those with conditions like asthma, COPD, diabetes, and cardiovascular disease.
T23 1636-1750 Sentence denotes The focus of this paper revolves around wearable devices for asthma, but can be applied for any chronic condition.
T24 1751-1920 Sentence denotes If these home devices can provide usable data in a reliable, cheap, and easy-to-use format, then the need for in-person visits in the future will be drastically reduced.
T25 1922-1938 Sentence denotes Connected Health
T26 1939-2106 Sentence denotes Innovations in personalized health technology provide a unique opportunity to develop connected healthcare models that are built around the patients’ individual needs.
T27 2107-2439 Sentence denotes The term connected health describes the use of a variety of technologies to inform and aid healthcare delivery in a data-driven manner with the individual at the center.7 It covers a broad domain, including digital, mobile health, and telehealth, and ensures all stakeholders are connected with data that is accurate and timely [1].
T28 2440-2698 Sentence denotes An integrative connected health model can also offer social support through online forums or networks where users are able to interact with peers with similar healthcare conditions or goals helping to further enhance patient experience and improve adherence.
T29 2699-2921 Sentence denotes Commercial weight loss programs like WW (formerly Weight Watchers) was one of the first large-scale programs to take advantage of social support networks to motivate their clients and make them accountable to other people.
T30 2922-3238 Sentence denotes A 2005 systematic review of commercial and proprietary weight loss programs’ efficacy concluded that WW was the only program with demonstrated efficacy in achieving modest weight loss based on results from 3 randomized controlled trials (RCTs), and their unique social approach likely contributed to its success [2].
T31 3239-3432 Sentence denotes A recently published systematic review found relatively strong evidence that greater social support, self-efficacy, and self-motivation can predict higher adherence to home-based therapies [3].
T32 3433-3665 Sentence denotes There is enough data to suggest that social support networks improve adherence to fitness, weight loss, and home-based therapies that healthcare providers should be actively curating a wider support network for their patients [4–6].
T33 3666-3885 Sentence denotes Wearable devices and associated apps take social connectivity to the next level and provided unparalleled access to support networks that have the potential to further encourage adherence to fitness and health regimens.
T34 3886-4115 Sentence denotes Promising results have already been reported with the use of apps to improve adherence and outcomes in various healthcare scenarios including weight loss, smoking cessation, diabetic management, and home exercise programs [7–11].
T35 4117-4152 Sentence denotes The First Wave of Wearable Devices:
T36 4153-4170 Sentence denotes Activity Trackers
T37 4171-4374 Sentence denotes The concepts of wellness and mindfulness have become an increasing part of the public health discussion as there seems to be a growing appreciation for a more holistic approach to fitness and well-being.
T38 4375-4574 Sentence denotes With the advent of more advanced wearable technology like fitness trackers and smartwatches starting in 2014, consumers are no longer content with just tracking their weight loss goals or step count.
T39 4575-4848 Sentence denotes Personalized healthcare devices arm users with snapshots of their activity and recovery data and allow them to track advanced performance metrics including step tracking, heart rate, body fat percentage, sleep quality, stress levels, menstrual cycle, and fertility windows.
T40 4849-5045 Sentence denotes As this data becomes more accessible, consumers are discovering that overall health is the sum of all the small choices you make each day: what you eat, how much you move, how much you sleep, etc.
T41 5046-5221 Sentence denotes Having fitness and weight loss goals is an important first step, but converting that enthusiasm to actual gym time and change in habits has always been the rate limiting step.
T42 5222-5497 Sentence denotes That is where innovative fitness startups and fitness technology companies are focusing their attention: getting people excited about working out, offering unparalleled convenience, and keeping members engaged long-term by utilizing the latest in technology and social media.
T43 5498-5561 Sentence denotes Since 2014, the use of commercial wearable devices has doubled.
T44 5562-5729 Sentence denotes Currently, 19% of Americans use a wearable fitness tracker (e.g., Fitbit, Apple Watch) with sales projected to double by 2022, becoming a $27 billion+ market [12, 13].
T45 5731-5779 Sentence denotes Wearable Devices that Promote Health and Fitness
T46 5780-5937 Sentence denotes As more and more patients use wearable devices and smartphone apps to track their personal health data, how can this information be used in a meaningful way?
T47 5938-6181 Sentence denotes Fitness technology companies like Fitbit and Apple Health are leveraging insights from over 10 years of activity, exercise, and sleep data to better inform future applications and provide behavior change techniques and insights to their users.
T48 6182-6374 Sentence denotes Apple recently announced that customers in the USA can enroll in three landmark health studies: the Apple Women’s Health Study, the Apple Heart and Movement Study, and the Apple Hearing Study.
T49 6375-6692 Sentence denotes Conducted in partnership with leading academic and research institutions like the World Health Organization, these multi-year longitudinal studies are leveraging the ubiquity of Apple products to provide a treasure trove of user data to inform potential medical discoveries that could improve healthcare for all [14].
T50 6693-6853 Sentence denotes Wearable devices themselves can provide crude feedback like reminders to move or stand which prompts users to take more steps per hour or stand more frequently.
T51 6854-7039 Sentence denotes For additional charges, some devices can provide more detailed personal wellness reports, offering actionable guidance and coaching to help users achieve their health and fitness goals.
T52 7040-7303 Sentence denotes Some companies like Fitbit are taking it a step further and offering personal, one-on-one coaching services for weight loss and diabetes control providing users with a personalized plans and direct support from their team of certified health and wellness coaches.
T53 7304-7388 Sentence denotes A small sampling of highly rated fitness and nutrition apps are included in Table 1.
T54 7389-7433 Sentence denotes Table 1 Top rated fitness and nutrition apps
T55 7434-7479 Sentence denotes App Supporting devices Cost structure Details
T56 7480-7512 Sentence denotes For all-around healthy lifestyle
T57 7513-7745 Sentence denotes   8fit iOS, Android Free; $59.99 per year; $44.99 per half-year; $19.99 per month for meal plans and more workouts On-demand workouts and meal planning for people who like a lot of guidance, suggestions, reminders, and instructions.
T58 7746-7846 Sentence denotes Provides realistic assessment of how hard or easy it will be to reach your health and fitness goals.
T59 7847-7851 Sentence denotes Yoga
T60 7852-7997 Sentence denotes   Asana Rebel iOS, Android $39.99 for 3 months; $58.99 for 12 months Yoga-inspired fitness that has guided yoga flows alongside regular workouts.
T61 7998-8072 Sentence denotes Input goals, track progress, and choose classes based on experience level.
T62 8073-8232 Sentence denotes   Yoga Wake Up iOS, Android $10 per month Offers different audio yoga and meditation sequences that are designed to start in bed and end with you on your feet.
T63 8233-8378 Sentence denotes   Alo Moves iOS, Android $20 per month Has over 2000 videos organized into 200 plans and over 500 single classes taught by the top names in yoga.
T64 8379-8481 Sentence denotes   YogaGlo iOS, Android $18 per month Offers more than 3800 yoga workouts and guided mediation classes.
T65 8482-8500 Sentence denotes On-demand workouts
T66 8501-8667 Sentence denotes   Peloton Digital iOS, Android $20 per month Access live-streamed classes to use on any bike or treadmill or try one of their boot camp, strength, or outdoor classes.
T67 8668-8845 Sentence denotes   Fitbit Coach iOS, Android Free; $9.99 per month or $79.99 per year for Premium Takes users daily Fitbit activity data to recommend exercises and personalized fitness feedback.
T68 8846-8917 Sentence denotes Large database of workout videos with step-by-step directions and tips.
T69 8918-8947 Sentence denotes Compatible with Fitbit Radio.
T70 8948-9131 Sentence denotes   Nike Training Club iOS, Android Free; $14.99 per month or $119.99 per year for Premium Has classic short sessions but includes workout routines that are 30, 45, or even 60 min long.
T71 9132-9227 Sentence denotes A Premium account also comes with programs led by trainers and nutrition and wellness guidance.
T72 9228-9371 Sentence denotes   Sworkit iOS, Android $10 per month Custom no-equipment training plans, complete with guided videos for each workout ranging from 5 to 60 min.
T73 9372-9457 Sentence denotes Users can also connect with personal trainers to ask questions and get expert advice.
T74 9458-9580 Sentence denotes   Aaptiv iOS, Android $15 per month Audio classes taught by trainers guiding users through a fitness studio-style session.
T75 9581-9679 Sentence denotes Over 2500 workouts in cycling, yoga, strength training, stretching, elliptical workouts, and more.
T76 9680-9756 Sentence denotes Also comes with full marathon, half marathon, 10K, and 5K training programs.
T77 9757-9773 Sentence denotes Fitness tracking
T78 9774-9934 Sentence denotes   Strava iOS, Android, Web Free; $7.99 per month or $59.99 per year Users can compete against themselves or others who have run, biked, or swam the same routes.
T79 9935-10057 Sentence denotes The app uses phone/watches GPS to track where users go and how fast then compares with other users creating a leaderboard.
T80 10058-10201 Sentence denotes   Map My Fitness iOS, Android Free; $5.99 per month or $29.99 per year for MVP Recommended for those just getting started on a fitness journey.
T81 10202-10335 Sentence denotes Has hundreds of activities you can track, everything from vacuuming to rock climbing motivating user to keep a more active lifestyle.
T82 10336-10404 Sentence denotes Consolidates data from various fitness trackers or apps such Fitbit.
T83 10405-10521 Sentence denotes   Charity Miles iOS, Android Free Motivates by donating money to charity for every mile users run, walk, or bicycle.
T84 10522-10695 Sentence denotes Supports a variety of nonprofit organizations, such as ASPCA, Habitat for Humanity, St. Jude Children’s Hospital, UNICEF, Save the Children, and the Wounded Warrior Project.
T85 10696-10714 Sentence denotes Nutrition-Tracking
T86 10715-10908 Sentence denotes   MyFitnessPal iOS, Android Free; $9.99 per month or $49.99 per year for Premium Calorie counting app that also figures out how many calories users should eat to gain, lose, or maintain weight.
T87 10909-11035 Sentence denotes Consolidates everything users eat and drink, plus all their activities to calculate calories consumed against calories burned.
T88 11036-11107 Sentence denotes It also has tools for tracking weight and other body changes over time.
T89 11108-11192 Sentence denotes It has the largest database of foods and is the best food logging app on the market.
T90 11193-11474 Sentence denotes   Noom iOS, Android $59 per month, $199 per year (additional pricing options available) Complete weight loss program with daily interactive content, a personal goal coach, and plenty of content to help users master the psychology involved with changing their relationships to food.
T91 11475-11667 Sentence denotes   MyPlate iOS, Android, Web Free; $9.99 per month, $30 for six months, or $44.99 per year for Gold All-in-one fitness app, combining calorie counting, weight management, recipes, and workouts.
T92 11668-11826 Sentence denotes Users look up and record everything they eat and can see a nutritional analysis of macronutrient intake for free (requires paid subscription in MyFitnessPal).
T93 11827-12043 Sentence denotes   WW Digital (formally WeightWatchers) iOS, Android, Web $23.99 per month or $219.99 per year Highly supportive community and app that focuses more on personalization and overall health rather than weight loss alone.
T94 12044-12152 Sentence denotes Users do not have to attend meetings or meet with a counselor (although this is an option for an added fee).
T95 12153-12228 Sentence denotes Monitors food intake with SmartPoints rather than counting calories or fat.
T96 12229-12255 Sentence denotes Mindfulness and meditation
T97 12256-12496 Sentence denotes   Calm iOS, Android $14.99 per month or $69.99 per year Guided mindfulness meditation that initially offers a “7 Days of Calm” course which introduces users to mindfulness meditation, as well as some guided and unguided meditation sessions.
T98 12497-12609 Sentence denotes Paid users have access to more multi-day courses, a “Daily Calm” course, and many, many more guided meditations.
T99 12610-12747 Sentence denotes   Headspace iOS, Android $12.99 per month or $69.99 per year Guided meditation for health issues, emotions, challenges, and productivity.
T100 12748-12823 Sentence denotes There are even “SOS” sessions for some of the more stressful times in life.
T101 12824-12940 Sentence denotes Recently added free content called Weathering the Storm for those struggling with the emotional effects of COVID-19.
T102 12941-13125 Sentence denotes   The Mindfulness App iOS, Android $9.99 per month or $59.99 per year Starts with a 5-day introduction to mindfulness along with guided meditations to get you familiar with meditating.
T103 13126-13300 Sentence denotes With subscription choose guided or silent meditation sessions for challenges, travel, sleep, relationships, stress relief, emotions, body awareness, focus, and relationships.
T104 13301-13507 Sentence denotes *The authors are aware of the transient nature of fitness, nutrition, and lifestyle apps and understand that the recommendations provided at the time of this publication might not be available in the future
T105 13508-13769 Sentence denotes The ultimate goal with these devices and apps is to provide real-time feedback to patients so that they actually see data that illustrates how destructive behaviors impact them physically, providing additional motivation to more proactively manage their health.
T106 13770-13902 Sentence denotes The more the patient understands about their personal health, the more empowered they will be to make meaningful behavioral changes.
T107 13903-14040 Sentence denotes Healthcare providers need to be able to access and interpret personalized health data, as well as distill it into usable teaching points.
T108 14041-14200 Sentence denotes In the past, physicians often took an authoritarian approach to health and fitness education which did little to encourage active participation by the patient.
T109 14201-14481 Sentence denotes By employing a patient-centered approach utilizing data gleaned from wearable devices, healthcare providers have an opportunity to work in concert with patients to impart measurable skills and behaviors in a real and tangible way with the ability to track this progress over time.
T110 14482-14702 Sentence denotes When patients are included in a collaborative and patient-centered discussion about their health and well-being, compliance and satisfaction rates improve, leading to a more effective doctor-patient relationship [15–17].
T111 14703-14890 Sentence denotes It is important to note that these devices are still in their infancy, and the accuracy and validity of the data still need to be strengthened in order to provide the best medical advice.
T112 14892-14918 Sentence denotes Wearable Devices in Asthma
T113 14919-15097 Sentence denotes Most of the wearable fitness device research to date has focused in diseases associated with low levels of physical activity, namely cardiovascular disease, diabetes, and cancer.
T114 15098-15261 Sentence denotes Few have focused on asthma and of the studies conducted in asthma populations, all have honed in on the use of Fitbit-derived sleep measures (i.e., sleep quality).
T115 15262-15356 Sentence denotes Castner et al. used the Fitbit Charge™ to validate sleep measures in women with asthma [18••].
T116 15357-15506 Sentence denotes The sleep measures collected by the Fitbit were compared with Actigraph GT3X +, a well-known and validated device to collect sleep measures [19, 20].
T117 15507-15620 Sentence denotes The Fitbit device tended to overestimate sleep efficiency and underestimate wake counts compared with actigraphy.
T118 15621-15820 Sentence denotes Two additional studies were conducted in pediatric populations and focused on correlating Fitbit-derived sleep measures to patient-reported outcomes such as asthma control and asthma impact [21, 22].
T119 15821-16096 Sentence denotes Bian and colleagues assessed the association between self-reported asthma impact and Fitbit-derived sleep quality (the ratio of minutes asleep to minutes in bed) and physical activity measures (daily minutes of moderate and vigorous activity) in adolescents with asthma [21].
T120 16097-16390 Sentence denotes Fitbit-derived sleep quality was moderately correlated with Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance score (r = − 0.31, P = 0.01) and had a weak but significant correlation with the PROMIS pediatric asthma impact score (average r = − 0.18, P = 0.02).
T121 16391-16508 Sentence denotes Fitbit-derived physical activity levels were not associated with PROMIS pediatric asthma impact (r = 0.04, P = 0.62).
T122 16509-16698 Sentence denotes These findings suggest that measurement of sleep quality, using the Fitbit device, may help develop personalized asthma management strategies for children and their caregivers in real time.
T123 16699-17081 Sentence denotes The final study measured several mobile metrics of asthma including physical activity and sleep using Fitbits, forced expiratory volume in 1 s and peak expiratory flow, indoor air quality using Foobot (https://foobot.io/), and a mobile app that collected information on asthma control (symptoms, physical limitations due to asthma, nighttime awakenings, and medication intake) [22].
T124 17082-17329 Sentence denotes These metrics were used together to digitally phenotype children with asthma and provide a better measure of the patient’s asthma control to their clinician when compared with the Asthma Control Test scores taken infrequently during clinic visits.
T125 17330-17553 Sentence denotes Additional work using this ecological metric of asthma control is needed and may be used in the future to generate insights on the relationship between a patient’s asthma symptoms and triggers across different seasons [23].
T126 17554-17642 Sentence denotes Acoustic monitoring is another type of wearable devices that has been studied in asthma.
T127 17643-17828 Sentence denotes Breathing sound measured by microphones over human skin can detect breathing patterns (respiratory rate, flow rate, tidal volume) and symptoms that may be due to asthma (wheeze, cough).
T128 17829-17932 Sentence denotes Moreover, chest movement signals can be acquired using an accelerometer or belt-shaped device [24, 25].
T129 17933-18038 Sentence denotes Boner et al. measured the nocturnal wheeze in children with asthma using an acoustic respiratory monitor.
T130 18039-18223 Sentence denotes They found that among children with apparently well-controlled asthma, 57% had considerable amounts of night wheezing that was unrelated to conventional measures of lung function [26].
T131 18224-18355 Sentence denotes The use of these continual wearable monitoring systems is still a developing field that needs further study on its clinical impact.
T132 18357-18403 Sentence denotes Use of Electronic Monitoring Devices in Asthma
T133 18404-18556 Sentence denotes Electronic monitoring devices (EMDs) in asthma are increasingly more common since they provide objective data and are not biased by patient self-report.
T134 18557-18724 Sentence denotes The majority of the currently available EMDs focus on addressing medication adherence, with a limited few focusing on sleep monitoring and identifying asthma triggers.
T135 18725-18905 Sentence denotes The devices measuring adherence use a variety of approaches from recording audio during inhaler use, using time and date to detect medication use and capturing spirometry measures.
T136 18906-19215 Sentence denotes These devices are paired with mobile applications (Apps) on smartphones which can provide the patient with audiovisual reminders for taking medications, correlate medication use with environmental exposures (i.e., weather, ozone, pollution) using smartphone GPS coordinates and feedback on proper inhaler use.
T137 19216-19318 Sentence denotes A summary of some of the current and emerging technologies in the asthma space is provided in Table 2.
T138 19319-19370 Sentence denotes Table 2 Current and emerging technologies in asthma
T139 19371-19426 Sentence denotes Technology Measures Outcomes in asthma studies Comments
T140 19427-19446 Sentence denotes Wearable technology
T141 19447-19456 Sentence denotes − Fitbit™
T142 19457-19637 Sentence denotes − Apple™ Watch Fitbit: heart rate (available on most but not all models), steps/day, physical activity (light, moderate and vigorous), sedentary time, sleep efficiency, wake counts
T143 19638-19842 Sentence denotes Apple Watch: heart rate, EKG, steps/day, physical activity (light, moderate and vigorous), sedentary time − Fitbit overestimated sleep efficiency and underestimated wake counts compared with actigraphy.18
T144 19843-19949 Sentence denotes − Fitbit-derived sleep quality correlated with PROMIS pediatric asthma impact score.21 Corresponding Apps:
T145 19950-20009 Sentence denotes Apple Watch App on iPhone, Fitbit App on iPhone and Android
T146 20010-20187 Sentence denotes Pros: portable; commercially available; may be useful when used with other measures such as air quality, lung function and asthma symptoms to digitally phenotype asthma patients
T147 20188-20193 Sentence denotes Cons:
T148 20194-20254 Sentence denotes No sleep data available on Apple Watch without 3rd party App
T149 20255-20268 Sentence denotes Data sharing:
T150 20269-20395 Sentence denotes Data does not sync to EMR directly but patient can access file and send to provider via mail, secure email, or patient portal.
T151 20396-20487 Sentence denotes Electronic monitoring devices (e.g., inhaler sensors ± digital health platform) Digihaler™:
T152 20488-20599 Sentence denotes − Inhaler time of inhaler use, peak inspiratory flow rate (PIFR), time to PIFR, inhalation volume and duration.
T153 20600-20624 Sentence denotes Propeller Health System:
T154 20625-20679 Sentence denotes − Inhaler sensor: date, time and number of doses taken
T155 20680-20709 Sentence denotes − Asthma Health Platform App:
T156 20710-20835 Sentence denotes Location of inhaler use using phone GPS, current weather/pollen counts/air pollution and self-report asthma symptoms/triggers
T157 20836-20853 Sentence denotes Hailie™ solution:
T158 20854-20929 Sentence denotes − Inhaler sensor: date, time, number of inhaler actuations and missed doses
T159 20930-20993 Sentence denotes − Hailie™ App: medication adherence, daily medication reminders
T160 20994-21031 Sentence denotes Inhaler compliance assessment device:
T161 21032-21127 Sentence denotes Time of dose, inhaler technique errors − Greater asthma control31,38–39 and symptom-free days33
T162 21128-21217 Sentence denotes − Reduction in daily symptoms31, rescue medication use29,32–33, and exacerbations34,38–39
T163 21218-21254 Sentence denotes − Improved medication adherence36–40
T164 21255-21327 Sentence denotes − High patient acceptability of device and digital health platform36–37.
T165 21328-21347 Sentence denotes Corresponding Apps:
T166 21348-21386 Sentence denotes Digihaler™, Propeller Health, Hailie™.
T167 21387-21460 Sentence denotes Web-based platform also available for Propeller Health, Hailie™ solution.
T168 21461-21626 Sentence denotes Pros: portable, high acceptability among patients, improvements in asthma control in those with a digital health platform (e.g., Propeller Health, Hailie™ solution).
T169 21627-21632 Sentence denotes Cons:
T170 21633-21753 Sentence denotes Additional efficacy studies of the devices are needed, cost of devices are not always covered by insurance reimbursement
T171 21754-21767 Sentence denotes Data sharing:
T172 21768-21928 Sentence denotes Provider platform available to share results (e.g. Digihaler™, Propeller Health, Hailie™ solution), patients may share data from Digihaler™ also via file share.
T173 21929-21974 Sentence denotes Mobile-based applications Self-monitoring of:
T174 21975-21992 Sentence denotes − Asthma symptoms
T175 21993-22003 Sentence denotes − Triggers
T176 22004-22082 Sentence denotes − Medication use -Improvements in asthma control though low-quality evidence45
T177 22083-22205 Sentence denotes -Improvements in asthma control in five studies, lung function in two studies and quality of life in three studies46 Pros:
T178 22206-22236 Sentence denotes Acceptable and feasible to use
T179 22237-22242 Sentence denotes Cons:
T180 22243-22364 Sentence denotes Vary in quality; data are self-reported, most apps have not been validated; risk of loss of privacy of health information
T181 22365-22378 Sentence denotes Data sharing:
T182 22379-22461 Sentence denotes Vary in ability to share with provider, most are up to user to share with provider
T183 22462-22649 Sentence denotes Teva’s Digihaler™ has been FDA approved for use with ProAir® (albuterol sulfate 117 mcg), AirDuo® (fluticasone propionate and salmeterol), and ArmonAir® (fluticasone propionate) inhalers.
T184 22650-22736 Sentence denotes The Digihaler™ contains built-in sensors that records inhalation data with timestamps.
T185 22737-22894 Sentence denotes The inhalation data includes parameters that are important for assessing inhaler technique including peak inspiratory flow rate and inhalation duration [27].
T186 22895-23020 Sentence denotes The device is connected via Bluetooth® technology to a companion App that provides information on inhaler use to the patient.
T187 23021-23155 Sentence denotes While to date, the efficacy of Digihalers has not been evaluated; one pilot study has shown its ability to predict exacerbations [28].
T188 23156-23245 Sentence denotes Adults with exacerbation-prone asthma (n = 360) used the ProAir® Digihaler™ for 12 weeks.
T189 23246-23416 Sentence denotes The Digihaler™ was able to predict asthma exacerbations (defined as need for oral corticosteroids) with an area under the receiver operating characteristic curve of 0.75.
T190 23417-23549 Sentence denotes The most predictive factor was the average number of albuterol inhalations per day during a period of 5 days before an exacerbation.
T191 23550-23686 Sentence denotes Further developments of the model in larger populations are needed to determine the efficacy of the Digihaler™ to predict exacerbations.
T192 23687-23841 Sentence denotes Propeller Health has developed a system which includes a sensor that can attach to both rescue and controller inhalers and an Asthma Health Platform [29].
T193 23842-23925 Sentence denotes The inhaler sensor collects date and time of inhaler use and number of puffs taken.
T194 23926-24098 Sentence denotes This data is transferred via Bluetooth® technology to the Asthma Health Platform on a mobile device and can be matched with GPS coordinates obtained from the mobile device.
T195 24099-24269 Sentence denotes The Asthma Health Platform can also be used to record asthma symptoms and triggers which integrates with other data streams such as weather, pollen counts, and pollution.
T196 24270-24333 Sentence denotes The Propeller Health System is one of the most studied to date.
T197 24334-24552 Sentence denotes A 4-month pilot study conducted in 30 individuals showed when the device and app were used along with weekly feedback, participants had an improvement in asthma control and a decline in day-to-day asthma symptoms [30].
T198 24553-24646 Sentence denotes The effectiveness of Propeller Health System on rescue inhaler has also been examined [31••].
T199 24647-24769 Sentence denotes In a study of 495 patients, all patients received the Propeller Health System but only 250 received sensor-based feedback.
T200 24770-24982 Sentence denotes The authors found a decrease in mean daily rescue medication use in those receiving sensor-based feedback (0.19 vs. 0.25 in control arm) which was more pronounced in patients with uncontrolled asthma at baseline.
T201 24983-25147 Sentence denotes These findings were confirmed in another study of 120 participants with a decrease in rescue medication use by 39% and an increase in symptom-free days by 12% [32].
T202 25148-25320 Sentence denotes Propeller Health has also developed a provider-facing web interface (portal) that allows providers and their staff to view patient medication use and asthma control status.
T203 25321-25502 Sentence denotes This is available to providers that enroll their patients with the Propeller Health System but can be integrated into existing EMR systems to allow for data sharing among providers.
T204 25503-25660 Sentence denotes Merchant et al. evaluated this enhanced Propeller Health System and found a decrease in asthma-related emergency department visits and hospitalizations [33].
T205 25661-25962 Sentence denotes The Hailie™ solution (previously known as SmartInhaler™ platform) is a system of medication sensors (e.g., SmartTrack™, SmartTouch™, SmartTouch AV™, SmartTurbo™; http://www.smartinhaler.com/devices/) that wrap around existing inhalers and automatically sends usage data to a patient’s smartphone [34].
T206 25963-26069 Sentence denotes The sensors record the date and time of actuations, the total number of actuations used, and missed doses.
T207 26070-26263 Sentence denotes The device pairs with the Hailie™ App and enables the patient and healthcare professionals to track medication adherence, set daily reminders, and discover insights into their medication usage.
T208 26264-26430 Sentence denotes The SmartInhaler™ sensors have been studied extensively and have demonstrated high user acceptability as well as efficacy in increasing medication adherence [35, 36].
T209 26431-26636 Sentence denotes Five randomized controlled trials using the SmartInhaler™ have been conducted in the UK, Australia, and New Zealand, including a total of 589 adults and children with asthma in a community setting [35–39].
T210 26637-26785 Sentence denotes The authors of these studies conclude that SmartInhaler™ devices were more effective than standard care in improving adherence to asthma medication.
T211 26786-26939 Sentence denotes Two of the studies showed significant improvement in clinical outcomes (e.g., asthma exacerbations, asthma control, and healthcare utilization) [37, 38].
T212 26940-27131 Sentence denotes The Inhaler Compliance Assessment (INCA) device uses time-stamped audio recordings of inhaler use to assess not only inhaler adherence but also inhaler technique (http://www.tueohealth.com/).
T213 27132-27276 Sentence denotes Specifically, it can assess proper inhaler technique by measuring a failure to prime the inhaler, inadequate inspiratory flow, and dose dumping.
T214 27277-27446 Sentence denotes This information can be used to determine if medication was not properly delivered due to inhaler technique errors (attempted adherence) or missed/late medication doses.
T215 27447-27587 Sentence denotes In one study of 184 people with chronic obstructive pulmonary disease, the INCA device was used to assess controller inhaler adherence [40].
T216 27588-27704 Sentence denotes The mean rate of attempted adherence was 58.7%, whereas actual adherence (proper timing and technique) was only 23%.
T217 27705-27828 Sentence denotes Only 7% of participants had actual adherence above 80%, underscoring the importance of addressing proper inhaler technique.
T218 27829-27942 Sentence denotes Currently, there is no mobile app for the INCA tool and the data must be downloaded onto a computer for analysis.
T219 27943-28059 Sentence denotes Additional studies are currently being conducted using an INCA App to assess its ability to improve asthma outcomes.
T220 28060-28196 Sentence denotes Tueo Health, which was acquired by Apple in 2019, developed a passive EMD to help parents monitor nighttime asthma symptoms in children.
T221 28197-28361 Sentence denotes Using commercial breathing sensors placed under the mattress, the device can passively measure key physiologic parameters during sleep (http://www.tueohealth.com/).
T222 28362-28490 Sentence denotes An asthma control score is then calculated from the physiologic data and available for the patient to view through a mobile app.
T223 28491-28659 Sentence denotes The score gives direct indication of their asthma control status based on their provider-issued asthma action plan and recommends evidence-based steps to manage asthma.
T224 28660-28793 Sentence denotes Such steps include reminders to avoid known triggers, refill a prescription, or make an appointment to see their healthcare provider.
T225 28795-28823 Sentence denotes Use of Mobile Apps in Asthma
T226 28824-28928 Sentence denotes As with wearable devices, the use of health apps on phones and tablets has rapidly been increasing [13].
T227 28929-29020 Sentence denotes There are a large number of asthma-related apps with well over 500 reported in 2019 [41••].
T228 29021-29141 Sentence denotes The mobile apps range from providing health education, symptom tracking, environmental alerts, and medication reminders.
T229 29142-29269 Sentence denotes A review conducted in 2015 selected 209 English asthma-related apps that were available in Google Play and/or Apple Store [42].
T230 29270-29672 Sentence denotes The majority (52%) of the apps evaluated were teaching and training information for patients, with 39% based on alternative treatments, such as yoga, acupressure, and breathing exercises; 22% helped users to monitor symptoms and medication adherence; 18% provided medical reference information for providers; 6% provided air quality information; and 2% served as social forums for patients with asthma.
T231 29673-29795 Sentence denotes Despite the great number of currently available mobile apps for asthma, few effectiveness evaluations have been conducted.
T232 29796-29898 Sentence denotes In 2013, Marcano and colleagues conducted a Cochrane review on mobile apps for asthma self-management.
T233 29899-30101 Sentence denotes Only two randomized controlled trials (RCTs) fit the review criteria and assessed efficacy of the apps on asthma outcomes such as asthma control, asthma quality of life, and healthcare utilization [43].
T234 30102-30290 Sentence denotes Both RCTs (n = 408) evaluated the effect of a mobile phone-based asthma self-management intervention on asthma control by comparing it with traditional, paper-based asthma self-management.
T235 30291-30428 Sentence denotes Overall, the results were inconclusive, as the evidence was low quality (GRADE) and attrition bias plus other sources of bias were found.
T236 30429-30520 Sentence denotes In 2017, another systematic review assessed asthma self-management using mHealth apps [44].
T237 30521-30665 Sentence denotes The authors found that mHealth apps improved asthma control in five studies, lung function in two studies, and quality of life in three studies.
T238 30666-30749 Sentence denotes There was no significant impact on economic outcomes such as hospitalization rates.
T239 30750-30929 Sentence denotes While there is preliminary evidence on the efficacy of asthma self-management mobile apps to improve asthma control and quality of life, the mechanisms have not been well studied.
T240 30930-31031 Sentence denotes Ramsey and colleagues reviewed the content and quality of mHealth asthma self-management apps [45••].
T241 31032-31221 Sentence denotes The mobile apps were identified through systematic searches of the Apple and Google Play stores and then coded to evaluate the inclusion of evidence-based behavior change techniques (BCTs).
T242 31222-31393 Sentence denotes Examples of BCTs include providing information about behavior-health link, identifying barriers to performing health behaviors, and prompting self-monitoring of behaviors.
T243 31394-31574 Sentence denotes The quality of the apps was also rated using the Mobile App Rating Scale (MARS) to determine app engagement, functionality, aesthetics, information quality, and subjective quality.
T244 31575-31655 Sentence denotes Of the twenty-three apps identified, a range of 1–11 BCTs were used by the apps.
T245 31656-31817 Sentence denotes The most commonly included BCTs were instruction, behavior-health link, self-monitoring, feedback, teach to use prompts/cues, consequences, and others’ approval.
T246 31818-31906 Sentence denotes Three apps used at least eight BCTs (i.e., AsthmaMD, Kiss myAsthma, and My Breathefree).
T247 31907-32011 Sentence denotes The overall quality of the apps, as measured by MARS, ranged from 2.45 to 4.50 (out of a possible 5.00).
T248 32012-32126 Sentence denotes Four apps had an overall MARS quality of > 4.0 (AsthmaMD, Asthma Health Storylines, Kiss myAsthma, and Wizdy Pets:
T249 32127-32146 Sentence denotes Kids’ Asthma Game).
T250 32147-32424 Sentence denotes As it is more common for patients to ask their healthcare providers to help them choose apps, it is important that providers are knowledgeable about which asthma management apps are high quality and include evidence-based components that will be successful for behavior change.
T251 32425-32581 Sentence denotes To date, Kiss myAsthma and AsthmaMD are the asthma management apps with the highest number of BCTs and quality scores, but this area is constantly evolving.
T252 32582-32665 Sentence denotes There are some limitations to consider regarding the use of mobile apps for asthma.
T253 32666-32754 Sentence denotes The majority of commercially available asthma apps lack validation in clinical settings.
T254 32755-32908 Sentence denotes Further, the apps are not regulated or approved as medical devices and may provide recommendations to patients that are not evidence-based or inaccurate.
T255 32909-33008 Sentence denotes Finally, there is a risk of loss of privacy of health information for patients that use these apps.
T256 33009-33105 Sentence denotes One study showed that only 30% of the most commonly used mHealth apps had privacy policies [46].
T257 33106-33261 Sentence denotes These policies often required a high-level of literacy for comprehension, were often not focused on the app itself, and were not informative for end users.
T258 33262-33431 Sentence denotes Therefore, clinicians should evaluate asthma management apps to ensure high quality and evidenced-based information prior to recommending them for their asthma patients.
T259 33433-33475 Sentence denotes Conclusion: a New Wave of Wearable Devices
T260 33476-33591 Sentence denotes The world and medicine as we know it are changing forever in the wake of the repercussions of the COVD-19 pandemic.
T261 33592-33793 Sentence denotes Limiting unnecessary in-person visits, especially for at-risk patients, and expanding the scope of what we can provide remotely using new technological advancements should be a priority moving forward.
T262 33794-33986 Sentence denotes The future of wearable devices seems to be headed towards continuous measurements of personal physiology to predict, prevent, or help to aid in the diagnosis of an underlying health condition.
T263 33987-34146 Sentence denotes This approach allows frequent and continuous measurements of body functions including heart rate, skin temperature, blood oxygen levels, and physical activity.
T264 34147-34389 Sentence denotes Recent studies investigating the utility of wearable sensors indicate that the information provided by these devices is physiologically meaningful and actionable and will likely to play an important role in managing health in the future [47].
T265 34390-34530 Sentence denotes Healthcare providers and patients themselves can do a much better job of tracking their health outside of regularly scheduled office visits.
T266 34531-34717 Sentence denotes Currently, providers are relying on patients with chronic health conditions to consistently self-report progress and medication compliance which is inefficient and unpredictable at best.
T267 34718-34927 Sentence denotes Having access to reliable home data on a consistent basis that is relevant to the patient’s specific medical condition is key to improving health outcomes not only for asthma but also for all chronic diseases.
T268 34928-35082 Sentence denotes Increased utilization of health monitoring devices by patients will likely become an important aspect of self-care and preventive medicine moving forward.
T269 35083-35272 Sentence denotes The data provided by these devices will allow care providers to provide patients with personalized tools and tailored solutions to improve their health and encourage fitness and diet goals.
T270 35273-35423 Sentence denotes They may also help to enhance accurate symptom reports, improve accuracy of diagnosis, and streamline appropriate specialty referral when appropriate.