Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review.

BACKGROUND: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. OBJECTIVE: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. METHODS: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. RESULTS: We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and "other" (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. CONCLUSIONS: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-048964.

Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial.

Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency-weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care.

Instant messaging application for the care of people living with HIV/aids / Aplicación de mensajes instantáneos en el cuidado a las personas que viven con VIH/sida / Aplicativo de mensagens instantâneas no cuidado às pessoas vivendo com HIV/aids

ABSTRACT Objective: To assess a specific instant messaging application as a tool of care for people living with HIV/aids, based on analysis of the interactions between nurse and patients. Method: Descriptive, quantitative study with 102 patients from two outpatient infectious disease clinics of Fortaleza, Ceará. During four months, participants received a message every 15 days, totaling eight messages, regarding: adherence to antiretroviral therapy; physical activity; social support; self-esteem; anxiety/depression; eating habits; alcohol and drugs; and sexuality. Results: There were 816 interactions, especially for dialogs about performing physical activity (27.87%), sharing of signs and symptoms (18.03%), report of engagement with treatment (9.84%) and requests of information on the intake of medicine (9.84%). Most participants showed satisfaction with the follow-up, with willingness to continue receiving messages (90.58%). Conclusion: The use of this application is a viable strategy to improve care for people with HIV by promoting instant communication.

RESUMEN Objetivo: Evaluar la aplicación de mensajes instantáneos como herramienta de cuidado a las personas que viven con VIH/sida, a partir del análisis de las interacciones entre enfermero y pacientes. Método: Estudio descriptivo, cuantitativo con 102 pacientes de dos ambulatorios de infectología de Fortaleza (Ceará, Brasil). Durante cuatro meses, los participantes recibieron un mensaje cada 15 días, resultando en ocho mensajes, acerca de: adhesión a la terapia antirretroviral; actividad física; apoyo social; autoestima; ansiedad/depresión; hábitos alimentarios; alcohol y drogas; y sexualidad. Resultados: Se realizaron 816 interacciones, con destaque para los diálogos sobre la realización de actividad física (27,87%), compartimiento de señales y síntomas (18,03%), relato de compromiso con el tratamiento (9,84%) y solicitud de información acerca de la toma de medicamentos (9,84%). La mayoría de los participantes demostró satisfacción en cuanto al seguimiento, y manifestó el deseo de seguir recibiendo mensajes (90,58%). Conclusión: El uso de esta aplicación es una estrategia viable para incrementar el cuidado a las personas con VIH, por promover la comunicación instantánea.

RESUMO Objetivo: Avaliar o aplicativo de mensagens instantâneas como ferramenta de cuidado às pessoas vivendo com HIV/aids, a partir da análise das interações entre enfermeiro e pacientes. Método: Estudo descritivo, quantitativo com 102 pacientes de dois ambulatórios de infectologia de Fortaleza, Ceará. Durante quatro meses, os participantes receberam uma mensagem a cada 15 dias, totalizando oito mensagens, sobre: adesão à terapia antirretroviral; atividade física; apoio social; autoestima; ansiedade/depressão; hábitos alimentares; álcool e drogas; e sexualidade. Resultados: Houve 816 interações, com destaque para os diálogos sobre realização de atividade física (27,87%), compartilhamento de sinais e sintomas (18,03%), relato de engajamento com o tratamento (9,84%) e requisição de informações sobre tomada de medicamentos (9,84%). A maioria dos participantes demonstrou satisfação com o acompanhamento, com desejo de continuar recebendo as mensagens (90,58%). Conclusão: O uso desse aplicativo é uma estratégia viável para incrementar o cuidado às pessoas com HIV, por promover comunicação instantânea.

Telessaúde (teleconsulta) aplicativos de celular e uso de mensagens de texto/SMS na atenção a adultos com sobrepeso e obesidade / Telehealth (teleconsultation) mobile apps and the use of text messages/SMS in the care of overweight and obese adults

Esta revisão rápida foi comissionada e subsidiada pelo Ministério da Saúde, no âmbito do projeto GEREB-010-FIO-20 e faz parte da Coleção "Rapid response for health promotion". Pergunta: Qual é a eficácia/efetividade e a segurança das intervenções oferecidas via telessaúde (teleconsulta), aplicativos de celular e uso de mensagens de texto/SMS na atenção a adultos com sobrepeso e obesidade (IMC ≥ 25)? Métodos: A partir de um protocolo prévio, nove bases eletrônicas da literatura foram consultadas em novembro de 2020, para identificar revisões sistemáticas (RS), publicadas em inglês, português e espanhol, sem restrição quanto ao ano de publicação. A qualidade metodológica das revisões sistemáticas foi avaliada utilizando o instrumento AMSTAR 2. Para executar está revisão rápida em 15 dias, apenas o processo de triagem de títulos e resumos foi realizado em duplicidade e de forma independente. Resultados: A busca nas bases de dados resultou em 1.269 estudos e após seleção foram incluídas 14 revisões sistemáticas. Com relação à qualidade metodológica, uma revisão foi categorizada como de confiança alta, cinco apresentaram confiança baixa e oito criticamente baixa. A análise dos estudos trouxe resultados de intervenções individuais e em grupo, com tecnologias únicas e combinadas. As ferramentas usadas variaram entre interações online, mensagens de texto, e-mail, programas, websites, fóruns, chats, aplicativos, telefone e automonitoramento. A maioria de participantes foi composta por mulheres, que receberam intervenções de 4 semanas a 30 meses, e cujos desfechos se referiam a peso, Índice de Massa Corporal (IMC), circunferência da cintura, hábitos alimentares ou de atividade física e proporção de gordura corporal. De modo geral, o uso de diferentes tecnologias proporcionou maior facilidade de acesso aos cuidados em saúde e práticas para melhorar a qualidade de vida. O desfecho mais estudado e que apresenta maior quantidade de resultados favoráveis é a perda de peso, avaliada com relação a intervenções de telessaúde, seguidos por aplicativos de celular, mensagem de texto, websites/computador e tecnologias combinadas. O Índice de Massa Corporal (IMC) resultou em pelo menos um resultado favorável para intervenções por meio de aplicativos de celular, mensagens de texto e tecnologias combinadas, enquanto para a mudança de circunferência da cintura os resultados foram indiferentes aos comparadores. Os estudos voltados para mudança de hábitos alimentares e atividades físicas foram indiferentes ou mais favoráveis a atividade presencial em detrimento do uso de aplicativos. Apenas uma comparação de intervenções analisou o efeito sobre a produção de gordura corporal e obteve bons resultados para programas online e aconselhamento contínuo por telefone celular. Conclusão: A revisão mostrou que intervenções por meio de aplicativos, ferramentas online, mensagens de texto e telessaúde podem ter efeitos positivos para alcançar a redução de peso, IMC e proporção da gordura corporal. Desta forma, vale a pena considerar o uso de tais ferramentas em programas de saúde. No entanto, também é preciso compreender que os resultados aqui apresentados são quase todos provenientes de estudos primários citados nas revisões sistemáticas, e não de metanálises. Além disso, chamamos a atenção para a qualidade metodológica das RS analisadas

This rapid review was commissioned and subsidized by the Ministry of Health, within the scope of the GEREB-010-FIO-20 project and is part of the "Rapid response for health promotion" Collection. Question: What is the efficacy/effectiveness and safety of interventions offered via telehealth (teleconsultation), mobile apps, and use of text messages/SMS in caring for overweight and obese adults (BMI ≥ 25)? Methods: Based on a previous protocol, nine electronic literature databases were consulted in November 2020 to identify systematic reviews (SR), published in English, Portuguese and Spanish, without restriction as to the year of publication. The methodological quality of the systematic reviews was evaluated using the AMSTAR 2 instrument. To perform this rapid review in 15 days, only the process of screening titles and abstracts was carried out in duplicate and independently. Results: The search in the databases resulted in 1,269 studies and, after selection, 14 systematic reviews were included. With regard to methodological quality, one review was categorized as having high confidence, five had low confidence and eight critically low. The analysis of the studies brought results from individual and group interventions, with single and combined technologies. The tools used ranged from online interactions, text messages, email, programs, websites, forums, chats, apps, phone and self-monitoring. Most participants were women, who received interventions from 4 weeks to 30 months, and whose outcomes referred to weight, Body Mass Index (BMI), waist circumference, eating or physical activity habits and body fat proportion. . In general, the use of different technologies provided easier access to health care and practices to improve quality of life. The most studied outcome with the highest number of favorable results is weight loss, evaluated in relation to telehealth interventions, followed by mobile apps, text messaging, websites/computer and combined technologies. The BMI resulted in at least one favorable result for interventions through mobile apps, text messages and combined technologies, while for the change in waist circumference the results were indifferent to the comparators. Studies aimed at changing eating habits and physical activities were indifferent or more favorable to face-to-face activity over the use of apps. Only one comparison of interventions looked at the effect on body fat production and found good results for online programs and ongoing cell phone counseling. Conclusion: The review showed that interventions through apps, online tools, text messages and telehealth can have positive effects in achieving weight reduction, BMI and body fat ratio. Therefore, it is worth considering the use of such tools in health programs. However, it is also necessary to understand that the results presented here are almost all from primary studies cited in systematic reviews, and not from meta-analyses. In addition, we draw attention to the methodological quality of the analyzed SRs.