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Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor 4.31) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, MEDLINE and Science Citation Index Expanded (SCIE), and in June 2020 received an Impact Factor of 4.31, ranking the journal Q1 in the medical informatics category indexed by the Science Citation Index Expanded (SCIE) by Thomson Reuters/Clarivate

The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics.

JMIR mHealth and uHealth publishes since 2013 and was the first mhealth journal in Pubmed. It publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research

JMIR mHealth and uHealth features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.

JMIR mHealth and uHealth adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.


Recent Articles:

  • Source: Image created by the authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis


    Background: Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. Objective: A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. Methods: The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration’s tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. Results: Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD –0.93, 95% CI –1.95 to 0.09), muscle balance test (SMD –0.27, 95% CI –0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI −0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD –0.10, 95% CI –4.01 to 3.82; simulated page turning, SMD –0.99, 95% CI –2.01 to 0.02; simulated feeding, SMD –0.64, 95% CI –1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI –0.02 to 2.00; picking up large light objects, SMD –0.42, 95% CI –1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI –0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD –0.23, 95% CI –1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI –1.24 to 2.36), elbow flexion (SMD –0.36, 95% CI –1.14 to 0.42), elbow extension (SMD –0.21, 95% CI –0.99 to 0.57), wrist extension (SMD 1.44, 95% CI –2.19 to 5.06), and elbow supination (SMD –0.18, 95% CI –1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD –1.33, 95% CI –2.42 to –0.24). Conclusions: The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.

  • Source: Image created by the Authors (Imma Grau-Corral); Copyright: The Authors (Imma Grau-Corral); URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Availability of Spanish-Language Medical Apps in Google Play and the App Store: Retrospective Descriptive Analysis Using Google Tools


    Background: The number of medical and health apps in the App Store and Google Play repositories has been increasing in the recent years, and most of these apps are in English. However, little is known about the domain of Spanish health apps and their evolution. Objective: The aim of this study was to perform a retrospective descriptive analysis of medical apps for patients in the Spanish language by using Google search tools over a 5-year period and to compare the results by using a reproducible methodology to obtain a better knowledge of the medical apps available in the Spanish Language. Methods: Over a 5-year period, medical apps were catalogued using a Google-based methodology. Keywords of the first 14 categories of the International Classification of Diseases, Tenth Revision, were selected, and in December of each year, searches of the URLs of Google Play and the App Store were conducted using Google Advanced Search. The first 10 results were taken, and apps meeting the inclusion criteria were selected and rated with the iSYScore method. Results: Out of a sample of 1358 apps, 136 met the inclusion criteria. The 3 main categories of the medical apps were in the fields of endocrinology (diabetes), respiratory (chronic obstructive pulmonary disease, asthma, and allergies), and neurology (multiple sclerosis, Parkinson disease, and Alzheimer disease). Few apps were maintained over the 5 years. Only 10 of the 136 apps were maintained for 3 years or more. There was a large number of original apps in other languages that were translated into Spanish (56/136, 41.2%). In the last year of the study, the main reason (73/280, 26.1%) for discarding an app was the date of the last update. Conclusions: The market of Spanish apps is poor; only few apps have appeared repeatedly over 5 years. Differences were found with the international market in terms of apps related to mental health, heart and circulatory system, and cancer, and coincidences were found in the relevance of apps for diabetes control.

  • Source: Adobe Stock; Copyright: fizkes; URL:; License: Licensed by JMIR.

    Ambulatory Phonation Monitoring With Wireless Microphones Based on the Speech Energy Envelope: Algorithm Development and Validation


    Background: Voice disorders mainly result from chronic overuse or abuse, particularly in occupational voice users such as teachers. Previous studies proposed a contact microphone attached to the anterior neck for ambulatory voice monitoring; however, the inconvenience associated with taping and wiring, along with the lack of real-time processing, has limited its clinical application. Objective: This study aims to (1) propose an automatic speech detection system using wireless microphones for real-time ambulatory voice monitoring, (2) examine the detection accuracy under controlled environment and noisy conditions, and (3) report the results of the phonation ratio in practical scenarios. Methods: We designed an adaptive threshold function to detect the presence of speech based on the energy envelope. We invited 10 teachers to participate in this study and tested the performance of the proposed automatic speech detection system regarding detection accuracy and phonation ratio. Moreover, we investigated whether the unsupervised noise reduction algorithm (ie, log minimum mean square error) can overcome the influence of environmental noise in the proposed system. Results: The proposed system exhibited an average accuracy of speech detection of 89.9%, ranging from 81.0% (67,357/83,157 frames) to 95.0% (199,201/209,685 frames). Subsequent analyses revealed a phonation ratio between 44.0% (33,019/75,044 frames) and 78.0% (68,785/88,186 frames) during teaching sessions of 40-60 minutes; the durations of most of the phonation segments were less than 10 seconds. The presence of background noise reduced the accuracy of the automatic speech detection system, and an adjuvant noise reduction function could effectively improve the accuracy, especially under stable noise conditions. Conclusions: This study demonstrated an average detection accuracy of 89.9% in the proposed automatic speech detection system with wireless microphones. The preliminary results for the phonation ratio were comparable to those of previous studies. Although the wireless microphones are susceptible to background noise, an additional noise reduction function can alleviate this limitation. These results indicate that the proposed system can be applied for ambulatory voice monitoring in occupational voice users.

  • Source: Unsplash; Copyright: YouVersion; URL:; License: Licensed by JMIR.

    Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals


    Background: Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective: The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. Methods: Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results: The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions: The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

  • Source: Rawpixel; Copyright:; URL:; License: Licensed by JMIR.

    Evaluation of the Design and Implementation of a Peer-To-Peer COVID-19 Contact Tracing Mobile App (COCOA) in Japan


    We evaluate a Bluetooth-based mobile contact-confirming app, COVID-19 Contact-Confirming Application (COCOA), which is being used in Japan to contain the spread of COVID-19, the disease caused by the novel virus termed SARS-COV-2. The app prioritizes the protection of users’ privacy from a variety of parties (eg, other users, potential attackers, and public authorities), enhances the capacity to balance the current load of excessive pressure on health care systems (eg, local triage of exposure risk and reduction of in-person hospital visits), increases the speed of responses to the pandemic (eg, automated recording of close contact based on proximity), and reduces operation errors and population mobility. The peer-to-peer framework of COCOA is intended to provide the public with dynamic and credible updates on the COVID-19 pandemic without sacrificing the privacy of their information. However, cautions must be exercised to address critical concerns, such as the rate of participation and delays in data sharing. The results of a simulation imply that the participation rate in Japan needs to be close 90% to effectively control the spread of COVID-19.

  • Source: Pixabay; Copyright: DariuszSankowski; URL:; License: Licensed by JMIR.

    Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery:...


    Background: Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. Objective: This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. Methods: A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. Results: A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality–based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. Conclusions: These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.

  • Source: Pixabay; Copyright: viarami; URL:; License: Licensed by JMIR.

    COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control


    As the world struggles with the new COVID-19 pandemic, contact tracing apps of various types have been adopted in many jurisdictions for combating the spread of the SARS-CoV-2 virus. However, even if they are successful in containing the virus within national borders, these apps are becoming ineffective as international travel is gradually resumed. The problem rests in the plurality of apps and their inability to operate in a synchronized manner, as well as the absence of an international entity with the power to coordinate and analyze the information collected by the disparate apps. The risk of creating a useless Tower of Babel of COVID-19 contact tracing apps is very real, endangering global health. This paper analyzes legal barriers for realizing the interoperability of contact tracing apps and emphasizes the need for developing coordinated solutions to promote safe international travel and global pandemic control.

  • Source: freepik; Copyright: stockking; URL:; License: Licensed by JMIR.

    Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review


    Background: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. Objective: This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. Methods: MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. Results: No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Conclusions: Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254;

  • Source: freepik; Copyright: gpointstudio; URL:; License: Licensed by JMIR.

    Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey


    Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults’ attitudes toward and use of mHealth technologies for self-tracking purposes—an area that is increasingly important and relevant during the COVID-19 era. Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults’ use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers.

  • Evident smartphone app. Source: Image created by the authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Effectiveness of an mHealth Intervention Combining a Smartphone App and Smart Band on Body Composition in an Overweight and Obese Population: Randomized...


    Background: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. Objective: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. Methods: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire. Results: The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m2, 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m2 (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m2 (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m2 (95% CI –0.83 to –0.19). Conclusions: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m2 and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect. Trial Registration: NCT03175614;

  • Source: Image created by authors / Placeit; Copyright: The Authors / Placeit; URL:; License: Licensed by JMIR.

    Smartphone-Based Monitoring of Parkinson Disease: Quasi-Experimental Study to Quantify Hand Tremor Severity and Medication Effectiveness


    Background: Hand tremor typically has a negative impact on a person’s ability to complete many common daily activities. Previous research has investigated how to quantify hand tremor with smartphones and wearable sensors, mainly under controlled data collection conditions. Solutions for daily real-life settings remain largely underexplored. Objective: Our objective was to monitor and assess hand tremor severity in patients with Parkinson disease (PD), and to better understand the effects of PD medications in a naturalistic environment. Methods: Using the Welch method, we generated periodograms of accelerometer data and computed signal features to compare patients with varying degrees of PD symptoms. Results: We introduced and empirically evaluated the tremor intensity parameter (TIP), an accelerometer-based metric to quantify hand tremor severity in PD using smartphones. There was a statistically significant correlation between the TIP and self-assessed Unified Parkinson Disease Rating Scale (UPDRS) II tremor scores (Kendall rank correlation test: z=30.521, P<.001, τ=0.5367379; n=11). An analysis of the “before” and “after” medication intake conditions identified a significant difference in accelerometer signal characteristics among participants with different levels of rigidity and bradykinesia (Wilcoxon rank sum test, P<.05). Conclusions: Our work demonstrates the potential use of smartphone inertial sensors as a systematic symptom severity assessment mechanism to monitor PD symptoms and to assess medication effectiveness remotely. Our smartphone-based monitoring app may also be relevant for other conditions where hand tremor is a prevalent symptom.

  • Source:; Copyright: MartinPrescott; URL:; License: Licensed by the authors.

    Nurses’ Use of Personal Smartphone Technology in the Workplace: Scoping Review


    Background: There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal and professional purposes. Despite the proliferation of smartphone use in the health care setting, there is limited research on the clinical use of these devices by nurses. It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice. Objective: This review aimed to understand the current breadth of research on nurses’ personal smartphone use in the workplace and to identify implications for research, practice, and education. Methods: A scoping review using Arksey and O’Malley’s methodological framework was conducted, and the following databases were used in the literature search: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Inclusion criteria included research focused on nurses’ use of their own digital technologies, reported in English, and published between January 2010 and January 2020. Exclusion criteria were if the device or app was implemented for research purposes, if it was provided by the organization, if it focused on infection control, and if it was focused on nursing students or nursing education. Results: A total of 22 out of 2606 articles met the inclusion criteria. Two main themes from the thematic analyses included personal smartphone use for patient care and implications of personal smartphone use. Nurses used their smartphones to locate information about medications, procedures, diagnoses, and laboratory tests. Downloaded apps were used by nurses to locate patient care–related information. Nurses reported improved communication among health team members and used their personal devices to communicate patient information via text messaging, calling, and picture and video functions. Nurses expressed insight into personal smartphone use and challenges related to distraction, information privacy, organizational policies, and patient perception. Conclusions: Nurses view personal smartphones as an efficient method to gather patient care information and to communicate with the health care team. This review highlights knowledge gaps regarding nurses’ personal device use and information safety, patient care outcomes, and communication practices. This scoping review facilitates critical reflection on patient care practices within the digital context. We infer that nurses’ use of their personal devices to communicate among the health care team may demonstrate a technological “work-around” meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care. The current breadth of research is focused on acute care, with little research focus in other practices settings. Research initiatives are needed to explore personal device use across the continuum of health care settings.

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  • Quality of popular mobile apps for smoking cessation in France: Content analysis using the mobile app rating scale (MARS) and behavior change techniques taxonomy.

    Date Submitted: Nov 28, 2020

    Open Peer Review Period: Nov 28, 2020 - Jan 23, 2021

    Background: The mobile app market differs from country to country, and to date no previous review of smoking cessation applications (apps) content quality has been conducted in France. Objective: The...

    Background: The mobile app market differs from country to country, and to date no previous review of smoking cessation applications (apps) content quality has been conducted in France. Objective: The current review aims to examine the general quality of the most popular smoking cessation apps in France and also determine the degree to which apps adhere to established behavioral and cognitive techniques (BCT’s) proven effective in clinical practice. Methods: A systematic research of smoking cessation apps was conducted in both Google Play and Apple store in the French market. The general quality of popular apps was rated with the Mobile App Rating Scale (MARS) and the therapeutical quality was assessed with the ratio of adherence of the BCT taxonomy for smoking cessation treatment. Results: 14 mobile apps met all the inclusion criteria of the content analysis. The inter-rater reliability varies from “substantial’ (0,79) to “almost perfect” (0,9) for both measures. The mean MARS score was 3,5 out of 5 (median 3,1- IQR 1,3). Findings suggest that popular apps focused primary on the functionality dimension of the MARS scale (4.2 out of 5). The average number of BCT techniques was 22, with a huge difference between apps (min=4/max=38). At least half of the apps addressed motivation (63%) and advise on using behavioral skills in order to quit or stay nonsmoker (62%). However, only a handful of apps gathered important information (42%) in order to deliver proper advice regarding the use of approved medication or the implementation of the behavioral techniques (31%). The average MARS score was positively correlated with the price (r = .70, p = < .001), and with the number of BCT’s used (r = .66, p = < .005). User rating was not correlated with any quality scale. Conclusions: Content quality of popular smoking cessation apps in France varied by app type and price. Most popular apps propose in general a good quality content but lack the implementation of evidence based BCT’s associated with effectiveness on smoking cessation treatment. Further research is needed to evaluate the improvement of the quality content of smoking cessation apps in France.

  • Smartphone applications for the detection of atrial fibrillation in primary care: a review

    Date Submitted: Nov 24, 2020

    Open Peer Review Period: Nov 24, 2020 - Jan 19, 2021

    Background: Smartphone technology continues to advance at a fervid pace. In the field of cardiology, traditional physical tests recommended to detect cardiac arrhythmias may soon be superseded by low-...

    Background: Smartphone technology continues to advance at a fervid pace. In the field of cardiology, traditional physical tests recommended to detect cardiac arrhythmias may soon be superseded by low-cost, convenient and reliable smartphone apps. We aimed to determine the screening test accuracy of smartphone apps in detecting atrial fibrillation (AF) in patients within primary care. Objective: The aim of this review was to determine the screening test accuracy of smartphone apps in detecting atrial fibrillation (AF) in patients within primary care. Methods: Systematically searched MEDLINE, PUBMED, Web of Science, CINAHL and Cochrane Library until 01 February 2019. Articles were screened, and evaluated before relevant data extracted and study quality appraised using the QUADAS-2 tool. The raw test accuracy data was constructed into a 2x2 contingency table and the test accuracy statistics were calculated, and organised in descriptive plots. Results: Seven cross-sectional studies tested one, or two smartphone apps including the AliveCor 1-lead 30 sec ECG (seven studies; n=16,359), and the Cardiio Rhythm PPG (one study; n=1,012). The prevalence of AF ranged from 1.17%-12.29%, with a mean of 2.65%. The AliveCor 1-lead device reported a sensitivity ranging from 0.92 to 0.99, and specificity from 0.99 to 1.00. Sensitivity and PPV showed the greatest heterogeneity, with results ranging from suboptimal to excellent. The Cardiio Rhythm PPG app recorded a sensitivity of 0.71 (95% CI 0.51-0.87) and specificity of 0.99 (95% CI 0.98-1.00). Conclusions: Community screening for AF using smartphone electrocardiography (ECG) or photoplethysmography (PPG) is feasible. Smartphone apps that screen for AF in primary care demonstrate excellent specificity, but suboptimal sensitivity. Further optimisation of detection algorithms, to accommodate the spectrum of disease seen within the community, should be considered before such devices are used as a tool for systematic auto-screening.

  • Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: A Randomized Controlled Trial

    Date Submitted: Nov 22, 2020

    Open Peer Review Period: Nov 22, 2020 - Jan 17, 2021

    Background: Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any...

    Background: Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations. Objective: The aim of this study was to investigate how purposeful smartphone use compared to recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, on the evaluation of attentiveness, and on the evaluation of smartphone use in physiotherapy in general. Methods: Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in four different ways: (1) with therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist’s professional competence, social competence, and empathetic behavior. They also rated the physiotherapist’s and the patient’s attentiveness and evaluated the usage of smartphones generally in physiotherapy. Results: One hundred and eighteen participants (63 woman and 55 men) were included in the analysis. When the physiotherapist used the smartphone in a purposeful way she was perceived as more professionally competent (P=.007) and socially competent (P=.03), and more empathetic (P=.04) than if she used it with no therapeutic purpose. These effects occurred because recreational smartphone use by the physiotherapist was evaluated more negatively than the behavior in the control condition (professional competence: P=.001; social competence: P=.03; empathy: P=.04). Moreover, when the physiotherapist used the smartphone in a recreational way she was perceived as being less attentive (P<.001). Likewise, when the patient used the smartphone in a recreational way, she was also perceived as being less attentive (P<.001). Finally, smartphone use in physiotherapy was rated as more positive in general when the smartphone was used in a purposeful way, compared to the conditions in which the physiotherapist or the patient looked at the smartphone with no therapeutic purpose (P<.001). This positive evaluation occurred because a purposeful use led to a more positive rating than no smartphone use (P<.001, R=0.42). Conclusions: We conclude that smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment. Clinical Trial: The study was pre-registered on the pre-registration platform AsPredicted ( before we began data collection (registration number: #24740;

  • Stuttering mHealth Applications: A Qualitative Rubric Assessment

    Date Submitted: Nov 20, 2020

    Open Peer Review Period: Nov 20, 2020 - Jan 15, 2021

    Background: Mobile applications (apps) that offer a variety of techniques to improve stuttering have been flourishing in the digital marketplace. In evidence-based clinical practice, speech therapists...

    Background: Mobile applications (apps) that offer a variety of techniques to improve stuttering have been flourishing in the digital marketplace. In evidence-based clinical practice, speech therapists will recommend audio-enriched mobile apps to individuals with stuttering problems based on empirical research evidence. Unfortunately, many stuttering mobile apps available in the market are developed without a substantial research base. Hence, speech therapists necessitate a guideline which they could use to assess the quality of a stuttering mobile app before recommending the app to stutterers. Objective: The objective of this study is to develop a rubric for assessing the quality of the stuttering mobile app in assisting speech therapists to make informed recommendations Methods: The rubric was initially developed based on a set of criteria reviewed from the literature. Online surveys and focused group discussion were then conducted for results verification. Results: The outcome of this study is a rubric designed with four categories and 18-evaluative dimensions tailored to analyze the quality of stuttering mobile apps. The stuttering mobile app assessment rubric presented in the serve multiple purposes, including an evaluation instrument, providing guidelines for developing stuttering mobile apps and for creating a standard form that can be shared with professionals to facilitate a collective effort. Conclusions: This rubric also offers a guidance to steer drive the future development of stuttering mobile apps that are evidence-based, and theoretically grounded

  • Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) Application: A Mixed-Methods study

    Date Submitted: Nov 2, 2020

    Open Peer Review Period: Nov 1, 2020 - Dec 27, 2020

    Background: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea,...

    Background: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, the paper-based Self-report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR in an Android application, which has the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective: This study was tested validity and reliability of a mobile version of a self-report assessment application for elderly persons contextualized to the South Korean culture with comparing paper-based test. Methods: In this mixed-methods study, we recruited and interviewed 567 elderly drivers (≥65 years) between August 2018 and May 2019. For participants who provided consent, the application-based test was repeated after 2 weeks, and an additional paper-based Driver 65 Plus test was also administered. Using the collected data, we analyzed the reliability and validity of the application-based SAFE-DR. In the reliability analysis, exploratory factor analysis on 40 of the 44 items established five subdomains: On-road (8 items), Coping (16 items), Cognitive Functions (5 items), General Conditions (8 items), and Medical Health (3 items). In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing a very high reliability. Results: A very strong negative correlation of -0.864 was observed between the total score for the application-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The application-based test was reliable. Conclusions: This assessment can be applied to the education and preventive screening of elderly drivers’ license renewal policy in South Korea and can contribute to safe driving among elderly drivers.

  • Change position, good way to reduce cardio-metabolic risk of sedentary behavior in fibromyalgia patients?:Cross-sectional study

    Date Submitted: Oct 27, 2020

    Open Peer Review Period: Oct 27, 2020 - Dec 22, 2020

    Background: Patients with fibromyalgia (FM), often exhibit sedentary behaviors and being overweight or obese places them at greater risk of developing cardiometabolic disease. Position changes have be...

    Background: Patients with fibromyalgia (FM), often exhibit sedentary behaviors and being overweight or obese places them at greater risk of developing cardiometabolic disease. Position changes have been found to be associated with positive effects on cardiometabolic outcomes in several chronical illness affected populations. Objective: The aim of this study is to evaluate the effect of position changes on cardiometabolic risk markers in sedentary patients diagnosed with FM who are overweight or moderately obese. Methods: Cross-sectional studies conducted on 78 women with FM. Activities were quantified: sitting time, number of position changes (sitting/standing), number of steps and metabolic output for one week using the activPAL device. In addition, anthropometric measurements, clinical and biochemical variables related to cardiometabolic risk were taken. Results: Of the sedentary activities studied, only a higher number of position changes were associated with a lower body mass index and a lower tricipital fold. No differences are observed when analyzing by number of steps or energy expenditure. Clinical and biochemical variables are in the range of normality regardless of sedentary habits. Conclusions: This study highlights the beneficial effects of increased positional changes in sedentary overweight or obese people with fibromyalgia that may be incorporated into interventions to decrease cardiometabolic risk in these patients. Clinical Trial: NCT01729936