Mobile health solutions are advancing fast. Based on the analysis of the Hub service portfolio validation survey, 95% of mHealth solution providers and enablers consider evidence of health outcomes, costs-benefit and user acceptance assessment being crucial.
Addressing stakeholders needs, European mHealth Hub has started compiling a repository / list of resources on evidence available in mHealth, especially on clinical validation. Such non exhaustive repository may assist stakeholders keeping up to date on latest data on evidence on health outcomes, quality of life and care efficiency gains in the diseases’ management by using mHealth solutions.
This resource is still growing and is starting with some initial example content. We would value your feedback on the relevance of the content and/or any missing valuable source of evidence within one of the topics covered, or suggestions for non-covered evidence-based topics (contact: firstname.lastname@example.org).
Click on any item below to jump to its summary.
There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes.
This paper is not a comprehensive review, but provides examples of evidenced patient benefit from the use of mHealth in the areas of diagnostics, clinical decision-making, behaviour change, digital therapeutics and education. Whilst not being the evidence one would need to justify a specific programme, this can be a useful high-level illustration of evidenced patient benefit to support a case for initiating any new mHealth programme. This review paper organises the programmes it covers by the kind of impact achieved.
This is a useful comprehensive review because it provides an organised one-stop point to discover many studies and mHealth programmes. These are grouped by disease area, or by the behavioural intervention the programme was designed to achieve. The review article itself concludes that the evidence in favour of impact is still limited, but rightly points out that this is sometimes due to poor quality methodologies making evaluation difficult, rather than unsuccessful programmes.
This article can therefore be a useful catalogue for discovering existing mHealth programmes in an area that a new programme is being planned, and a reminder to ensure that the implementation, adoption and evaluation methods are carefully defined in order to generate convincing evidence of value.
This review paper organises the programmes it covers by the kind of disease area or behavioural change intended.
The application of mobile computing and communication technology is rapidly expanding in the fields of health care and public health. This systematic review will summarise the evidence for the effectiveness of mobile technology interventions for improving health and health service outcomes (M-health) around the world.
The health application evaluator was established to provide patients and healthcare professionals with an informed overview of the health and health behavior mobile applications used in Estonia. Each such application has more or less impact on health and, in most cases, also processes health data. The health application evaluator provides comprehensive information on health applications created and used in Estonia in all categories that may potentially affect users.
This disruptive system will incorporate behavior change methods, such as “Do Something Different”. The objectives will be achieved by empowering patients with tools and services, made available on smartphone or tablet.
When looking at the healthcare and societal costs baseline state are 695€ and 695€ in the control group, but 204€ and 213€ in the intervention group.
The HeartMan project will develop a personal health system to help congestive heart failure (CHF) patients manage their disease. Its core will be a decision support system that will provide personalised advice to the patients. Its first key feature will be evidence-based predictive models.
HeartMan system showed to be successful in improving self-care behaviour and as such resulting in better disease management. Clinical outcomes were affected by HeartMan, as shown by the improvement in left ventricular ejection fraction. The HeartMan system provided a boost to the area of mHealth.
By means of our innovative and portable ICT tool we will improve the socio-economic impact of the cystic fibrosis (CF), promoting healthy lifestyle, intertwining patient empowerment, education and training with self-management and prevention of secondary CF-complications. The multidisciplinary and complementary approach of this co-developed integrative project guarantees the patient’s adherence to the treatment and the best outcome of the nutritional intervention mainly in childhood. The beneficiaries of the application comprise patients, care-givers, families and health professionals as well as health monitoring authorities.
A multidisciplinary team of 12 partners coordinate their efforts in 9 work packages that cover the entire so-called ‘from laboratory to market’ approach by means of an original and innovative co-design process. A cohort of 200 patients with cystic fibrosis aged 1–17 years are enrolled. We will develop an innovative, clinically tested mobile health application for patients and health professionals involved in cystic fibrosis management. Project pursues a final scenario where children with CF and their families and the health professionals can jointly and barriers-free manage the treatment of the disease.
Objectives: To assess the usability and clinical effectiveness of diabetes mobile applications (diabetes apps) developed for adults with type 2 diabetes.
Results: Clinical effectiveness, measured by reductions in HbA1c, ranged from 0.15% to 1.9%.
Focusing on systematic reviews that offered the most direct evidence, this overview demonstrates that on average, mHealth interventions improve glycemic control (HbA1c) compared to standard care or other non-mHealth approaches by as much as 0.8% for patients with type 2 diabetes and 0.3% for patients with type 1 diabetes, at least in the short-term (≤12 months).
For type 1 diabetes, a significant 0.49% reduction in HbA1c was seen (95% CI, 0.04‐0.94; I2 = 84%), with unexplained heterogeneity and a low GRADE of evidence. For type 2 diabetes, using diabetes apps was associated with a mean reduction of 0.57% (95% CI, 0.32‐0.82; I2 = 77%).
For type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=.46) with acceptable heterogeneity (I2=39%) in the short-term subgroup (4 studies) and significant heterogeneity between the short-term and long-term subgroups (I2=64%).
Regarding type 2 diabetes, the overall effect on HbA1c was statistically significant (P<.01) in both subgroups, and when the 2 subgroups were combined, there was virtually no heterogeneity within and between the subgroups
Both the results from the previous study and from the MAFEIP tool lead to the conclusion that even though the telemonitoring intervention is more expensive, it is still a cost-effective choice for the Greek national health system, especially when considering the QALYs gained by the DM2 patients.
Dr. Sema Basat, is already reporting that close to 90% of the patients monitored in their homes via the ProEmpower solutions have returned to normal glucose values
Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers’ fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost–effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management.
For patients with T2D (N = 77,622), multivariable analyses revealed that a 1% reduction in HbA1c was associated with a 2% reduction in all-cause total health care costs and a 13% reduction in diabetes-related total healthcare costs (both p < .0001), and that these reductions resulted in annual cost savings of $429 and $736, respectively.
For patients with an index HbA1c ≥7% (N = 33,648), a 1% reduction in HbA1c was associated with a 1.7% reduction in all-cause total healthcare costs and a 6.9% reduction in diabetes-related healthcare costs (both p ≤ .0001), with associated annual cost savings of $545 and $555, respectively.
Sensitivity analyses showed that, with the exception of conditions where the transition probability of insulin therapy, utility value, or increased medical costs increases, the ICER for the introduction of CGM apps was below the threshold of US $43,478/QALY.
All groups demonstrated a decreased HbA1c, with no significant difference between groups.
The cost-utility was assessed by considering the WHO-CHOICE methodology and using the Greek GDP/capita for 2011 (€18,625) as a readily available indicator. The ICER calculated [€5,460.11 per QALY < €18,625] indicated that even though telemedicine is more expensive, it is a cost-effective choice for the Greek national health system.
The review found promising but limited evidence for the effectiveness of mHealth interventions for improving glycaemic control in LMICs
HbA1c reduction of 0.92% in insulin-treated type 2 diabetes patients (T2DM) was associated with a 2.3% decreased 10-year risk for fatal MI. In combination with a 10% reduction of hypoglycemic events this risk reduction led to cost savings of €16.1 million (France), €57.8 million (Germany), €30.9 million (Italy), €23.8 million (Spain), and €5.8 million (UK), considering all insulin-treated T2DM patients in the respective countries.
This paper reports on a systematic review of lifestyle related apps used for patients with non communicable diseases, Conducted in 2017, the noteworthy finding is the result of a meta-analysis of seven diabetes mobile health applications. In use between three and six months these apps demonstrated a reduction in HbA1c, But this became more significant and consistent across the reviewed applications between six and 12 months of use. This suggests that there is a sustained impact rather than a short-term effect which is often the claim made about innovative interventions.
The primary objective of this report is to provide an overview and assessment of the most recent evidence base of mHealth for diabetes as an example of high burden chronic conditions. The report furthermore aims to inform the reader on the particular characteristics of the disease and the challenges of strong evidence building as a good understanding may influence the effect of future mHealth interventions.
Conclusions: mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.
This is a systematic review and meta-analysis to assess the efficacy of mobile phone apps to promote weight loss and increase physical activity. 12 studies were examined and the authors found a significant impact on weight loss and on physical activity levels. They conclude that mobile phone app-based interventions may be useful tools for weight loss.
Current research suggests the most promising evidence-based behaviour change techniques for weight loss maintenance (WLM) are self-monitoring. The NoHoW project tests whether ICT-based delivery of the most promising evidence-based behavior change techniques is effective for WLM.
The study’s primary objectives are to evaluate whether using a new digital toolkit is effective for WLM. No post-2019 follow-up yet available.
EmERGE will develop a mHealth platform to enable self-management of HIV in patients with stable disease. The platform will provide users with web based and mobile device applications which interface securely with relevant medical data and facilitate remote access to key healthcare providers.
Based on prior work showing a high uptake rate and use of mHealth in HIV patient populations, EmERGE aims to demonstrate the benefits to patients and simultaneous increases in cost-effectiveness for healthcare providers by reducing face-to-face consultations, estimated at 6000 saved per year within this study alone.
Most of the identified measures of empowerment had acceptable construct validity, however there were insufficient data to determine the reliability or responsiveness of many of the scales.
In European Union approximately 5 million people suffer from psychotic disorders. Between 30-50% can be considered resistant to treatment, and 10-20% ultra-resistant. A high proportion of the total cost for treating schizophrenia is spent on this population. m-RESIST aims to develop an intervention programme based on mHealth to allow patients suffering from resistant schizophrenia to self-manage their condition.
List of further publications from the deliverables may be obtained on request from projects’ project manager.
We will determine disease burden of comorbidity, calculate its socioeconomic impact, and reveal risk factors. We will study biological pathways of comorbidity and derive biomarkers. A pilot clinical trial to study non-pharmacologic, dopamine-based and chronobiological treatments will be performed, employing innovative mHealth to monitor and support patients’ daily life.
Taking on the results of the mHealth app development in by KIT (PI Ebner-Priemer) in WP05 and the results of previous intervention studies, the aim of the current pilot randomized controlled (RCT) Phase-IIa study is to establish effect sizes of these two kind of interventions in combination with mHealth based reinforcement in adolescents and young adults aged 14 to 30 years old with ADHD.
Mobile health (mHealth) is a rapidly growing field providing the potential to enhance patient education, prevent disease, enhance diagnostics, improve treatment, lower health care costs and increase access to health care services, and advance evidence-based research.
For the field of nursing the potential capabilities of mHealth are not only for patient care but for delivery of nursing education to our future practicing nurses, providing a means of communication between healthcare professionals located close and at greater geographic distances, and provides access to information and personal monitoring for geographically isolated clients.
Although mHealth capabilities’ value appears significant for training, and practice, there remains a significant need for research and evaluation of the devices that now appear in the health care marketplace. The National Institute of Nursing Research’s strategic plan includes supporting research to develop and test the flood of health apps to assist clients in the management of their health.
The purposes of this paper are to: 1) discuss the importance of mHealth in nursing practice, education, and research, and 2) describe the mHealth initiatives underway at the University of Pittsburgh School of Nursing as exemplars to stimulate mHealth research and promote nursing role in providing health care to patients in this age of information technology.
Telehealth and mHealth technology have propelled the nurse from a note-taker and hand-holder to a controller and dispenser of information. And they’re using those skill to improve care management and coordination.
Globally, prostate cancer is a major healthcare problem. It is among the most frequently diagnosed malignancies and is the primary cancer in males in North America and the Caribbean, Europe, and some parts of Africa. Mobile health interventions afford prostate cancer patients in following prostate specific antigen results including trends, getting a better understanding of the severity of their disease and evaluate carefully the benefits and risks of the available treatment options. This review will examine the use of mobile health applications in prostate cancer research particularly in (1) clinical decision of selecting best treatment option or active surveillance, (2) monitoring disease- and treatment-related symptoms, (3) oncological and supportive care, (4) treatment decisions, and (5) health literacy and promotion of physical exercise. The benefits of telemedicine are discussed. Challenges will be examined and recommendations given for the development and efficient use of mobile health applications by prostate cancer patients and healthcare providers.
The platform will be centred in a Personal Health Record that will exploit recent advances on Health Avatars for the individual cancer patient surrounded by mHealth applications designed to encourage the patient.
Perceived usefulness of the platform was lower in prostate than breast cancer patients. The data gathered on costs and absences from work has identified an interesting area within this population to investigate further.
The different cost-effectiveness studies demonstrated that teleophthalmology holds great promise for reducing the cost of inmate care and reducing blindness caused by diabetic retinopathy.
iPrognosis interventions can potentially lead to a significant reduction of the healthcare/societal costs (400€-550€ per PD patient per year), over a model horizon of 20 years
Patient centric ecosystem for Parkinson’s disease (PD) management. Data mining studies will lead to the implementation of a Decision Support Platform with suggestions for modifications in the medication which is the key for prolongation of independence and improved Quality of Life. Compliance with medical recommendations will also be studied; the patient will be motivated to adhere to his medication and diet.
In total, about 120 unique rules were produced to assign PD patients into the rapid progression group with a mean classification accuracy of 86.3%. The most informative of these rules are presented in this work, while all of them are used to develop a decision support system (DSS).
Urinary incontinence affects 25-45% of all women. The most common type is stress urinary incontinence, which is the leakage of urine on physical exertion. Pelvic floor muscle training is an effective first-line treatment for this condition but many women do not seek help from their ordinary health care service. There is a need to evaluate new methods to offer effective treatment, and internet-based treatment has previously been found to be effective for women with stress urinary incontinence.
Urinary incontinence is common among women, with prevalence most often reported to be between 25% and 45%. The most common type is stress urinary incontinence (SUI), defined as leakage upon exertion. First-line treatment includes pelvic floor muscle training (PFMT) and lifestyle advice. eHealth, the use of information and communication technology for health, can lower barriers to seeking help, save time and provide easily accessible care. In other conditions, the use of mobile technology has been argued to improve adherence to, and serve as a support for, self-management leading to improved symptom control.
Stress urinary incontinence (SUI) affects 10’35%of women andcan impair quality of life. There is a need for new, easily accesible ways to provide treatment. The aim is to evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an internet-based tratment programme for SUI. The results shows that an Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.
The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT).During three months’ use of the app Tät, containing information, providing a pelvic floor muscle training programme and lifestyle advices, the results showed that the app Tät was effective for self-management of urinary incontinence. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.
Previous studies have found high prevalence rates of anxiety and depression in women with urinary incontinence (UI). This study investigates the prevalence in women who had turned to eHealth for treatment of UI and identifies possible factors associated with depression.The odds of depression in women with MUI/UUI were increased compared with SUI. The prevalence of anxiety and depression was considerably lower than reported in large cross-sectional surveys. Socioeconomic differences may partly explain this finding, as the use of eHealth still is more common among highly educated women.
Female stress urinary incontinence can be treated using self-management programmes focused on pelvic floor muscle training. This study evaluates the effect of two different programmes, one provided as a booklet and one Internet-based, when made freely available to the public both programmes rendered clinically relevant improvements. Self-management of stress urinary incontinence should be recommended to women that request treatment.
The Department of Public Health and Clinical Medicine( Umeå University), have developed the Tät app, which provides a 3-month treatment program with a focus on pelvic floor muscle training for women with Stress urinary incontinence (SUI). The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, it has been investigated participant experiences of the app-based treatment.The main conclusion emphasises that the use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment.
Stress urinary incontinence is common among women. First-line treatment includes pelvic floor muscle training (PFMT) and lifestyle advice, which can be provided via a mobile app. The study aimed to analyze factors associated with successful
treatment. The results extracted, indicate that app-based treatment effects are better in women who are interested in and have high
expectations of such treatment. Also, the findings underline the importance of strengthening the pelvic floor muscles and offering lifestyle advice
The study is focus on the long-term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training. A previous randomized controlled trial of 123 women aged 27–72 years found that three months of self-managing stress urinary incontinence with support from the Tät® app was effective. The researchers followed up the women in the app group two years after the initial trial. The results drawn from the study that self-management of stress urinary incontinence with support from the Tät® app had significant and clinically relevant long-term effects and may serve as first-line treatment.
Mobile apps can increase access to care, facilitate self-management, and improve adherence to treatment. An app with instructions for pelvic floor muscle training (PFMT) is available as first-line treatment, the objective of this study was to evaluate the health economy of the app for treating SUI. The conclusions extracted from this study shows that the app for treating stress urinary incontinence is a new, cost-effective, first-line treatment with potential for increasing access to care in a sustainable way for this patient group.
With increasing smartphone availability, mobile health apps are a growing field that offers new possibilities for delivering health services.9 Health apps may increase access to care for people who are unwilling to seek out or have limited access to ordinary health care. research group developed a mobile app with a treatment program for stress urinary incontinence (SUI), with a focus on pelvic floor muscle training (PFMT). The aim of this study was to compare the mobile app treatment program to no treatment for effects on symptom severity and condition-specific quality of life in women with SUI.The mobile app treatment was effective for women with SUI during the study and yielded clinically relevant improvements. This app may increase access to first-line treatment and adherence to PFMT.