ABSTRACT
Objective: Given the reductions in in-person visits and the increases in teleneurology visits, we sought to determine whether patients increased their use of virtual complementary and integrative therapies. Background: Patients with neurological disorders may seek treatment options in addition to those recommended by their providers. Prior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). Design/Methods: By examining two separate datasets that included cohorts of patients with neurological disorders, we assessed patients' use of virtual (and non-virtual) CITs and determined whether there were clinical characteristics that predicted their use. The two studies that comprised this report included one that examined patient and provider experiences with teleneurology visits, and another that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. Results: Patients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage. Conclusions: Data from our investigations demonstrated that, in addition to its other roles in teleneurology, CIT-related technologies may be utilized in the treatment of neurologic conditions.
ABSTRACT
Objective: The study has three aims: 1) highlight challenges of clinical behavioral trials in neurology during the COVID-19 pandemic, 2) determine approaches to maximize generalizability of pandemic-era studies, and 3) offer strategies for future successful behavioral trials. Background: Behavioral therapies are safe, effective treatments for many neurological conditions. However, over 20,000 clinical trials have been affected by the COVID-19 pandemic, with high impact on behavioral studies that require increased in-person interactions to deliver the therapeutic intervention. Design/Methods: We reviewed existing literature on clinical trials to evaluate the pandemic's influences upon clinical behavioral studies in neurology, including study design, participant recruitment, demographics, and adherence. Using Pubmed and Google Scholar, we conducted a search of peer-reviewed articles based on the following key terms: “pandemic clinical trials,” “neurology,” “inequities,” and “adherence.” The review focused on 43 articles published from 2000 to 2021. Results: Common themes surrounding the pandemic's impact are noted in the following statements. Social-distancing guidelines disrupted protocols for behavioral studies, given difficulty shifting from in-person to virtual settings. Traditional routes of recruitment (e.g., brochures) were hindered, whereas digital methods (e.g., social media) were popularized. Transforming trials into virtual settings resulted in the exclusion of some diverse participants without access to required digital tools. Adherence has been affected variably, with increased rates for participants with more flexible schedules versus possible decreased adherence/motivation for those with pandemic-related psychological changes (e.g., depression). onclusions: Future clinical behavioral trials might: 1) broaden recruitment using newly popularized digital techniques, 2) improve trial access for diverse populations, 3) expand protocols to include virtual and in-person participation, 4) increase patient adherence and retention, and 5) incorporate measures to evaluate for mood- and anxiety-related comorbidities into statistical analysis. As these strategies are integrated, more research is needed to devise methods to protect clinical trials from pandemic-related or other disruptions in the future.
ABSTRACT
Objective: To analyze the characteristics of commercially available sleep-exclusive apps using the Mobile Health Index and Navigation (MIND) apps database published by the Division of Digital Psychiatry at BIDMC for app review. Background: Over 70 million Americans endure a chronic sleep disorder during their lifetime. Due to the COVID-19 pandemic, mobile app benefits have been postulated as a means of expanding patient access to scientifically-based interventions in aiding their sleep disorders. With the increasing adoption of mobile health apps, it is critical that information regarding these mobile apps are sufficiently analyzed. Design/Methods: Using pre-specified criteria, we identified 106 sleep related mobile apps in the iOS and Google Playstores, and rated them using a 105 question review that is part of the MIND database. Questions focused on: Accessibility, Privacy & Security, Clinical Foundation, Engagement Style, and Interoperability. The features of the 106 apps were compared to a control group of non-sleep apps to evaluate the features and limitations sleep apps bear relative to the remainder of the marketplace. Results: The most common features of sleep apps were mindfulness (68.9%), deep breathing (54.7%), and psychoeducation (30.2%). Regarding functionality, 39.6% of apps have accessibility features and 49.1% can be used offline. However, sleep apps lack sleep trackers (22.6%), exportability features (21.7%), and opportunities to collaborate with one's provider (7.6%). Only 10.4% of sleep apps have an efficacy study. Conclusions: Sleep apps in the marketplace are primarily used to help the user fall and stay asleep. In its current state, sleep apps can assist only the user as a self-help tool. The lack of sleep tracking, support, exportability, the inability to collaborate with one's provider and efficacy studies limit the potential of implementing sleep apps for clinical use.
ABSTRACT
Objective: We aimed to assess the characteristics of the pain application (app) marketplace and determine improvements to mobile health (m Health) that could assist patients with pain disorders in obtaining more accessible care. Background: During the COVID-19 pandemic, complementary and integrative therapies delivered via mHealth technologies have become more popular due to their accessibility. As more users are downloading apps to address health concerns, it is important to analyze the ever growing marketplace's features and limitations. Design/Methods: After searching the iOS and Google Play Stores for commercially available pain apps that met pre-specified search criteria, trained app raters entered 47 apps into the Mobile-Health Index and Navigation Database (MIND) published by the Division of Digital Psychiatry at BIDMC. Through a 105-question objective rating framework, each app was evaluated for its accessibility, privacy, cost, functionalities, features, and clinical foundations. The data was compared with a control group of non-pain apps-matched for platform and cost -to examine the traits of pain apps in contrast with the rest of the marketplace. Results: The top features were 44.7% (21/47) offered symptom tracking, 34.0% (16/47) offered medication tracking, and 42.6% (20/47) offered physical health exercises. Just 2.13% (1/47) of apps offered HIPAA privacy protections or had a crisis management feature. Additionally, only 10.64% (5/47) of pain apps were supported by efficacy studies. Conclusions: Commercially available pain apps are typically used to record pain episodes or document medications. However, the lack of privacy, crisis management, and efficacy studies may be preventing their clinical implementation.
ABSTRACT
Objective: To assess the practice of telehealth for headache visits in the US. Background: The rapid roll-out of telehealth during the COVID-19 pandemic impacted headache specialists. Design/Methods: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. Results: 225 of 1348 (16.7%) AHS members responded. Most were female (59.8%;113/189). Mean age was 47.4±11.8 (N=154). The vast majority were MD/DOs (83.2%;158/190) and NP/PAs (14.7%;28/190), and most (65.1%;123/189) were in academia. Years in practice were: 0-3: 28;4-10: 58;11-20: 42;20+: 61. Mean number of telehealth visits was 199.4 ± 214.8 in prior 3 months. Respondents were "comfortable" or "very comfortable" treating via telehealth a (a) new patient with a chief complaint of headache (137/185);(b) follow-up for migraine (184/186);(c) follow-up for secondary headache (116/182). About half (51.1%;97/190) offer urgent telehealth. Beyond being unable to perform in-person procedures, top barriers cited were conducting parts of the neurologic exam (157/189), absence of vital signs (116/189), and socioeconomic/technologic barriers (88/189). The top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby(103/190). Only 20% (31/155) of providers said that telehealth visit length differed compared to in person visits and 55.3% (105/190) believe the no-show rate improved. Providers were "interested"/"very interested" (128/188) in digitally prescribing headache apps and "interested"/"very interested" (121/189) in the remote monitoring of patient symptoms. Conclusions: Respondents were comfortable treating migraine patients via telehealth They note positive attributes for patients and how access to care may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest for headache specialists and warrant future research.
ABSTRACT
Objective: To assess the clinical course and outcomes of COVID-19 in patients with pre-existing neurologic disorders and the impact of COVID-19 on neurologic disorder during and after COVID-19. Background: In March of 2020, as COVID-19 increased in the United States, several risk factors for severe COVID-19 emerged, including age, hypertension, diabetes, and immunocompromised state. Neurologic disorders were not among these risk factors, and no information existed on the course and outcomes of COVID-19 in patients with various neurologic disorders. Design/Methods: After receiving IRB approval, a structured questionnaire was distributed via various media platforms between April-October 2020 to the US neurologists and neurology trainees with questions pertaining to their patients with pre-existing neurologic disorders who had COVID-19 infection confirmed either by SARS-Co-V2 PCR or IgG test. Results: Over a 6-month period, 66 patients, (age range 1-94, mean 49.2 years, 39 females, 27 males) were submitted, with most frequent neurologic disorders being chronic migraine (23%), epilepsy (12%) and multiple sclerosis (MS) (11%). Of these, 58% had a mild-to-moderate course of COVID-19 requiring no hospitalization, 41% required hospitalization or intensive care unit admission, and 5 patients died (2 were in their 90s with a history of stroke, 2 in their 60s with malignancy, and one 31-year-old male with MS.) COVID-19 resulted in exacerbation of the underlying neurologic disorder during or after COVID-19 in 57% of patients. Common persistent symptoms after COVID-19 included fatigue, exercise intolerance and headache. Conclusions: In this cohort, majority of patients with pre-existing neurologic disorders had a mild-to-moderate course of COVID-19 requiring no hospitalization, but many experienced exacerbation of their pre-existing neurologic disorder during or after COVID-19 and had persistent symptoms of fatigue, exercise intolerance and headache. Large prospective studies are needed to determine which neurologic disorders present a significant risk in order to protect the most vulnerable patient population.