Pearls of wisdom from the past 5 years of working in telehealth

Over the past several years the perception of telehealth – and its role in healthcare delivery – has changed dramatically. Previously limited to just a few use cases including low-acuity virtual urgent care and chronic outpatient disease management, telehealth now plays some role in virtually every medical specialty and has seen considerable growth in technologies beyond the simple video visit. In this chapter, we highlight the forces that have driven telehealth's rapid growth and adoption. First, we discuss the evolution of the telehealth landscape in the years leading up to the COVID‐19 pandemic, including increasing consumer demand for virtual services, the emergence of new payment models that promote telehealth use, advancements in technical capabilities, and new structures that enabled reimbursement of digital health activities. Then we cover advancements in telehealth directly related to the pandemic and important considerations for continued growth including provider workflow integration, accessibility and equity, and clarity around reimbursement. Finally, we discuss technological innovations and new modes of care delivery – such as digital therapeutics and virtual-first health plans – that are likely to enhance the sophistication and expand the role of telehealth services over the coming years. © 2023 Elsevier Inc. All rights reserved.

Evaluation of Clinical Symptoms Improvement by Cognitive Behavioral Therapy Using a Smartphone Application in Patients with Temporomandibular Disorder.

Since the start of the 2019 coronavirus pandemic, interest in digital therapeutics (DTx) has increased. Temporomandibular disorder (TMD) fundamentally requires cognitive behavioral therapy (CBT), including physical self-regulation. An application that records TMD pain and parafunctional activities for CBT has recently been developed. However, evidence of the reduction of clinical symptoms in patients via repetitive software-driven CBT is lacking. The purpose of the present study was to evaluate the impact of applications that support CBT regarding the performance of CBT and the improvement of clinical symptoms in temporomandibular joint patients. From 20 October 2020 to 7 January 2021, we randomly assigned 41 participants diagnosed with TMD to control (conventional treatment) and experimental (conventional treatment + application use) groups. We randomly assigned 41 participants diagnosed with TMD to control (conventional treatment) and experimental (conventional treatment + application use) groups. Improvements regarding the number of tender points, mouth opening, visual analog scale score, pain level upon palpation, joint sound, and stress were compared between the two groups. Compared with the control group, the experimental group showed significant improvements in the number of tender points and degree of mouth opening. They also showed improvements in pain level, joint sound, and locking, although not statistically significantly, as compared with the control group. Thus, further studies with a greater sample size need to be conducted to confirm the findings. Nevertheless, our results showed that repetitive cognitive behavioral therapy using a smartphone application can be used as digital therapeutics for temporomandibular disorder patients.

The mechanism of reducing anxiety through mindfulness interventions: Digital therapeutic program

The COVID-19 pandemic exacerbated the prevalence of anxiety disorders, making it a population health concern in the United States and worldwide. The growing need for effective prevention and treatment of anxiety coincides with a deficit of mental health providers and physicians. With the healthcare system currently overwhelmed and the slow training pipeline of new providers, the gap between patient demand and treatment providers will not be closed in the next decade. There is a growing need for evidence-based treatments for anxiety disorders that can increase access to care while addressing the underlying mechanisms of anxiety. Digital therapeutics is a fast-developing field that can be one such solutions provided in ?one-to-many? format. It can be used in conjunction with individual therapy, as well as independently, depending on the severity of patients? symptoms. This quantitative dissertation study aimed to investigate the mechanism of reducing anxiety in the digital application (app) Unwinding Anxiety Program and its impact on emotion regulation, self-representation (self-esteem), and the degree of attachment security in adults. The study used a single-case experimental design to assess the effect size of the intervention in these domains. Five study participants completed the program. The results of the study demonstrated the efficacy of the intervention for reducing anxiety among participants with medium to large effect size and decrease of attachment-related anxiety for all participants with small effect size. All study participants demonstrated improved emotion regulation with moderate effect size for the sample. Self-esteem scores improved for some participants, while decreased for others. These findings support the existing evidence for the efficacy of mindfulness-based interventions for anxiety demonstrating the key role of emotion regulation in the mechanism of change. This study brings the novelty of examining the impact of digital therapeutic intervention on attachment security. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

User experience research in the development of digital health products: Research letter

Background Digital health solutions are facing an increasing impact on healthcare. The current scientific focus is mainly set on clinical studies providing efficacy for different indications. In contrast to pharmaceutical therapy, user experience plays a major role in digital health. However, fundamental scientific knowledge about patient engagement, adoption and qualitative user experience of digital health solutions is missing. Objective To perform user experience design research for the development of a disease management platform for fibromyalgia-like post-COVID19 syndrome. To discuss relevant user experience and its current status in digital health products development. Methods A literature review on PubMed and interviews with digital health stakeholders were performed. German registered digital health applications (DiGAs) for musculoskeletal indications were reviewed in terms of front-end design and navigation. An online user experience design survey about Patient Reported Outcomes (PROs) collection was sent to patients from a Swiss post-COVID19 patient association. Results The literature documenting patient experience aspects in digital health is poor despite all stakeholders agreed on its importance, potentially also influencing efficacy of the therapies. Currently available DiGAs have a heterogeneous front-end design without clear user interface design or navigation strategy, respectively. Patient online surveys have shown to be easily feasible and effective tools for qualitative user experience research. Basic user experience research provided helpful guidelines for choices in design features for the purpose of the development of a digital health product. Conclusions User experience research as a tool in the patient-centric development of a digital health product provides valuable data. This data has the potential to help increase adoption and efficacy of the product. Further research studies are needed to clarify the role of user experience in digital therapies.

Digital health technologies and major depressive disorder.

There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.

The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study.

BACKGROUND: This study explored whether participants with substance use disorder (SUD) would adopt and use a smart-phone app with a cognitive behavioral therapy program, weekly Brief Addiction Monitor (BAM) assessments, daily check-ins, tools to track sobriety and treatment, and other patient-centered resources. In addition, participants with SUD could access a social worker and peer support specialists. METHODS: The study sought participants from two groups: those referred by a justice-related agency and participants who responded to outreach from the Addiction Policy Forum (APF). The Connections smart-phone app was offered to both groups. The study examined use of the app and social worker/peer recovery support services by participants who downloaded and used the app; those referred by a justice-related agency and those who self-referred through APF. The app provided primary data, including socio-demographics, referral status, dates of use, activities completed, and BAM scores. RESULTS: The app was offered to 1973 participants, 40% of whom downloaded it. Three groups emerged from among the 350 who used the app: those who used only the cognitive behavioral aspects of the app, those who used only the recovery support services offered, and those who used both the app and recovery support services. Looking at the two referral groups, the justice-referred group preferred telehealth recovery support services with the social worker; the self-referred group used the app and the app plus the recovery support services equally. Scores on the BAM improved across time. Justice-referred participants' protective behaviors improved more than those of the self-referred participants while self-referred participants' risk behaviors improved more than those of justice-referred participants. Older participants were more likely to use the app, and to report fewer risky behaviors, as measured by the BAM. CONCLUSIONS: Use of a digital therapeutic appears to support recovery of participants with SUD although many clients need and want the integration of social worker-driven recovery support services. Basically, the app can be an extension to personal services, but many people with SUD (particularly during COVID-19) crave human interaction. It also appears that those who seek assistance on their own, rather than being referred by a justice-related agency, may be more likely to benefit from digital therapeutics such as the Connections app.

Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran.

BACKGROUND: The COVID-19 pandemic. In this framework, digital self-help interventions have the potential to provide flexible and scalable solutions for delivering evidence-based treatments that do not necessitate face-to-face meetings. OBJECTIVE: as part of a multicentric project, the purpose of the current randomized controlled trial was to evaluate the efficacy of a Virtual-Reality-based self-help intervention (namely, COVID Feel Good) in lowering the psychological distress experienced during the COVID-19 pandemic in Iran. METHODS: 60 participants were randomly assigned to the experimental (COVID Feel Good intervention group) or the control (no-treatment control group) condition. At the beginning of the intervention (Day 0), at the end of the intervention (Day 7), and after a 2-week follow-up (Day 21), measurements of depressive and anxiety levels, general distress, perceived levels of stress, hopelessness (primary outcome measures), perceived interpersonal closeness with the social world, and fear of COVID-19 (secondary outcome measure) were collected. The protocol consists of two integrated parts: the first part includes a relaxing 10-min three-hundred-sixty-degree (360°) video, while the second one includes social tasks with specified objectives. RESULTS: In terms of the primary outcomes, participants in the COVID Feel Good intervention group improved in depression, stress, anxiety, and perceived stress but not hopelessness. Secondary outcome results showed an improvement in perceived social connectedness and a substantial decrease in fear of COVID-19. CONCLUSIONS: these findings on the efficacy of COVID Feel Good training add to the growing body of evidence demonstrating the feasibility of digital self-help interventions in promoting well-being during this unique period.

Patient Engagement With a Game-Based Digital Therapeutic for the Treatment of Opioid Use Disorder: Protocol for a Randomized Controlled Open-Label, Decentralized Trial.

BACKGROUND: Prescription digital therapeutics are software-based disease treatments that are regulated by the US Food and Drug Administration; the reSET-O prescription digital therapeutic was authorized in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder. Although reSET-O improves outcomes for individuals with opioid use disorder, most of the therapeutic content is delivered as narrative text. PEAR-008 is an investigational device based on reSET-O that uses an interactive, game-based platform to deliver similar therapeutic content designed to enhance patient engagement, which may further improve treatment outcomes. OBJECTIVE: We aim to investigate how participants interact with the prescription digital therapeutic's new content delivery format. Secondary objectives include evaluating treatment success, symptoms of co-occurring mental health disorders, recovery capital, and skill development. METHODS: Due to the COVID-19 pandemic, this study was redesigned using a decentralized model because it was not possible to conduct medication initiation and study visits in person, as initially intended. A decentralized, randomized controlled trial design will be utilized to compare patient engagement with PEAR-008 and that with reSET-O using both subjective and objective assessments. The study population will consist of approximately 130 individuals with opioid use disorder (based on Diagnostic and Statistical Manual of Mental Disorders 5 criteria) who have recently started buprenorphine treatment for opioid use disorder. Participants will be virtually recruited and randomly assigned to receive either PEAR-008 or reSET-O. All study sessions will be virtual, and the duration of the study is 12 weeks. The primary outcome measure of engagement is operationalized as the number of active sessions per week with either PEAR-008 or reSET-O. (An active session is any session that contains some active participation in the app, such as navigating to a different screen, engaging with a learning module, or responding to a notification.) Subjective dimensions of engagement will be assessed with participant surveys. The hypothesis is that PEAR-008 will have significantly greater participant engagement than reSET-O. RESULTS: As of February 2021, participant enrollment is ongoing. CONCLUSIONS: This randomized controlled trial will investigate if changing the delivery format and enhancing the content of a prescription digital therapeutic for opioid use disorder will affect how participants use and interact with the prescription digital therapeutic. The study design may serve as a useful model for conducting decentralized studies in this patient population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04542642; https://clinicaltrials.gov/ct2/show/NCT04542642. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32759.

Exploring new digital therapeutics technologies for psychiatric disorders using BERTopic and PatentSBERTa

Coronavirus disease 2019 (COVID-19) has accelerated the growth of the digital therapeutics (DTx) market;therefore, development strategies for new DTx products are necessary to satisfy market needs. However, data-driven methods for recommending digital healthcare technologies for novel DTx applications are scarce. We propose a technology opportunity discovery framework that recommends 1) potential technologies as new DTx products, and 2) the applicable target disorders. We applied BERTopic and PatentSBERTa to patents filed with the United States Patent and Trademark Office and calculated the score of potential technologies on the basis of their thematic characteristics with respect to their digital capabilities and similarity to DTx technologies. By identifying the target disorder of similar technologies, specific disorders were proposed that can be treated with the proposed technique. By applying the proposed framework to psychiatric disorders—one of the largest therapeutic areas of DTx, we recommend digital monitoring technologies applicable to poor breathing or sleeping patterns for cognitive impairment. Furthermore, we provide strategies to utilize the recommended digital technologies for DTx for specific disorders to facilitate a direct intervention or treatment, which can contribute to the planning of roadmaps for DTx. © 2022 Elsevier Inc.

Digital Therapeutics in Migraine Management: A Novel Treatment Option in the COVID-19 Era.

Migraine is a chronic and often lifelong disease that directly affects over one billion people globally. Because access to migraine medical services is limited, only a minority of migraine patients are treated adequately. This situation worsened during the COVID-19 pandemic. Digital therapeutics (DTx) is an emerging therapeutic approach that opens up many new possibilities for remote migraine management. For instance, migraine management tools, online migraine diagnosis, guideline-based treatment options, digitally networked patients, and collecting anonymized information about migraine attacks and course parameters for scientific evaluation. Various applications of DTx in migraine management have been studied in recent years, such as the usefulness of digital migraine self-management tools in diagnosing and tracking migraine attacks, and the efficacy and safety of digital cognitive behavioural therapy. However, the development of DTx is still in its infancy and still faces many obstacles. The primary goal of this study is to review the latest research on DTx in migraine management, identify challenges, and outline future trends.

Personalized Computerized Training for Cognitive Dysfunction after COVID-19: A Before-and-After Feasibility Pilot Study.

The current pilot study was set to evaluate the feasibility and potential benefit of a personalized computerized cognitive training (CCT) intervention to improve cognitive function among people living with post-acute sequelae of COVID-19 (PASC). Seventy three adults who self-reported cognitive dysfunction more than 3 months after a diagnosis of COVID-19 took part in an 8-week training study. Participants' general cognitive function was assessed before they completed as many cognitive daily training sessions as they wished during an 8-week period, using a personalized CCT application at home. At the end of this period, participants repeated the general cognitive function assessment. The differences between the scores at 8 weeks and baseline in five cognitive domains (attention, memory, coordination, perception, reasoning), complemented with analyses of the changes based on the participants' age, training time, self-reported health level at baseline and time since the initial COVID-19 infection. Participants had significant cognitive dysfunction and self-reported negative health levels at baseline. Most of the participants obtained higher scores after CCT in each of the domains as compared with baseline. The magnitude of this score increase was high across domains. It is concluded that a self-administered CCT based on gamified cognitive tasks could be an effective way to ameliorate cognitive dysfunction in persons with PASC. The ClinicalTrials.gov identifier is NCT05571852.

Editorial: Control alt delete - technology and children's mental health.

With international contributions from Denmark, Peru, Italy, Turkey, Estonia, Russia, Canada, the USA, Australia and the UK, this special issue offers insights and evidence about the technology's ability to act as a force of good and a source of harm for young people's mental health. As we better understand the complex and bidirectional relationship between technology and mental health, we need to move beyond dichotomous narratives about it being good or bad; it is both, depending on how it is used. Collective responsibility across technology companies, researchers, public services and community organisations, parents and the young people themselves can make a difference in the way technology is used to protect and improve mental health.

Mental Health Problems During COVID-19 and Attitudes Toward Digital Therapeutics.

OBJECTIVE: We aimed to elucidate public mental health problems and associated factors during the coronavirus disease-2019 (COVID-19). Furthermore, we evaluated people's attitudes toward digital therapeutics during the pandemic. METHODS: Data was collected online from participants, aged between 20-50 without any history of mental illness, from June 1st to June 30th 2021. The survey consisted of questions regarding demographics, changes during pandemic and attitude towards digital therapeutics, and mental health measures. RESULTS: Among the total of 445 participants, 49.2% reported significant level of stress and 13.5% and 7.0% met the screening criteria for major depressive disorder and generalized anxiety disorder, respectively. Significant predictive factors for mental health problems were-younger age group, female sex, currently being treated for medical or surgical disease, change in the amount of time spent on mobile device or computer after pandemic, change in household income, and change in work environment due to pandemic. Furthermore, 35.1% of participants, considered psychiatric consultation, at least slightly, but were hesitant to receive it due to the fear of contacting COVID-19 at the clinics. Instead, 54.4% of them preferred using digital therapeutics as an alternative to visiting offline clinics. CONCLUSION: We demonstrated that COVID-19 increased mental health problems along with access problems and identified their predictive factors. Digital therapeutics emerged as a viable solution to mental health problems and it was well-received by those in need of psychiatric consultation. Therefore, development and implementation of digital therapeutics should be considered to improve the mental health of people.

New way of Providing Care: the Role of Telemental Health

Telemental health care can be defined as the delivery of mental health care services at distance, by using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of mental illnesses, as well as for research and education in the field of clinical psychiatry. While telemental health care practice was long established in many countries, its development proceeded with some variability worldwide. Over the past months, however, the recent COVID-19 pandemic has abruptly spread telemental health care practice worldwide, mostly to ensure the provision of care and assistance to psychiatric patients in spite of the governmental social contact restrictions. Although the process of rapid implementation has often happened at different rates and with different quality standards, across the various countries and sites, a global increase of the use of digital technologies has been reported. On the other hand, such recent events have also sparked a real paradigm shift in mental health care, significantly expanding the scope of e-mental health, given the recent availability of newer tools of digital psychiatry. In more detail, the use of mobile phones applications, of social media, of immersive reality and of chatbots is now driving psychiatry towards envisioning a more hybrid form of psychiatric practice, which holds the potential to finally overcome the traditional gap between the unmet needs of psychiatric patients and the relative lack of services and resources in mental health care. Here, the research evidence and the most compelling implementation issues in digital psychiatry will be reviewed.

Designing Spellcasters from Clinician Perspectives: A Customizable Gesture-Based Immersive Virtual Reality Game for Stroke Rehabilitation

Developing games is time-consuming and costly. Overly clinical therapy games run the risk of being boring, which defeats the purpose of using games to motivate healing in the first place [10, 23]. In this work, we adapt and repurpose an existing immersive virtual reality (iVR) game, Spellcasters, originally designed purely for entertainment for use as a stroke rehabilitation game-which is particularly relevant in the wake of COVID-19, where telehealth solutions are increasingly needed [4]. In preparation for participatory design sessions with stroke survivors, we collaborate with 14 medical professionals to ensure Spellcasters is safe and therapeutically valid for clinical adoption. We present our novel VR sandbox implementation that allows medical professionals to customize appropriate gestures and interactions for each patient's unique needs. Additionally, we share a co-designed companion app prototype based on clinicians' preferred data reporting mechanisms for telehealth. We discuss insights about adapting and repurposing entertainment games as serious games for health, features that clinicians value, and the potential broader impacts of applications like Spellcasters for stroke management.

Clinical Utility of a Digital Therapeutic Intervention in Indian Patients With Type 2 Diabetes Mellitus: 12-Week Prospective Single-Arm Intervention Study.

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) having elevated levels of blood glucose and glycated hemoglobin (HbA1c) are at higher risk of macro- and microvascular complications. Nonetheless, the goal of achieving glycemic control cannot be met with the use of pharmacotherapy alone. The recent emergence of digital therapeutic tools has shown the possibility of improving the modifiable risk factors and self-management of diabetes. OBJECTIVE: The aim of this study was to examine the clinical utility of a digital therapeutic intervention as an add-on therapy to achieve glycemic control in patients with T2DM. METHODS: This was a 12-week prospective, single-arm digital intervention study in patients with T2DM receiving regular antidiabetic treatment. The eligibility criteria included male and female patients with HbA1c≥6.5%, functional English literacy, and a mobile phone capable of running the intervention app. Outcome measures of the study were mean changes in HbA1c, fasting blood glucose (FBG), postprandial blood glucose (PPBG), BMI, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index at the end of 12 weeks. RESULTS: A total of 128 participants completed the study period of 12 weeks. There were 54.7% (70/128) men and 45.3% (58/128) women with a mean age of 48.48 years (SD 10.27). At the end of 12 weeks, the mean change in HbA1c, FBG, PPBG, and BMI for the overall study population was -0.84% (P<.001), -8.39 mg/dl (P=.02), -14.97 mg/dl (P<.001), and -0.24 kg/m2 (P=.06), respectively. Among the participants showing improvement in the HbA1c value at the end of 12 weeks (responders), the mean change in HbA1c, FBG, PPBG, and BMI was -1.24% (P<.001), -12.42 mg/dl (P=.003), -21.45 mg/dl (P<.001), and -0.34 kg/m2 (P=.007), respectively. There was an increase in HOMA-IR values for the overall study population (0.54, P=.29). HbA1c response showed a significant association with a baseline HbA1c level ≥7.5%, no prior history of smoking, and no prior COVID-19 infection, as well as with higher levels of program engagement. CONCLUSIONS: A digital therapeutic intervention when used alongside standard medications significantly reduces HbA1c, FBG, and PPBG levels in patients with T2DM.

The Value of Technology to Support Dyadic Caregiving for Individuals Living With Heart Failure: Qualitative Descriptive Study.

BACKGROUND: The demand for health services to meet the chronic health needs of the aging population is significant and remains unmet because of the limited supply of clinical resources. Specifically, in managing heart failure (HF), digital health sought to address this gap during the COVID-19 pandemic but highlighted an access issue for those who could not use technology-mediated health care services without the support of their informal caregivers (ICs). The complexity of managing HF symptoms and recurrent exacerbations requires many patients to comanage their illness with their ICs in a care dyad, working together to optimize patient outcomes and health-related quality of life. However, most HF programs have missed the opportunity to consider the dyadic perspective despite interdependencies on HF outcomes. OBJECTIVE: This study aims to characterize the value of technology in supporting caregiving for individuals living with HF. METHODS: Motivated by an observed unique pattern of engagement in patients enrolled in our Medly HF management program at the Peter Munk Cardiac Centre in Toronto, Canada, we conducted 20 semistructured interviews with a convenience sample of ICs. All interviews were analyzed using the iterative refinement of a codeveloped codebook. The team maintained reflexivity journals to reflect the impact of their positionality on their coding. Themes were first derived deductively using HF typologies (patient-oriented dyads, caregiver-oriented dyads, and collaboratively oriented dyads) and then inductively refined and recategorized based on concepts from the van Houtven et al framework. RESULTS: We believe that there is a need to formally and intentionally expand HF technologies to include dyadic needs and goals. We suggest defining 3 opportunities in which value can be added to technological design. First, identify how technology may be leveraged to increase psychological bandwidth by reducing uncertainty and providing peace of mind. We found that actionable feedback was highly desired by both partners. Second, develop technology that can serve as a member of the dyad's support system. In our experience, automated prompts for patients to take measurements can mimic the support typically provided by ICs and ease their workload. Third, consider how technology can mitigate the dyad's clinical knowledge requirements and learning curve. Our approach includes real-time actionable feedback paired with a human-in-the-loop, nurse-led model of care. CONCLUSIONS: Our findings identified a need to focus on improving the dyadic experience as a whole by building IC functionality into digital health self-management interventions. Through a shared model of care that supports the role of the patient in their own HF management, includes ICs to expand and enhance the patient's capacity to care, and acknowledges the need of ICs to care for themselves, we anticipate improved outcomes for both partners.

Efficacy and safety of digital therapeutics-based cardiac rehabilitation in heart failure patients: a systematic review.

During the coronavirus disease 2019 (COVID-19) pandemic, it has become difficult to provide centre-based cardiac rehabilitation for heart failure patients. Digital therapeutics is a novel concept proposed in recent years that refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. However, little is known about the use of this technology in heart failure patients. This study aims to explore the safety and efficacy of digital therapeutics-based cardiac rehabilitation in heart failure patients and to provide new insights into a new cardiac rehabilitation model during the COVID-19 era. To identify technologies related to digital therapeutics, such as the use of medical applications, wearable devices, and the Internet, all relevant studies published on PubMed, EMBASE, Cochrane database, and China National Knowledge Internet were searched from the time the database was established until October 2021. The PEDro was used to assess the quality of included studies. We ultimately identified five studies, which included 1119 patients. The mean age was 66.37, the mean BMI was 25.9, and the NYHA classification ranged from I to III (I = 232, II = 157, III = 209). The mean 6-min walk distance was 397.7 m. The PEDro scores included in the study ranged from 4 to 8, with a mean of 5.8. Exercise training was performed in four studies, and psychological interventions were conducted in three studies. No death or serious adverse events were observed. Adherence was reported in three studies, and all exceeded 85%. The results of most studies showed that digital therapeutics-based cardiac rehabilitation significantly increases exercise capacity and quality of life in heart failure patients. Overall, although this study suggests that digital therapeutics-based cardiac rehabilitation may be a viable intervention for heart failure patients during the COVID-19 era, the efficacy of this new model in routine clinical practice needs to be further validated in a large clinical trial.

Measuring Health-Related Quality of Life With Multimodal Data: Viewpoint.

The ability to objectively measure aspects of performance and behavior is a fundamental pillar of digital health, enabling digital wellness products, decentralized trial concepts, evidence generation, digital therapeutics, and more. Emerging multimodal technologies capable of measuring several modalities simultaneously and efforts to integrate inputs across several sources are further expanding the limits of what digital measures can assess. Experts from the field of digital health were convened as part of a multi-stakeholder workshop to examine the progress of multimodal digital measures in two key areas: detection of disease and the measurement of meaningful aspects of health relevant to the quality of life. Here we present a meeting report, summarizing key discussion points, relevant literature, and finally a vision for the immediate future, including how multimodal measures can provide value to stakeholders across drug development and care delivery, as well as three key areas where headway will need to be made if we are to continue to build on the encouraging progress so far: collaboration and data sharing, removal of barriers to data integration, and alignment around robust modular evaluation of new measurement capabilities.

How Virtual Reality Influenced EmotionalWell-being Worldwide During the Covid-19 Pandemics

Use in the Virtual Reality (VR) world has spiked with the outbreak of domestic lockdowns and social distancing measures for the covid-19 pandemics and the simultaneous market launch of the Oculus Quest 2 standalone VR device. TRIPP is a VR app in the VR world as a wellness platform based on scientific research, e.g., Artificial Intelligence (AI), binaural beats, differential color tuning, VR-based relaxation, and mindfulness. This paper analyses the dynamic of emotional and mood transitions of a large set of TRIPP users exposed to VR devices' emotional experiences from the end of 2019 (i.e., when the pandemic started) to April 2021, when our study has begun. A clear and well-documented data analysis is presented, focusing on emotional well-being. In particular, this study presents a data breakdown of users' accesses and analyzed the impact on emotional well-being based on the feedback given within the app, access time, and users' anagraphical distributions. The systematic experimental analysis of anonymized data found the studied AI and VR wellness techniques to be indicators and positive modifiers of users' mental and emotional states during the most impactful global crisis of the millennium. © 2021 ACM.