JMIR Publications

ABSTRACT

Background:

Studies have shown the effectiveness and user acceptance of mobile health (mHealth) technologies in managing chronic kidney disease (CKD) patients. However, incorporating mHealth technology into the standard care of CKD patients still faces many challenges, including comprehensive evaluations of mHealth intervention that could motivate a wider adoption of the technology. There is no review on mHealth inventions and their assessment specific for the dialysis patient management.

Objective:

This study provided a scoping review on existing applications and interventions of mHealth technologies in adult chronic dialysis patients and identified the gaps in the outcome evaluation of mHealth technologies in the literature.

Methods:

The five-stage methodological framework for scoping reviews, as outlined by Arksey & O’Malley (2005), was used to systematically search MEDLINE/PubMed, Scopus and CINAHL databases, as well as grey literature sources. Two keywords, “mHealth” and “dialysis” were combined to address the main concepts of the objectives. Inclusion criteria were: 1) mHealth interventions, which are on a smartphone, mobile device, tablet or web-based portals that are accessible through mobile devices; and 2) adult patients (age ≥ 18 years) on chronic dialysis. Only English articles published from January 2008 to October 2018 were included. Studies with mHealth applications for other chronic conditions, e-consultation or videoconferencing, non-English, or review articles were excluded.

Results:

Of the 1054 articles identified, 22 met the inclusion/exclusion criteria. Most studies (n = 20) were randomized controlled trials and cohort studies. These studies were carried out in 7 countries. The main purposes of these mHealth interventions are: nutrition/dietary self-monitoring (n = 7), remote biometric monitoring (RBM) (n = 7), online portal (n = 4), self-monitoring of in-session dialysis-specific information (n = 3), and self-monitoring of lifestyle/behavioral change (n = 1). The outcomes of the 22 included studies were organized into five categories: i) patient satisfaction and acceptance, ii) clinical effectiveness, iii) economic assessment, iv) health-related quality of life (HRQoL), and v) impact on lifestyle/behavioral change. The mHealth interventions showed neutral to positive results in chronic dialysis patient management, reporting non- to significant improvement of dialysis-specific measurements and some components of the overall QoL assessment. Evaluation of these mHealth interventions consistently demonstrated evidence in patients’ satisfaction, high level of user acceptance, as well as reduced use of health resources and cost savings to health care services throughout intervention periods. However, there is a lack of evaluation on safety, organizational, socio-cultural, ethical, and legal aspects of mHealth technologies. Furthermore, a comprehensive cost-effectiveness and cost-benefit analysis of adopting mHealth technologies were not found in the literature.

Conclusions:

mHealth technologies have been used for chronic dialysis patient management. The gaps identified in this study will inform the creation of health policies and organizational support for mHealth implementation in dialysis patients. The findings of this review would lay the foundation of a co-design process in intervention studies. They will inform the development of a comprehensive service model that utilizes mHealth technologies for home monitoring and self-management of chronic dialysis patients.