JMIR Publications

ABSTRACT

Background:

Travel to health centers associated to chronic wounds are burdensome to patients. Remote assessment and management of wounds using mobile and telehealth strategies have been demonstrated to reduce this burden and improve patient outcome. Capturing wound images is an essential step of wound documentation, but the quality of the images can have a large influence on the reliability of the assessment. To date, no study investigated the quality of remotely acquired wound images and whether these are suitable for wound self-management and telemedical interpretation of wound status.

Objective:

Our goal was to develop and validate an mHealth tool for the remote self-assessment of digital ulcers (DUs) in patients with Systemic Sclerosis (SSc). Our specific aims were to 1) define objective measures for assessing the image quality, 2) evaluate whether an automated feedback feature that evaluates wound image quality in real-time improves the quality of the wound images, and 3) evaluate the feasibility of deploying the mHealth tool for home-based monitoring of chronic wounds and wound self-management in patients with SSc.

Methods:

We developed an mHealth tool that was composed of a wound imaging and management app, a custom color reference sticker, and a smartphone holder. We randomly assigned patients with SSc and DUs to two device groups (feedback and basic) to self-document images without supervision at home. We introduced objective image quality parameters, i.e.the color checker detection ratio (CCDR) and color checker sharpness (CCS), that evaluated the quality in region of interest of the color reference sticker. We evaluated the feasibility of the mHealth tool by analyzing the usability feedback from questionnaires, user behavior throughout the study, and the overall obtained quality of the wound images.

Results:

A total of 21 patients were enrolled, of which 15 patients were included in the image quality analysis. The average CCDR was 0.96 (191/199) in the feedback group and 0.86 (158/183) in the basic group. The feedback group showed significantly higher CCS compared to the basic group (P < .001). The results from the usability questionnaire showed that the majority of patients were satisfied with the tool, but could benefit from disease specific adaptations. The median duration of an assessment was below 50 s in all patients, indicating that the mHealth tool was efficient to use and could be integrated into the daily routine of patients.

Conclusions:

We have developed an mHealth tool that enables SSc patients to acquire good quality DU imagesand demonstrated that it is feasible to deploy such an app in this patient group. The introduced feedback mechanism improved the overall image quality compared to a solution without feedback. The system had a positive rating from patients, and the study indicated room for improvement to address disease specific needs. The introduced technical solutions consist of a further step towards reliable and trustworthy digital health for home-based self-management of wounds.