Inflammatory bowel disease (IBD), as the name implies, comprises diseases which are associated with inflammation of the gastrointestinal tract, such as Ulcerative colitis and Crohn’s disease. As of the present date, the cause of these diseases are unclear, and treatment success is limited. However, mobile health apps (mHealth) seem to show some promising results in outcomes such as patient engagement, and the results with IBD mHealth apps seem to be just as promising. So, where do we stand with the benefits, concerns, and future directions?
But first, a little more on IBD…
These diseases, which affects approximately 7%- 21% of the population, are often characterized by active and remitting periods of abdominal cramps, diarrhea, and fever, although the symptoms are often heterogeneous (i.e., there is no ‘typical’ combination of symptoms, making it hard to identify or treat). Although the cause is unclear, there are key players that influence IBD symptoms, namely intestinal gut bacteria, the immune system, and the layer of cells in the gastrointestinal tract (‘epithelial barrier’). Once again, the usual culprits, genetics, and environmental factors such as diet, stress, and sleep, seem to influence the course of the disease, making management of these and other lifestyle factors a good idea.
As of today, there seems to be about 60 apps related to IBD available for iOS and Android, with features that allows the users to track symptoms, diet, weight, physical activity, medication, health record data, and other information. However, currently, these apps are designed as an end-user product, and do not allow for communication of healthcare provider advice. Therefore, the expert advice benefit of the app is limited.
The research on the disease impact of mHealth applications is still in its infancy, but there seems to be a lot of promise with IBD related mHealth apps. Overall, these apps seem to show improvements in patient treatment adherence, personalization of treatment, quality of life, and other health outcomes. For example, one of the first randomized controlled trials (these are close to the top in the hierarchy of scientific evidence) on mHealth and IBD, the healthPROMISE App, found that patients who used the app had better quality of life and quality of care than patients who did not use a health related app.
These benefits are a great start, but a couple of limitations should be mentioned. Perhaps one of the biggest questions people are asking revolves around privacy and security of patient information, however, there are groups that are currently developing collaborative industry guidelines for data security. Other areas of improvement include more involvement with healthcare professionals in the development of these apps, so as to help with the validity and accuracy of the information they are collecting.
Oh, the possibilities…
The data derived from these apps will be a major leap forward in the search for a cure. These electronic platforms are able to generate massive amounts of data, which can contribute to a fairly new form of data analysis… Big Data from thousands of IBD patients. As the name implies, these are just large data sets, but allow for more complex statistical models, and it is promising new tool for the development of predictive models and precision medicine in IBD treatments.
The app form of these health tracking programs also seem to offer additional benefits above and beyond ‘traditional’ eHealth websites, as people are spending more and more time on their phones, and there is evidence suggesting that push notifications can promote regular use. Engaging with the app and recording their symptoms also seems to provide the patient with a sense of control over the disease, or a sense of empowerment, which often leads to better quality of life.
Moving forward…
Perhaps the next biggest step is adding the genetic component… there is data indicating that some gene variants are predictive of risk for IBD, and not to mention the potential for gene-environment interactions, but again (and not to sound cliché), more research needs to be done.
Getting the word out…
It seems that social media platforms such as Facebook might be a good way for mHealth companies trying to get their apps to hit critical mass, as there is evidence indicating that more than 50% of patients are interested in seeking help and information via IBD Facebook groups.
In summary, mHealth apps, seem to have tremendous potential, not only for research purposes (which in turn benefits patients), but for allowing the patient to participate and personalize their treatment, communicating and getting advice with expert health providers, feeling empowered, and increasing their quality of life.
References
Atreja, A., Otobo, E., Ramireddy, K., & Deorocki, A. (2018). Remote patient monitoring in IBD: current state and future directions. Current gastroenterology reports, 20(2), 6.
Fourment, C., Beaulieu, D. B., Adams, D. W., Barocas, M., Nagwekar, P., Horst, S. N., & Schwartz, D. A. (2017). IBData, a Wearable Application for Patients With Inflammatory Bowel Disease: Platform Design and Clinical Characteristics of Patients: 695. American Journal of Gastroenterology, 112, S384-S385.
Hamilton, M. J. (2018). The Use of Mobile Applications in the Management of Patients With Inflammatory Bowel Disease. Gastroenterology & hepatology, 14(9), 529.
Ho, S. M., Lewis, J. D., Mayer, E. A., Bernstein, C. N., Plevy, S. E., Chuang, E., & Hyams, J. S. (2019). Challenges in IBD research: environmental triggers. Inflammatory bowel diseases, 25(Supplement_2), S13-S23.
Kelso, M., & Feagins, L. A. (2018). Can smartphones help deliver smarter care for patients with inflammatory bowel disease?. Inflammatory bowel diseases, 24(7), 1453-1459.
Olivera, P., Danese, S., Jay, N., Natoli, G., & Peyrin-Biroulet, L. (2019). Big data in IBD: a look into the future. Nature Reviews Gastroenterology & Hepatology, 1.
