mHealth App Reduces UTIs in Patients with Spinal Cord Injury

A mobile health (mHealth) system could be a valuable tool to prevent urinary tract infections (UTIs) or reduce depressive symptoms of patients with spinal cord injury, according to a study published in the Journal of Medical Research.

Patients who used the mHealth system experienced about half as many UTIs during the study period when compared to before the start of the study. The app did not lead to extreme improvements in psychosocial outcomes when compared to traditional care.

Researchers aimed to determine if the use of the Interactive Mobile Health and Rehabilitation (iMHere) system would be associated with improved health over a nine-month period for patients with spinal cord injury. The research team, led by scientists at the University of Pittsburgh, also wanted to see if using the mHealth system would improve psychosocial outcomes.

iMHere consists of an app used by the patient and a web-based portal for the clinician. The app has modules for medication management, urinary and bowel program reminds, skincare tracking with photo capabilities, mood tracking and messaging to communicate with the clinician.

The system was developed to promote self-management for patients with disabilities and to facilitate communication between patients and their medical teams, according to the researchers.

Patients were randomly assigned to the control group — standard care in an outpatient physiatry spinal cord injury clinic — or the intervention group. Those in the intervention group received a Samsung Galaxy S5 smartphone with the iMHere app and received standard care in the same outpatient clinic.

The 38 participants were at least 18 years old with a diagnosis of a spinal cord injury. To be eligible, participants also had to attend an outpatient physiatry clinic for spinal cord injury and live in a community setting, not a care facility, according to the authors.

Participants had 30 minutes of training to learn how to use the iMHere app. After setting up the modules, the app sent them reminders in conjunction with their self-management routine. The researchers asked participants to respond to all of the reminders when they appeared on their phone. If a participant found a pressure injury during their skin check remind, the patient was instructed to upload the location and a photo to the app. A physical therapist monitored participant data using the web portal and communicated with participants through the app.

The research team collected participant health outcomes nine months before the study, as well as throughout the nine-month intervention. The researchers collected the number of UTIs, pressure injuries, emergency department visits and number of hospitalizations.

To measure psychosocial outcomes, the researchers interviewed participants over the phone at baseline and every three months for nine months to assess independence, mood and quality of life in individuals with disabilities. Researchers used a variety of questionnaires to obtain the information needed.

Patients who used the mHealth app had a reduction of 0.47 UTIs per person during the intervention compared to before the intervention. The control group did not see such a reduction, the study authors noted.

“One explanation for reduction in UTIs aside from the use of the catheterization module is increased general health awareness and improved self-management that resulted from using the app in general,” the authors wrote.

While overall, psychosocial outcomes did not differ significantly between the groups, the reduction in depressive symptoms based on the Beck Depression Inventory-II was the closest to approach significance. Participants in the intervention group had an average of 33% decrease over time — twice that of the control group.

Researchers already developed a second version of the mHealth app with additional modules and a personal health record, they added.

In the future, the researchers seek to evaluate the implementation of additional app features into clinical workflows, translation to larger and different disability populations and settings and interface with other electronic health systems.

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