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Digital therapeutics

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Digital therapeutics, a subset of digital health, is a health discipline and treatment option that utilizes a digital and often online health technologies to treat a medical or psychological condition.[1][2][3][4] The treatment relies on behavioral and lifestyle changes usually spurred by a collection of digital impetuses.[5][6] Because of the digital nature of the methodology, data can be collected and analyzed as both a progress report and a preventative measure.[7][8][9][10][11][12] Treatments are being developed for the prevention and management of a wide variety of diseases and conditions, including type II diabetes, congestive heart failure, obesity, Alzheimer's disease, dementia, asthma, substance abuse, ADHD, panic attacks, anxiety, depression, and several others.[1][13][14][15][16] Digital therapeutics often employ strategies rooted in cognitive behavioral therapy.[17][18][19]

Definitions

Although digital therapeutics can be employed in numerous ways, the term can broadly be defined as a treatment or therapy that utilizes digital and often Internet-based health technologies to spur changes in patient behavior.[3][20] The use of digital products to improve health outcomes dates as far back as 2000[8][2]. The term itself has been in use since around 2012.[21] The first mention of the term in a peer-reviewed research publication was in 2015, in which Dr. Cameron Sepah formally defined the field as: "Digital therapeutics are evidence-based behavioral treatments delivered online that can increase accessibility and effectiveness of health care."[5] Digital therapeutics can be used as a standalone therapy or in conjunction with more conventional treatments like pharmacological or in-person therapy.[3][17] As of 2018, digital therapeutics continues to be an evolving field that medical professionals, students, and patients are beginning to utilize.[22]

It is often used as a preventive measure for patients who are at risk of developing more serious conditions. For instance, a patient with prediabetes may be prescribed digital therapeutics as a method to change their diet and behavior that could otherwise lead to a diabetes diagnosis.[5][1][14][19] Digital therapeutics can also be used as a treatment option for existing conditions. For instance, a patient with type II diabetes can use digital therapeutics to manage the disease more effectively.[1][5][14]

The methodology uses a variety of digital implements to help manage, monitor, and prevent illnesses in at-risk patients. These include mobile devices and technologies, apps, sensors, desktop computers, and various Internet of Things devices.[23] These implements can collect a wide variety of data, ranging from big to small. Digital therapeutics can theoretically collect a high volume of data from a variety of sources. It also collects "smaller" data, "capturing personalized physiological parameters, behavior patterns and social and geographical patterns that can be recorded from multiple digital sources."[7]

Methodologies

Digital therapeutics can be used for a variety of conditions. There is no single methodology used in the practice of digital therapeutics. It uses methods rooted in cognitive behavioral therapy to spur patients to make lifestyle changes. The method can be used to manage and prevent numerous conditions, including type II diabetes, Alzheimer's disease, dementia, congestive heart failure, chronic obstructive pulmonary disease, asthma, lung disease, obesity, substance abuse, ADHD, insomnia, panic attacks, anxiety, depression, and others.[1][15][16][10]

Methodologies can be as simple as sending notifications designed to alter behavior to patients who are at risk of obesity or diabetes[14][1] and as complex as administering an ingestible radio tag that communicates with an external sensor to monitor the efficacy of a given medication.[3] Diabetes and obesity prevention and management is a major focus in the field of digital therapeutics.[24][9] Connected devices like insulin pumps, blood glucose meters, and wearable gadgets can all send data to a unified system. The therapy also uses self-reported data like diet or other lifestyle factors.[1][5] It is also often used to monitor the potential for heart and lung conditions and change behaviors like smoking, poor diet, or a lack of exercise.[23][1]

Digital therapeutics can also be used to treat patients with psychological and neurological disorders. For example, patients with disorders like ADHD, depression, and anxiety can receive cognitive behavioral therapy via their mobile devices.[17] One study looked at the efficacy of avatar-based therapeutic interventions to reduce depressive symptoms.[13] Another study demonstrated that a 4-week at-home treatment eliminated or reduced panic attacks.[15]

Outcomes

The general consensus among researchers in the field of digital therapeutics is that the discipline requires more clinical data and investigation to be fully evaluated.[2][22] A variety of studies have been conducted to evaluate the efficacy and impact of behavior change techniques that utilize a digital platform, however.[5][2][10][24] In a meta-analysis of 85 such studies comprising a total sample size of over 43,000 participants, researchers discovered that digital therapeutics have a "statistically small but significant effect on health-related behavior." The study also showed that a broader use of theory, behavior change techniques, and modes of delivery (especially regular notifications) improved the efficacy of a given program.[2]

Individual studies have also showed some benefits for patients. For instance, a diabetes prevention program using digital therapeutics saw participants lose an average of 4.7% of baseline body weight after 1 year (4.2% after 2 years) and undergo a 0.38% reduction in A1c levels after 1 year (0.43% after 2 years).[5] Another weight loss pilot program using digital therapeutics reported a mean weight loss of 13.5 pounds (or 7.3% of baseline) with a significant average drop in both systolic and diastolic blood pressure (18.6 mmHg and 6.4 mmHg respectively). The study also saw a slight but statistically insignificant drop in total cholesterol, LDL, triglycerides, and A1c.[24]

See also

References

  1. ^ a b c d e f g h Kvedar, Joseph C.; Fogel, Alexander L.; Elenko, Eric; Zohar, Daphne (March 2016). "Digital medicine's march on chronic disease" (PDF). Nature Biotechnology. 34 (3): 239–246. doi:10.1038/nbt.3495. Retrieved 19 October 2016.
  2. ^ a b c d e Webb, Thomas L.; Joseph, Judith; Yardley, Lucy; Michie, Susan (17 February 2010). "Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy". Journal of Medical Internet Research. 12 (1): e92. doi:10.2196/jmir.4052. Retrieved 21 October 2016.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  3. ^ a b c d Hixon, Todd (9 December 2015). "Digital Therapeutics Have Huge Promise And They Are Real Today". Forbes. Retrieved 19 October 2016. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  4. ^ Cymerys, Ed; Duffy, Sean (May 2015). "Implementing USPSTF Recommendations on Behavioral Counseling for Cardiovascular Disease". Health Watch (78). Society of Actuaries.
  5. ^ a b c d e f g Sepah, Cameron S.; Jiang, Luohua; Peters, Anne L. (2015). "Long-Term Outcomes of a Web-Based Diabetes Prevention Program: 2-Year Results of a Single-Arm Longitudinal Study". Journal of Medical Internet Research. 17 (4): e92. doi:10.2196/jmir.4052. Retrieved 19 October 2016.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  6. ^ Duffy, Sean (17 April 2014). "What If Doctors Could Finally Prescribe Behavior Change?". Forbes. Retrieved 19 October 2016. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  7. ^ a b Hird, Nick; Ghosh, Samik; Kitano, Hiroaki (June 2016). "Digital health revolution: perfect storm or perfect opportunity for pharmaceutical R&D?". Drug Discovery Today. 21 (6): 900–911. doi:10.1016/j.drudis.2016.01.010. Retrieved 19 October 2016.
  8. ^ a b Capobianco, Enrico (10 November 2015). "On Digital Therapeutics". Frontiers in Digital Humanities. 2 (6). doi:10.3389/fdigh.2015.00006. Retrieved 19 October 2016.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ a b Vlachopapadopoulou, Elpis; Fotiadis, Dimitrios I. (26 January 2016). "Chapter 7: The Contribution of mHealth in the Care of Obese Pediatric Patients". In Moumtzoglou, Anastasius (ed.). M-Health Innovations for Patient-Centered Care. IGI Global. pp. 126–146. ISBN 978-1466698611. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help); Unknown parameter |lastauthoramp= ignored (|name-list-style= suggested) (help)
  10. ^ a b c Dahlberg, Leif E.; Grahn, Daniel; Dahlberg, Jakob E.; Thorstensson, Carina A. (2016). "A Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study" (PDF). Journal of Medical Internet Research. 5 (2): e115. doi:10.2196/resprot.5665. Retrieved 19 October 2016.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. ^ Wicklund, Eric (13 October 2016). "Is Digital Therapeutics the Next Big Thing in mHealth?". mHealth Intelligence. Retrieved 19 October 2016.
  12. ^ Dignan, Larry (18 November 2015). "Ready for digital therapeutics? Andreessen Horowitz hopes so". ZDNet. Retrieved 19 October 2016.
  13. ^ a b Pinto, Melissa D.; Greenblatt, Amy M.; Hickman, Ronald L.; Rice, Heather M.; Thomas, Tami L.; Clochesy, John M. (19 March 2015). "Assessing the Critical Parameters of eSMART-MH: A Promising Avatar-Based Digital Therapeutic Intervention to Reduce Depressive Symptoms". Perspectives in Psychiatric Care. 52 (3): 157–168. doi:10.1111/ppc.12112. Retrieved 21 October 2016.
  14. ^ a b c d Lorenzetti, Laura (22 April 2016). "This Company Is Tackling Diabetes With 'Digital Therapeutics'". Fortune. Retrieved 19 October 2016. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  15. ^ a b c Tolin, David F.; McGrath, Patrick B.; Hale, Lisa R.; Weiner, Daniel N.; Gueorguieva, Ralitza (2017-02-13). "A Multisite Benchmarking Trial of Capnometry Guided Respiratory Intervention for Panic Disorder in Naturalistic Treatment Settings". Applied Psychophysiology and Biofeedback. 42 (1): 51–58. doi:10.1007/s10484-017-9354-4. ISSN 1090-0586. PMC 5344940. PMID 28194546.
  16. ^ a b Baum, Stephanie (30 April 2016). "Digitizing substance abuse treatment and recovery". Med City News. Retrieved 19 October 2016.
  17. ^ a b c Gebremedhin, Dan; Schuster, Matthew (29 August 2016). "Overview: Health tech startups innovating the behavioral health space". Mobi Health News. Retrieved 19 October 2016.
  18. ^ Honeyman, Matthew; Gretton, Cosima (15 April 2016). "Eight technologies that could change healthcare beyond recognition". The Guardian. Retrieved 19 October 2016.
  19. ^ a b Suennen, Lisa (29 March 2016). "Is the time right for digital therapeutics?". Med City News. Retrieved 19 October 2016.
  20. ^ Yeager, David (November 2014). "Fighting Chronic Disease With Digital Therapeutics". Today's Dietitian. Retrieved 19 October 2016. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  21. ^ http://tsdr.uspto.gov/documentviewer?caseId=sn85765357&docId=FTK20121101070417#docIndex=4&page=1
  22. ^ a b Le Ber, Jeanne M.; Lombardo, Nancy T.; Wimmer, Erin (22 January 2015). "Building Technology Services That Address Student Needs". Medical Reference Services Quarterly. 34 (1): 1–16. doi:10.1080/02763869.2015.986708. Retrieved 21 October 2016.
  23. ^ a b Kvedar, Joseph (25 August 2016). "It's time to break free of the traditional paradigms of disease management". Med City News. Retrieved 19 October 2016.
  24. ^ a b c Willey, Steven; Walsh, James K. (8 January 2016). "Outcomes of a Mobile Health Coaching Platform: 12-Week Results of a Single-Arm Longitudinal Study". Journal of Medical Internet Research. 4 (1): e3. doi:10.2196/mhealth.4933. PMC 4723727. PMID 26747611.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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