Mount Sinai Apple ResearchKit study on asthma shows feasibility of smartphone-only studies

By Heather Mack
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A new study demonstrates that conducting some studies entirely via smartphones is feasible, fruitful and scalable: it stands up to scientific rigor, allows for large-scale participant enrollment,and captures unique environmental data not available through traditional methods, as researchers at the Icahn School of Medicine at Mount Sinai have learned.

In a new article published today in the journal Nature Biotechnology, researchers show how they used the Apple ResearchKit framework to develop an iOS app to study how asthma affects the every day life of different people, as well as how they are managing their condition over time. They launched the Asthma Mobile Health Study in March 2015, and interest was immediately evident: within six months, 50,000 iPhone users had downloaded the app, which featured surveys to assess symptoms, medication adherence and other factors about the condition.

The total sample size capped at 7,593 people who completed the electronic informed consent process and enrolled in the study, and 85 percent of this group completed as least one survey. During the six-month study, 2,317 people ended up being “robust users,” filling out multiple surveys, and the results were compared to existing asthma patient studies and controlled for external factors like the reliability of patient-reported data.

“We critically assessed the feasibility, strengths, and limitations of a smartphone-based study and found that this methodology is particularly suitable for studies of short duration that require rapid enrollment across diverse geographical locations, frequent data collection and real-time feedback to participants,” Dr. Yvonne Chan, principal investigator of the study and the director of Digital Health and Personalized Medicine at the Icahn Institute for Genomics and Multiscale Biology, said in a statement. “Our study demonstrates the power of mobile health tools to scale and accelerate clinical research so that we can derive the evidence needed to inform clinical practice and improve patient care.” 

The added advantage of the smartphone was the ability to collect other useful data such as geolocation and air quality, helping researchers to correlate daily asthma symptoms to environmental factors (for example, wildfires in Washington state that led to increased symptoms in some participants). Other factors that could be corroborated include pollen and heat.

“The Asthma Mobile Health study represents the coming together of academia and industry to benefit from the ubiquity of smartphones and harness the power of citizen-science to modernize the clinical research process,” Dr. Eric Schadt, senior author on the paper, said in a statement. Schadt is also a genomics professor and the founding director of the Icahn Institute for Genomics and Multiscale Biology at Mount Sinai.

At the time of the study, there were some three billion smartphones in use around the world, a figure that is expected to double by 2020. This has Mount Sinai thinking seriously about the future impact of mobile health studies in terms of reaching huge numbers of participants, which could be accomplished through actions like enterprise-level electronic informed consent.

“We now have the ability to capture rich research data from thousands of individuals, to better characterize ‘real world’ patterns of disease, wellness, and behavior,” Schadt said in a statement. “This approach provides a more comprehensive and accurate view of our patients that was not feasible in the past due to logistical limitations and prohibitive costs.”