{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T11:42:31Z","timestamp":1745235751247},"reference-count":47,"publisher":"Georg Thieme Verlag KG","issue":"S 01","license":[{"start":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T00:00:00Z","timestamp":1619481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Methods Inf Med"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The adherence to inhaled controller medications is of critical importance for achieving good clinical results in patients with chronic respiratory diseases. Self-management strategies can result in improved health outcomes and reduce unscheduled care and improve disease control. However, adherence assessment suffers from difficulties on attaining a high grade of trustworthiness given that patient self-reports of high-adherence rates are known to be unreliable.<\/jats:p><jats:p>\n          Objective\u2003Aiming to increase patient adherence to medication and allow for remote monitoring by health professionals, a mobile gamified application was developed where a therapeutic plan provides insight for creating a patient-oriented self-management system. To allow a reliable adherence measurement, the application includes a novel approach for objective verification of inhaler usage based on real-time video capture of the inhaler's dosage counters.<\/jats:p><jats:p>\n          Methods\u2003This approach uses template matching image processing techniques, an off-the-shelf machine learning framework, and was developed to be reusable within other applications. The proposed approach was validated by 24 participants with a set of 12 inhalers models.<\/jats:p><jats:p>\n          Results\u2003Performed tests resulted in the correct value identification for the dosage counter in 79% of the registration events with all inhalers and over 90% for the three most widely used inhalers in Portugal. These results show the potential of exploring mobile-embedded capabilities for acquiring additional evidence regarding inhaler adherence.<\/jats:p><jats:p>\n          Conclusion\u2003This system helps to bridge the gap between the patient and the health professional. By empowering the first with a tool for disease self-management and medication adherence and providing the later with additional relevant data, it paves the way to a better-informed disease management decision.<\/jats:p>","DOI":"10.1055\/s-0041-1726277","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T22:54:40Z","timestamp":1619564080000},"page":"e9-e19","source":"Crossref","is-referenced-by-count":8,"special_numbering":"S","title":["InspirerMundi\u2014Remote Monitoring of Inhaled Medication Adherence through Objective Verification Based on Combined Image Processing Techniques"],"prefix":"10.1055","volume":"60","author":[{"given":"Pedro","family":"Vieira-Marques","sequence":"additional","affiliation":[{"name":"CINTESIS\u2014Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Rute","family":"Almeida","sequence":"additional","affiliation":[{"name":"CINTESIS\u2014Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Jo\u00e3o F.","family":"Teixeira","sequence":"additional","affiliation":[{"name":"INESC TEC, Porto, Portugal"}]},{"given":"Jos\u00e9","family":"Valente","sequence":"additional","affiliation":[{"name":"MEDIDA\u2014Servi\u00e7os em Medicina, EDuca\u00e7\u00e3o, Investiga\u00e7\u00e3o, Desenvolvimento e Avalia\u00e7\u00e3o, LDA, Porto, Portugal"}]},{"given":"Cristina","family":"J\u00e1come","sequence":"additional","affiliation":[{"name":"CINTESIS\u2014Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Afonso","family":"Cachim","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Rui","family":"Guedes","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Ana","family":"Pereira","sequence":"additional","affiliation":[{"name":"CINTESIS\u2014Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Allergy Unit, Instituto and Hospital CUF, Porto, Portugal"}]},{"given":"Tiago","family":"Jacinto","sequence":"additional","affiliation":[{"name":"CINTESIS\u2014Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"MEDIDA\u2014Servi\u00e7os em Medicina, EDuca\u00e7\u00e3o, Investiga\u00e7\u00e3o, Desenvolvimento e Avalia\u00e7\u00e3o, LDA, Porto, Portugal"},{"name":"Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal"}]},{"given":"Jo\u00e3o A.","family":"Fonseca","sequence":"additional","affiliation":[{"name":"CINTESIS\u2014Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"MEDIDA\u2014Servi\u00e7os em Medicina, EDuca\u00e7\u00e3o, Investiga\u00e7\u00e3o, Desenvolvimento e Avalia\u00e7\u00e3o, LDA, Porto, Portugal"},{"name":"Allergy Unit, Instituto and Hospital CUF, Porto, Portugal"}]}],"member":"194","published-online":{"date-parts":[[2021,4,27]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.pmedr.2018.10.008","article-title":"The global burden of multiple chronic conditions: A narrative review","volume":"12","author":"C Hajat","year":"2018","journal-title":"Prev Med Rep"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S2213-2600(20)30105-3","article-title":"Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"8","author":"GBD Chronic Respiratory Disease Collaborators","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref4","volume-title":"Respiratory Diseases in the World","author":"European Respiratory Society","year":"2013"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40733-016-0029-3","article-title":"Asthma costs and social impact","volume":"3","author":"C Nunes","year":"2017","journal-title":"Asthma Res Pract"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"GBD 2016 Causes of Death Collaborators","year":"2017","journal-title":"Lancet"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1183\/09031936.00138707","article-title":"Global strategy for asthma management and prevention: GINA executive summary","volume":"31","author":"E D Bateman","year":"2008","journal-title":"Eur Respir J"},{"key":"ref9","volume-title":"A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS - Practical systematic Review of Self-Management Support for long-term conditions","author":"S JC Taylor","year":"2014"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12916-017-0823-7","article-title":"Systematic meta-review of supported self-management for asthma: a healthcare perspective","volume":"15","author":"H Pinnock","year":"2017","journal-title":"BMC Med"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1164\/ajrccm.164.8.2104102","article-title":"Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial","volume":"164","author":"P M O'Byrne","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S0140-6736(03)12891-7","article-title":"Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial","volume":"361","author":"R A Pauwels","year":"2003","journal-title":"Lancet"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1016\/j.jaip.2018.12.021","article-title":"Assessment of adherence and asthma medication ratio for a once-daily and twice-daily inhaled corticosteroid\/long-acting \u03b2-agonist for asthma","volume":"7","author":"R H Stanford","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1183\/09031936.00075614","article-title":"Medication adherence and the risk of severe asthma exacerbations: a systematic review","volume":"45","author":"M Engelkes","year":"2015","journal-title":"Eur Respir J"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1471-2466-13-15","article-title":"The association between asthma control, health care costs, and quality of life in France and Spain","volume":"13","author":"M Doz","year":"2013","journal-title":"BMC Pulm Med"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/pds.819","article-title":"How well do patients report noncompliance with antihypertensive medications?: a comparison of self-report versus filled prescriptions","volume":"13","author":"P S Wang","year":"2004","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"ref17","first-page":"217047","article-title":"Medication adherence measures: an overview","volume":"2015","author":"W Y Lam","year":"2015","journal-title":"BioMed Res Int"},{"issue":"11","key":"ref18","doi-asserted-by":"crossref","first-page":"e031732","DOI":"10.1136\/bmjopen-2019-031732","article-title":"Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts","volume":"9","author":"C J\u00e1come","year":"2019","journal-title":"BMJ Open"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"1700076","DOI":"10.1183\/13993003.00076-2017","article-title":"Urging Europe to put non-adherence to inhaled respiratory medication higher on the policy agenda: a report from the First European Congress on Adherence to Therapy","volume":"49","author":"J FM van Boven","year":"2017","journal-title":"Eur Respir J"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1164\/rccm.200906-0907OC","article-title":"Shared treatment decision making improves adherence and outcomes in poorly controlled asthma","volume":"181","author":"S R Wilson","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"issue":"03","key":"ref21","first-page":"e00136216","article-title":"Use of pharmacy records to measure treatment adherence: a critical review of the literature","volume":"33","author":"E DC Lima-Dellamora","year":"2017","journal-title":"Cad Saude Publica"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/1471-2288-11-149","article-title":"Suitability of measures of self-reported medication adherence for routine clinical use: a systematic review","volume":"11","author":"S Garfield","year":"2011","journal-title":"BMC Med Res Methodol"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/1545109709352884","article-title":"A simple single-item rating scale to measure medication adherence: further evidence for convergent validity","volume":"8","author":"S C Kalichman","year":"2009","journal-title":"J Int Assoc Physicians AIDS Care (Chic)"},{"issue":"06","key":"ref24","doi-asserted-by":"crossref","first-page":"e98701","DOI":"10.1371\/journal.pone.0098701","article-title":"A method to assess adherence in inhaler use through analysis of acoustic recordings of inhaler events","volume":"9","author":"S D'Arcy","year":"2014","journal-title":"PLoS One"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1038\/s41598-018-20523-w","article-title":"Objective assessment of patient inhaler user technique using an audio-based classification approach","volume":"8","author":"T E Taylor","year":"2018","journal-title":"Sci Rep"},{"issue":"10","key":"ref26","doi-asserted-by":"crossref","first-page":"e0185453","DOI":"10.1371\/journal.pone.0185453","article-title":"The effect of electronic monitoring feedback on medication adherence and clinical outcomes: a systematic review","volume":"12","author":"M van Heuckelum","year":"2017","journal-title":"PLoS One"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"e000128","DOI":"10.1136\/bmjresp-2016-000128","article-title":"Validation of a metered dose inhaler electronic monitoring device: implications for asthma clinical trial use","volume":"3","author":"J Pilcher","year":"2016","journal-title":"BMJ Open Respir Res"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jaip.2015.01.024","article-title":"Using electronic monitoring devices to measure inhaler adherence: a practical guide for clinicians","volume":"3","author":"A H Chan","year":"2015","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"e000159","DOI":"10.1136\/bmjresp-2016-000159","article-title":"What are the pros and cons of electronically monitoring inhaler use in asthma? A multistakeholder perspective","volume":"3","author":"S Howard","year":"2016","journal-title":"BMJ Open Respir Res"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.2196\/jmir.3951","article-title":"Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review","volume":"17","author":"S Hamine","year":"2015","journal-title":"J Med Internet Res"},{"issue":"05","key":"ref32","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.2196\/jmir.4883","article-title":"The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review","volume":"18","author":"L Whitehead","year":"2016","journal-title":"J Med Internet Res"},{"issue":"05","key":"ref33","doi-asserted-by":"crossref","first-page":"1700447","DOI":"10.1183\/13993003.00447-2017","article-title":"Realising the potential of mHealth to improve asthma and allergy care: how to shape the future","volume":"49","author":"J Bousquet","year":"2017","journal-title":"Eur Respir J"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1183\/09031936.00000810","article-title":"A mobile telephone-based interactive self-care system improves asthma control","volume":"37","author":"W T Liu","year":"2011","journal-title":"Eur Respir J"},{"issue":"04","key":"ref35","doi-asserted-by":"crossref","first-page":"343","DOI":"10.4104\/pcrj.2009.00064","article-title":"The CYMPLA trial. Mobile phone-based structured intervention to achieve asthma control in patients with uncontrolled persistent asthma: a pragmatic randomised controlled trial","volume":"18","author":"D Ryan","year":"2009","journal-title":"Prim Care Respir J"},{"issue":"04","key":"ref36","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/1479972316660977","article-title":"Living with asthma and chronic obstructive airways disease: Using technology to support self-management - an overview","volume":"14","author":"D Morrison","year":"2017","journal-title":"Chron Respir Dis"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1080\/07370024.2014.993471","article-title":"The lens of intrinsic skill atoms: a method for Gameful design","volume":"30","author":"S Deterding","year":"2015","journal-title":"Hum Comput Interact"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.invent.2016.10.002","article-title":"Gamification for health and wellbeing: a systematic review of the literature","volume":"6","author":"D Johnson","year":"2016","journal-title":"Internet Interv"},{"issue":"08","key":"ref39","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.2196\/mhealth.7177","article-title":"The potential of mobile apps for improving asthma self-management: a review of publicly available and well-adopted asthma apps","volume":"5","author":"P Tinschert","year":"2017","journal-title":"JMIR Mhealth Uhealth"},{"issue":"03","key":"ref40","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1177\/1479972316687209","article-title":"Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: An observational comparative study","volume":"14","author":"W H Ramadan","year":"2017","journal-title":"Chron Respir Dis"},{"key":"ref41","first-page":"131","article-title":"Inhalation drug delivery devices: technology update","volume":"8","author":"M Ibrahim","year":"2015","journal-title":"Med Devices (Auckl)"},{"issue":"08","key":"ref42","doi-asserted-by":"crossref","first-page":"10821","DOI":"10.1007\/s11042-018-6613-1","article-title":"A robust model for salient text detection in natural scene images using MSER feature detector and Grabcut","volume":"78","author":"N Gupta","year":"2019","journal-title":"Multimedia Tools Appl"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"919406","DOI":"10.1155\/2014\/919406","article-title":"Object detection based on template matching through use of best-so-far ABC","volume":"2014","author":"A Banharnsakun","year":"2014","journal-title":"Comput Intell Neurosci"},{"issue":"08","key":"ref49","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/j.1398-9995.2009.02310.x","article-title":"Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma","volume":"65","author":"J A Fonseca","year":"2010","journal-title":"Allergy"},{"issue":"06","key":"ref50","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1109\/TPAMI.1986.4767851","article-title":"A computational approach to edge detection","volume":"8","author":"J Canny","year":"1986","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13601-019-0286-3","article-title":"High oral corticosteroid exposure and overuse of short-acting beta-2-agonists were associated with insufficient prescribing of controller medication: a nationwide electronic prescribing and dispensing database analysis","volume":"9","author":"A S\u00e1-Sousa","year":"2019","journal-title":"Clin Transl Allergy"},{"issue":"04","key":"ref52","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.jaip.2016.03.005","article-title":"Improvement in asthma control using a minimally burdensome and proactive smartphone application","volume":"4","author":"K A Cook","year":"2016","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"05","key":"ref53","doi-asserted-by":"crossref","first-page":"1601966","DOI":"10.1183\/13993003.01966-2016","article-title":"Perspectives of patients and healthcare professionals on mHealth for asthma self-management","volume":"49","author":"A J Simpson","year":"2017","journal-title":"Eur Respir J"},{"issue":"03","key":"ref54","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/j.1398-9995.2006.01016.x","article-title":"Asthma patients are willing to use mobile and web technologies to support self-management","volume":"61","author":"J A Fonseca","year":"2006","journal-title":"Allergy"},{"key":"ref55","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ypmed.2014.08.026","article-title":"A meta-analysis of serious digital games for healthy lifestyle promotion","volume":"69","author":"A DeSmet","year":"2014","journal-title":"Prev Med"}],"container-title":["Methods of Information in Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1726277.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T22:35:55Z","timestamp":1626906955000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1726277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,27]]},"references-count":47,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2021,7,21]]},"published-print":{"date-parts":[[2021,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1726277","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0026-1270","2511-705X"],"issn-type":[{"value":"0026-1270","type":"print"},{"value":"2511-705X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,27]]}}}