{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:49:45Z","timestamp":1785854985208,"version":"3.56.0"},"reference-count":73,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Maintaining functional health, or the ability to live independently, is a primary goal of individuals as they age, but most older adults develop chronic conditions that threaten this goal. Physical activity is a key aspect of self-care that can improve functional health, and digital interventions offering guidance on appropriate exercise can help. However, older adults with multiple morbidities may be unable to use a laptop or smartphone-based eHealth because poor vision, dexterity, mobility, or other physical challenges make typing or touch navigation difficult. A smart display platform\u2014comprising a smart speaker plus a small visual screen\u2014has the potential to remove these barriers because it is voice-activated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The study aims to compare usage patterns of an eHealth intervention for older adults when delivered via a voice-based smart display versus a typing-based laptop, and assess whether the smart display outperforms the laptop in improving functional health and its specific physical and mental aspects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A minimum of 356 adults aged 60 years and older with at least 5 chronic health conditions are to be recruited from primary care clinics and community organizations. Participants will be randomized 1:1 to 12 months of access to an evidence-based intervention, ElderTree, delivered on either a smart display or a touchscreen laptop, with a postintervention follow-up at 18 months. The primary outcome is differences between groups on a comprehensive measure of physical and mental functional health. Secondary outcomes are between-group differences in the subscales of functional health (eg, physical function and depression), as well as measures of health distress, loneliness, unscheduled health care, and falls. We will also examine mediators and moderators of the effects of ElderTree on both platforms. Participants will complete surveys at baseline, 6, 12, and 18 months, and ElderTree use data will be collected continuously during the intervention period in system logs. We will use linear mixed-effect models to evaluate outcomes over time, with treatment condition and time point as between-subjects factors. Separate analyses will be conducted for each outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Recruitment began in July 2023 and was completed in May 2024, with 387 participants enrolled. The 12-month intervention period will end in May 2025; data collection will end in November 2025. Findings will be disseminated via peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Voice-activated digital health interventions have theoretical but untested advantages over typing-based technologies for older adults with physical limitations. As the population ages, and as multiple morbidities threaten the functional health of the majority of older adults, innovations in self-management are a matter of public health as well as individual quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT05240534; https:\/\/clinicaltrials.gov\/study\/NCT05240534<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>International Registered Report Identifier (IRRID)<\/jats:title>\n                    <jats:p>DERR1-10.2196\/64449<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/64449","type":"journal-article","created":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T16:25:07Z","timestamp":1741451107000},"page":"e64449","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Smart Display Versus Laptop Platforms for an eHealth Intervention to Improve Functional Health for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Clinical Trial"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0660-1902","authenticated-orcid":false,"given":"David H","family":"Gustafson Sr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0811-3056","authenticated-orcid":false,"given":"Marie-Louise","family":"Mares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1403-5242","authenticated-orcid":false,"given":"Darcie C","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-938X","authenticated-orcid":false,"given":"John J","family":"Curtin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-0458","authenticated-orcid":false,"given":"Klaren","family":"Pe-Romashko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7323-2521","authenticated-orcid":false,"given":"Gina","family":"Landucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"ref1","unstructured":"EdemekongPFBomgaarsDLSukumaranSSchooCActivities of Daily Living20232024-07-12Treasure Island, FLStatPearls Publishinghttps:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470404\/"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-009-9579-7"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000183191.65316.0a"},{"key":"ref4","unstructured":"The top 10 most common chronic conditions in older adultsNational Council on Aging20242024-07-13https:\/\/www.ncoa.org\/article\/the-top-10-most-common-chronic-conditions-in-older-adults"},{"key":"ref5","unstructured":"Chronic conditions among medicare beneficiaries: Chartboook 2012 editionCenters for Medicare & Medicaid Services20122024-07-13https:\/\/www.cms.gov\/research-statistics-data-and-systems\/statistics-trends-and-reports\/chronic-conditions\/downloads\/2012chartbook.pdf"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.20.2269"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1177\/1077558711399580"},{"issue":"6","key":"ref8","first-page":"256","volume":"4","author":"Lorig, KR","year":"2001","journal-title":"Eff Clin Pract"},{"key":"ref9","unstructured":"Healthy people 2030: questions and answersOffice of Disease Prevention and Health Promotion20232024-07-11https:\/\/health.gov\/our-work\/national-health-initiatives\/healthy-people\/healthy-people-2030\/questions-answers"},{"key":"ref10","unstructured":"Healthy people 2030: older adults: overview and objectivesOffice of Disease Prevention and Health Promotion20212024-07-13https:\/\/health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/older-adults#cit1"},{"key":"ref11","unstructured":"Older adult activity: an overviewPhysical Activity Basics20232024-07-13https:\/\/www.cdc.gov\/physical-activity-basics\/guidelines\/older-adults.html"},{"key":"ref12","unstructured":"Living with a chronic conditionChronic Disease20242024-07-13https:\/\/www.cdc.gov\/chronic-disease\/living-with\/index.html"},{"key":"ref13","unstructured":"Physical activity: digital health interventions for adults 55 years and olderOffice of Disease Prevention and Health Promotion20192024-07-13https:\/\/health.gov\/healthypeople\/tools-action\/browse-evidence-based-resources\/physical-activity-digital-health-interventions-adults-55-years-and-older"},{"key":"ref14","unstructured":"Physical activity: home-based exercise interventions for adults aged 65 years and olderCommunity Guide20222024-07-14https:\/\/www.thecommunityguide.org\/findings\/physical-activity-home-based-exercise-interventions-adults-65-years-older.html"},{"key":"ref15","unstructured":"CapanFWhy amazon device is a gift for healthcareViewpoint20162025-03-22https:\/\/media.mmm-online.com\/documents\/188\/january_2016_viewpoint_46793.pdf"},{"key":"ref16","unstructured":"Amazon echo voice commands offer big benefits to users with disabilitiesConsumer Reports20172024-07-14https:\/\/www.consumerreports.org\/amazon\/amazon-echo-voice-commands-offer-big-benefits-to-users-with-disabilities\/"},{"key":"ref17","unstructured":"ThompsonACPersuading your older parents to take the smart home leapCNET20172024-07-14https:\/\/www.cnet.com\/news\/how-to-have-the-tech-talk-with-your-aging-parents\/"},{"key":"ref18","unstructured":"WoykeEThe octogenarians who love Amazon's AlexaMIT Technology Review20172024-07-14https:\/\/www.technologyreview.com\/s\/608047\/the-octogenarians-who-love-amazons-alexa\/"},{"key":"ref19","unstructured":"Amazon echo for dementia: technology for seniorsDailyCaring20182024-07-14https:\/\/dailycaring.com\/amazon-echo-for-dementia-technology-for-seniors\/"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.2196\/33498"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.2196\/26767"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1145\/3469595.3469603"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1177\/1071181319631121"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1080\/10447318.2022.2050541"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1145\/3373759"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1080\/17483107.2022.2065369"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00907-7"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06888-1"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.2196\/25175"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.2196\/preprints.59588"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.2196\/37522"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3502"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1177\/1099800420958068"},{"key":"ref34","unstructured":"PenaMTMohamedMBurnsAFuglestenBJOchiengNChidambaramPA profile of medicare-medicaid enrollees (dual eligibles)KFF20232025-01-23https:\/\/www.kff.org\/medicare\/issue-brief\/a-profile-of-medicare-medicaid-enrollees-dual-eligibles\/#:~:text=About%20one%2Dquarter%20(26%25),Number%20of%20Chronic%20Conditions%20tab"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2022.w30135"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1007\/s12199-007-0022-9"},{"key":"ref37","unstructured":"Data snapshotsCenters for Medicare & Medicaid Services20232024-07-14https:\/\/www.cms.gov\/priorities\/health-equity\/minority-health\/research-data\/care-disparities\/data-snapshots"},{"key":"ref38","unstructured":"Exercise and screening for you: EASY toolEasy For You20212024-07-14https:\/\/www.easyforyou.info\/screening-tool"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2005.04.008"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1252"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1016\/0306-4603(86)90034-1"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1348\/135910707X224504"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2601_01"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1177\/1359105308095067"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2013.4642"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1964"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1016\/s0749-3797(98)00108-1"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.15.1305"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016007435.x"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-2466.2008.00383.x"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27939"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1037\/\/0003-066x.55.1.68"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.2196\/humanfactors.4853"},{"key":"ref54","unstructured":"What is calmconnect?PrioHealth20242024-07-12https:\/\/www.priohealth.com\/what-is-calmconnect\/"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-018-1842-3"},{"key":"ref56","unstructured":"PROMIS adult profile instrumentsPROMIS20212024-07-14https:\/\/www.healthmeasures.net\/images\/PROMIS\/manuals\/PROMIS_Adult_Profile_Scoring_Manual.pdf"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.02.004"},{"issue":"6","key":"ref58","first-page":"256","volume":"4","author":"Lorig, KR","year":"2001","journal-title":"Eff Clin Pract"},{"key":"ref59","first-page":"25","author":"Lorig, K","year":"1996","journal-title":"Outcome Measures for Health Education and Other Health Care Interventions"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1037\/a0028586"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1111\/jabr.12026"},{"key":"ref62","unstructured":"The GLMPOWER procedureSAS Institute20192024-07-14https:\/\/documentation.sas.com\/doc\/en\/pgmsascdc\/9.4_3.4\/statug\/statug_glmpower_overview.htm"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.3758\/bf03193146"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-118"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.2307\/2531905"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.20982\/tqmp.19.4.p347"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1037\/a0022634"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1037\/a0022640"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-11"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.2307\/2986113"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1016\/j.techsoc.2022.102133"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics9020022"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2023.1117280"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2025\/1\/e64449","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:57:17Z","timestamp":1785851837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2025\/1\/e64449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":73,"URL":"https:\/\/doi.org\/10.2196\/64449","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.64449","asserted-by":"object"}]},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,3]]}}}