Monitoring and maintaining chronic disease requires constant vigilance from the patient…

It has been shown that guided self-care can produce remarkably improved outcomes for these types of patients. Traditional face-to-face methods for delivering guided self-care face a number of limitations:

  • The radius of care for a particular clinician is limited to the range that is convenient for patients to travel.
  • Patients with chronic disease may find traveling any distance to be burdensome.
  • Overseeing the individualized care plans of multiple patients is a time consuming endeavor without the proper tools.

iMHere seeks to overcome these limitations by providing clinicians with a system to remotely deliver and efficiently monitor customized self-care plans to patients, and providing patients with reminders to follow those plans.



The medical complexity of spina bifida (SB) results in equally complex self-care regimes that many SB patients struggle to effectively manage and maintain. Lack of consistent execution of self-care routines and health care recommendations often results in the development of secondary conditions, impacting morbidity and mortality in this population. The clinical needs and functional abilities of the SB population were integrated into iMHere application. Results for the first six months of the clinical study are shared comparing self-management outcomes for the intervention group using the iMHere system, versus the control group receiving traditional care through the UPMC Adult SB clinic. Significance was found in looking at time x group (p = .006). In particular, improvements in self-management skills as assessed by the AMIS-II were noted in the intervention-group-participants from three months to six months. A moderate effect size of 0.46 was found in the association of group and time as calculated with change scores. Limitations of the clinical study are discussed at length as well as potential future research opportunities, including expanding usage of the iMHere system to other populations with chronic conditions and application of the intervention during the transition years (14-21 years).

This project was funded in part by the National Institute of Health (NIH) grant #1R21HD071810-01A1, by National Institute on Disability and Rehabilitation Research (NIDRR)’s RERC on Telerehabilitation (project #H133E040012, project #H133E980025), and by Verizon Foundation.



Individuals with spinal cord injury (SCI) often require complex self-management routines to manage a neurogenic bowel and bladder, skin integrity, and general health and wellness. Tasks such as self-catheterization, bowel regimens, skin checks, and routine administration of medications require consistent execution to prevent complications. Early detection and treatment of problems such as urinary tract infections (UTIs) or wounds can prevent serious complications, such as osteomyelitis and sepsis, which can result in hospitalization, death, and expensive medical care.

iMHere—equipped with a suite of five modules geared to address neurogenic bowel, neurogenic bladder, skin integrity, medication management, and mood—is used in this study. People with complex care regimens can use iMHere to remind themselves to carry out bowel/bladder routines or take medications, report success with their activities or new problems (e.g. new wound, UTI symptoms, etc.), and track symptoms of depression. A clinician can view a dashboard that organizes data from a cohort of users on a computer or mobile device. The system alerts the clinician monitoring the dashboard in real time, allowing him/her to quickly triage patients and intervene when necessary.



We are now carrying out a randomized clinical trial in young adults with SB. In just six months we have already found improved self-management skill scores (measured by the Adolescent Self Management and Independence Scale II) in those who used the system compared to the control group. The clinical trial is still ongoing, but given these promising results, further investigation into the application of this technology for those with other conditions and needs is warranted. Individuals with SCI are high priority since they have similar medical issues and adverse outcomes from these issues, but the cases of higher-level motor impairment may have different needs when it comes to accessibility of mobile phones.