Mind and Body:A Clinical Trial Evaluation of a Smartphone App-based Mindfulness Intervention

To evaluate the cost-benefit measures of the Am smartphone-app by measuring length of stay in hospital and levels of health services utilization

As no Electronic Health Records (EHR) are kept by Providence, a chart review, including progress notes, will be required to assess the following:

• Date of admission.
• Date of discharge.

Cost of Treatment will also be measured using patient self-reports of health services utilization at 3 and 6 months post intervention. Participants will answer five questions related to their use of health services utilization drawn from peer-reviewed literature (Van den Brink et al., 2005).

• Compared to the 3 months prior to the study, in the past 3 months my use of health care services has: (1) greatly decreased (2) stayed the same (3) greatly increased
• How many times did you visit your doctor's office visits in the last 3 months?
• How many times a caregiver visit you in your home in the last 3 months?
• How many times were you admitted to a hospital in the last 3 months.

Indicates whether the patient returns home, or is discharged to another care facility (e.g., long term or palliative care).

If Alternate Level of Care (ALC) assigned, the reasons underlying the decision. The term ALC is a clinical designation that identifies patients who no longer require the intensity of resources or services provided in their current settings and who are wait

The NRS minimum data set contains clinical data on functional status based on the 18-item Functional Independence Measure (FIM®) instrument.

FIM™ is comprised of 18 items, grouped into 2 subscales - motor and cognition.

Each item is scored on a 7 point ordinal scale, ranging from a score of 1 to a score of 7. The higher the score, the more independent the patient is in performing the task associated with that item.

• - Total assistance with helper
• - Maximal assistance with helper
• - Moderate assistance with helper
• - Minimal assistance with helper
• - Supervision or setup with helper
• - Modified independence with no helper
• - Complete independence with no helper

The NRS gives an RPG score used to categorize patient data based on their primary reason for receiving inpatient rehabilitation services.

Based on a patient's primary reason for receiving inpatient rehabilitation services, and using client age at admission and motor and cognitive functional status, patient's are assigned to one of 83 RPGs.

Post six-month retrospective report of patients' clinic visits.

To evaluate the efficacy of the Am smartphone-app to relieve symptoms of stress

The NIH Toolbox Perceived Stress Fixed Form contains measures in the domains of emotional health and was designed for use in epidemiological and clinical trials health-related research. It was selected for inclusion and subsequent national norming for the NIH Toolbox based on its psychometric performance.

To evaluate the efficacy of the Am smartphone-app for treating symptoms of anxiety, sleep disturbance, mood disturbance, and overall quality of life

PROMIS57 is a collection of short forms containing a fixed number of items from seven PROMIS domains (Depression, Anxiety, Physical Function, Pain Interference, Fatigue, Sleep Disturbance, and Ability to Participate in Social Roles and Activities). There are 8 questions per domain, and an additional pain intensity 0-10 numeric rating scale (NRS). The Profiles are universal rather than disease-specific.

Survey 1

• How has this patient's mental health impacted the quality of time spent during your appointments with them to-date?
• Have you had to make last minute changes to your care plan for this patient depending on their mental state when they have come to attend appointments?

Survey 2

• How has the quality of time spent during your appointments with this patient has changed over the last 4 weeks?
• Over the last 4 weeks, how has this patient's mental health impacted the quality of time spent during your appointments with them?
• Over the last 4 weeks, have you had to make last minute changes to your care plan for this patient depending on their mental state when they have come to attend appointments?

Am quantifies the efficacy of mindfulness training on each individual user through self-reports.

Self-reported mood will be collected by the participant's selection of mood words from Mobio's circumplex model of affect (based on Posner, Russell & Peterson, 2005). This model holds that all emotions derive from two underlying, orthogonal dimensions of emotional experience: valence and arousal. These orthogonal dimensions divide the circumplex into four quarters: low arousal - low affect; low arousal - high affect; high arousal - low affect; high arousal - high affect.

The Acceptance & Action Questionnaire-II (AAQ-II) was developed in order to measure psychological flexibility, and scores have been found to predict many outcomes, including mental health and work absence rates.

The AAQ-II is a seven item, one factor measure of psychological inflexibility or experiential avoidance. The scale is scored by summing the responses. Higher scores equal greater levels of psychological inflexibility.

The time, date and type of meditation users choose while participating in the study.

Am quantifies the efficacy of mindfulness training on each individual user through heart rate, an objective assessment of stress made possible through computer vision (biometrics) with the mobile device camera.

Am quantifies the efficacy of mindfulness training on each individual user through respiratory rate, an objective assessment of stress made possible through computer vision (biometrics) with the mobile device camera.

Am quantifies the efficacy of mindfulness training on each individual user through relative blood oxygen saturation, an objective assessment of stress made possible through computer vision (biometrics) with the mobile device camera.

Am quantifies the efficacy of mindfulness training on each individual user through self-reports.

Self-reported stress will be indicated by the participant's adjustment of a dynamic slider between the minimum score "no stress" and the maximum score "max stress" will be collected.

This will be based on the participants' indication as per their selection of between 1 and 3 "intent words". There are 24 options from which the participant can choose. These are divided into 6 outward intentions, and 18 inward intentions.

Users are rewarded with in-app points according to a point structure that encourages engagement with the app.

• Page/screen views and dwell time.