Integration of interactive and passive movement assessments into an App for mild traumatic brain injury (I am brain aware - Movemed)

Mild traumatic brain injury (mTBI), also known as concussion, affects 1 out of 200 people in Europe every year.(1) In the UK, >1 million people attend emergency departments (ED) annually with a recent head injury.(2) "Mild" TBI should not be underestimated; 30 to 40% of patients when discharged from the ED following a CT scan for head injury experience significant, life-changing problems that can last months to years.(3,4) These include severe fatigue, poor memory, headaches, and mental health issues (including anxiety, depression, and post-traumatic stress).(1) Currently the majority of patients are sent home with written discharge advice and no planned follow up.(5) There is an expectation that patients with persisting problems will seek help themselves.(6) However, the nature of mTBI makes this difficult, and often patients are lost to the care they need. This is an unmet healthcare need affecting millions of individuals worldwide each year. As part of an NIHR Rosetrees Trust Advanced Fellowship the Lead Applicant is currently developing and co-designing with patients an App "I am brain aware" which will provide these patients with information to assist with self-management of problems from mTBI and access further care if required in a scalable and potentially cost-effective way. The App comprises five key elements: 1. Discharge advice 2. Detection of problems over time 3. Provide information for self-management with ways to manage the symptoms causing most problems for individuals high-lighted for ease of use (intervention). 4. Identification of patients who need more formalised followed-up 5. Enable long-term follow up including as part of research studies using outcomes chosen as important by stakeholders including patient reported measures. In previous work we have shown that psychomotor slowing is an important determinant of outcome.(7-9) In addition, an increase in falls occurs (particularly in older adults) after TBI, and wearable sensors and Apps have shown that digital metrics of gait may predict this. The App does not currently incorporate background activity monitoring (assessment while the phone is on the person but not in use) or formally test digital metrics of psychomotor slowing. In response to concerns from patients to address this we are submitting to this call. Movemed (https://movemed.io/, Developer and Collaborator Mr Ben Davies) is an App developed in Cambridge to assess movement and coordination of patients who have degenerative cervical myelopathy (DCM), which has been found to have good reliability and valididity.(10) We plan to assess the feasibility and acceptability of adding these assessments to the "I am brain aware" App. Public & patient involvement has been essential throughout the development of this App and this proposal. Key concerns expressed by patient and carers included the current lack of routine follow-up and the long-term consequences of mTBI including risk for falls and ongoing psychomotor slowing which directly led to the development of this proposal. We have ongoing PPI planned with regular patient involvement in steering group meetings and planned focus groups. Patient perspectives are planned to be integrated in all aspects of design, implementation and results including dissemination.