Are electronic diaries useful for symptoms research? A systematic review
Table of contents
- 1. Research design/methodology
- 1.1. Eligibility criteria
- 1.2. Search methodology
- 1.3. Analysis
- 1.4. Assessment of methodological quality
- 2. Research question
- 3. Intervention
- 3.1. Technologies
- 4. Outcome
- 5. Further areas for research
Are electronic diaries useful tools for examining the relationships between physical symptoms and psychological variables in psychosomatic research?
This qualitative systematic review demonstrated that definitive interactions and specific constructs between physical symptoms and psychosocial variables could not be concluded.
Electronic diaries appear to be preferred over pen-and-paper and may generate usable and valid data. However, decision factors for the use of electronic diaries in self-reported symptoms research include end-user training and comfort, higher cost considerations, and the potential for device failure.
Are electronic diaries useful for symptoms research? A systematic review
Burton C, Weller D, Sharpe M. J Psychosom Res. 2007 May;62(5):553-61.
Reviewed by Craig J. Huang, MD
Research design/methodology
Qualitative systematic review of 32 papers from 24 clinical studies
Eligibility criteria
Clinical electronic diary studies, with recordings of physical symptoms, employing a variety of study designs: cross-over, case control and feasibility studies.
Studies belonged to two groups of research questions:
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Group 1: Are there associations between physical symptoms and psychosocial variables?
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Group 2: Do electronic diaries generate accurate and usable data for symptom studies?
Exclusion criteria:
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Studies using only pen-and-paper diaries
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Studies that did not include physical symptoms
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Drug trials that only used electronic diaries for repeated symptom measurements
Search methodology
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Medline, Embase and PsychInfo databases were searched for symptom disorder studies using electronic diaries
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Publication between 1985 and November 2005
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Search query: intersections of the terms (pain or symptom$ or somatoform), (diary or diaries or handhelds) and (computer$ or electronic)
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An additional query included: electronic diary studies in symptom disorders with “ecological momentary assessment” psychological disorders
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Relevant studies were also identified from the references of other reviewed articles
Assessment of methodological quality
The authors do not describe the results of their search strategy.
The majority of the studies were not directly comparable. Reviewed studies had differing data collection intervals, number of items per diary entry and on-screen data collection methods (that employed VAS, Likert and numeric scales, and event-based recording). Eleven different conditions were studied: chronic pain, pain, fibromyalgia, temporomandibular dysfunction, migraine, multiple chemical sensitivity, asthma, overactive bladder, menstrual symptoms, heartburn and mood.
Research question
In pain and symptom studies using electronic diaries:
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Are the data collected valid and accurate?
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Are there associations between physical symptoms and psychosocial variables?
Intervention
In diary-based psychosomatic research, several electronic devices were used to facilitate entry recordings for physical symptoms and to minimize recall bias through real-time entry recording and event-based sampling. The majority of the devices used were touch screen-based PDAs.
Technologies
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Psion organizers (http://www.mypsionsupport.com/mypsion)
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Touch-screen based devices
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Wrist-worn actigraph keypads (http://www.minimitter.com/Products/Actiwatch/aw16_aw64.html)
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Push-button devices
Outcome
HIGHLIGHTS:
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Electronic diaries generate usable and valid data for psychosomatic symptoms research.
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Most participants preferred electronic diaries to pen-and-paper, with compliance rates between 76 to 100% (measured as possible entries recorded).
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The interactions and measures of somatic and psychological symptoms had a wide range, generally modest in magnitude, and often unclear whether there was a causal or consequential relationship.
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Data accuracy in electronic diaries is not consistently reported in the studies.
IMPLICATIONS: Electronic diaries appear to be a convenient, valid, and acceptable tool for data collection in symptom-based psychosomatic research. However, definitive associations between physical symptoms and psychosocial variables could not be made.
GENERALIZABILITY: It is difficult to generalize across research settings because of the variety of research designs, data collection devices and conditions studied.
CONSISTENCY: There were heterogeneous findings among the articles reviewed.
Further areas for research
There is a need for further research in the following areas of electronic diary-based studies:
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The number of items recorded per entry and the required completion time
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Comparisons of graphical and text-based data entry
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Assessment of temporal issues with data recording
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The optimal training and support required by electronic diary users
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