A Series of Personalized Virtual Light Therapy Interventions for Fatigue: Feasibility Randomized Crossover Trial for N-of-1 Treatment

• Published in: JMIR formative research 2023-09, Vol.7, p.e45510-e45510
• Main Authors: Butler, Mark, D'Angelo, Stefani, Ahn, Heejoon, Chandereng, Thevaa, Miller, Danielle, Perrin, Alexandra, Romain, Anne-Marie N, Scatoni, Ava, Friel, Ciaran P, Cheung, Ying-Kuen, Davidson, Karina W
• Format: Article
• Language: English
• Subjects: Accountability; Circadian rhythm; Clinical outcomes; Consent; Data collection; Diabetes; Family medical history; Fatigue; Health insurance; Information systems; Light; Light therapy; Mental disorders; Mental health; Original Paper; Patients; Questionnaires; Review boards; Smartphones; Text messaging
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/45510

Fatigue is one of the most common symptoms treated in primary care and can lead to deficits in mental health and functioning. Light therapy can be an effective treatment for symptoms of fatigue; however, the feasibility, scalability, and individual-level heterogeneity of light therapy for fatigue are unknown. This study aimed to evaluate the feasibility, acceptability, and effectiveness of a series of personalized (N-of-1) interventions for the virtual delivery of bright light (BL) therapy and dim light (DL) therapy versus usual care (UC) treatment for fatigue in 60 participants. Participants completed satisfaction surveys comprising the System Usability Scale (SUS) and items assessing satisfaction with the components of the personalized trial. Symptoms of fatigue were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) daily, PROMIS weekly, and ecological momentary assessment (EMA) questionnaires delivered 3 times daily. Comparisons of fatigue between the BL, DL, and UC treatment periods were conducted using generalized linear mixed model analyses between participants and generalized least squares analyses within individual participants. Participants rated the usability of the personalized trial as acceptable (average SUS score=78.9, SD 15.6), and 92% (49/53) of those who completed satisfaction surveys stated that they would recommend the trial to others. The levels of fatigue symptoms measured using the PROMIS daily fatigue measure were lower or improved in the BL (B=-1.63, 95% CI -2.63 to -0.63) and DL (B=-1.44, 95% CI -2.50 to -0.38) periods relative to UC. The treatment effects of BL and DL on the PROMIS daily measure varied among participants. Similar findings were demonstrated for the PROMIS weekly and EMA measures of fatigue symptoms. The participant scores on the SUS and satisfaction surveys suggest that personalized N-of-1 trials of light therapy for fatigue symptoms are both feasible and acceptable. Both interventions produced significant (P