title: A randomized comparison of online and paper mood charts for people with bipolar disorder.
abstract: BACKGROUND
  Longitudinal mood instability is the essential feature of bipolar disorder, however most rating scales are cross sectional in nature, and focus on acute symptoms. By contrast, the NIMH Life Chart Methodology (LCM) characterizes in detail the severity, duration, and frequency of mood episodes. Adherence to daily rating, however, tends to be low. In this study an online version of the LCM, designed to enhance adherence, was compared to the standard paper version.
  
  
  METHODS
  Patients from a mood disorders specialty clinic were randomized to the standard LCM or an online, open-source adaptation. The online version used hypertext links embedded in a daily email as the primary rating interface. Participants rated for 90 days. The total number of days rated and the number of days with complete data were compared for the two groups.
  
  
  RESULTS
  Forty-eight patients participated in the study. The online group rated approximately twice as many days compared to the standard group (44.3 versus 20.4, p=.029). The online group also entered complete data for a larger portion of days (55.2% versus 27.7%, p=.039).
  
  
  CONCLUSIONS
  This was a small, short-term study. The implications for longer-term rating are unclear.
  
  
  CONCLUSIONS
  Despite the advantages of documenting mood fluctuation on a daily basis, the LCM is not commonly used, in part because ensuring adequate adherence can be resource intensive. An easily accessible online adaptation that utilizes email checking behavior can make this tool available to a wider range of patients.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, NW Room 8-421, Washington, DC 20037, USA. dlieberman@mfa.gwu.edu
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Lieberman
authors.forename: Tammas F
authors.initials: TF
authors.lastname: Kelly
authors.forename: Lanny
authors.initials: L
authors.lastname: Douglas
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D000339:Affect; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D003430:Cross-Sectional Studies; D034742:Electronic Mail; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012984:Software