%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e47 %T Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? %+ Beacon HospitalUniversity College Dublin Beacon AcademySandyfordDublin, D18Ireland353 01 540 4646rob.argent@insight-centre.org  %A Argent,Rob %A Daly,Ailish %A Caulfield,Brian %K patient compliance %K rehabilitation %K exercise therapy %K biomedical technology %K review %D 2018 %7 01.03.2018 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Adherence to home exercise in rehabilitation is a significant problem, with estimates of nonadherence as high as 50%, potentially having a detrimental effect on clinical outcomes. In this viewpoint, we discuss the many reasons why patients may not adhere to a prescribed exercise program and explore how connected health technologies have the ability to offer numerous interventions to enhance adherence; however, it is hard to judge the efficacy of these interventions without a robust measurement tool. We highlight how well-designed connected health technologies, such as the use of mobile devices, including mobile phones and tablets, as well as inertial measurement units, provide us with the opportunity to better support the patient and clinician, with a data-driven approach that incorporates features designed to increase adherence to exercise such as coaching, self-monitoring and education, as well as remotely monitor adherence rates more objectively. %M 29496655 %R 10.2196/mhealth.8518 %U https://mhealth.jmir.org/2018/3/e47/ %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e65 %T Therapist-Assisted Rehabilitation of Visual Function and Hemianopia after Brain Injury: Intervention Study on the Effect of the Neuro Vision Technology Rehabilitation Program %+ Herlev HospitalDepartment of Neurology N108University Hospital of CopenhagenHerlev Ringvej 75Herlev, 2730Denmark45 28757500rsr@sund.ku.dk  %A Rasmussen,Rune Skovgaard %A Schaarup,Anne Marie Heltoft %A Overgaard,Karsten %K stroke %K vision %K rehabilitation %K brain injury %D 2018 %7 27.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Serious and often lasting vision impairments affect 30% to 35% of people following stroke. Vision may be considered the most important sense in humans, and even smaller permanent injuries can drastically reduce quality of life. Restoration of visual field impairments occur only to a small extent during the first month after brain damage, and therefore the time window for spontaneous improvements is limited. One month after brain injury causing visual impairment, patients usually will experience chronically impaired vision and the need for compensatory vision rehabilitation is substantial. Objective: The purpose of this study is to investigate whether rehabilitation with Neuro Vision Technology will result in a significant and lasting improvement in functional capacity in persons with chronic visual impairments after brain injury. Improving eyesight is expected to increase both physical and mental functioning, thus improving the quality of life. Methods: This is a prospective open label trial in which participants with chronic visual field impairments are examined before and after the intervention. Participants typically suffer from stroke or traumatic brain injury and will be recruited from hospitals and The Institute for the Blind and Partially Sighted. Treatment is based on Neuro Vision Technology, which is a supervised training course, where participants are trained in compensatory techniques using specially designed equipment. Through the Neuro Vision Technology procedure, the vision problems of each individual are carefully investigated, and personal data is used to organize individual training sessions. Cognitive face-to-face assessments and self-assessed questionnaires about both life and vision quality are also applied before and after the training. Results: Funding was provided in June 2017. Results are expected to be available in 2020. Sample size is calculated to 23 participants. Due to age, difficulty in transport, and the time-consuming intervention, up to 25% dropouts are expected; thus, we aim to include at least 29 participants. Conclusions: This investigation will evaluate the effects of Neuro Vision Technology therapy on compensatory vision rehabilitation. Additionally, quality of life and cognitive improvements associated to increased quality of life will be explored. Trial Registration: ClinicalTrials.gov NCT03160131; https://clinicaltrials.gov/ct2/show/NCT03160131 (Archived by WebCite at http://www.webcitation.org/6x3f5HnCv) %M 29487042 %R 10.2196/resprot.8334 %U http://www.researchprotocols.org/2018/2/e65/ %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e45 %T Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial %+ Department of Psychological MedicineFaculty of Medical and Health SciencesThe University of Auckland12th floor Auckland Hosptial Support BuildingPark Road, GraftonAuckland, 1142New Zealand64 9 3737599 ext 86756e.broadbent@auckland.ac.nz  %A Broadbent,Elizabeth %A Garrett,Jeff %A Jepsen,Nicola %A Li Ogilvie,Vickie %A Ahn,Ho Seok %A Robinson,Hayley %A Peri,Kathryn %A Kerse,Ngaire %A Rouse,Paul %A Pillai,Avinesh %A MacDonald,Bruce %K robotics %K chronic obstructive pulmonary disease %K hospitalization %K medication adherence %K telehealth %K rehabilitation exercise %D 2018 %7 13.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Socially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization. Objective: This pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group. Methods: At discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted. Results: Intention-to-treat and per protocol analyses showed no significant differences in the number of respiratory-related hospitalizations between groups. The intervention group was more adherent to their long-acting inhalers (mean number of prescribed puffs taken per day=48.5%) than the control group (mean 29.5%, P=.03, d=0.68) assessed via electronic recording. Self-reported adherence was also higher in the intervention group after controlling for covariates (P=.04). The intervention group increased their rehabilitation exercise frequency compared with the control group (mean difference −4.53, 95% CI −7.16 to −1.92). There were no significant differences in quality of life. Of the 25 patients who had the robot, 19 had favorable attitudes. Conclusions: This pilot study suggests that a homecare robot can improve adherence to medication and increase exercise. Further research is needed with a larger sample size to further investigate effects on hospitalizations after improvements are made to the robots. The robots could be especially useful for patients struggling with adherence. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000259549; http://www.anzctr.org.au (Archived by WebCite at  http://www.webcitation.org/6whIjptLS) %M 29439942 %R 10.2196/jmir.8640 %U https://www.jmir.org/2018/2/e45/ %0 Journal Article %I JMIR Publications %V 1 %N 1 %P e1 %T Accessible Communication Tools for Surgical Site Infection Monitoring and Prevention in Joint Reconstruction: Feasibility Study %+ Department of SurgeryWashington University in Saint Louis4901 Forest Park AvenueSt Louis, MO, 63108United States1 (314) 362 12721 (314) 362 5743kirbyj@wudosis.wustl.edu  %A Lu,Keyin %A Chermside-Scabbo,Christopher J %A Marino,Nikolas Evan %A Concepcion,Angela %A Yugawa,Craig %A Aladegbami,Bola %A Paar,Theodora %A St John,Theresa A %A Ross,Will %A Clohisy,John C %A Kirby,John P %K communication tool %K decolonization %K mobile health %K surgical site infection %K automated %K messaging %D 2018 %7 17.01.2018 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The National Surgical Quality Improvement Program logs surgical site infections (SSIs) as the most common cause of unplanned postoperative readmission for a variety of surgical interventions. Hospitals are making significant efforts preoperatively and postoperatively to reduce SSIs and improve care. Telemedicine, defined as using remote technology to implement health care, has the potential to improve outcomes across a wide range of parameters, including reducing SSIs. Objective: The purpose of this study was to assess the feasibility and user satisfaction of two automated messaging systems, EpxDecolonization and EpxWound, to improve perioperative care in a quality improvement project for patients undergoing total joint replacement. Methods: We designed two automated text messaging and calling systems named EpxDecolonization, which reminded patients of their preoperative decolonization protocol, and EpxWound, which monitored pain, wound, and fever status postoperatively. Daily patient responses were recorded and a post-usage survey was sent out to participants to assess satisfaction with the systems. Results: Over the 40-week study period, 638 and 642 patients were enrolled in EpxDecolonization (a preoperative decolonization reminder) and EpxWound (a postoperative surgical site infection telemonitoring system), respectively. Patients could be enrolled in either or both EpxDecolonization and EpxWound, with the default option being dual enrollment. The proportion of sessions responded to was 85.2% for EpxDecolonization and 78.4% for EpxWound. Of the 1280 patients prescribed EpxWound and EpxDecolonization, 821 (64.14%) fully completed the postoperative system satisfaction survey. The median survey score (scale 1-9) was 9 for patient-rated overall care and 8 for whether the telemonitoring systems improved patient communication with providers. The majority of patients (69.0%, 566/821) indicated that the systems sent out an ideal number of messages (not too many, not too few). Conclusions: EpxDecolonization and EpxWound demonstrated high response rates and improved patient-rated communication with providers. These preliminary data suggest that these systems are well tolerated and potentially beneficial to both patients and providers. The systems have the potential to improve both patient satisfaction scores and compliance with preoperative protocols and postoperative wound monitoring. Future efforts will focus on testing the sensitivity and specificity of alerts generated by each system and on demonstrating the ability of these systems to improve clinical quality metrics with more authoritative data. %R 10.2196/periop.7874 %U http://periop.jmir.org/2018/1/e1/ %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e202 %T A Telerehabilitation Approach to Enhance Quality of Life Through Exercise Among Adults With Paraplegia: Study Protocol %+ Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)Department of Kinesiology and Physical EducationMcGill UniversityCurrie Gymnasium475 Pine Avenue WestMontreal, QC, H2W 1S4Canada1 514 398 4184 ext 099031 514 398 4186shane.sweet@mcgill.ca  %A Sweet,Shane Norman %A Rocchi,Meredith %A Arbour-Nicitopoulos,Kelly %A Kairy,Dahlia %A Fillion,Brigitte %K telehealth %K spinal cord injuries %K exercise %K motivation %K telerehabilitation %D 2017 %7 19.10.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite compelling evidence linking physical activity and quality of life among adults with spinal cord injury (SCI), exercise participation rates are extremely low in this population. Unfortunately, a lack of behavioral exercise interventions, in particular theory-based randomized controlled trials (RCT), exists within the SCI literature. A pilot RCT is needed to first examine the feasibility to conduct such interventions and determine the appropriate effect size to inform future full-scale interventions. Objective: The overall goal of this pilot RCT is to test an 8-week innovative, video-based telerehabilitation intervention based on self-determination theory and aimed at enhancing the basic psychological needs, motivation, exercise participation, and quality of life‒related outcomes of adults with paraplegia. The objectives are to (1) determine if individuals in the intervention group have greater increases in their basic psychological needs and autonomous motivation and a decrease in controlled motivation compared to the control group, (2) determine whether the intervention group reports greater increases in exercise participation and quality of life‒related variables (eg, life satisfaction, participation in daily/social activities, depressive symptoms) compared to the control group, and (3) examine if adults with paraplegia who received the intervention report improved scores on psychosocial predictors of exercise (eg, action planning) and well-being (eg, positive affect) compared to the control group. We also aimed to examine the implementation characteristics of the intervention (eg, satisfaction with the technology, counselor’s ability to foster the psychological needs). Methods: Adults with paraplegia (N=24) living in the community will be recruited. All participants will be invited to complete assessments of their psychological needs, motivation, exercise, and quality of life‒related variables at three time points (baseline, 6, and 10 weeks). Following the baseline assessment, participants will be randomly assigned to the intervention or control group. Participants in the intervention group will participate in 8 weekly, 1-hour video-based telerehabilitation sessions with a trained physical activity counselor, while participants in the control group will be asked to continue with their regular routine. Results: We expect higher ratings of the basic psychological needs and autonomous motivation and lower scores for controlled motivation for the intervention group compared to the control group (Objective 1). We also expect that our video-based intervention will have moderate effects on exercise participation, as well as small-to-moderate positive effects on the quality of life‒related variables (Objective 2). Finally, we expect the intervention to have a small positive effect on psychosocial predictors of physical activity and well-being (Objective 3). Conclusions: We anticipate that the results will show that the intervention is appropriate for adults with paraplegia and feasible to test in a full-scale RCT. Trial Registration: ClinicalTrials.gov NCT02833935; https://clinicaltrials.gov/ct2/show/NCT02833935 (Archived by WebCite at http://www.webcitation.org/6u8U9x2yt) %M 29051134 %R 10.2196/resprot.8047 %U http://www.researchprotocols.org/2017/10/e202/ %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 4 %P e19 %T Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study %+ Utrecht UniversityPrincetonplein 5Utrecht, 3584 CCNetherlands31 30253411631 302532804yunlingcn@gmail.com  %A Ling,Yun %A Ter Meer,Louis P %A Yumak,Zerrin %A Veltkamp,Remco C %K rehabilitation exercise %K computer games %K hip replacement %K elderly %K physical therapists %D 2017 %7 12.10.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. Objective: The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient’s personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient’s medical status. Methods: This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. Results: The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed. Conclusions: The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time. %M 29025696 %R 10.2196/games.7969 %U http://games.jmir.org/2017/4/e19/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 4 %N 2 %P e9 %T Mobile App to Streamline the Development of Wearable Sensor-Based Exercise Biofeedback Systems: System Development and Evaluation %+ Insight Centre for Data AnalyticsUniversity College Dublin3rd Floor, O'Brien Centre for ScienceScience Centre EASTBelfield, D4Ireland353 871245972353 17162667martin.oreilly@insight-centre.org  %A O'Reilly,Martin %A Duffin,Joe %A Ward,Tomas %A Caulfield,Brian %K exercise therapy %K biomedical technology %K lower extremity %K physical therapy specialty %D 2017 %7 21.08.2017 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Biofeedback systems that use inertial measurement units (IMUs) have been shown recently to have the ability to objectively assess exercise technique. However, there are a number of challenges in developing such systems; vast amounts of IMU exercise datasets must be collected and manually labeled for each exercise variation, and naturally occurring technique deviations may not be well detected. One method of combatting these issues is through the development of personalized exercise technique classifiers. Objective: We aimed to create a tablet app for physiotherapists and personal trainers that would automate the development of personalized multiple and single IMU-based exercise biofeedback systems for their clients. We also sought to complete a preliminary investigation of the accuracy of such individualized systems in a real-world evaluation. Methods: A tablet app was developed that automates the key steps in exercise technique classifier creation through synchronizing video and IMU data collection, automatic signal processing, data segmentation, data labeling of segmented videos by an exercise professional, automatic feature computation, and classifier creation. Using a personalized single IMU-based classification system, 15 volunteers (12 males, 3 females, age: 23.8 [standard deviation, SD 1.8] years, height: 1.79 [SD 0.07] m, body mass: 78.4 [SD 9.6] kg) then completed 4 lower limb compound exercises. The real-world accuracy of the systems was evaluated. Results: The tablet app successfully automated the process of creating individualized exercise biofeedback systems. The personalized systems achieved 89.50% (1074/1200) accuracy, with 90.00% (540/600) sensitivity and 89.00% (534/600) specificity for assessing aberrant and acceptable technique with a single IMU positioned on the left thigh. Conclusions: A tablet app was developed that automates the process required to create a personalized exercise technique classification system. This tool can be applied to any cyclical, repetitive exercise. The personalized classification model displayed excellent system accuracy even when assessing acute deviations in compound exercises with a single IMU. %M 28827210 %R 10.2196/rehab.7259 %U http://rehab.jmir.org/2017/2/e9/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 4 %N 2 %P e7 %T Telerehabilitation: Review of the State-of-the-Art and Areas of Application %+ School of PharmacyTelemedicine and TelepharmacyUniversity of CamerinoVia Madonna delle Carceri 9Camerino,Italy39 0737401729alessandro.peretti@unicam.it  %A Peretti,Alessandro %A Amenta,Francesco %A Tayebati,Seyed Khosrow %A Nittari,Giulio %A Mahdi,Syed Sarosh %K telerehabilitation %K rehabilitation %K telemedicine %K health care %K remote rehabilitation assistance %D 2017 %7 21.07.2017 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Various types of telerehabilitation treatments and their relative intensities and duration have been reported. Objective: The objective of this review is to provide a detailed overview of the rehabilitation techniques for remote sites (telerehabilitation) and their fields of application, with analysis of the benefits and the drawbacks related to use. We discuss future applications of telerehabilitation techniques with an emphasis on the development of high-tech devices, and on which new tools and applications can be used in the future. Methods: We retrieved relevant information and data on telerehabilitation from books, articles and online materials using the Medical Subject Headings (MeSH) “telerehabilitation,” “telemedicine,” and “rehabilitation,” as well as “disabling pathologies.” Results: Telerehabilitation can be considered as a branch of telemedicine. Although this field is considerably new, its use has rapidly grown in developed countries. In general, telerehabilitation reduces the costs of both health care providers and patients compared with traditional inpatient or person-to-person rehabilitation. Furthermore, patients who live in remote places, where traditional rehabilitation services may not be easily accessible, can benefit from this technology. However, certain disadvantages of telerehabilitation, including skepticism on the part of patients due to remote interaction with their physicians or rehabilitators, should not be underestimated. Conclusions: This review evaluated different application fields of telerehabilitation, highlighting its benefits and drawbacks. This study may be a starting point for improving approaches and devices for telerehabilitation. In this context, patients’ feedback may be important to adapt rehabilitation techniques and approaches to their needs, which would subsequently help to improve the quality of rehabilitation in the future. The need for proper training and education of people involved in this new and emerging form of intervention for more effective treatment can’t be overstated. %M 28733271 %R 10.2196/rehab.7511 %U http://rehab.jmir.org/2017/2/e7/ %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 3 %P e14 %T Rehabilitation-Oriented Serious Game Development and Evaluation Guidelines for Musculoskeletal Disorders %+ Sorbonne University, Université de technologie de Compiègne, CNRS, UMR 7338 Biomechanics and BioengineeringCentre de recherche RoyallieuCompiègne, CS 60 319France33 034423433433 0344234334tien-tuan.dao@utc.fr  %A Idriss,Mohamad %A Tannous,Halim %A Istrate,Dan %A Perrochon,Anaick %A Salle,Jean-Yves %A Ho Ba Tho,Marie-Christine %A Dao,Tien-Tuan %K rehabilitation exercise %K virtual rehabilitation %K rehabilitation %K user computer interface %K musculoskeletal diseases %D 2017 %7 04.07.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: The progress in information and communication technology (ICT) led to the development of a new rehabilitation technique called “serious game for functional rehabilitation.” Previous works have shown that serious games can be used for general health and specific disease management. However, there is still lack of consensus on development and evaluation guidelines. It is important to note that the game performance depends on the designed scenario. Objective: The objective of this work was to develop specific game scenarios and evaluate them with a panel of musculoskeletal patients to propose game development and evaluation guidelines. Methods: A two-stage workflow was proposed using determinant framework. The development guideline includes the selection of three-dimensional (3D) computer graphics technologies and tools, the modeling of physical aspects, the design of rehabilitation scenarios, and the implementation of the proposed scenarios. The evaluation guideline consists of the definition of evaluation metrics, the execution of the evaluation campaign, the analysis of user results and feedbacks, and the improvement of the designed game. Results: The case study for musculoskeletal disorders on the healthy control and patient groups showed the usefulness of these guidelines and associated games. All participants enjoyed the 2 developed games (football and object manipulation), and found them challenging and amusing. In particular, some healthy subjects increased their score when enhancing the level of difficulty. Furthermore, there were no risks and accidents associated with the execution of these games. Conclusions: It is expected that with the proven effectiveness of the proposed guidelines and associated games, this new rehabilitation game may be translated into clinical routine practice for the benefit of patients with musculoskeletal disorders. %M 28676468 %R 10.2196/games.7284 %U http://games.jmir.org/2017/3/e14/ %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e16 %T Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial %+ Institute of Psychiatry, Psychology and NeuroscienceDepartment of PsychologyKing's College LondonDe Crespigny ParkLondon, SE5 8AFUnited Kingdom44 207848076244 2078480762Sara.Simblett@kcl.ac.uk  %A Simblett,Sara K %A Yates,Matthew %A Wagner,Adam P %A Watson,Peter %A Gracey,Fergus %A Ring,Howard %A Bateman,Andrew %K cognitive therapy %K technology %K stroke %K depression %K anxiety %D 2017 %7 31.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy. Objectives: The aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator. Methods: Of the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment. Results: Both cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, d=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, d=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, d=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups (P=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported. Conclusions: A pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support. %M 28566265 %R 10.2196/mental.6022 %U http://mental.jmir.org/2017/2/e16/ %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e93 %T The Effectiveness of a Computer Game-Based Rehabilitation Platform for Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial %+ College of Rehabilitation SciencesUniversity of ManitobaR 106771 McDermot AveWinnipeg, MB, R3E0T6Canada1 204 787 77471 204 789 3927tony.szturm@umanitoba.ca  %A Kanitkar,Anuprita %A Szturm,Tony %A Parmar,Sanjay %A Gandhi,Dorcas BC %A Rempel,Gina Ruth %A Restall,Gayle %A Sharma,Monika %A Narayan,Amitesh %A Pandian,Jeyaraj %A Naik,Nilashri %A Savadatti,Ravi R %A Kamate,Mahesh Appasaheb %K repetitive task practice %K cerebral palsy %K fine motor skills %K game-based exercise %K randomized controlled trial %K upper extremity function %D 2017 %7 18.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy. As such, there is a need for innovative approaches and tools to motivate these children. We developed the low-cost, computer game-based rehabilitation platform CGR that combines fine manipulation and gross movement exercises with attention and planning game activities appropriate for young children with CP. Objective: The objective of this study is to provide evidence of the therapeutic value of CGR to improve upper extremity (UE) motor function for children with CP. Methods: This randomized controlled, single-blind, clinical trial with an active control arm will be conducted at 4 sites. Children diagnosed with CP between the ages of 4 and 10 years old with moderate UE impairments and fine motor control abnormalities will be recruited. Results: We will test the difference between experimental and control groups using the Quality of Upper Extremity Skills Test (QUEST) and Peabody Developmental Motor Scales, Second Edition (PDMS-2) outcome measures. The parents of the children and the therapist experiences with the interventions and tools will be explored using semi-structured interviews using the qualitative description approach. Conclusions: This research protocol, if effective, will provide evidence for the therapeutic value and feasibility of CGR in the pediatric rehabilitation of UE function. Trial Registration: Clinicaltrials.gov NCT02728375; http:https://clinicaltrials.gov/ct2/show/NCT02728375 (Archived by WebCite at http://www.webcitation.org/6qDjvszvh) %M 28526673 %R 10.2196/resprot.6846 %U http://www.researchprotocols.org/2017/5/e93/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 4 %N 1 %P e5 %T Counting Grasping Action Using Force Myography: An Exploratory Study With Healthy Individuals %+ Schools of Mechatronics Systems Engineering and Engineering ScienceSimon Fraser UniversitySFU Surrey, 4374 Galleria250-13450 102 AvenueSurrey, BC, V3T 0A3Canada1 778 782 93381 778 782 7514cmenon@sfu.ca  %A Xiao,Zhen Gang %A Menon,Carlo %K myography %K classification %K upper extremity %K grasp %K rehabilitation %D 2017 %7 16.05.2017 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Functional arm movements generally require grasping an object. The possibility of detecting and counting the action of grasping is believed to be of importance for individual with motor function deficits of the arm, as it could be an indication of the number of the functional arm movements performed by the individuals during rehabilitation. In this exploratory work, the feasibility of using armbands recording radial displacements of forearm muscles and tendons (ie, force myography, FMG) to estimate hand grasping with healthy individuals was investigated. In contrast to previous studies, this exploratory study investigates the feasibility of (1) detecting grasping when the participants move their arms, which could introduce large artifacts to the point of potentially preventing the practical use of the proposed technology, and (2) counting grasping during arm-reaching tasks. Objective: The aim of this study was to determine the usefulness of FMG in the detection of functional arm movements. The use of FMG straps placed on the forearm is proposed for counting the number of grasping actions in the presence of arm movements. Methods: Ten healthy volunteers participated in this study to perform a pick-and-place exercise after providing informed consent. FMG signals were simultaneously collected using 2 FMG straps worn on their wrist and at the midposition of their forearm, respectively. Raw FMG signals and 3 additional FMG features (ie, root mean square, wavelength, and window symmetry) were extracted and fed into a linear discriminant analysis classifier to predict grasping states. The transition from nongrasping to grasping states was detected during the process of counting the number of grasping actions. Results: The median accuracy for detecting grasping events using FMG recorded from the wrist was 95%, and the corresponding interquartile range (IQR) was 5%. For forearm FMG classification, the median accuracy was 92%, and the corresponding IQR was 3%. The difference between the 2 median accuracies was statistically significant (P<.001) when using a paired 2-tailed sign test. The median percentage error for counting grasping events when FMG was recorded from the wrist was 1%, and the corresponding IQR was 2%. The median percentage error for FMG recorded from the forearm was 2%, and the corresponding IQR was also 2%. While the median percentage error for the wrist was lower than that of the forearm, the difference between the 2 was not statistically significant based on a paired 2-tailed sign test (P=.29). Conclusions: This study reports that grasping can reliably be counted using an unobtrusive and simple FMG strap even in the presence of arm movements. Such a result supports the foundation for future research evaluating the feasibility of monitoring hand grasping during unsupervised ADL, leading to further investigations with individuals with motor function deficits of the arm. %M 28582263 %R 10.2196/rehab.6901 %U http://rehab.jmir.org/2017/1/e5/ %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e8 %T A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase Methodology %+ PhysiologySchool of MedicineNUI GalwayUniversity RoadGalway, IRLIreland353 91493710353 91750544leo.quinlan@nuigalway.ie  %A Harte,Richard %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Baker,Paul MA %A Scharf,Thomas %A Quinlan,Leo R %A ÓLaighin,Gearóid %K human-centered design %K user-centered design %K usability testing %K user interface design %K connected health %K human factors %K mHealth %D 2017 %7 16.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Design processes such as human-centered design, which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of human-centered design can often present a challenge when design teams are faced with the necessary, rapid, product development life cycles associated with the competitive connected health industry. Objective: We wanted to derive a structured methodology that followed the principles of human-centered design that would allow designers and developers to ensure that the needs of the user are taken into account throughout the design process, while maintaining a rapid pace of development. In this paper, we present the methodology and its rationale before outlining how it was applied to assess and enhance the usability, human factors, and user experience of a connected health system known as the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system, a system designed to continuously assess fall risk by measuring gait and balance parameters associated with fall risk. Methods: We derived a three-phase methodology. In Phase 1 we emphasized the construction of a use case document. This document can be used to detail the context of use of the system by utilizing storyboarding, paper prototypes, and mock-ups in conjunction with user interviews to gather insightful user feedback on different proposed concepts. In Phase 2 we emphasized the use of expert usability inspections such as heuristic evaluations and cognitive walkthroughs with small multidisciplinary groups to review the prototypes born out of the Phase 1 feedback. Finally, in Phase 3 we emphasized classical user testing with target end users, using various metrics to measure the user experience and improve the final prototypes. Results: We report a successful implementation of the methodology for the design and development of a system for detecting and predicting falls in older adults. We describe in detail what testing and evaluation activities we carried out to effectively test the system and overcome usability and human factors problems. Conclusions: We feel this methodology can be applied to a wide variety of connected health devices and systems. We consider this a methodology that can be scaled to different-sized projects accordingly. %M 28302594 %R 10.2196/humanfactors.5443 %U http://humanfactors.jmir.org/2017/1/e8/ %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e3 %T Game-Based Rehabilitation for Myoelectric Prosthesis Control %+ Christian Doppler Laboratory for Restoration of Extremity FunctionDepartment of Plastic and Reconstructive SurgeryMedical University of ViennaUniversity Clinic for SurgeryWähringer Gürtel 18-20Vienna, 1090Austria43 140400 ext 6109843 14040061098cosima.prahm@meduniwien.ac.at  %A Prahm,Cosima %A Vujaklija,Ivan %A Kayali,Fares %A Purgathofer,Peter %A Aszmann,Oskar C %K upper limb prosthesis control %K upper extremity amputees %K gaming %K serious games %K neuromuscular rehabilitation %K intrinsic motivation %K EMG control %D 2017 %7 09.02.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: A high number of upper extremity myoelectric prosthesis users abandon their devices due to difficulties in prosthesis control and lack of motivation to train in absence of a physiotherapist. Virtual training systems, in the form of video games, provide patients with an entertaining and intuitive method for improved muscle coordination and improved overall control. Complementary to established rehabilitation protocols, it is highly beneficial for this virtual training process to start even before receiving the final prosthesis, and to be continued at home for as long as needed. Objective: The aim of this study is to evaluate (1) the short-term effects of a commercially available electromyographic (EMG) system on controllability after a simple video game-based rehabilitation protocol, and (2) different input methods, control mechanisms, and games. Methods: Eleven able-bodied participants with no prior experience in EMG control took part in this study. Participants were asked to perform a surface EMG test evaluating their provisional maximum muscle contraction, fine accuracy and isolation of electrode activation, and endurance control over at least 300 seconds. These assessments were carried out (1) in a Pregaming session before interacting with three EMG-controlled computer games, (2) in a Postgaming session after playing the games, and (3) in a Follow-Up session two days after the gaming protocol to evaluate short-term retention rate. After each game, participants were given a user evaluation survey for the assessment of the games and their input mechanisms. Participants also received a questionnaire regarding their intrinsic motivation (Intrinsic Motivation Inventory) at the end of the last game. Results: Results showed a significant improvement in fine accuracy electrode activation (P<.01), electrode separation (P=.02), and endurance control (P<.01) from Pregaming EMG assessments to the Follow-Up measurement. The deviation around the EMG goal value diminished and the opposing electrode was activated less frequently. Participants had the most fun playing the games when collecting items and facing challenging game play. Conclusions: Most upper limb amputees use a 2-channel myoelectric prosthesis control. This study demonstrates that this control can be effectively trained by employing a video game-based rehabilitation protocol. %M 28183689 %R 10.2196/games.6026 %U https://games.jmir.org/2017/1/e3/ %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e26 %T Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients’ Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment %+ Roessingh Research and DevelopmentTelemedicine groupPO Box 310Enschede, 7500 AHNetherlands31 0 53 487577731 0 53 43408k.cranen@rrd.nl  %A Cranen,Karlijn %A Groothuis-Oudshoorn,Catharina GM %A Vollenbroek-Hutten,Miriam MR %A IJzerman,Maarten J %K patient preference %K patient acceptance of health care %K telerehabilitation %K choice behavior %K decision making %K decision support techniques %K patient compliance %K chronic disease %K exercise therapy %K chronic pain %D 2017 %7 20.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients’ preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients’ perspective. In addition, limited evidence is available about the best way to explore patients’ preferences. Therefore, the assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients’ treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: “Intermediate” telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment. %M 28108429 %R 10.2196/jmir.5951 %U http://www.jmir.org/2017/1/e26/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e11 %T A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole %+ Computer Science Research InstituteFaculty of Computing and EngineeringUlster UniversityJordanstownShore Road, NewtownabbeyBelfast, BT37 0QBUnited Kingdom44 02890 36891344 02890 366216rj.davies@ulster.ac.uk  %A Davies,Richard John %A Parker,Jack %A McCullagh,Paul %A Zheng,Huiru %A Nugent,Chris %A Black,Norman David %A Mawson,Susan %K ambulatory monitoring %K gait %K rehabilitation %K self-management %K smart insole %K stroke %D 2016 %7 08.11.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges. Objective: Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home. Methods: A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a “smart insole” to facilitate measurement of walking activities in a free-living, nonrestrictive environment. Results: Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants’ affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use. Conclusion: Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants. %M 28582260 %R 10.2196/rehab.5449 %U http://rehab.jmir.org/2016/2/e11/ %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e259 %T The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review %+ School of Health and Related Research (ScHARR)University of SheffieldRegent Court, 30 Regent StreetSheffield, S14DAUnited Kingdom44 114222827544 1142220749l.a.powell@sheffield.ac.uk  %A Powell,Lauren %A Parker,Jack %A Martyn St-James,Marrissa %A Mawson,Susan %K wearable technology %K stroke %K gait %K rehabilitation %D 2016 %7 07.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness. Objective: This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs. Results: In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity. %M 27717920 %R 10.2196/jmir.5891 %U http://www.jmir.org/2016/10/e259/ %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e265 %T Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial %+ Department of Primary Health CareNorrbotten County CouncilFurunäsets hälsocentralModigs grändPiteå, SE-94152Sweden46 70242090646 91192553Catharina.Nordin@nll.se  %A Nordin,Catharina A %A Michaelson,Peter %A Gard,Gunvor %A Eriksson,Margareta K %K coping behavior %K pain %K patient compliance %K patient satisfaction %K rehabilitation %K self-efficacy %K Web-based intervention %D 2016 %7 05.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). Objective: The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated. Methods: A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items. Results: Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003). Conclusions: Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable. ClinicalTrial: Clinicaltrials.gov NCT01475591; https://clinicaltrials.gov/ct2/show/NCT01475591 (Archived by WebCite at http://www.webcitation.org/6kUnt7VQh) %M 27707686 %R 10.2196/jmir.5634 %U http://www.jmir.org/2016/10/e265/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e9 %T How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information %+ School of Electrical Engineering and Computer ScienceQueensland University of TechnologyGPO Box 2434Brisbane, 4001Australia61 73138 ext 492761 731384927b.ploderer@qut.edu.au  %A Ploderer,Bernd %A Fong,Justin %A Klaic,Marlena %A Nair,Siddharth %A Vetere,Frank %A Cofré Lizama,L. Eduardo %A Galea,Mary Pauline %K stroke %K upper-limb rehabilitation %K therapy %K information visualization %K dashboard %K wearable technology %D 2016 %7 05.10.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Stroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30% to 60% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients’ adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient’s arm movement and a Web-based dashboard to visualize this information for therapists. Objective: The aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process. Methods: An interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis. Results: Therapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients’ activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and (3) to engage with other clinicians and researchers based on objective data. A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living. Conclusions: Upper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and visualization of contextual information to provide meaningful insights into patient engagement in activities of daily living. These findings open the door for further work to develop a fully functioning system and to trial it with patients and clinicians during therapy. %M 28582257 %R 10.2196/rehab.6182 %U http://rehab.jmir.org/2016/2/e9/ %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e16 %T Effects of Visual Display on Joint Excursions Used to Play Virtual Dodgeball %+ School of Rehabilitation and Communication SciencesOhio UniversityW281 Grover CenterAthens, OH, 45701United States1 740 593 41781 740 593 0293thomasj5@ohio.edu  %A Thomas,James S %A France,Christopher R %A Applegate,Megan E %A Leitkam,Samuel T %A Pidcoe,Peter E %A Walkowski,Stevan %K virtual reality %K avatar presentation %K joint kinematics %D 2016 %7 15.09.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) interventions hold great potential for rehabilitation as commercial systems are becoming more affordable and can be easily applied to both clinical and home settings. Objective: In this study, we sought to determine how differences in the VR display type can influence motor behavior, cognitive load, and participant engagement. Methods: Movement patterns of 17 healthy young adults (8 female, 9 male) were examined during games of Virtual Dodgeball presented on a three-dimensional television (3DTV) and a head-mounted display (HMD). The participant’s avatar was presented from a third-person perspective on a 3DTV and from a first-person perspective on an HMD. Results: Examination of motor behavior revealed significantly greater excursions of the knee (P=.003), hip (P<.001), spine (P<.001), shoulder (P=.001), and elbow (P=.026) during HMD versus 3DTV gameplay, resulting in significant differences in forward (P=.003) and downward (P<.001) displacement of the whole-body center of mass. Analyses of cognitive load and engagement revealed that relative to 3DTV, participants indicated that HMD gameplay resulted in greater satisfaction with overall performance and was less frustrating (P<.001). There were no significant differences noted for mental demand. Conclusions: Differences in visual display type and participant perspective influence how participants perform in Virtual Dodgeball. Because VR use within rehabilitation settings is often designed to help restore movement following orthopedic or neurologic injury, these findings provide an important caveat regarding the need to consider the potential influence of presentation format and perspective on motor behavior. %M 27634561 %R 10.2196/games.6476 %U http://games.jmir.org/2016/2/e16/ %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e171 %T Application of a Web-Enabled Leg Training System for the Objective Monitoring and Quantitative Analysis of Exercise-Induced Fatigue %+ MedExercise ProjectResearch and DevelopmentMDXD Pty LtdUnit 765 Sandringham StreetSydney,Australia61 42521605661 295296245vdedov@tpg.com.au  %A Dedov,Vadim N %A Dedova,Irina V %K exercise intervention %K cardiac rehabilitation %K training equipment %K online monitoring %K exercise dose %K muscle fatigue %K heart rate %K leg work output %K fatigability %D 2016 %7 22.08.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Sustained cardiac rehabilitation is the key intervention in the prevention and treatment of many human diseases. However, implementation of exercise programs can be challenging because of early fatigability in patients with chronic diseases, overweight individuals, and aged people. Current methods of fatigability assessment are based on subjective self-reporting such as rating of perceived exertion or require specialized laboratory conditions and sophisticated equipment. A practical approach allowing objective measurement of exercise-induced fatigue would be useful for the optimization of sustained delivery of cardiac rehabilitation to improve patient outcomes. Objectives: The objective of this study is to develop and validate an innovative approach, allowing for the objective assessment of exercise-induced fatigue using the Web-enabled leg rehabilitation system. Methods: MedExercise training devices were equipped with wireless temperature sensors in order to monitor their usage by temperature rise in the resistance unit (Δt°). Since Δt° correlated with the intensity and duration of exercise, this parameter was used to characterize participants’ leg work output (LWO). Personal smart devices such as laptop computers with wireless gateways and relevant software were used for monitoring of self-control training. Connection of smart devices to the Internet and cloud-based software allowed remote monitoring of LWO in participants training at home. Heart rates (HRs) were measured by fingertip pulse oximeters simultaneously with Δt° in 7 healthy volunteers. Results: Exercise-induced fatigue manifested as the decline of LWO and/or rising HR, which could be observed in real-time. Conversely, training at the steady-state LWO and HR for the entire duration of exercise bout was considered as fatigue-free. The amounts of recommended daily physical activity were expressed as the individual Δt° values reached during 30-minute fatigue-free exercise of moderate intensity resulting in a mean of 8.1°C (SD 1.5°C, N=7). These Δt° values were applied as the thresholds for sending automatic notifications upon taking the personalized LWO doses by self-control training at home. While the mean time of taking LWO doses was 30.3 (SD 4.1) minutes (n=25), analysis of times required to reach the same Δt° by the same participant revealed that longer durations were due to fatigability, manifesting as reduced LWO at the later stages of training bouts. Typically, exercising in the afternoons associated with no fatigue, although longer durations of evening sessions suggested a diurnal fatigability pattern. Conclusions: This pilot study demonstrated the feasibility of objective monitoring of fatigue development in real-time and online as well as retrospective fatigability quantification by the duration of training bouts to reach the same exercise dose. This simple method of leg training at home accompanied by routine fatigue monitoring might be useful for the optimization of exercise interventions in primary care and special populations. %M 27549345 %R 10.2196/resprot.4985 %U http://www.researchprotocols.org/2016/3/e171/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e7 %T Machine Learning to Improve Energy Expenditure Estimation in Children With Disabilities: A Pilot Study in Duchenne Muscular Dystrophy %+ Department of Computer ScienceUniversity of California DavisOne Shields AveDavis, CA,United States1 530 554 15541 530 752 4767pande@ucdavis.edu  %A Pande,Amit %A Mohapatra,Prasant %A Nicorici,Alina %A Han,Jay J %K accelerometry %K physical activity %K heart rate %K neuromuscular disease %K children %D 2016 %7 19.07.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Children with physical impairments are at a greater risk for obesity and decreased physical activity. A better understanding of physical activity pattern and energy expenditure (EE) would lead to a more targeted approach to intervention. Objective: This study focuses on studying the use of machine-learning algorithms for EE estimation in children with disabilities. A pilot study was conducted on children with Duchenne muscular dystrophy (DMD) to identify important factors for determining EE and develop a novel algorithm to accurately estimate EE from wearable sensor-collected data. Methods: There were 7 boys with DMD, 6 healthy control boys, and 22 control adults recruited. Data were collected using smartphone accelerometer and chest-worn heart rate sensors. The gold standard EE values were obtained from the COSMED K4b2 portable cardiopulmonary metabolic unit worn by boys (aged 6-10 years) with DMD and controls. Data from this sensor setup were collected simultaneously during a series of concurrent activities. Linear regression and nonlinear machine-learning–based approaches were used to analyze the relationship between accelerometer and heart rate readings and COSMED values. Results: Existing calorimetry equations using linear regression and nonlinear machine-learning–based models, developed for healthy adults and young children, give low correlation to actual EE values in children with disabilities (14%-40%). The proposed model for boys with DMD uses ensemble machine learning techniques and gives a 91% correlation with actual measured EE values (root mean square error of 0.017). Conclusions: Our results confirm that the methods developed to determine EE using accelerometer and heart rate sensor values in normal adults are not appropriate for children with disabilities and should not be used. A much more accurate model is obtained using machine-learning–based nonlinear regression specifically developed for this target population. %M 28582264 %R 10.2196/rehab.4340 %U http://rehab.jmir.org/2016/2/e7/ %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e8 %T Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series %+ School of Health ProfessionsUniversity of Alabama at Birmingham1720 2nd Ave SBirmingham, AL,United States1 205 934 59041 205 975 7787bickel@uab.edu  %A Lai,Byron %A Rimmer,James %A Barstow,Beth %A Jovanov,Emil %A Bickel,C Scott %K exercise %K physical activity %K telehealth %K spinal cord injury %K persons with disabilities %D 2016 %7 14.07.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. Objective: To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. Methods: Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. Results: Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. Conclusion: A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample. %M 28582252 %R 10.2196/rehab.5524 %U http://rehab.jmir.org/2016/2/e8/ %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e69 %T Cardiac Patients’ Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial %+ Department of Cardiothoracic SurgeryAalborg University HospitalSøndre Skovvej 5, 313Aalborg, 9000Denmark45 2072995045 78453075cbt@rn.dk  %A Thorup,Charlotte %A Hansen,John %A Grønkjær,Mette %A Andreasen,Jan Jesper %A Nielsen,Gitte %A Sørensen,Erik Elgaard %A Dinesen,Birthe Irene %K heart disease %K rehabilitation %K step counters %K physical activity %K telerehabilitation %D 2016 %7 04.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients’ adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event. Objective: The purpose of this substudy was to explore cardiac patients’ walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data. Methods: A total of 64 patients from a randomized controlled telerehabilitation trial (Teledi@log) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In Teledi@log, the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps. Results: Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups. Conclusions: This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients’ behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters. Trial Registration: ClinicalTrails.gov NCT01752192; https://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6fgigfUyV) %M 27044310 %R 10.2196/jmir.5191 %U http://www.jmir.org/2016/4/e69/ %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e2 %T Feasibility of Applied Gaming During Interdisciplinary Rehabilitation for Patients With Complex Chronic Pain and Fatigue Complaints: A Mixed-Methods Study %+ Tranzo Scientific Center for Care and WelfareTilburg School of Social and Behavioral SciencesTilburg UniversityP.O. Box 90153Tilburg, 5000 LENetherlands31 13 466 827131 13 466 8271m.a.p.vugts@tilburguniversity.edu  %A Vugts,Miel A P %A Joosen,Margot C W %A van Bergen,Alfonsus H M M %A Vrijhoef,Hubertus J M %K behavioral medicine %K therapy %K computer-assisted %K computer games %K mind-body therapies %K patient acceptance of health care %K feasibility studies %K fatigue syndrome, chronic %K fibromyalgia %K musculoskeletal pain %D 2016 %7 01.04.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Applied gaming holds potential as a convenient and engaging means for the delivery of behavioral interventions. For developing and evaluating feasible computer-based interventions, policy makers and designers rely on limited knowledge about what causes variation in usage. Objective: In this study, we looked closely at why and by whom an applied game (LAKA) is demanded and whether it is feasible (with respect to acceptability, demand, practicality, implementation, and efficacy) and devised a complementary intervention during an interdisciplinary rehabilitation program (IRP) for patients with complex chronic pain and fatigue complaints. Methods: A mixed-methods design was used. Quantitative process analyses and assessments of feasibility were carried out with patients of a Dutch rehabilitation center who received access to LAKA without professional support during a 16-week interdisciplinary outpatient program. The quantitative data included records of routinely collected baseline variables (t0), additional surveys to measure technology acceptance before (t1) and after 8 weeks of access to LAKA (t2), and automatic log files of usage behavior (frequency, length, and progress). Subsequently, semistructured interviews were held with purposively selected patients. Interview codes triangulated and illustrated explanations of usage and supplemented quantitative findings on other feasibility domains. Results: Of the 410 eligible patients who started an IRP during the study period, 116 patients participated in additional data collections (108 with problematic fatigue and 47 with moderate or severe pain). Qualitative data verified that hedonic motivation was the most important factor for behavioral intentions to use LAKA (P<.001). Moreover, quotes illustrated a positive association between usage intentions (t1) and baseline level (t0) coping by active engagement (Spearman ρ=0.25; P=.008) and why patients who often respond by seeking social support were represented in a group of 71 patients who accessed the game (P=.034). The median behavioral intention to use LAKA was moderately positive and declined over time. Twenty patients played the game from start to finish. Behavioral change content was recognized and seen as potentially helpful by interview respondents who exposed themselves to the content of LAKA. Conclusions: Variation in the demand for applied gaming is generally explained by perceived enjoyment and effort and by individual differences in coping resources. An applied game can be offered as a feasible complementary intervention for more patients with complex chronic pain or fatigue complaints by embedding and delivering in alignment with patient experiences. Feasibility, effectiveness, and cost-effectiveness can be evaluated in a full-scale evaluation. New observations elicit areas of further research on the usage of computer-based interventions. %M 27036094 %R 10.2196/games.5088 %U http://games.jmir.org/2016/1/e2/ %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 2 %P e11 %T Automated Management of Exercise Intervention at the Point of Care: Application of a Web-Based Leg Training System %+ MedExercise ProjectResearch and DevelopmentMDXD Pty LtdUnit 765 Sandringham StreetSydney, 2219Australia61 425 216 05661 295 296 245vdedov@tpg.com.au  %A Dedov,Vadim N %A Dedova,Irina V %K digital intervention %K exercise intervention %K cardiac rehabilitation %K training equipment %K online monitoring %K exercise dose %K telerehabilitation %K leg mobilization %K Web-based apps %K eHealth recordings %D 2015 %7 23.11.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Recent advances in information and communication technology have prompted development of Web-based health tools to promote physical activity, the key component of cardiac rehabilitation and chronic disease management. Mobile apps can facilitate behavioral changes and help in exercise monitoring, although actual training usually takes place away from the point of care in specialized gyms or outdoors. Daily participation in conventional physical activities is expensive, time consuming, and mostly relies on self-management abilities of patients who are typically aged, overweight, and unfit. Facilitation of sustained exercise training at the point of care might improve patient engagement in cardiac rehabilitation. Objective: In this study we aimed to test the feasibility of execution and automatic monitoring of several exercise regimens on-site using a Web-enabled leg training system. Methods: The MedExercise leg rehabilitation machine was equipped with wireless temperature sensors in order to monitor its usage by the rise of temperature in the resistance unit (Δt°). Personal electronic devices such as laptop computers were fitted with wireless gateways and relevant software was installed to monitor the usage of training machines. Cloud-based software allowed monitoring of participant training over the Internet. Seven healthy participants applied the system at various locations with training protocols typically used in cardiac rehabilitation. The heart rates were measured by fingertip pulse oximeters. Results: Exercising in home chairs, in bed, and under an office desk was made feasible and resulted in an intensity-dependent increase of participants’ heart rates and Δt° in training machine temperatures. Participants self-controlled their activities on smart devices, while a supervisor monitored them over the Internet. Individual Δt° reached during 30 minutes of moderate-intensity continuous training averaged 7.8°C (SD 1.6). These Δt° were used as personalized daily doses of exercise with automatic email alerts sent upon achieving them. During 1-week training at home, automatic notifications were received on 4.4 days (SD 1.8). Although the high intensity interval training regimen was feasible on-site, it was difficult for self- and remote management. Opportunistic leg exercise under the desk, while working with a computer, and training in bed while viewing television were less intensive than dosed exercise bouts, but allowed prolonged leg mobilization of 73.7 minutes/day (SD 29.7). Conclusions: This study demonstrated the feasibility of self-control exercise training on-site, which was accompanied by online monitoring, electronic recording, personalization of exercise doses, and automatic reporting of adherence. The results suggest that this technology and its applications are useful for the delivery of Web-based exercise rehabilitation and cardiac training programs at the point of care. %M 28582243 %R 10.2196/rehab.4812 %U http://rehab.jmir.org/2015/2/e11/ %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 2 %P e10 %T Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera %+ Shubert Consulting1 Coggins Mine CtChapel Hill, NC, North CarolinaUnited States1 919 360 19701 919 360 1970tiffany@shubertconsulting.net  %A Shubert,Tiffany E %A Basnett,Jeanna %A Chokshi,Anang %A Barrett,Mark %A Komatireddy,Ravi %K aging, fall prevention, technology, evidence-based, Kinect, falls %D 2015 %7 05.11.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs. Objective: Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise. Methods: Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience. Results: A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as “at risk for falls”. Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 ± 21.2 with a range of 32.5 to 97.5. Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk. Conclusions: Results support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries. Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care. %M 28582244 %R 10.2196/rehab.4776 %U http://rehab.jmir.org/2015/2/e10/ %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e118 %T Games and Telerehabilitation for Balance Impairments and Gaze Dysfunction: Protocol of a Randomized Controlled Trial %+ College of Rehabilitation SciencesDepartment of Physical TherapyUniversity of ManitobaR106771 McDermot Avenue,Winnipeg, MB, R3E 0T6Canada1 (204) 789 38971 (204) 789 3927tony.szturm@umanitoba.ca  %A Szturm,Tony %A Hochman,Jordan %A Wu,Christine %A Lisa,Lix %A Reimer,Karen %A Wonneck,Beth %A Giacobbo,Andrea %K balance-exercises %K gaze-exercises %K home therapy %K telerehabilitation %K therapeutic-gaming %K vestibular rehabilitation %D 2015 %7 21.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Digital media and gaming have received considerable interest from researchers and clinicians as a model for learning a broad range of complex tasks and facilitating the transfer of skills to daily life. These emerging rehabilitation technologies have the potential to improve clinical outcomes and patient participation because they are engaging, motivating, and accessible. Our research goal is to develop preventative and therapeutic point-of-care eHealth applications that will lead to equivalent or better long-term health outcomes and health care costs than existing programs. We have produced a novel computer-aided tele-rehabilitation platform that combines computer game-based exercises with tele-monitoring. Objective: Compare the therapeutic effectiveness of an in-home, game-based rehabilitation program (GRP) to standard care delivered in an outpatient physical therapy clinic on measures of balance, gaze control, dizziness, and health-related quality of life. Methods: A randomized, controlled, single-blind pilot trial will be conducted. Fifty-six participants with a diagnosis of peripheral vestibular disorder will be randomly assigned to either usual physical therapy (comparator group) or to a game-based intervention (experimental group). Measures to be assessed will include gaze control, dynamic balance, and self-reported measures of dizziness. Results: The project was funded and enrollment was started in August 2014. To date, 36 participants have been enrolled. There have been 6 drop-outs. It is expected that the study will be completed January 2016 and the first results are expected to be submitted for publication in Spring of 2016. Conclusions: A successful application of this rehabilitation program would help streamline rehabilitation services, leverage therapist time spent with clients, and permit regular practice times at the client’s convenience. Trial Registration: Clinicaltrials.gov: NCT02134444; https://clinicaltrials.gov/ct2/show/NCT02134444 (Archived by WebCite at http://www.webcitation.org/6cE18bqqY) %M 26490109 %R 10.2196/resprot.4743 %U http://www.researchprotocols.org/2015/4/e118/ %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 2 %P e8 %T Interchangeability of the Wii Balance Board for Bipedal Balance Assessment %+ Laboratory of Anatomy, Biomechanics and Organogenesis (LABO)Faculty of MedicineUniversité Libre de BruxellesLennik Street 808Brussels, 1070Belgium32 2555626232 25556378bbonnech@ulb.ac.be  %A Bonnechère,Bruno %A Jansen,Bart %A Omelina,Lubos %A Rooze,Marcel %A Van Sint Jan,Serge %K force plate %K balance board %K balance performance %K validity %K repeatability %D 2015 %7 27.08.2015 %9 Short Paper %J JMIR Rehabil Assist Technol %G English %X Background: Since 2010, an increasing interest in more portable and flexible hardware for balance and posture assessment led to previously published studies determining whether or not the Wii Balance Board could be used to assess balance and posture, both scientifically and clinically. However, no previous studies aimed at comparing results from different Wii Balance Boards for clinical balance evaluation exist. Objective: The objective of this crossover study is to assess the interchangeability of the Wii Balance Board. Methods: A total of 6 subjects participated in the study and their balance was assessed using 4 different Wii Balance Boards. Trials were recorded simultaneously with Wii Balance Boards and with a laboratory force plate. Nine relevant clinical parameters were derived from center of pressure displacement data obtained from Wii Balance Board and force plate systems. Intraclass correlation coefficients (ICC), F tests, and Friedman tests were computed to assess the agreement between trials and to compare the Wii Balance Board and force plate results. Results: Excellent correlations were found between the Wii Balance Board and force plate (mean ρ =.83). With the exception of 2 parameters, strong to excellent agreements were found for the 7 remaining parameters (ICC=.96). No significant differences were found between trials recorded with different Wii Balance Boards. Conclusions: Our results indicate that for most of the parameters analyzed, balance and posture assessed with one Wii Balance Board were statistically similar to results obtained from another. Furthermore, the good correlation between the Wii Balance Board and force plate results shows that Wii Balance Boards can be reliably used for scientific assessment using most of the parameters analyzed in this study. These results also suggest that the Wii Balance Board could be used in multicenter studies and therefore, would allow for the creation of larger populations for clinical studies. Trial Registration: Ethical Committee of the Erasme Hospital (CCB B406201215142). %M 28582237 %R 10.2196/rehab.3832 %U http://rehab.jmir.org/2015/2/e8/ %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e11 %T Usability and Acceptability of ASSESS MS: Assessment of Motor Dysfunction in Multiple Sclerosis Using Depth-Sensing Computer Vision %+ Microsoft ResearchHuman Experience & Design21 Station RoadCambridge, United Kingdom44 1223 47995144 1223 479700cecilym@microsoft.com  %A Morrison,Cecily %A D'Souza,Marcus %A Huckvale,Kit %A Dorn,Jonas F %A Burggraaff,Jessica %A Kamm,Christian Philipp %A Steinheimer,Saskia Marie %A Kontschieder,Peter %A Criminisi,Antonio %A Uitdehaag,Bernard %A Dahlke,Frank %A Kappos,Ludwig %A Sellen,Abigail %K depth-sensing computer vision %K information interfaces and presentation %K Kinect %K motor skills %K multiple sclerosis %K rehabilitation %D 2015 %7 24.06.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: Sensor-based recordings of human movements are becoming increasingly important for the assessment of motor symptoms in neurological disorders beyond rehabilitative purposes. ASSESS MS is a movement recording and analysis system being developed to automate the classification of motor dysfunction in patients with multiple sclerosis (MS) using depth-sensing computer vision. It aims to provide a more consistent and finer-grained measurement of motor dysfunction than currently possible. Objective: To test the usability and acceptability of ASSESS MS with health professionals and patients with MS. Methods: A prospective, mixed-methods study was carried out at 3 centers. After a 1-hour training session, a convenience sample of 12 health professionals (6 neurologists and 6 nurses) used ASSESS MS to capture recordings of standardized movements performed by 51 volunteer patients. Metrics for effectiveness, efficiency, and acceptability were defined and used to analyze data captured by ASSESS MS, video recordings of each examination, feedback questionnaires, and follow-up interviews. Results: All health professionals were able to complete recordings using ASSESS MS, achieving high levels of standardization on 3 of 4 metrics (movement performance, lateral positioning, and clear camera view but not distance positioning). Results were unaffected by patients’ level of physical or cognitive disability. ASSESS MS was perceived as easy to use by both patients and health professionals with high scores on the Likert-scale questions and positive interview commentary. ASSESS MS was highly acceptable to patients on all dimensions considered, including attitudes to future use, interaction (with health professionals), and overall perceptions of ASSESS MS. Health professionals also accepted ASSESS MS, but with greater ambivalence arising from the need to alter patient interaction styles. There was little variation in results across participating centers, and no differences between neurologists and nurses. Conclusions: In typical clinical settings, ASSESS MS is usable and acceptable to both patients and health professionals, generating data of a quality suitable for clinical analysis. An iterative design process appears to have been successful in accounting for factors that permit ASSESS MS to be used by a range of health professionals in new settings with minimal training. The study shows the potential of shifting ubiquitous sensing technologies from research into the clinic through a design approach that gives appropriate attention to the clinic environment. %M 27025782 %R 10.2196/humanfactors.4129 %U http://humanfactors.jmir.org/2015/1/e11/ %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e131 %T The Relationship Between Balance Measured With a Modified Bathroom Scale and Falls and Disability in Older Adults: A 6-Month Follow-Up Study %+ School for Public Health and Primary Care (CAPHRI)Department of Health Services ResearchMaastricht UniversityDuboisdomein 30Maastricht, 6229 GTNetherlands31 43388219931 433884162j.vermeulen@maastrichtuniversity.nl  %A Vermeulen,Joan %A Neyens,Jacques CL %A Spreeuwenberg,Marieke D %A van Rossum,Erik %A Boessen,April BCG %A Sipers,Walther %A de Witte,Luc P %K telemonitoring %K balance %K bathroom scale %K older adults %K falls %K disability %K validity %D 2015 %7 27.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale. Objective: The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults. Methods: For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated—higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up. Results: A total of 128 participants with complete datasets—25.8% (33/128) male—and a mean age of 75.33 years (SD 6.26) were included in the analyses of this study. Balance scores of participants who reported at baseline that they had fallen at least once in the past 6 months were lower compared to nonfallers—8.9 and 11.2, respectively (P<.001). The correlation between mean balance score and disability sum-score at baseline was -.51 (P<.001). No significant associations were found between balance at baseline and falls after 6 months of follow-up. Baseline balance scores were significantly associated with the development of disability after 6 months of follow-up in the univariate analysis—odds ratio (OR) 0.86 (95% CI 0.76-0.98)—but not in the multivariate analysis when correcting for age, gender, baseline disability, and falls at follow-up—OR 0.94 (95% CI 0.79-1.11). Conclusions: There is a cross-sectional relationship between balance measured by a modified bathroom scale and falls and disability in older adults. Despite this cross-sectional relationship, longitudinal data showed that balance scores have no predictive value for falls and might only have limited predictive value for disability development after 6 months of follow-up. %M 26018423 %R 10.2196/jmir.3802 %U http://www.jmir.org/2015/5/e131/ %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 1 %P e5 %T A Smart Insole to Promote Healthy Aging for Frail Elderly Individuals: Specifications, Design, and Preliminary Results %+ CHU de ToulouseGerontopôleUPS170 Avenue de CasselarditF-31400 Toulouse, France33 56132301033 561325232piau.a@chu-toulouse.fr  %A Piau,Antoine %A Charlon,Yoann %A Campo,Eric %A Vellas,Bruno %A Nourhashemi,Fati %K frail elderly %K gait %K healthy aging %K wearable sensors %D 2015 %7 25.05.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Older individuals frequently experience reversible “frailty syndrome,”, increasing incidence of disability. Although physical exercise interventions may delay functional decline, there are difficulties in implementing them and performing seamless follow-up at home. Very few technological solutions attempt to address this challenge and improve individual participation. Objective: Our objectives are to (1) develop a technological solution designed to support active aging of frail older persons, (2) conduct a first laboratory evaluation of the device, and (3) design a multidimensional clinical trial to validate our solution. Methods: We conducted a first phase of multidisciplinary meetings to identify real end users and health professional’s unmet needs, and to produce specifications for the architecture of the solution. In a second phase, we performed laboratory tests of the first proposed prototype (a smart insole) with 3 healthy volunteers. We then designed an ongoing clinical trial to finalize the multidimensional evaluation and improvement of the solution. Results: To respond to the needs expressed by the stakeholders (frailty monitoring and adherence improvement), we developed a prototype of smart shoe insole to monitor key parameters of frailty during daily life and promote walking. It is a noninvasive wireless insole, which automatically measures gait parameters and transmits information to a remote terminal via a secure Internet connection. To ensure the solution’s autonomy and transparency, we developed an original energy harvesting system, which transforms mechanical energy produced by the user’s walking movement into electrical energy. The first laboratory tests of this technological solution showed good reliability measures and also a good acceptability for the users. We have planned an original iterative medical research protocol to validate our solution in real life. Conclusions: Our smart insole could support preventive strategies against disability in primary care by empowering the older patients without increasing the busy health professional’s workload. Trial Registration: Clinicaltrials.gov NCT02316600; https://clinicaltrials.gov/ct2/results?term=NCT02316600&Search=Search. Accessed: 2015-05-13 . (Archived by WebCite at http://www.webcitation.org/6YUTkObrQ). %M 28582238 %R 10.2196/rehab.4084 %U http://rehab.jmir.org/2015/1/e5/ %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 1 %P e3 %T Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults %+ Rehabilitation Research Program, Vancouver Coastal Health Research InstituteDepartment of Occupational TherapyUniversity of ManitobaR106771 McDermot AvenueWinnipeg, MB, Canada1 204 977 56301 204 789 3927ed.giesbrecht@umanitoba.ca  %A Giesbrecht,Edward Mark %A Miller,William C %A Jin,Boyang Tom %A Mitchell,Ian M %A Eng,Janice J %K wheelchairs %K telemedicine %K self-efficacy %K aged %K pilot projects %D 2015 %7 30.04.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Alternative and innovative strategies such as mHealth and eLearning are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due in part to restricted availability of clinicians and challenges for consumers to attend appointments. A research team of occupational therapists and computer scientists engaged clinicians, consumers, and care providers using a participatory action design approach. A tablet-based application, Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), was developed to enable in-chair home training, online expert trainer monitoring, and trainee-trainer communication via secure voice messaging. Objective: Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted to determine the acceptability and feasibility of administering an mHealth wheelchair skills training program safely and effectively with two participants of different skill levels. The findings were used to determine whether further enhancements to the program were indicated. Methods: The program included two in-person sessions with an expert trainer and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided with a 10-inch Android tablet, mounting apparatus, and mobile Wi-Fi device. Frequency and duration of tablet interactions were monitored and uploaded daily to an online trainer interface. Participants completed a structured evaluation survey and provided feedback post-study. The trainer provided feedback on the training protocol and trainer interface. Results: Both participants perceived the program to be comprehensive, useful, and easily navigated. The trainer indicated usage data was comprehensive and informative for monitoring participant progress and adherence. The application performed equally well with multiple devices. Some initial issues with log-in requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, was specific to individual Wi-Fi devices and resolved by standardizing configuration. Based on the pilot results, the software was updated to make content download more robust. Additional features were also incorporated such as check marks for completed content, a more consumer-friendly aesthetic, and achievement awards. The trainer web interface was updated to improve usability and provides both a numerical and visual summary of participant data. Conclusions: The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults, justifying advancement to evaluation in an RCT. The program may be expanded for use with other rehabilitation interventions and populations, particularly for those living in rural or remote locations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities. Trial Registration: ClinicalTrials.gov NCT01644292; https://clinicaltrials.gov/ct2/show/NCT01644292 (Archived by WebCite at http://www.webcitation.org/6XyvYyTUf). %M 28582240 %R 10.2196/rehab.4274 %U http://rehab.jmir.org/2015/1/e3/ %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e39 %T The Use of Virtual World-Based Cardiac Rehabilitation to Encourage Healthy Lifestyle Choices Among Cardiac Patients: Intervention Development and Pilot Study Protocol %+ Mayo Clinic College of MedicineDepartment of Medicine200 First Street SWRochester, MN, 55905United States1 507 284 96011 507 266 0228kopecky.stephen@mayo.edu  %A Brewer,LaPrincess C %A Kaihoi,Brian %A Zarling,Kathleen K %A Squires,Ray W %A Thomas,Randal %A Kopecky,Stephen %K cardiac rehabilitation %K cardiovascular diseases %K eHealth %K telemedicine %K Internet %K health behavior %D 2015 %7 08.04.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite proven benefits through the secondary prevention of cardiovascular disease (CVD) and reduction of mortality, cardiac rehabilitation (CR) remains underutilized in cardiac patients. Underserved populations most affected by CVD including rural residents, low socioeconomic status patients, and racial/ethnic minorities have the lowest participation rates due to access barriers. Internet-and mobile-based lifestyle interventions have emerged as potential modalities to complement and increase accessibility to CR. An outpatient CR program using virtual world technology may provide an effective alternative to conventional CR by overcoming patient access limitations such as geographics, work schedule constraints, and transportation. Objective: The objective of this paper is to describe the research protocol of a two-phased, pilot study that will assess the feasibility (Phase 1) and comparative effectiveness (Phase 2) of a virtual world-based (Second Life) CR program as an extension of a conventional CR program in achieving healthy behavioral change among post-acute coronary syndrome (ACS) and post-percutaneous coronary intervention (PCI) patients. We hypothesize that virtual world CR users will improve behaviors (physical activity, diet, and smoking) to a greater degree than conventional CR participants. Methods: In Phase 1, we will recruit at least 10 patients enrolled in outpatient CR who were recently hospitalized for an ACS (unstable angina, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction) or who recently underwent elective PCI at Mayo Clinic Hospital, Rochester Campus in Rochester, MN with at least one modifiable, lifestyle risk factor target (sedentary lifestyle, unhealthy diet, and current smoking). Recruited patients will participate in a 12-week, virtual world health education program which will provide feedback on the feasibility, usability, and design of the intervention. During Phase 2, we will conduct a 2-arm, parallel group, single-center, randomized controlled trial (RCT). Patients will be randomized at a 1:1 ratio to adjunct virtual world-based CR with conventional CR or conventional CR only. The primary outcome is a composite including at least one of the following (1) at least 150 minutes of physical activity per week, (2) daily consumption of five or more fruits and vegetables, and (3) smoking cessation. Patients will be assessed at 3, 6, and 12 months. Results: The Phase 1 feasibility study is currently open for recruitment which will be followed by the Phase 2 RCT. The anticipated completion date for the study is May 2016. Conclusions: While research on the use of virtual world technology in health programs is in its infancy, it offers unique advantages over current Web-based health interventions including social interactivity and active learning. It also increases accessibility to vulnerable populations who have higher burdens of CVD. This study will yield results on the effectiveness of a virtual world-based CR program as an innovative platform to influence healthy lifestyle behavior and self-efficacy. %M 25857331 %R 10.2196/resprot.4285 %U http://www.researchprotocols.org/2015/2/e39/ %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e83 %T Cost Analysis of In-Home Telerehabilitation for Post-Knee Arthroplasty %+ Research Centre on Aging, University Institute of Geriatrics of Sherbrooke1036 Belvédère SudSherbrooke, QC, J1H4C4Canada1 819 780 2220 ext 453511 819 829 7141michel.tousignant@usherbrooke.ca  %A Tousignant,Michel %A Moffet,Hélène %A Nadeau,Sylvie %A Mérette,Chantal %A Boissy,Patrick %A Corriveau,Hélène %A Marquis,François %A Cabana,François %A Ranger,Pierre %A Belzile,Étienne L %A Dimentberg,Ronald %K telemedicine %K economics %K cost analysis %K knee arthroplasty %D 2015 %7 31.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation. Objective: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits. Methods: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student’s t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs). Results: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient’s home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $90<$152, P<.001). Conclusions: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient’s home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient’s home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic. Trial Registration: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4). %M 25840501 %R 10.2196/jmir.3844 %U http://www.jmir.org/2015/3/e83/ %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 1 %P e2 %T Measurement and Data Transmission Validity of a Multi-Biosensor System for Real-Time Remote Exercise Monitoring Among Cardiac Patients %+ Department of Sport and Exercise ScienceUniversity of AucklandPrivate Bag 92019Auckland, 1142New Zealand64 9 373 7599 ext 8449864 9 373 7043j.rawstorn@auckland.ac.nz  %A Rawstorn,Jonathan C %A Gant,Nicholas %A Warren,Ian %A Doughty,Robert Neil %A Lever,Nigel %A Poppe,Katrina K %A Maddison,Ralph %K telemedicine %K remote sensing technology %K telemetry %K smartphone %K mHealth %K rehabilitation %K cardiac rehabilitation %D 2015 %7 20.03.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Remote telemonitoring holds great potential to augment management of patients with coronary heart disease (CHD) and atrial fibrillation (AF) by enabling regular physiological monitoring during physical activity. Remote physiological monitoring may improve home and community exercise-based cardiac rehabilitation (exCR) programs and could improve assessment of the impact and management of pharmacological interventions for heart rate control in individuals with AF. Objective: Our aim was to evaluate the measurement validity and data transmission reliability of a remote telemonitoring system comprising a wireless multi-parameter physiological sensor, custom mobile app, and middleware platform, among individuals in sinus rhythm and AF. Methods: Participants in sinus rhythm and with AF undertook simulated daily activities, low, moderate, and/or high intensity exercise. Remote monitoring system heart rate and respiratory rate were compared to reference measures (12-lead ECG and indirect calorimeter). Wireless data transmission loss was calculated between the sensor, mobile app, and remote Internet server. Results: Median heart rate (-0.30 to 1.10 b∙min-1) and respiratory rate (-1.25 to 0.39 br∙min-1) measurement biases were small, yet statistically significant (all P≤.003) due to the large number of observations. Measurement reliability was generally excellent (rho=.87-.97, all P<.001; intraclass correlation coefficient [ICC]=.94-.98, all P<.001; coefficient of variation [CV]=2.24-7.94%), although respiratory rate measurement reliability was poor among AF participants (rho=.43, P<.001; ICC=.55, P<.001; CV=16.61%). Data loss was minimal (<5%) when all system components were active; however, instability of the network hosting the remote data capture server resulted in data loss at the remote Internet server during some trials. Conclusions: System validity was sufficient for remote monitoring of heart and respiratory rates across a range of exercise intensities. Remote exercise monitoring has potential to augment current exCR and heart rate control management approaches by enabling the provision of individually tailored care to individuals outside traditional clinical environments. %M 28582235 %R 10.2196/rehab.3633 %U http://rehab.jmir.org/2015/1/e2/ %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 3 %N 1 %P e2 %T Therapists’ Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation %+ Sunny Hill Health Centre for Children3644 Slocan AvenueVancouver, BC, V5M 3E8Canada1 604 453 83001 604 453 8302statla2@cw.bc.ca  %A Tatla,Sandy K %A Shirzad,Navid %A Lohse,Keith R %A Virji-Babul,Naznin %A Hoens,Alison M %A Holsti,Liisa %A Li,Linda C %A Miller,Kimberly J %A Lam,Melanie Y %A Van der Loos,HF Machiel %K virtual reality %K technology adoption %K rehabilitation %K therapy %K social media %K gaming %K stroke %K cerebral palsy %K hemiplegia %D 2015 %7 10.03.2015 %9 Original Paper %J JMIR Serious Games %G English %X Background: The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians’ perspectives regarding technology adoption by their clients. Objective: The objective of our study was to explore therapists’ perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation. Methods: We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes. Results: Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media. Conclusions: This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that clinicians will adopt innovative technologies. %M 25759148 %R 10.2196/games.3401 %U http://games.jmir.org/2015/1/e2/ %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e33 %T Clinical Effect Size of an Educational Intervention in the Home and Compliance With Mobile Phone-Based Reminders for People Who Suffer From Stroke: Protocol of a Randomized Controlled Trial %+ Universidad de MalagaC/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, Malaga, 29071, SpainMalaga, 29071Spain34 951 952 82334 951 952 823acuesta.var@gmail.com  %A Merchán-Baeza,Jose Antonio %A Gonzalez-Sanchez,Manuel %A Cuesta-Vargas,Antonio %K stroke %K ADL %K environment %K patient adherence %K mobile apps %K mobile health %D 2015 %7 10.03.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stroke is the third-leading cause of death and the leading cause of long-term neurological disability in the world. Cognitive, communication, and physical weakness combined with environmental changes frequently cause changes in the roles, routines, and daily occupations of stroke sufferers. Educational intervention combines didactic and interactive intervention, which combines the best choices for teaching new behaviors since it involves the active participation of the patient in learning. Nowadays, there are many types of interventions or means to increase adherence to treatment. Objective: The aim of this study is to enable patients who have suffered stroke and been discharged to their homes to improve the performance of the activities of daily living (ADL) in their home environment, based on advice given by the therapist. A secondary aim is that these patients continue the treatment through a reminder app installed on their mobile phones. Methods: This study is a clinical randomized controlled trial. The total sample will consist of 80 adults who have suffered a stroke with moderate severity and who have been discharged to their homes in the 3 months prior to recruitment to the study. The following tests and scales will be used to measure the outcome variables: Barthel Index, the Functional Independence Measure, the Mini-Mental State Examination, the Canadian Neurological Scale, the Stroke Impact Scale-16, the Trunk Control Test, the Modified Rankin Scale, the Multidimensional Scale of Perceived Social Support, the Quality of Life Scale for Stroke, the Functional Reach Test, the Romberg Test, the Time Up and Go test, the Timed-Stands Test, a portable dynamometer, and a sociodemographic questionnaire. Descriptive analyses will include mean, standard deviation, and 95% confidence intervals of the values for each variable. The Kolmogov-Smirnov (KS) test and a 2x2 mixed-model analysis of variance (ANOVA) will be used. Intergroup effect sizes will be calculated (Cohen’s d). Results: Currently, the study is in the recruitment phase and implementation of the intervention has begun. The authors anticipate that during 2015 the following processes should be completed: recruitment, intervention, and data collection. It is expected that the analysis of all data and the first results should be available in early-to-mid 2016. Conclusions: An educational intervention based on therapeutic home advice and a reminder app has been developed by the authors with the intention that patients who have suffered stroke perform the ADL more easily and use their affected limbs more actively in the ADL. The use of reminders via mobile phone is proposed as an innovative tool to increase treatment adherence in this population. Trial Registration: ClinicalTrials.gov NCT01980641; https://clinicaltrials.gov/ct2/show/NCT01980641 (Archived by WebCite at http://www.webcitation.org/6WRWFmY6U). %M 25757808 %R 10.2196/resprot.4034 %U http://www.researchprotocols.org/2015/1/e33/ %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 4 %P e80 %T A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial %+ Department of Occupational Science and Occupational TherapyUniversity of British ColumbiaKoerner Pavilion, Room T3142211 Wesbrook MallVancouver, BC, V6T 2B3Canada1 604 714 41081 604 714 4168bill.miller@ubc.ca  %A Imam,Bita %A Miller,William C %A Finlayson,Heather C %A Eng,Janice J %A Payne,Michael WC %A Jarus,Tal %A Goldsmith,Charles H %A Mitchell,Ian M %K amputation %K adult %K aged %K randomized controlled trial %K telemedicine %K walking %D 2014 %7 22.12.2014 %9 Protocol %J JMIR Res Protoc %G English %X Background: The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective: The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods: This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Results: Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Conclusions: Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial Registration: Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP). %M 25533902 %R 10.2196/resprot.4031 %U http://www.researchprotocols.org/2014/4/e80/