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JMIR Rehabilitation and Assistive Technologies

Development and Evaluation of Rehabilitation, Physiotherapy and Assistive Technologies, Robotics, Prosthetics and Implants, Mobility and Communication Tools, Home Automation and Telerehabilitation


Recent Articles:

  • The graded activity scheme, which is one of the functionalities of the portal. Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Exploring Determinants of Patient Adherence to a Portal-Supported Oncology Rehabilitation Program: Interview and Data Log Analyses


    Background: Telemedicine applications often do not live up to their expectations and often fail once they have reached the operational phase. Objective: The objective of this study was to explore the determinants of patient adherence to a blended care rehabilitation program, which includes a Web portal, from a patient’s perspective. Methods: Patients were enrolled in a 12-week oncology rehabilitation treatment supported by a Web portal that was developed in cooperation with patients and care professionals. Semistructured interviews were used to analyze thought processes and behavior concerning patient adherence and portal use. Interviews were conducted with patients close to the start and the end of the treatment. Besides, usage data from the portal were analyzed to gain insights into actual usage of the portal. Results: A total of 12 patients participated in the first interview, whereas 10 participated in the second round of interviews. Furthermore, portal usage of 31 patients was monitored. On average, 11 persons used the portal each week, with a maximum of 20 in the seventh week and a drop toward just one person in the weeks in the follow-up period of the treatment. From the interviews, it was derived that patients’ behavior in the treatment and use of the portal was primarily determined by extrinsic motivation cues (eg, stimulation by care professionals and patient group), perceived severity of the disease (eg, physical and mental condition), perceived ease of use (eg, accessibility of the portal and the ease with which information is found), and perceived usefulness (eg, fit with the treatment). Conclusions: The results emphasized the impact that care professionals and fellow patients have on patient adherence and portal usage. For this reason, the success of blended care telemedicine interventions seems highly dependent on the willingness of care professionals to include the technology in their treatment and stimulate usage among patients.

  • An exercise instruction video from the Kaia app (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results


    Background: Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. Objective: The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Methods: Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Results: Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects.

  • Caregiver reviews a report of their child's current participation in activities on a personal computer. Source: Image created by the Authors; Copyright: Mary Alunkal Khetani; URL:; License: Creative Commons Attribution (CC-BY).

    Caregiver Input to Optimize the Design of a Pediatric Care Planning Guide for Rehabilitation: Descriptive Study


    Background: Caregiver input has informed the design of a valid electronic patient-reported outcome (PRO) measure for use in pediatric rehabilitation. This proxy assessment may be further developed to expedite and enhance patient-centered care planning processes, but user input is first needed to finalize the core requirements that will guide its design. Objective: The objective of this study was to examine the feasibility of a stepwise process for building on a baseline assessment of young children's participation in activities to develop a care plan relevant to pediatric rehabilitation. Methods: A cross-sectional descriptive study design was employed using qualitative methods. Data were collected via Web-based technology and by telephone. Twenty-five caregivers of young children (9 with developmental delays, 16 without delays) and between 1 and 7 years were recruited from a subsample of parents who had previously enrolled in a Web-based validation of a PRO on children’s participation and provided consent for future contact. Each caregiver completed a demographic questionnaire and Young Children’s Participation and Environment Measure (YC-PEM) online, followed by a 20- to 60-min semistructured and audiotaped phone interview to review and build upon PRO results as summarized in an electronic report. Interview data were content coded to the interview guide and reviewed by multiple research staff to estimate feasibility according to stepwise completion rates, perceptions of difficulty in step completion, and perceptions of overall utility. Results: Half of the participants in the final study sample (N=25) fully completed a stepwise process of building on their baseline PRO assessment to develop an initial care plan for their child. In most cases, similar stepwise completion rates and trends in the approaches taken for step completion were found regardless of the child’s disability status. However, more parents of children with disabilities reported difficulties in rank ordering their priorities for change and identified child-focused strategies for goal attainment. Nearly 77% (19/25) of users were willing to use the process to develop and communicate intervention priorities and strategies with professionals, family, and friends. Conclusions: Results informed revisions to the care planning guide before usability and feasibility testing of an initial Web-based prototype that is now underway.

  • App in use (montage). Source: The Authors /; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Mobile App to Streamline the Development of Wearable Sensor-Based Exercise Biofeedback Systems: System Development and Evaluation


    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.

  • Diagram depicting increasing specificity of activity recognition models in terms of what groups of individuals (able-bodied or individuals with disabilities/patients) they are trained on. Patients are depicted using their control (black) or novel (red) assistive device. Each model is used to predict activities for the patient of interest (Test), walking with the novel assistive device. The top 3 layers of the pyramid contain global models, which are trained on individuals other than the one used to test the model. The 2 bottom layers of the pyramid contain personal models, which are trained and tested with data from the same individual. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Activity Recognition in Individuals Walking With Assistive Devices: The Benefits of Device-Specific Models


    Background: Wearable sensors gather data that machine-learning models can convert into an identification of physical activities, a clinically relevant outcome measure. However, when individuals with disabilities upgrade to a new walking assistive device, their gait patterns can change, which could affect the accuracy of activity recognition. Objective: The objective of this study was to assess whether we need to train an activity recognition model with labeled data from activities performed with the new assistive device, rather than data from the original device or from healthy individuals. Methods: Data were collected from 11 healthy controls as well as from 11 age-matched individuals with disabilities who used a standard stance control knee-ankle-foot orthosis (KAFO), and then a computer-controlled adaptive KAFO (Ottobock C-Brace). All subjects performed a structured set of functional activities while wearing an accelerometer on their waist, and random forest classifiers were used as activity classification models. We examined both global models, which are trained on other subjects (healthy or disabled individuals), and personal models, which are trained and tested on the same subject. Results: Median accuracies of global and personal models trained with data from the new KAFO were significantly higher (61% and 76%, respectively) than those of models that use data from the original KAFO (55% and 66%, respectively) (Wilcoxon signed-rank test, P=.006 and P=.01). These models also massively outperformed a global model trained on healthy subjects, which only achieved a median accuracy of 53%. Device-specific models conferred a major advantage for activity recognition. Conclusions: Our results suggest that when patients use a new assistive device, labeled data from activities performed with the specific device are needed for maximal precision activity recognition. Personal device-specific models yield the highest accuracy in such scenarios, whereas models trained on healthy individuals perform poorly and should not be used in patient populations.

  • Telemedicine consult. Source: Flickr; Copyright: Intel Free Press; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Telerehabilitation: Review of the State-of-the-Art and Areas of Application


    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.

  • Training mode app. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Mobile Phone–Supported Physiotherapy for Frozen Shoulder: Feasibility Assessment Based on a Usability Study


    Background: Patients with frozen shoulder show limited shoulder mobility often accompanied by pain. Common treatment methods include physiotherapy, pain medication, administration of corticosteroids, and surgical capsulotomy. Frozen shoulder often lasts from months to years and mostly affects persons in the age group of 40 to 70 years. It severely reduces the quality of life and the ability to work. Objective: The objective of this study was to evaluate the feasibility of a mobile health (mHealth) intervention that supports patients affected by “stage two” frozen shoulder. Patients were supported with app-based exercise instructions and tools to monitor their training compliance and progress. These training compliance and progress data supplement the patients’ oral reports to the physiotherapists and physicians and can assist them in therapy adjustment. Methods: In order to assess the feasibility of the mHealth intervention, a pilot study of a newly developed app for frozen shoulder patients was conducted with 5 patients for 3 weeks. The main function of the app was the instruction for exercising at home. Standardized questionnaires on usability such as System Usability Scale (SUS) and USE (Usefulness, Satisfaction, and Ease of use), and Technology Acceptance Model-2 (TAM-2) were completed by the study participants at the end of the study. Additionally, a nonstandardized questionnaire was completed by all patients. The correctness of the exercises as conducted by the patients was assessed by a physiotherapist at the end of the study. The mobility of the shoulder and pain in shoulder movement was assessed by a physiotherapist at the start and the end of the study. Results: The pilot study was successfully conducted, and the app was evaluated by the patients after 3 weeks. The results of the standardized questionnaires showed high acceptance (TAM-2) and high usability (SUS) of the developed app. The overall usability of the system as assessed by the SUS questionnaire was very good (an average score of 88 out of 100). The average score of the TAM-2 questionnaire on the intention to further use the app was 4.2 out of 5, which indicated that most patients would use the app if further available. The results of the USE questionnaires highlighted that the patients learned how to use the app easily (an average score of 4.2 out of 5) and were satisfied with the app (an average score of 4.7 out of 5). The frequency of app usage and training was very high based on patient reports and verified by analysis of the usage data. The patients conducted the exercises almost flawlessly. Conclusions: Our results indicate the feasibility of the mHealth intervention, as the app was easy to use and frequently used by the patients. The app supported the patients’ physiotherapy by providing clear exercising instructions.

  • Detect grasping action using force myographic signal. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Counting Grasping Action Using Force Myography: An Exploratory Study With Healthy Individuals


    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.

  • The Hinge Health kit: a tablet computer preloaded with the Hinge Health software, and two custom-made movement sensors to guide participants through their exercises. Source: Image created by the authors.; Copyright: The authors; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Translating Comprehensive Conservative Care for Chronic Knee Pain Into a Digital Care Pathway: 12-Week and 6-Month Outcomes for the Hinge Health Program


    Background: Chronic knee pain (CKP) affects a large number of adults, many of whom do not receive best-practice care and are at high risk for unnecessary surgery. Objective: The aim of this study was to investigate the effect of the Hinge Health 12-week digital care program (DCP) for CKP on knee pain and function, with secondary outcomes of surgery interest and satisfaction, at 12 weeks and 6 months after starting the program. Methods: Individuals with CKP were recruited onto the 12-week program, comprising sensor-guided physical exercises, weekly education, activity tracking, and psychosocial support such as personal coaching and cognitive behavioral therapy (CBT). We used a single-arm design with assessment of outcomes at baseline, 12 weeks, and 6 months after starting the program. We used a linear mixed effects model with Tukey contrasts to compare timepoints and report intention-to-treat statistics with last observation carried forward. Results: The cohort consisted of 41 individuals (32 female, mean age 52 years, SD 9 years). Between baseline and week 12, participants reported clinically significant improvements in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) function scales of 16 points (95% CI 12-21, P<.001) and 10 points (95% CI 6-14, P<.001), respectively. Significant reductions of 57% (mean difference 30, 95% CI 21-38, P<.001) and 51% (mean difference 25, 95% CI 16-33, P<.001) in visual analog scale (VAS) knee pain and stiffness, respectively, were observed at 12 weeks, as well as a 67% reduction in surgery interest (mean reduction 2.3 out of 10, 95% CI 1.5-3.1, P<.001). Average satisfaction at week 12 was 9.2 out of 10. Critically, all improvements were maintained at 6 months at similar or greater magnitude. Conclusions: Participants on the Hinge Health DCP for CKP showed substantial clinical improvements that were maintained 6 months after enrolling in the program. This shows that DCPs carry strong potential to deliver evidence-based, cost-effective care to those suffering from CKP.

  • Mobili-T(R) system and past iterations. Copyright: Image created by the authors;

    Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study


    Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development.

  • Mobile mirror therapy facilitated by augmented reality using the tablet-integrated camera. Source: Figure 5 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach


    Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients’ adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain. Objective: The main aim of this study was to describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain. We addressed 3 research questions: (1) Which requirements are defined by patients and therapists for the content and functions of a telerehabilitation platform and how can these requirements be prioritized to develop a first prototype of the platform? (2) How can the user interface of the telerehabilitation platform be designed so as to match the predefined critical user requirements and how can this interface be translated into a medium-fidelity prototype of the platform? (3) How do patients with phantom limb pain and their treating therapists judge the usability of the medium-fidelity prototype of the telerehabilitation platform in routine care and how can the platform be redesigned based on their feedback to achieve a high-fidelity prototype? Methods: The telerehabilitation platform was developed using an iterative user-centered design process. In the first phase, a questionnaire followed by a semistructured interview was used to identify the user requirements of both the patients and their physical and occupational therapists, which were then prioritized using a decision matrix. The second phase involved designing the interface of the telerehabilitation platform using design sketches, wireframes, and interface mock-ups to develop a low-fidelity prototype. Heuristic evaluation resulted in a medium-fidelity prototype whose usability was tested in routine care in the final phase, leading to the development of a high-fidelity prototype. Results: A total of 7 categories of patient requirements were identified: monitoring, exercise programs, communication, settings, background information, log-in, and general requirements. One additional category emerged for therapists: patient management. Based on these requirements, patient and therapist interfaces for the telerehabilitation platform were developed and redesigned by the software development team in an iterative process, addressing the usability problems that were reported by the users during 4 weeks of field testing in routine care. Conclusions: Our findings underline the importance of involving the users and other stakeholders early and continuously in an iterative design process, as well as the need for clear criteria to identify critical user requirements. A decision matrix is presented that incorporates the views of various stakeholders in systematically rating and prioritizing user requirements. The findings and lessons learned might help health care providers, researchers, software designers, and other stakeholders in designing and evaluating new teletreatments, and hopefully increase the likelihood of user acceptance.

  • Old man's phone. Image Source: Author: Jcfrog. Copyright: CC0 Public Domain.

    Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and...


    Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

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  • Ehealth Solutions in Multiple Sclerosis: Use of Digital and Remote Communication Technologies

    Date Submitted: Dec 13, 2017

    Open Peer Review Period: Dec 14, 2017 - Feb 8, 2018

    Despite recent advances in multiple sclerosis (MS) care, many patients only infrequently access healthcare services, or are unable to access them easily, for reasons such as mobility restrictions, tra...

    Despite recent advances in multiple sclerosis (MS) care, many patients only infrequently access healthcare services, or are unable to access them easily, for reasons such as mobility restrictions, travel costs, consultation and treatment time constraints, and a lack of locally available MS expert services. Advances in mobile communications have led to the introduction of eHealth technologies, which are helping to improve both access to, and the quality of healthcare services. As the Internet is now readily accessible through smart mobile devices, most people can take advantage of eHealth applications. The development of digital applications and remote communication technologies for patients with MS has increased rapidly in recent years. These applications are intended to complement traditional in-clinic approaches and can bring significant benefits to both patients with MS and healthcare providers. For patients, such eHealth applications have been shown to improve outcomes and increase access to care, disease information and support. These applications also help patients to participate actively in self-management, for example by tracking adherence to treatment, changes in bladder and bowel habits, activity and mood. For healthcare providers, MS eHealth solutions can: simplify the multidisciplinary approaches needed to tailor MS management strategies to individual patients; facilitate remote monitoring of patient symptoms, adverse events, and outcomes; enable the efficient use of limited resources and clinic time; and potentially allow more timely intervention than is possible with scheduled face-to-face visits. These benefits are important because MS is a long-term, multifaceted chronic condition that requires ongoing monitoring, assessment, and management. We identified in the literature 28 eHealth solutions for patients with MS that fall within the four categories of: screening and assessment; disease monitoring and self-management; treatment and rehabilitation; and advice and education. We review each solution, focusing on any clinical evidence supporting their use from prospective trials (including ASSESS MS, Deprexis, MSdialog, and the MS Performance Test), and consider the opportunities, barriers to adoption, and potential pitfalls of eHealth technologies in routine healthcare.

  • Perceptions of existing wearable robotic devices for upper extremity: Findings from therapists and people with stroke

    Date Submitted: Nov 29, 2017

    Open Peer Review Period: Nov 30, 2017 - Jan 25, 2018

    Background: Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limi...

    Background: Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limited. There are also questions regarding how well these devices address users’ (therapists and patients) needs. Objective: this study was conducted with three main objectives: 1. To describe users’ perceptions about existing wearable robotic devices for upper extremity. 2. To identify if there is a need to develop new devices for upper extremity and the desired features. 3. To explore the obstacles that would influence the utilization of these new devices (if needed). Methods: Focus groups were the primary means of data collection. Data were analyzed thematically. Results: Sixteen participants took part in the focus group discussions. Our analysis identified three main themes: “They exist, but?” described participants’ perceptions about existing devices for upper extremity. “Indeed, we need more, Can we have it all?” reflected participants’ desire to have new devices for upper extremity, but also revealed heterogeneity among different participants. “Bumps on the road” identified challenges that the participants felt needed to be taken into consideration during the development of these devices. Conclusions: This study supported previous research efforts that highlighted the importance to involve the end users’ in the design process. The study suggested that having a single solution for stroke rehabilitation/assistance could be challenging or even impossible, and thus, engineers should clearly identify the targeted stroke population needs prior to the design of any device for upper extremity.

  • Internet based interventions for problem gambling: A scoping review.

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 14, 2017 - Jan 9, 2018

    Background: The rate of treatment seeking for problem gambling has been demonstrated to be low across several research environments. This is in part due to the systemic barriers that would be treatmen...

    Background: The rate of treatment seeking for problem gambling has been demonstrated to be low across several research environments. This is in part due to the systemic barriers that would be treatment seekers face to accessing traditional face-to-face treatment. Making problem gambling treatment resources available through the Internet is one way to reduce the impact of those systemic barriers. The use of Internet based resources to address problem gambling has been growing and a field of research evaluating it has developed as well. However, there has been little done to examine this growing field of research as a whole. Objective: To collect and evaluate research on the use of Internet based intervention for problem gambling in order to provide an understanding of the current state of the field. A secondary objective of this study is to outline the advantages and challenges that are associated with addressing problem gambling using Internet based resources. Methods: A scoping review was performed of five peer-reviewed research data bases (PsychINFO, CINAHL, Medline, Social Science Abstracts and Scopus) and three grey literature databases (MedEdPortal, Proquest: dissertations and Opengrey). Article inclusion required to have been published in the last ten years (2007-2017), include an intervention for problem gambling, and involve the use of the Internet to deliver that intervention. Results: A total of 21 articles were found that met the review requirements. Studies were found from several different areas with particularly strong representation for Australia and New Zealand, and Scandinavia. Cognitive behavioural therapy was the most common form of Internet based intervention. Internet based interventions we generally shown to be effective by the collected research in reducing problem gambling scores and gambling behaviours. Stated advantages include lower feelings of stigma, greater flexibility in time of treatment, and ease of access to relevant information. Stated disadvantages include ethical concerns related to clients in crisis and confidentiality, a lack of rapport in the client-provider relationship, and high rates of attrition. Conclusions: Internet based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barrier to accessing professional help. The state of the current literature is sparse and more research is needed in directly comparing Internet based interventions and their traditional counterparts.

  • Development and validity of physiotherapy questionnaires: An app with the main musculoskeletal assessment questionnaires

    Date Submitted: Oct 23, 2017

    Open Peer Review Period: Oct 24, 2017 - Dec 19, 2017

    Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is n...

    Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, a physiotherapy questionnaires (PQ) app was developed. Objective: This study aims to explain the development of the PQ app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. Methods: In the first stage, the PQ app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaires were selected to validate the PQ. 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study’s outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. Results: The PQ was approved by the experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients' data. In regards to validity, the mean of the total scores of the FAOS were 91.54% ± 8.86 for the paper version and 91.74% ± 9.20 for the app. There was no statistically significant difference in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 ± 8.47 for the paper version and 93.96 ± 8.48 for the app. No statistically significant difference was found for the total scores for the AOFAS or the subscales (P=1.00). The PQ app showed excellent agreement with the paper version of the FAOS, with an ICC value of .98 for the total score (CI 95%, 0.98–0.99) which was also found for the AOFAS with the ICC for the total score of .99 (IC 95%, 0.98–0.99). In regards to compliance, 72% of the participants in the FAOS and 94% in the AOFAS opted for the application as their preferred version. Conclusions: The PQ app showed validity and high levels of compliance for the FAOS and AOFAS, which means that it is not inferior to the paper version of these two questionnaires, thus confirming its viability and feasibility for use in clinical practice.