@Article{info:doi/10.2196/68233, author="Olimb Hillkirk, Anstein and Skavberg Roaldsen, Kirsti and Johnsen, Mari Hege", title="Physiotherapists' User Acceptance of a Lower Limb Robotic Exoskeleton in Specialized Rehabilitation: Qualitative Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="16", volume="12", pages="e68233", keywords="assistive technology", keywords="clinical implementation", keywords="deductive analysis", keywords="robot-assisted gait training therapy", keywords="RAGT", keywords="user experiences", keywords="unified theory of acceptance and use of technology", keywords="UTAUT", keywords="rehabilitation", abstract="Background: Robotic lower limb exoskeletons have emerged as promising tools in the clinical rehabilitation of patients with lower limb paralysis due to neurological disease, stroke, or spinal cord injury. Identified benefits in gait function rehabilitation include improved gait function, cardiovascular effects, enhanced training quality, patient motivation, and reduced physical and psychological workload for therapists. Despite the identified benefits, the successful adoption of this technology largely depends on therapists' user acceptance. Objective: This study aims to explore physiotherapists' perceptions of using robot-assisted lower-limb gait training in specialized neurological rehabilitation using the unified theory of acceptance and use of technology framework. Methods: A qualitative, exploratory research design with a deductive approach was used. Semistructured interviews were conducted with 7 expert physiotherapists in a Norwegian specialized rehabilitation hospital. Data collection and analysis were guided by the unified theory of acceptance and use of technology framework. Results: The physiotherapists' use of lower limb exoskeletons was greatly influenced by perceived benefits for patients or challenges, such as usability issues, the time required for adjustment to each patient, and the lack of personnel resources to facilitate their use. Thus, perceived usefulness and facilitating conditions (or lack thereof) had a great influence on the physiotherapists' intentions to use and the actual use of the exoskeleton. Conclusions: This study identified several factors influencing the physiotherapists' acceptance and integration of the lower limb exoskeleton. Available resources, such as time and personnel, were emphasized as important factors to increase the use of the exoskeleton in specialized rehabilitation. Our findings may inform service providers and engineers in specialized neurological rehabilitation settings. ", doi="10.2196/68233", url="https://rehab.jmir.org/2025/1/e68233", url="http://www.ncbi.nlm.nih.gov/pubmed/40238235" } @Article{info:doi/10.2196/69003, author="Huang, Jiaqi and Wei, Yixi and Zhou, Ping and He, Xiaokuo and Li, Hai and Wei, Xijun", title="Effect of Home-Based Virtual Reality Training on Upper Extremity Recovery in Patients With Stroke: Systematic Review", journal="J Med Internet Res", year="2025", month="Apr", day="4", volume="27", pages="e69003", keywords="stroke", keywords="upper extremity", keywords="virtual reality", keywords="home-based", keywords="rehabilitation", keywords="motor control", keywords="recovery", abstract="Background: Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable, and interactive alternative. However, the effect of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored. Objective: This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke. Methods: This systematic review followed the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Eligible studies involved patients with stroke with upper extremity dysfunction who received home-based VR interventions. Data extraction was performed by 2 independent reviewers, and study quality was assessed using the Physiotherapy Evidence Database scale. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed instead of a meta-analysis. Results: A total of 8 RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols and small sample sizes limited the validity of results. The effect of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients. Conclusions: This systematic review shows that home-based VR training has a positive impact on upper extremity rehabilitation for patients with stroke, particularly in those with varying degrees of dysfunction. However, heterogeneity in study design and differences in outcome measures affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. Future research should explore how VR technology can be integrated into comprehensive rehabilitation programs, focusing on patient-centered approaches that incorporate sustainable, personalized technology, and support services to optimize recovery outcomes. Trial Registration: PROSPERO CRD42024526650; https://tinyurl.com/5dny5bhp ", doi="10.2196/69003", url="https://www.jmir.org/2025/1/e69003", url="http://www.ncbi.nlm.nih.gov/pubmed/40074365" } @Article{info:doi/10.2196/68149, author="Hong, Seojin and Choi, Hyun and Kweon, Hyosun", title="Medical Device Based on a Virtual Reality--Based Upper Limb Rehabilitation Software: Usability Evaluation Through Cognitive Walkthrough", journal="JMIR Form Res", year="2025", month="Apr", day="1", volume="9", pages="e68149", keywords="usability", keywords="cognitive walkthrough", keywords="virtual reality-based upper limb rehabilitation software", keywords="upper limb", keywords="limb rehabilitation", keywords="rehabilitation", keywords="therapist", keywords="virtual reality", keywords="VR", keywords="medical device", keywords="formative evaluation", keywords="quantitative", keywords="qualitative", keywords="occupational therapy", keywords="user safety", keywords="usability testing", keywords="software", keywords="risk factor", abstract="Background: The use of virtual reality (VR) technology in rehabilitation therapy has been growing, leading to the development of VR-based upper-limb rehabilitation softwares. To ensure the effective use of such software, usability evaluations are critical to enhance user satisfaction and identify potential usability issues. Objective: This study aims to evaluate the usability of a VR-based upper-limb rehabilitation software from the perspective of occupational therapists. Specifically, the study seeks to identify usability challenges and provide insights to improve user satisfaction. Methods: The VR-based upper-limb rehabilitation software was tailored for therapists to operate while delivering therapy to patients. Usability testing was conducted with occupational therapists from the Korean National Rehabilitation Center using cognitive walkthroughs and surveys. Participants performed tasks that simulated real clinical scenarios, including turning the device on, assisting patients with wearing the device, and shutting it down. Observers recorded user reactions during task performance, and participants completed surveys to assess the ease of use of the user interface. This mixed-methods approach provided qualitative insights into user difficulties and their root causes. Results: Usability evaluations were conducted with 6 participants. Cognitive walkthroughs revealed potential areas for improvement in the software, including (1) enhancements to the graphical user interface for ease of use, (2) refinements in the natural user interface, and (3) better user manuals for clearer product instructions. The ease-of-use score for the user interface averaged 1.58 on a 5-point scale (1=very easy to 5=very difficult). Conclusions: This study provides valuable insights into improving user satisfaction by focusing on the needs of occupational therapists who operate a VR-based rehabilitation software. Future research should explore software refinement and clinical efficacy to maximize the therapeutic potential of such technologies. ", doi="10.2196/68149", url="https://formative.jmir.org/2025/1/e68149" } @Article{info:doi/10.2196/64729, author="Sheehy, Lisa and Taillon-Hobson, Anne and Sveistrup, Heidi and Bilodeau, Martin and Yang, Christine and Welch, Vivian and Finestone, Hillel", title="Home-Based Nonimmersive Virtual Reality Training After Discharge From Inpatient or Outpatient Stroke Rehabilitation: Parallel Feasibility Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2025", month="Mar", day="28", volume="12", pages="e64729", keywords="virtual reality", keywords="telerehabilitation", keywords="stroke", keywords="home", keywords="exercises", keywords="physical activity", keywords="physiotherapy", keywords="exergames", keywords="rehabilitation intensity", keywords="randomized controlled feasibility trial", keywords="motor", keywords="movement", keywords="patient care", keywords="patient engagement", keywords="health intervention", keywords="stroke rehabilitation", keywords="interactive games", keywords="game therapy", keywords="interactive therapy", keywords="rehabilitation", abstract="Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9 ", doi="10.2196/64729", url="https://rehab.jmir.org/2025/1/e64729" } @Article{info:doi/10.2196/68504, author="Sermsinsaithong, Natsinee and Yuenyongchaiwat, Kornanong and Thanawattano, Chusak and Buekban, Chatchai and Kulchanarat, Chitima and Buranapuntalug, Sasipa and Wattanananont, Khanistha and Satdhabudha, Opas", title="Effects of a Home-Based Rehabilitation Exercise Program on Cardiorespiratory Performance in Community-Dwelling Adults Who Underwent Heart Surgery: Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2025", month="Mar", day="28", volume="12", pages="e68504", keywords="virtual reality", keywords="cardiac surgery", keywords="cardiac rehabilitation", keywords="cardiopulmonary", keywords="aerobic exercise", abstract="Background: Patients undergoing heart surgery demonstrate impaired cardiorespiratory performance. Phase II cardiac rehabilitation (CR) in people undergoing open heart surgery (OHS) aims to reduce the adverse physical effects of cardiovascular diseases. Virtual reality (VR) exercise is now used in CR. Objective: This study aimed to explore the effects of VR exercise on functional capacity, pulmonary function, and respiratory muscle strength in patients who underwent OHS and were in phase II CR. Methods: Forty-nine patients who underwent elective OHS and were in phase II CR were randomized into a VR group (N=24) and a control group (N=25). The VR group completed 8 weeks of a home-based VR exercise program, including chest trunk mobilization and aerobic circuit training for 30 minutes, whereas the control group received an exercise brochure and information regarding the benefits of exercise. Intention-to-treat analysis was conducted, and 2-way mixed ANOVA was performed to compare between- and within-group differences in functional capacity and respiratory performance. Results: After completing the 8-week program, the VR group showed significant improvement in functional capacity compared to the control group (66.29, SD 25.84 m; P=.01). Inspiratory muscle strength increased in both the VR and control groups compared to baseline (9.46, SD 2.85 and 9.64, SD 2.78 cm H2O, respectively). In addition, after the 8-week intervention, significant improvements were found in expiratory muscle strength (15.79, SD 4.65 cm H2O) and forced expiratory volume in 1 second as a percentage of predicted values (2.96\%, SD 1.52\%) in the VR group compared to the baseline session. Conclusions: The home-based VR exercise program significantly improved functional capacity but not respiratory muscle or pulmonary function. Trial Registration: Thai Clinical Trial Registry TCTR20230602001; https://tinyurl.com/3xn44bku ", doi="10.2196/68504", url="https://rehab.jmir.org/2025/1/e68504" } @Article{info:doi/10.2196/69150, author="Twumasi, Clement and Aktas, Mikail and Santoni, Nicholas", title="Kinetic Pattern Recognition in Home-Based Knee Rehabilitation Using Machine Learning Clustering Methods on the Slider Digital Physiotherapy Device: Prospective Observational Study", journal="JMIR Form Res", year="2025", month="Mar", day="18", volume="9", pages="e69150", keywords="machine learning", keywords="cluster analysis", keywords="force measurement", keywords="knee replacement", keywords="musculoskeletal", keywords="physical therapy", keywords="Slider device", keywords="knee osteoarthritis", keywords="digital health", keywords="telerehabilitation", abstract="Background: Recent advancements in rehabilitation sciences have progressively used computational techniques to improve diagnostic and treatment approaches. However, the analysis of high-dimensional, time-dependent data continues to pose a significant problem. Prior research has used clustering techniques on rehabilitation data to identify movement patterns and forecast recovery outcomes. Nonetheless, these initiatives have not yet used force or motion datasets obtained outside a clinical setting, thereby limiting the capacity for therapeutic decisions. Biomechanical data analysis has demonstrated considerable potential in bridging these gaps and improving clinical decision-making in rehabilitation settings. Objective: This study presents a comprehensive clustering analysis of multidimensional movement datasets captured using a novel home exercise device, the ``Slider''. The aim is to identify clinically relevant movement patterns and provide answers to open research questions for the first time to inform personalized rehabilitation protocols, predict individual recovery trajectories, and assess the risks of potential postoperative complications. Methods: High-dimensional, time-dependent, bilateral knee kinetic datasets were independently analyzed from 32 participants using four unsupervised clustering techniques: k-means, hierarchical clustering, partition around medoids, and CLARA (Clustering Large Applications). The data comprised force, laser-measured distance, and optical tracker coordinates from lower limb activities. The optimal clusters identified through the unsupervised clustering methods were further evaluated and compared using silhouette analysis to quantify their performance. Key determinants of cluster membership were assessed, including demographic factors (eg, gender, BMI, and age) and pain levels, by using a logistic regression model with analysis of covariance adjustment. Results: Three distinct, time-varying movement patterns or clusters were identified for each knee. Hierarchical clustering performed best for the right knee datasets (with an average silhouette score of 0.637), while CLARA was the most effective for the left knee datasets (with an average silhouette score of 0.598). Key predictors of the movement cluster membership were discovered for both knees. BMI was the most influential determinant of cluster membership for the right knee, where higher BMI decreased the odds of cluster-2 membership (odds ratio [OR] 0.95, 95\% CI 0.94-0.96; P<.001) but increased the odds for cluster-3 assignment relative to cluster 1 (OR 1.05, 95\% CI 1.03-1.06; P<.001). For the left knee, all predictors of cluster-2 membership were significant (.001?P?.008), whereas only BMI (P=.81) could not predict the likelihood of an individual belonging to cluster 3 compared to cluster 1. Gender was the strongest determinant for the left knee, with male participants significantly likely to belong to cluster 3 (OR 3.52, 95\% CI 2.91-4.27; P<.001). Conclusions: These kinetic patterns offer significant insights for creating personalized rehabilitation procedures, potentially improving patient outcomes. These findings underscore the efficacy of unsupervised clustering techniques in the analysis of biomechanical data for clinical rehabilitation applications. ", doi="10.2196/69150", url="https://formative.jmir.org/2025/1/e69150" } @Article{info:doi/10.2196/60685, author="Jansen, Marjolein and van Iperen, D. Ingrid and Kroner, Anke and Hemler, Raphael and Dekker-Holverda, Esther and Spronk, E. Peter", title="Kangaroo Stimulation Game in Tracheostomized Intensive Care--Related Dysphagia: Interventional Feasibility Study", journal="JMIR Serious Games", year="2025", month="Mar", day="5", volume="13", pages="e60685", keywords="dysphagia", keywords="swallowing", keywords="intensive care", keywords="ICU", keywords="swallowing disturbance", keywords="kangaroo stimulation", keywords="game", keywords="feasibility study", keywords="surface electromyography", keywords="training", keywords="exercise", keywords="Rephagia biofeedback", keywords="muscle strength", keywords="stamina", keywords="timing", keywords="tracheostomy", keywords="clinical", keywords="feasibility", abstract="Background: Dysphagia is common in intensive care unit (ICU) patients. Using surface electromyography (sEMG) signals as biofeedback training exercises might offer a promising path to improving swallowing function. The Rephagia biofeedback system uses sEMG to assess muscle strength, stamina, and timing of the swallowing action. Objectives: The aim of this study was to evaluate the feasibility of the Rephagia system in ICU patients with dysphagia. Methods: This feasibility study included patients admitted to a 14-bed mixed medical-surgical ICU. All patients underwent a new tracheostomy placement during ICU stay due to persistent aspiration and ICU-acquired weakness, accompanied by verified dysphagia. Following Rephagia training, patients completed a questionnaire assessing comprehension, satisfaction, and motivation. Swallowing characteristics were assessed via mean sEMG peak values during exercise. Results: Twenty patients with a mean age of 69.4 (SD 8.2) years were included. The means of sEMG values at the beginning of a measurement were not significantly different at baseline versus everyone's last measurement (52 {\textmu}V [23 {\textmu}V] vs 57 {\textmu}V [22 {\textmu}V]; P=.50). The means of sEMG values obtained at the end of a measurement were not significantly different at baseline versus everyone's last measurement (56 {\textmu}V [18 {\textmu}V] vs 59 {\textmu}V [23 {\textmu}V]; P=.62). However, dysphagia improved in all patients. Patients understood the importance of the game in relation to their swallowing problems (16/80, 89\%), which kept them motivated to participate in the training sessions (9/18, 50\%). Conclusions: The Rephagia biofeedback system for stimulating swallowing actions in tracheotomized ICU patients with dysphagia is feasible. No relation was found between clinical improvement in swallowing function and sEMG signals. ", doi="10.2196/60685", url="https://games.jmir.org/2025/1/e60685" } @Article{info:doi/10.2196/57957, author="Rampioni, Margherita and Leonzi, Sara and Antognoli, Luca and Mura, Anna and Stara, Vera", title="Poststroke eHealth Technologies--Based Rehabilitation for Upper Limb Recovery: Systematic Review", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e57957", keywords="stroke", keywords="rehabilitation", keywords="technology-based interventions", keywords="upper limb", keywords="technologies-based rehabilitation", keywords="limb", keywords="systematic review", keywords="cerebral vascular diseases", keywords="patient", keywords="effectiveness", keywords="database", keywords="therapy", keywords="conventional therapy", keywords="mobile phone", abstract="Background: Stroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 years and older. It leads to a variety of disabilities requiring motor and cognitive rehabilitation. Poststroke rehabilitation is critical for recovery, particularly for upper limb impairments, which affect approximately 80\% of stroke survivors. Conventional rehabilitation often faces barriers such as cost, accessibility, and patient adherence. In contrast, eHealth technologies offer a promising alternative by providing accessible, cost-effective, and engaging rehabilitation solutions. Objective: While numerous systematic reviews have explored various aspects of technology-based rehabilitation for poststroke upper limb recovery, there is a notable lack of comprehensive synthesis of these findings. This gap presents challenges, primarily due to the focus on specific technologies, which complicates understanding the overall effectiveness of these interventions. Consequently, clinicians and researchers may find it difficult to assess the field holistically, potentially hindering informed decision-making in clinical practice. This review synthesizes evidence from systematic reviews evaluating the effectiveness of eHealth technology--based interventions for upper limb recovery in poststroke individuals. Two main questions are examined: (1) Are eHealth technology--based therapies more or equally effective than conventional therapies for stroke rehabilitation? (2) What are the main clinical considerations for low-cost eHealth technology--based rehabilitation? Methods: Comprehensive literature searches were conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar using predefined inclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework. Systematic reviews published in English without date restrictions were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart guided study selection. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) criteria. Results: A total of 1792 records were screened, resulting in 7 systematic reviews published between 2019 and 2023 being included. These reviews encompassed 95 studies involving 2995 participants with a mean age of 58.8 years across acute, subacute, and chronic stroke phases. Interventions included telerehabilitation, mobile health (mHealth) apps, augmented reality (AR), virtual reality (VR), wearable devices, and exergames. While AR and VR demonstrated potential benefits when combined with conventional therapies (eg, AR showing significant improvements in upper limb function with a standardized mean difference 0.657; P<.001), evidence for stand-alone effectiveness remained inconclusive due to heterogeneity in study designs, intervention protocols, and outcome measures. Most reviews were rated as critically low quality due to methodological limitations. Conclusions: eHealth technologies hold promise for enhancing upper limb rehabilitation post stroke by addressing barriers such as cost and accessibility while providing engaging interventions. However, the field remains fragmented with insufficient evidence to establish clear efficacy. Future research should focus on standardizing protocols, optimizing neurorehabilitation principles such as dosage and task specificity, and improving methodological rigor to evaluate these interventions' long-term impact better. ", doi="10.2196/57957", url="https://www.jmir.org/2025/1/e57957", url="http://www.ncbi.nlm.nih.gov/pubmed/40053744" } @Article{info:doi/10.2196/63512, author="Pearkao, Chatkhane and Apiratwarakul, Korakot and Wicharit, Lerkiat and Potisopha, Wiphawadee and Jaitieng, Arunnee and Homvisetvongsa, Sukuman and Namwaing, Puthachad and Pudtuan, Peerapon", title="Development of a Mobile App Game for Practicing Lung Exercises: Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Mar", day="4", volume="12", pages="e63512", keywords="mobile app game", keywords="practice lung exercises", keywords="feasibility study", keywords="mobile phone", keywords="pulmo device", keywords="app", abstract="Background: Chest injuries are a leading cause of death and disability, accounting for 10\% of hospital admissions and 25\% of injury-related deaths. About two-thirds of patients with thoracic injuries experience complications such as blood or air in the pleural space, causing lung deflation and poor gas exchange. Proper breathing management, using tools like incentive spirometers, improves lung function and recovery. However, there is a gap in mobile-based gaming apps designed for lung exercise, which could benefit both the general population and patients recovering from lung injuries. Objective: This research aimed to develop and evaluate a mobile app game for practicing lung exercises, accompanied by a prototype device called the Pulmo device. Methods: The study involved a sample group of 110 participants from the general public. It followed a research and development methodology comprising 4 steps. The research instruments included a mobile app game, a prototype lung exercise device, and questionnaires to assess users' satisfaction and the feasibility of both the app and the device. Results: The findings revealed that the participants demonstrated a high level of overall satisfaction with both the mobile app game and the prototype lung exercise device (mean 4.4, SD 0.4). The feasibility for the mobile app game and the prototype lung exercise device connected to the game was evaluated. The results indicated that the sample group perceived the overall feasibility to be at a high level (mean 4.4, SD 0.5). Conclusions: The research results reflected that the sample group believed the mobile app game for practicing lung exercises and the prototype device developed in this project have a high potential for practical application in promoting lung rehabilitation through gameplay. The mobile app game and the Pulmo device prototype received positive user feedback, indicating potential practical use; however, further validation is required among patients in need of pulmonary rehabilitation. ", doi="10.2196/63512", url="https://rehab.jmir.org/2025/1/e63512" } @Article{info:doi/10.2196/63235, author="Mills, Jodie and Duffy, Orla", title="Speech and Language Therapists' Perspectives of Virtual Reality as a Clinical Tool for Autism: Cross-Sectional Survey", journal="JMIR Rehabil Assist Technol", year="2025", month="Feb", day="27", volume="12", pages="e63235", keywords="virtual reality", keywords="VR", keywords="autistic", keywords="ASD", keywords="speech", keywords="language", keywords="autism", keywords="speech and language therapy", keywords="speech-language pathology", keywords="SLT", keywords="immersive", keywords="voice", keywords="vocal", keywords="cross sectional", keywords="surveys", keywords="questionnaires", keywords="experiences", keywords="attitudes", keywords="opinions", keywords="perceptions", keywords="perspectives", keywords="autism spectrum disorder", abstract="Background: Persistent difficulties with social skills form part of the diagnostic criteria for autism and in the past have required speech and language therapy (SLT) management. However, many speech and language therapists are moving toward neuro-affirmative practices, meaning that social skills approaches are now becoming redundant. Research demonstrates that virtual reality (VR) interventions have shown promise in overcoming challenges and promoting skill generalization for autistic children; however, the majority of these focus on social skills interventions. While VR is emerging as an SLT intervention, its application for autism remains unexamined in clinical practice. Objective: This research aimed to examine speech and language therapists' knowledge and attitudes toward immersive VR as a clinical tool for autistic children and explore the reasons for its limited integration into clinical practice. Methods: A web-based cross-sectional survey was available from April 3, 2023 to June 30, 2023. The survey, consisting of 23 questions, focused on VR knowledge, attitudes, and the support required by speech and language therapists to incorporate VR into clinical practice. Dissemination occurred through the Royal College of Speech and Language Therapists Clinical Excellence Networks to recruit speech therapists specializing in autism. Results: Analysis included a total of 53 responses from the cross-sectional survey. Approximately 92\% (n=49) of speech and language therapists were aware of VR but had not used it, and 1.82\% (n=1) had used VR with autistic children. Three key themes that emerged were (1) mixed general knowledge of VR, which was poor in relation to applications for autism; (2) positive and negative attitudes toward VR, with uncertainty about autism specific considerations for VR; and (3) barriers to adoption were noted and speech and language therapists required an improved neuro-affirming evidence base, guidelines, and training to adopt VR into clinical practice. Conclusions: While some speech and language therapists perceive VR as a promising intervention tool for autistic children, various barriers must be addressed before its full integration into the clinical toolkit. This study establishes a foundation for future co-design, development, and implementation of VR applications as clinical tools for autistic children. This study is the first to explore clinical implementation factors for the use of VR in SLT field, specifically with autistic children. Poor autism-specific VR knowledge, and mixed attitudes toward VR, highlight that specific barriers must be addressed before the technology can successfully integrate into the SLT clinical toolkit. Speech and language therapists require support from employers, funding, a robust neuro-affirming evidence base, and education and training to adopt VR into practice. Recommendations for a SLT VR education and training program for use with autistic children, are provided. ", doi="10.2196/63235", url="https://rehab.jmir.org/2025/1/e63235" } @Article{info:doi/10.2196/69205, author="Balloufaud, Maxime and Boujut, Arnaud and Marie, Romain and Guinaldo, Aur{\'e}lie and Fourcade, Laurent and Hamonet-Torny, Julia and Perrochon, Anaick", title="Augmented Reality Exergames for Upcoming Cognitive-Motor Rehabilitation: User-Centered Design Approach and User Experience of Healthy Children", journal="JMIR Rehabil Assist Technol", year="2025", month="Feb", day="19", volume="12", pages="e69205", keywords="augmented reality", keywords="exergames", keywords="user experience", keywords="healthy children", keywords="cognitive-motor intervention", abstract="Background: Traditional rehabilitation programs for children with cerebral palsy and acquired brain injuries aim to enhance motor and cognitive abilities through repetitive exercises, which are often perceived as tedious and demotivating. Extended reality technologies, including augmented reality (AR) and virtual reality, offer more engaging methods through exergames. However, to date, no AR exergames simultaneously integrate cognitive and motor aspects within navigational tasks. Developing these exergames necessitates rigorous methodological steps, especially when using emerging technologies such as AR. The MIDE (Multidisciplinary Iterative Design of Exergames) framework advocates a participatory design approach, involving users from the outset, the objective being to optimize the interface and validate game mechanics through user experience (UX) assessment. Some researchers initially test these mechanisms on healthy children before applying them to clinical populations. Objective: This study aims to evaluate the UX of our AR exergames, consisting of two games (AR Corsi and AR Zoo), in typically developing children. Methods: Typically developing children participated in two 1.5-hour sessions. During each session, they played one of two AR games using the Microsoft HoloLens 2 headset: AR Corsi and AR Zoo, both of which are designed to engage executive functions and motor skills through navigational capabilities. UX was assessed after each session using the following measures: System Usability Scale scores for usability, AttrakDiff for attractiveness and game quality, MeCue for emotional experience, and Rating scale of Perceived Exertion for Children for pre- and postsession mental and physical fatigue. Results: A total of 27 participants (mean age 11.9, SD 1.2 years) were included in the study. Mean System Usability Scale scores were 79.9 (SD 11.4) for AR Corsi and 76.3 (SD 12.1) for AR Zoo, indicating good usability. The AttrakDiff questionnaire yielded favorable results, with scores between 1 and 3 for overall attractiveness, pragmatic quality, and stimulation for both AR games. However, the hedonic quality ``identity'' received neutral scores (mean 0.6, SD 0.5 for AR Corsi and mean 0.7, SD 0.8 for AR Zoo). The MeCue emotions module yielded average scores of 5.2 (SD 0.7) for AR Corsi and 5.3 (SD 0.8) for AR Zoo, significantly exceeding the theoretical mean of 4 (P<.001). We observed a significant effect of physical fatigue (P=.02) and mental fatigue (P=.002) after exposure to both games. A comparative analysis of UX between the two games showed no significant differences. Conclusions: This study demonstrates that our exergame, comprising two AR games, is user-friendly and well-received by typically developing children, eliciting positive emotions and overall appeal. Although some children reported fatigue, favorable UX evaluation confirms the validity of the game's content and mechanisms, suggesting its suitability for use among children with cerebral palsy and acquired brain injuries. ", doi="10.2196/69205", url="https://rehab.jmir.org/2025/1/e69205", url="http://www.ncbi.nlm.nih.gov/pubmed/39970421" } @Article{info:doi/10.2196/66802, author="Xu, Shiqi and Xu, Yanwen and Wen, Ruyi and Wang, Jun and Qiu, Yuyu and Chan, CH Chetwyn", title="Virtual Reality Enhanced Exercise Training in Upper Limb Function of Patients With Stroke: Meta-Analytic Study", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e66802", keywords="virtual reality", keywords="stroke", keywords="upper limb function", keywords="exercise training", keywords="meta-analysis", abstract="Background: Recovery of upper limb function after stroke secondary to ischemia or hemorrhage is crucial for patients' independence in daily living and quality of life. Virtual reality (VR) is a promising computer-based technology designed to enhance the effects of rehabilitation; however, the results of VR-based interventions remain equivocal. Objective: This study aims to review the plausible factors that may have influenced VR's therapeutic effects on improving upper limb function in patients with stroke, with the goal of synthesizing an optimal VR intervention protocol. Methods: The databases PubMed, EMBASE, Web of Science, and Cochrane Library were queried for English-language papers published from May 2022 onward. Two reviewers independently extracted data from the included papers, and discrepancies in their findings were resolved through consensus during joint meetings. The risk of bias was assessed using the Physiotherapy Evidence Database Scale and the Methodological Index for Non-Randomized Studies. Outcome variables included the Action Research Arm Test, Box-Block Test, Functional Independence Measure, Upper Extremity Fugl-Meyer Assessment, and Wolf Motor Function Test. The plausible factors examined were age, total dosage (hours), trial length (weeks), session duration (hours/session), frequency (sessions/week), and VR content design. The Bonferroni adjustment was applied to P values to prevent data from being incorrectly deemed statistically significant. Results: The final sample included 15 articles with a total of 1243 participants (age range 48.6-75.59 years). Participants in the VR therapy (VRT) group (n=455) demonstrated significantly greater improvements in upper limb function and independence in activities of daily living compared with those in the conventional therapy group (n=301). Significant factors contributing to improved outcomes in upper limb function were younger age (mean difference [MD] 5.34, 95\% CI 2.18-8.5, P<.001; I2=0\%), interventions lasting more than 15 hours (MD 9.67, 95\% CI 4.19-15.15, P<.001; I2=0\%), trial lengths exceeding 4 weeks (MD 4.02, 95\% CI 1.39-6.65, P=.003; I2=15\%), and more than 4 sessions per week (MD 3.48, 95\% CI 0.87-6.09, P=.009; I2=0\%). However, the design of the VR content, including factors such as the number of features (eg, offering exercise and functional tasks; individualized goals; activity quantification; consideration of comorbidities and baseline activity level; addressing patient needs; aligning with patient background such as education level; patient-directed goals and interests; goal setting; progressive difficulty levels; and promoting self-efficacy), did not demonstrate significant effects (MD 3.89, 95\% CI --6.40 to 1.09; effect Z=1.36, P=.16). Conclusions: Greater VR effects on improving upper limb function in patients with stroke were associated with higher training doses (exceeding 15 hours) delivered over 4-6 weeks, with shorter sessions (approximately 1 hour) scheduled 4 or more times per week. Additionally, younger patients appeared to benefit more from the VR protocol compared with older patients. ", doi="10.2196/66802", url="https://www.jmir.org/2025/1/e66802", url="http://www.ncbi.nlm.nih.gov/pubmed/39969977" } @Article{info:doi/10.2196/65358, author="Peramalaiah, Kanakapura Mrudula and Parmar, Tejraj Sanjay and Sepehri, Nariman and Muthukumarana, Saman and Kanitkar, Anuprita and Hin, Kit-Fong Cherry and Szturm, Joseph Tony", title="Evaluation of a Game-Based Mechatronic Device for Rehabilitation of Hand-Arm Function in Children With Cerebral Palsy: Feasibility Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2025", month="Feb", day="18", volume="12", pages="e65358", keywords="cerebral palsy", keywords="computer game--assisted rehabilitation", keywords="manual dexterity", keywords="repetitive task practice", keywords="robotic manipulandum", abstract="Background: Children with neurodevelopmental disorders, such as cerebral palsy (CP), often experience motor impairments in manual dexterity, which hinder daily tasks and social interactions. Traditional rehabilitation methods require repetitive task practice, which can be difficult for children to sustain due to low engagement. Game-based rehabilitation devices and robots offer a promising alternative by combining therapy with digital play, improving motivation and compliance. However, many systems fail to incorporate actual object manipulation, which is essential for motor learning through sensory feedback. To address this limitation, a low-cost, easy-to-use robotic manipulandum device (RMD) was developed. The RMD enables real-time object manipulation during gameplay while providing assistive force, allowing the practice of a wide range of manual dexterity skills beyond gross reaching. This system offers an engaging and effective rehabilitation approach to enhance hand function in children with CP. Objective: This study aimed to provide evidence for the feasibility and therapeutic value of the RMD game--based exercise program for children with CP. Methods: In total, 34 children with CP, aged 4 to 10 years, were randomly assigned to the experimental group (XG) or the control group (CG). The XG received a computer game--based exercise program using the RMD, focusing on object manipulation tasks, while the CG received task-specific training similar to constraint-induced movement therapy. Both groups received their respective therapy programs 3 times per week for 8 weeks. Semistructured interviews with parents and children, along with qualitative analysis, were conducted to evaluate their experiences with the exercise program. The following outcome measures were used: (1) the Peabody Developmental Motor Scale-2 (PDMS-2) grasping and visual-motor integration subtests and (2) the computer game--based upper extremity (CUE) assessment of manual dexterity. Results: No dropouts occurred during the 8-week program. Both groups showed significant improvements in the PDMS-2 subtests (P<.001) and the CUE assessment of manual dexterity, including success rates (tennis ball: P=.001; cone: P<.001; medicine ball: P=.001; and peanut ball: P<.001) and movement errors (tennis ball: P=.01; cone: P<.001; medicine ball: P=.04; and peanut ball: P<.001). The XG outperformed the CG, showing greater improvements in PDMS-2 grasping (P=.002) and visual-motor integration (P=.01). In the CUE assessment, the XG demonstrated higher success rates (medicine ball: P=.001 and peanut ball: P=.02) and fewer movement errors (cone: P<.001). Parents reported an increase in the children's independence in daily tasks. Conclusions: This study demonstrates the feasibility, acceptability, and positive outcomes of the RMD game--based exercise program for improving hand function in children with CP. The findings support further research and development of computer game--assisted rehabilitation technologies. Trial Registration: Clinical Trials Registry - India CTRI/2021/07/034903; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc4ODU ", doi="10.2196/65358", url="https://rehab.jmir.org/2025/1/e65358", url="http://www.ncbi.nlm.nih.gov/pubmed/39964707" } @Article{info:doi/10.2196/56397, author="Binyamin-Netser, Reut and Handelzalts, Shirley and Goldhamer, Noy and Avni, Inbar and Tayer Yeshurun, Adi and Koren, Yogev and Bibas Levy, Ofri and Kramer, Shilo and Bar Haim, Simona and Shmuelof, Lior", title="Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients With Subacute Stroke: Feasibility Study", journal="JMIR Serious Games", year="2025", month="Feb", day="13", volume="13", pages="e56397", keywords="stroke", keywords="rehabilitation", keywords="neurotechnology", abstract="Background: Upper-extremity hemiparesis is a common and debilitating impairment after stroke, severely restricting stroke survivors' ability to participate in daily activities and function independently. Alarmingly, only a small percentage of stroke patients fully recover upper extremity function. Animal models indicate that high-dose upper extremity training during the early poststroke phase can significantly enhance motor recovery. However, translating such programs for human patients remains challenging due to resource limitations, patient compliance issues, and administrative constraints. Objective: This study aimed to assess the feasibility and potential efficacy of an intensive, video game--based upper-extremity training protocol designed to improve movement quality during inpatient stroke rehabilitation. Additionally, it evaluated the resources required for this intervention. Specifically, the protocol provides high-intensity, high-dose training to facilitate motor recovery by engaging patients in targeted interactive exercises. Methods: Twelve patients with upper-extremity hemiparesis completed a 4-week intensive training program comprising 40 sessions of 60 minutes; the training was conducted for 2 hours per day, 5 days per week. This was delivered in addition to standard care, which included 3 therapeutic sessions daily. Two video game--based platforms were used: one platform (tech 1) targeted proximal movements involving the shoulder and elbow, while the second platform (tech 2) emphasized distal movements of the wrist and fingers. Feasibility was assessed using the measure of time on task and measures of patients' motivation and engagement. Potential effectiveness was assessed using the Fugl-Meyer Assessment of the upper extremity (FMA-UE) scale, Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS). Results: Of the 12 patients, 8 completed the full protocol, 3 completed 34?38 sessions, and 1 completed 27 sessions. On average, patients actively engaged in exercises for 35 (SD 4) minutes per hour on the proximal platform (tech 1) and 37 (SD 2) minutes on the distal platform (tech 2). Patients reported high motivation and enjoyment throughout the sessions, with an Intrinsic Motivation Inventory enjoyment score of 6.49 (SD 0.66) out of 7. Pain levels were minimal, with a visual analogue scale (VAS) mean score of 2.00 (SD 2.32). Significant improvements were observed in motor function assessments: the mean improvement in FMA-UE score was 16.5 (SD 10.2) points, ARAT scores increased by 22.9 (SD 13.1) points, and the SIS Hand Function and Recovery score showed a mean delta of 1.23 (SD 0.80) points and a 23.33\% (SD 21.5\%) improvement, respectively. Conclusions: These findings demonstrate that a high-dose, high-intensity, video game--based training protocol is feasible and can be successfully integrated into subacute stroke rehabilitation. Additionally, preliminary evidence suggests that this supplementary intervention may be effective in enhancing motor recovery. This approach holds promise for future stroke rehabilitation protocols by offering an engaging, high-dose, and high-intensity program during early recovery. Trial Registration: Clinicaltrials.gov NCT04737395, https://clinicaltrials.gov/study/NCT04737395 ", doi="10.2196/56397", url="https://games.jmir.org/2025/1/e56397" } @Article{info:doi/10.2196/66692, author="Steinmetz, Carolin and Stenzel, Christina and Sylvester, Maj and Glage, Denis and Linke, Anne and Sadlonova, Monika and von Arnim, F. Christine A. and Schnieder, Marlena and Valentov{\'a}, Miroslava and Heinemann, Stephanie", title="Use of a Technology-Based Fall Prevention Program With Visual Feedback in the Setting of Early Geriatric Rehabilitation: Controlled and Nonrandomized Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e66692", keywords="fall prevention", keywords="fall prevention program", keywords="early geriatric rehabilitation", keywords="gerontology", keywords="older adult", keywords="elder", keywords="aging", keywords="digital exercise intervention", keywords="digital activity", keywords="physical exercise", keywords="functional capacity", keywords="new technology", keywords="technology-based", keywords="digital intervention", keywords="feasibility", abstract="Background: The Otago program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) are unclear. Objective: This study investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR. Methods: We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; mini-mental status test score >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP thrice/week for 20 minutes using a technology-based platform called ``Pixformance.'' The device is a digital trainer and enables real-time corrections. The primary end point was the feasibility (given when 80\% of the IG participated in 6 trainings within 2 weeks). Secondary outcomes were usability (patients' and facilitators' perspective; ?75\%), risk of falls (Berg Balance Scale), mobility (Timed Up and Go Test), functional independence (Functional Independence Measure), and activities of daily living (Barthel Index). Several further exploratory end points were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire; PH-Q4). Data were accessed at entry to EGR and after 2 weeks prior to discharge. To analyze the pre-posttest results, the dependent Student t test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes. Results: A cohort of 60 patients (mean 80.2, SD 6.1 y; 58\% females, 35/60) was analyzed. The main indication for EGR was stroke (9/60, 15\%). Patients were recruited into a prospective IG (n=30) and a retrospective control group (n=30). Of the 30 patients in the prospective IG, 11 patients (37\%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33\%), pain/discomfort (33\%), or fatigue (17\%). EGR patients rated FPP usability at 84\% and facilitators at 65\% out of 100\%. Pre-posttest analysis of the standard assessments showed a significant interaction in Berg Balance Scale (<.01). In both groups, a significant improvement over time was found in the Timed Up and Go Test (<.01), Barthel Index (<.01), and Functional Independence Measure (<.01). Likewise, in the IG, the PH-Q4 score (.02) improved. Conclusions: While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37\% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility. ", doi="10.2196/66692", url="https://formative.jmir.org/2025/1/e66692" } @Article{info:doi/10.2196/59935, author="J{\"a}{\"a}skel{\"a}inen, Elina and Manninen, Mikko and Hurri, Heikki and Rantasalo, Mikko and Zhou, Yun and Kautiainen, Hannu and Ristolainen, Leena", title="Effectiveness of Anti-Gravity Treadmill Exercise After Total Knee Arthroplasty: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Feb", day="11", volume="14", pages="e59935", keywords="total knee arthroplasty", keywords="AlterG", keywords="anti-gravity treadmill", keywords="postoperative rehabilitation", keywords="walking ability", keywords="quality of life", keywords="pain", abstract="Background: Postoperative rehabilitation following total knee arthroplasty (TKA) varies worldwide. In Finland, patients receive guidance on safe walking and home exercises from a physiotherapist both before and after TKA. These are performed independently after surgery. However, a sedentary lifestyle is rather common among patients who have undergone TKA, with pain often limiting postoperative walking, training, and activities of daily living. Objective: This randomized controlled trial aimed to investigate the effectiveness of anti-gravity exercise, precisely the AlterG anti-gravity treadmill, on postoperative rehabilitation following TKA and to obtain new knowledge on this form of rehabilitation to better use it in the future. Methods: This randomized controlled trial study divided the patients into two groups: the intervention group and the control group. The follow-up period was 12 months. Research data were collected through questionnaires and functional tests. All patients in both groups responded to the questionnaires and participated in functional tests before surgery as well as 4 and 12 months after surgery. Patients in the intervention group exercised on the AlterG treadmill 10 times after the surgery. All the patients in this study performed the exercises as instructed when they were in the hospital. The primary outcomes were perceived pain, walking ability, and quality of life. Results: The data collection process began in 2018 and concluded in 2022, intending to obtain valuable information regarding the effect of AlterG training after TKA and determine whether it, along with traditional exercises, could be an effective form of rehabilitation that can be performed at home. We hypothesized that AlterG training would lead to faster rehabilitation, better walking quality, improved quality of life, improved physical activity, and improved overall functioning. The results of this study will be analyzed in 2025 and 2026. Conclusions: This study provides information on how AlterG training can be used in rehabilitation after TKA, further enhancing the rehabilitation program for patients undergoing TKA in general. Trial Registration: ClinicalTrials.gov NCT03904030; https://clinicaltrials.gov/study/NCT03904030 International Registered Report Identifier (IRRID): DERR1-10.2196/59935 ", doi="10.2196/59935", url="https://www.researchprotocols.org/2025/1/e59935", url="http://www.ncbi.nlm.nih.gov/pubmed/39932768" } @Article{info:doi/10.2196/58713, author="Klatt, N. Brooke and Hovareshti, Pedram and Holt, S. Lisa and Dunlap, M. Pamela and Zalkin, Chad and Tolani, Devendra and Whitney, L. Susan", title="A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation: Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Feb", day="4", volume="12", pages="e58713", keywords="technology", keywords="rehabilitation", keywords="vestibular", keywords="physical therapy", keywords="vestibulo-ocular reflex", keywords="ocular", keywords="physiotherapy", keywords="vision", keywords="feasibility", keywords="exercises", keywords="mHealth", keywords="mobile health", keywords="app", keywords="tablet", keywords="digital health", keywords="telerehabilitation", keywords="e-health", keywords="web-based", keywords="clinical use", keywords="physiotherapist", keywords="home exercise", keywords="usability study", keywords="mobile app", abstract="Background: A low-cost home exercise system called VestAid has been developed to assist participants during vestibulo-ocular reflex gaze stabilization exercises outside of clinic visits. The system includes a tablet-based app for the participant and a web-based portal for the physical therapist that provides data to make judgments about exercise accuracy and performance. Objective: The purpose of this study was to assess the feasibility and acceptability of VestAid in a pilot study of 10 participants (mean age 45 [SD 19] years; 6 women) with various vestibular diagnoses. Methods: All participants completed twelve 30-second horizontal vestibulo-ocular reflex exercises in a seated position (6 ``easy'' and 6 ``hard'' exercises). The exercises differed by variations in the background color, pattern, and movement. One of the exercises was repeated to assess the test-retest reliability of the measure of gaze stability accuracy and head motion compliance during the exercise. Participants rated the difficulty of the exercises (0?10 where 0=easy, 10=difficult) and completed usability surveys. Results: Participants completed the VestAid session without adverse events. The responses from the usability survey demonstrate the acceptability of VestAid. The mean rating of the ``easy'' exercises was 2.7/10 (SD 1.9). The mean rating for the ``difficult'' exercises across participants was 4.8/10 (SD 2.1). Conclusions: The consistency of the mean ratings of the participants with the exercise classifications (``easy'' and ``difficult'') suggests that VestAid has clinical utility. ", doi="10.2196/58713", url="https://rehab.jmir.org/2025/1/e58713" } @Article{info:doi/10.2196/54790, author="Oh, Sejun and Lee, SangHeon", title="Rehabilomics Strategies Enabled by Cloud-Based Rehabilitation: Scoping Review", journal="J Med Internet Res", year="2025", month="Jan", day="28", volume="27", pages="e54790", keywords="cloud-based", keywords="health", keywords="rehabilitation", keywords="rehabilomics", keywords="strategies", abstract="Background: Rehabilomics, or the integration of rehabilitation with genomics, proteomics, metabolomics, and other ``-omics'' fields, aims to promote personalized approaches to rehabilitation care. Cloud-based rehabilitation offers streamlined patient data management and sharing and could potentially play a significant role in advancing rehabilomics research. This study explored the current status and potential benefits of implementing rehabilomics strategies through cloud-based rehabilitation. Objective: This scoping review aimed to investigate the implementation of rehabilomics strategies through cloud-based rehabilitation and summarize the current state of knowledge within the research domain. This analysis aims to understand the impact of cloud platforms on the field of rehabilomics and provide insights into future research directions. Methods: In this scoping review, we systematically searched major academic databases, including CINAHL, Embase, Google Scholar, PubMed, MEDLINE, ScienceDirect, Scopus, and Web of Science to identify relevant studies and apply predefined inclusion criteria to select appropriate studies. Subsequently, we analyzed 28 selected papers to identify trends and insights regarding cloud-based rehabilitation and rehabilomics within this study's landscape. Results: This study reports the various applications and outcomes of implementing rehabilomics strategies through cloud-based rehabilitation. In particular, a comprehensive analysis was conducted on 28 studies, including 16 (57\%) focused on personalized rehabilitation and 12 (43\%) on data security and privacy. The distribution of articles among the 28 studies based on specific keywords included 3 (11\%) on the cloud, 4 (14\%) on platforms, 4 (14\%) on hospitals and rehabilitation centers, 5 (18\%) on telehealth, 5 (18\%) on home and community, and 7 (25\%) on disease and disability. Cloud platforms offer new possibilities for data sharing and collaboration in rehabilomics research, underpinning a patient-centered approach and enhancing the development of personalized therapeutic strategies. Conclusions: This scoping review highlights the potential significance of cloud-based rehabilomics strategies in the field of rehabilitation. The use of cloud platforms is expected to strengthen patient-centered data management and collaboration, contributing to the advancement of innovative strategies and therapeutic developments in rehabilomics. ", doi="10.2196/54790", url="https://www.jmir.org/2025/1/e54790" } @Article{info:doi/10.2196/62809, author="R{\'i}os Rinc{\'o}n, M. Adriana and Guptill, Christine and Liubaoerjijin, Yilina and Figeys, Mathieu and Koubasi, Farnaz and Gregson, Geoffrey and Miguel Cruz, Antonio", title="Effectiveness of a New Device for Hand, Wrist, and Forearm Rehabilitation: Feasibility Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="27", volume="12", pages="e62809", keywords="hand", keywords="upper limb", keywords="motion", keywords="movement", keywords="wrist", keywords="therapeutics", keywords="rehabilitation", keywords="musculoskeletal", keywords="musculoskeletal diseases", keywords="stroke", keywords="wrist fractures", keywords="feasibility studies", keywords="randomized controlled trial", keywords="digital health", keywords="physiotherapy", keywords="physical therapy", keywords="occupational therapy", abstract="Background: Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation. Objective: We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm. Methods: Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation. Results: The trial retention rate (36/38, 95\%) and compliance (control group: 100\%; intervention group: 89\%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2\% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=?0.335, P=.008) and grip strength (t34=?1.841, P=.04). Conclusions: The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 ", doi="10.2196/62809", url="https://rehab.jmir.org/2025/1/e62809" } @Article{info:doi/10.2196/50669, author="Chang, Chien-Hsiang and Wei, Chun-Chun and Lien, Wei-Chih and Yang, Tai-Hua and Liu, Bo and Lin, Yimo and Tan, Thong Poh and Lin, Yang-Cheng", title="The Usability and Effect of a Novel Intelligent Rehabilitation Exergame System on Quality of Life in Frail Older Adults: Prospective Cohort Study", journal="JMIR Serious Games", year="2025", month="Jan", day="21", volume="13", pages="e50669", keywords="frailty", keywords="exergame", keywords="older adults", keywords="intelligent rehabilitation", keywords="reminiscence therapy", keywords="eHealth care", abstract="Background: Aging in older adults results in a decline in physical function and quality of daily life. Due to the COVID-19 pandemic, the exercise frequency among older adults decreased, further contributing to frailty. Traditional rehabilitation using repetitive movements tends not to attract older adults to perform independently. Objective: Intelligent Rehabilitation Exergame System (IRES), a novel retro interactive exergame that incorporates real-time surface electromyography, was developed and evaluated. Methods: Frail older adults were invited to use the IRES for rehabilitation using lower limb training twice per week for 4 weeks. Participants were required to have no mobility or communication difficulties and be willing to complete the 4-week study. The enrolled cohort had baseline scores ranging from 1 to 5 on the Clinical Frailty Scale, as described by Rockwood et al. Three major lower limb movements (knee extension, plantar flexion, and dorsiflexion) were performed 20 times for each leg within 30 minutes. The surface electromyography collected and analyzed muscle potential signals for review by health care professionals to customize the protocol for the next training. The System Usability Scale (SUS) and Taiwanese version of the EuroQol-5 Dimensions (EQ-5D) were administered after completing the first (week 1, baseline) and last training (week 4, one-month follow-up) to evaluate the usability of the IRES and its effects on the quality of life of participants. Results: A total of 49 frail older adults (mean age 74.6 years) were included in the analysis. The usability of the IRES improved according to the mean SUS score, from 82.09 (good) at baseline to 87.14 (good+) at 1-month follow-up. The willingness to use (t96=?4.51; P<.001), learnability (t96=?4.83; P<.001), and confidence (t96=?2.27; P=.02) in working with the IRES increased. After using the IRES for 1 month, significant improvements were observed in the ease of use (t47=2.05; P=.04) and confidence (t47=2.68; P<.001) among participants without previous rehabilitation experience. No sex-based differences in the SUS scores were found at baseline or 1-month follow-up. The quality of life, as assessed by the EQ-5D, improved significantly after 1 month of IRES training compared to that at baseline (t96=6.03; P<.001). Conclusions: The novel IRES proposed in this study received positive feedback from frail older adults. Integrating retro-style exergame training into rehabilitation not only improved their rehabilitation motivation but also increased their learning, system operability, and willingness to continue rehabilitation. The IRES provides an essential tool for the new eHealth care service in the post--COVID-19 era. ", doi="10.2196/50669", url="https://games.jmir.org/2025/1/e50669" } @Article{info:doi/10.2196/59704, author="Ramos, Aur{\'e}lien and Boisvert, Maxence and Traverse, Elodie and Levac, Danielle and Lemay, Martin and Demers, Marika and Bordeleau, Martine and Ruest, Sarah-Maude and P{\'e}rinet-Lacroix, Roxanne and Best, L. Krista and Robert, T. Maxime", title="Bridging Needs and Expectations of Individuals With Physical Disabilities and Community Services Stakeholders for the Cocreation of an Adapted Physical Activity Platform in Virtual Reality: Qualitative Study", journal="JMIR Serious Games", year="2025", month="Jan", day="17", volume="13", pages="e59704", keywords="virtual reality", keywords="physical activity", keywords="community organizations", keywords="accessibility", keywords="physical disability", abstract="Background: Physical activity supports the health and well-being of individuals with physical disabilities. Despite the significance of engaging in physical activity, barriers faced by individuals with disabilities, such as limited access to adapted facilities and lack of transportation, can restrict their participation. Community organizations play a role in addressing these challenges, but virtual reality (VR) also offers a way to diversify adapted activities. In some situations, VR can help overcome the resource limitations of organizations by providing accessible, engaging, and highly personalized options for physical activity. Objective: The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a VR physical activity platform in a community organization. Methods: A descriptive qualitative study was conducted using semistructured interviews with individuals with physical disabilities and their interventionists, all associated with a nonprofit organization promoting physical activity among people with disabilities. Data were analyzed using an inductive thematic approach. Results: In total, 15 participants, including 8 people with physical disabilities and 7 interventionists, were interviewed. Through this discussion, we gained insights into the everyday challenges faced by individuals with disabilities and identified priorities for community organizations. Subsequently, we discussed key considerations for using VR, including adapting activities, the possibility of fostering a more positive perception of physical activity, and harnessing the potential of VR to improve access to physical activity. We also discussed the importance of supporting personal goals and creating inclusive experiences while recognizing challenges such as technical difficulties and connectivity issues. Conclusions: By exploring the needs and expectations regarding VR technology from individuals with physical disabilities and their interventionists, this study provided essential insights for integrating immersive and nonimmersive VR into community organizations, informing next steps for the design of adapted physical activities in VR. ", doi="10.2196/59704", url="https://games.jmir.org/2025/1/e59704" } @Article{info:doi/10.2196/64825, author="Mastropietro, Alfonso and Peruzzo, Denis and Taccogna, Giovanna Maria and Sanna, Nicole and Casali, Nicola and Nossa, Roberta and Biffi, Emilia and Ambrosini, Emilia and Pedrocchi, Alessandra and Rizzo, Giovanna", title="Multiparametric MRI Assessment of Morpho-Functional Muscle Changes Following a 6-Month FES-Cycling Training Program: Pilot Study in People With a Complete Spinal Cord Injury", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="16", volume="12", pages="e64825", keywords="functional electrical stimulation", keywords="FES", keywords="cycling", keywords="exercise", keywords="physical activity", keywords="spinal cord injury", keywords="multiparametric MRI", keywords="skeletal muscle", keywords="rehabilitation", keywords="magnetic resonance imaging", keywords="muscle", keywords="muscular", keywords="musculoskeletal", keywords="spine", keywords="MRI", keywords="mpMRI", keywords="image", keywords="imaging", abstract="Background: Spinal cord injuries (SCIs) cause debilitating secondary conditions such as severe muscle deterioration, cardiovascular, and metabolic dysfunctions, significantly impacting patients' quality of life. Functional electrical stimulation (FES) combined with cycling exercise (FES-cycling) has shown promise in improving muscle function and health in individuals with SCI. Objective: This pilot study aimed to investigate the potential role of multiparametric magnetic resonance imaging (MRI) to assess muscle health during and after an FES-cycling rehabilitation program. Methods: Four male participants with chronic SCI underwent a 6-month FES-cycling training program, consisting of two 30-minute sessions per week. MRI scans were performed at baseline (T0), after 3 months (T1), at the end of the training (T2), and 1-month posttraining (T3). The MRI protocol included T1-weighted imaging for volume quantification, Dixon imaging for fat fraction, multi-echo spin echo for T2 relaxation times, and diffusion tensor imaging to assess diffusion parameters. Results: Muscle hypertrophy was observed, with an average increase in muscle volume of 22.3\% at T1 and 36.7\% at T2 compared with baseline. One month posttraining, muscle volume remained 23.2\% higher than baseline. Fat fraction decreased from 11.1\% at T0 to 9.1\% at T2, with a rebound to 10.9\% at T3. T2 relaxation times showed a reduction even though this was not consistent among participants. Diffusion tensor imaging parameters revealed subtle changes in muscle tissue microstructure, with a decrease in fractional anisotropy mainly associated to an increase of radial diffusivity. Conclusions: Although preliminary, this study provides evidence that 6 months of low-intensity FES-bike training can increase muscle volume and decrease fat infiltration in individuals with SCI. The study demonstrates that the use of a multiparametric MRI provides comprehensive insights into both macroscopic and microscopic changes within muscle tissues, supporting its integration into clinical practice for assessing the efficacy of rehabilitation interventions. Trial Registration: ClinicalTrials.gov NCT06321172; https://clinicaltrials.gov/study/NCT06321172 ", doi="10.2196/64825", url="https://rehab.jmir.org/2025/1/e64825" } @Article{info:doi/10.2196/63641, author="S{\o}rensen, Linda and Sagen Johannesen, Tomas Dag and Melkas, Helin{\"a} and Johnsen, Mari Hege", title="User Acceptance of a Home Robotic Assistant for Individuals With Physical Disabilities: Explorative Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="13", volume="12", pages="e63641", keywords="physical artificial intelligence", keywords="physical AI", keywords="health care robotics", keywords="assistive technology", keywords="content analysis", keywords="qualitative", keywords="health care", keywords="robotics", keywords="assistive", keywords="robot interaction", keywords="physical disabilities", keywords="readiness", keywords="amputations", abstract="Background: Health care is shifting toward 5 proactive approaches: personalized, participatory, preventive, predictive, and precision-focused services (P5 medicine). This patient-centered care leverages technologies such as artificial intelligence (AI)--powered robots, which can personalize and enhance services for users with disabilities. These advancements are crucial given the World Health Organization's projection of a global shortage of up to 10 million health care workers by 2030. Objective: This study aimed to investigate the acceptance of a humanoid assistive robot among users with physical disabilities during (1) AI-powered (using a Wizard of Oz methodology) robotic performance of predefined personalized assistance tasks and (2) operator-controlled robotic performance (simulated distant service). Methods: An explorative qualitative design was used, involving user testing in a simulated home environment and individual interviews. Directed content analysis was based on the Almere model and the model of domestic social robot acceptance. Results: Nine participants with physical disabilities aged 27 to 78 years engaged in robot interactions. They shared their perceptions across 7 acceptance concepts: hedonic attitudes, utilitarian attitudes, personal norms, social norms, control beliefs, facilitating conditions, and intention to use. Participants valued the robot's usefulness for practical services but not for personal care. They preferred automation but accepted remote control of the robot for some tasks. Privacy concerns were mixed. Conclusions: This study highlights the complex interplay of functional expectations, technological readiness, and personal and societal norms affecting the acceptance of physically assistive robots. Participants were generally positive about robotic assistance as it increases independence and lessens the need for human caregivers, although they acknowledged some current shortcomings. They were open to trying more home testing if future robots could perform most tasks autonomously. AI-powered robots offer new possibilities for creating more adaptable and personalized assistive technologies, potentially enhancing their effectiveness and viability for individuals with disabilities. ", doi="10.2196/63641", url="https://rehab.jmir.org/2025/1/e63641", url="http://www.ncbi.nlm.nih.gov/pubmed/39805579" } @Article{info:doi/10.2196/58384, author="Kang, Xin and Zhang, Yiping and Sun, Chaonan and Zhang, Jiaxin and Che, Zhe and Zang, Jinhui and Zhang, Rongzhi", title="Effectiveness of Virtual Reality Training in Improving Outcomes for Dialysis Patients: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2025", month="Jan", day="8", volume="27", pages="e58384", keywords="virtual reality", keywords="VR", keywords="training", keywords="dialysis", keywords="hemodialysis", keywords="peritoneal dialysis", keywords="chronic kidney disease", keywords="rehabilitation", keywords="quality of life", keywords="meta-analysis", abstract="Background: Virtual reality (VR) training uses computer-generated simulations that enable users to engage with immersive virtual environments, simulating real-world activities or therapeutic exercises. This technology is increasingly recognized as a promising intervention to address the physical and psychological challenges faced by dialysis patients, who frequently experience diminished physical function, social isolation, and emotional distress associated with prolonged treatment regimens. Given the increasing prevalence of dialysis patients and the limitations of conventional rehabilitation approaches, VR presents a novel, interactive method that has the potential to enhance patient well-being and improve quality of life. Objective: This meta-analysis aimed to evaluate the effectiveness of VR training interventions for dialysis patients, with a focus on assessing their impact on motor abilities, psychological symptoms (specifically anxiety and depression), social functioning, and self-efficacy. This analysis also explores whether VR can offer comprehensive benefits to support both the physical and mental health of dialysis patients. Methods: The meta-analysis was conducted following Cochrane guidelines. Comprehensive searches were performed across major databases, including China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, China Biomedical Literature database, Cochrane library, Web of Science, PubMed, and Embase, encompassing all studies up to December 2023. Inclusion criteria targeted studies assessing VR's impact on motor performance, psychological well-being, social functioning, and self-efficacy in dialysis patients. Two reviewers independently extracted data and assessed methodological quality using Cochrane's risk of bias criteria, ensuring data synthesis reliability. Results: A total of 12 studies, involving 625 dialysis patients in total, met the inclusion criteria. The meta-analysis demonstrated that VR training led to significant improvements across multiple domains. VR interventions were associated with improved physical capacity, evidenced by higher scores in the 6-minute walk test (standardized mean difference [SD]=29.36, 95\% CI 14.32-44.4, P<.001, I2=46\%). VR training was associated with significant reductions in depression (SD=--6.30, 95\% CI --7.14 to --5.47, P<.001, I2=96\%) and anxiety (SD=--8.91, 95\% CI --9.69 to --8.14, P<.001, I2=95\%). In addition, VR interventions enhanced social functioning (SD=16.20, 95\% CI 14.49-17.9, P<.001, I2=72\%), and improved self-efficacy (SD=20.47, 95\% CI 18.55-22.39, P<.001, I2=99\%). However, VR training did not yield significant differences in gait speed, balance, or functional tests (Ten Sit-to-Stand Test, Five Sit-to-Stand Test, Sixty Sit-to-Stand Test, Timed Up and Go Test, and fatigue) compared with control groups. Conclusions: The findings suggest that VR training is a promising intervention for dialysis patients, providing benefits in physical endurance, social engagement, and psychological well-being. Despite these advantages, VR remains underused among peritoneal dialysis patients compared with hemodialysis patients. Further studies with larger sample sizes and more refined experimental designs are recommended to validate these results and support VR as a complementary tool in the holistic care of dialysis patients. ", doi="10.2196/58384", url="https://www.jmir.org/2025/1/e58384" } @Article{info:doi/10.2196/64121, author="Soulard, Julie and Kairy, Dahlia and Walha, Roua and Duclos, Cyril and Nadeau, Sylvie and Auger, Claudine", title="Professionals' Perspectives of Smart Stationary Bikes in Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Dec", day="31", volume="11", pages="e64121", keywords="health professionals", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="cross-sectional", keywords="survey", keywords="questionnaire", keywords="technology", keywords="stationary bike", keywords="cycling", keywords="rehabilitation", keywords="physical activity", keywords="bike", keywords="bicycle", keywords="qualitative", keywords="content analysis", keywords="digital health", abstract="Background: Stationary bikes are used in numerous rehabilitation settings, with most offering limited functionalities and types of training. Smart technologies, such as artificial intelligence and robotics, bring new possibilities to achieve rehabilitation goals. However, it is important that these technologies meet the needs of users in order to improve their adoption in current practice. Objective: This study aimed to collect professionals' perspectives on the use of smart stationary bikes in rehabilitation. Methods: Twelve health professionals (age: mean 43.4, SD 10.1 years) completed an online questionnaire and participated in a semistructured interview regarding their needs and expectations before and after a 30-minute session with a smart bike prototype. Results: A content analysis was performed with inductive coding. Seven main themes emerged: (1) bike functionalities (cycling assistance, asymmetric resistance, and forward and backward cycling), (2) interface between bike and users (simple, user-friendly, personalized, with written reminders during training), (3) feedback to users (user and performance data), (4) training programs (preprogrammed and personalized, and algorithmic programs), (5) user engagement (telerehabilitation, group sessions, music, and automatic suggestion of training), (6) the bike as a physical device (dimensions, comfort, setup, screen, etc), and (7) business model (various pricing strategies, training for professionals, and after-sales service). Conclusions: This study provides an interpretive understanding of professionals' perspectives regarding smart stationary bikes and is the first to identify the expectations of health professionals regarding the development of future bikes in rehabilitation. ", doi="10.2196/64121", url="https://rehab.jmir.org/2024/1/e64121" } @Article{info:doi/10.2196/60374, author="Pearce, Nettleton Louise Michelle and Pryor, Julie and Redhead, Jason and Sherrington, Catherine and Hassett, Leanne", title="Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e60374", keywords="rehabilitation", keywords="technology", keywords="digital health", keywords="virtual reality", keywords="robotics", keywords="exoskeleton device", keywords="implementation science", keywords="physiotherapy", keywords="physical therapy", keywords="occupational therapy", keywords="mobile phone", abstract="Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65\%), occupational therapists (1396/4208, 33\%), and allied health assistants (96/4208, 2\%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70\%). Devices were typically used to target impairment and activity limitation--related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94\%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47\%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51\%, vs outpatient services, 963/2335, 41\%) ($\chi$21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51\%, vs all other conditions, between 24\%-31\%; $\chi$25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use. ", doi="10.2196/60374", url="https://www.jmir.org/2024/1/e60374" } @Article{info:doi/10.2196/58734, author="Funao, Hiroki and Momosaki, Ryo and Tsujikawa, Mayumi and Kawamoto, Eiji and Esumi, Ryo and Shimaoka, Motomu", title="Virtual Reality--Applied Home-Visit Rehabilitation for Patients With Chronic Pain: Protocol for Single-Arm Pre-Post Comparison Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="30", volume="13", pages="e58734", keywords="chronic pain", keywords="homebound patient", keywords="home-visit rehabilitation", keywords="virtual reality", keywords="protocol", keywords="feasibility study", keywords="VR", keywords="pain", keywords="recurrent pain", keywords="home visit", keywords="rehabilitation", keywords="home rehabilitation", keywords="in-home", keywords="effective", keywords="screening", keywords="VR intervention", keywords="feasibility", keywords="alleviate pain", abstract="Background: Pain inhibits rehabilitation. In rehabilitation at medical institutions, the usefulness of virtual reality (VR) has been reported in many cases to alleviate pain. In recent years, the demand for home rehabilitation has increased. Unlike in medical situations, the patients targeted for in-home rehabilitation often have chronic pain due to physical and psychosocial factors, and the environment is not specialized for rehabilitation. However, VR might be effective for in-home rehabilitation settings. Objective: This study aims to evaluate the feasibility of applying VR to home-visit rehabilitation for homebound patients with chronic pain. Methods: This study will test the feasibility of VR applied to home-visit rehabilitation for patients with chronic pain. A single-arm pre-post comparison will be conducted to evaluate its feasibility. Screening will be conducted on patients who have given consent to participate in the study, and those who have pain that persists or recurs for more than 3 months and receive home-visit rehabilitation will be enrolled in the study. Baseline measurements will be conducted on study participants before the start of the VR intervention. VR-applied home-visit rehabilitation will be conducted once a week for a total of 10 VR interventions. The primary endpoint is the change in pain from the baseline to the tenth intervention. Pain is a subjective symptom of the study participants and will be subjectively assessed by the Numerical Rating Scale of 11 levels from 0 to 10. Pain as the primary endpoint will be measured at 3-time points per rehabilitation session: before, during, and after the rehabilitation so that changes between time points can be evaluated. Secondary endpoints are heart rate variability, range of motion of the area in the musculoskeletal system where the pain occurs, motivation for rehabilitation, catastrophic thoughts of pain, mood state, quality of life, and interviews. Assessments will be conducted at the baseline, first, fifth, and tenth interventions. After completing the clinical study (10 VR interventions), patients will continue their regular home-visit rehabilitation as usual. Results: Recruitment of participants began on February 22, 2022, and data collection is ongoing as of November 2024. The research results will be published in international peer-reviewed journals and through presentations at national and international conferences. Conclusions: This study will contribute to the development of novel rehabilitation-based solutions for homebound patients who have had difficulty obtaining adequate relief from chronic pain. Future studies will consider conducting randomized controlled trials as clinical trials to validate the efficacy of VR during home-visit rehabilitation for patients with chronic pain. International Registered Report Identifier (IRRID): DERR1-10.2196/58734 ", doi="10.2196/58734", url="https://www.researchprotocols.org/2024/1/e58734" } @Article{info:doi/10.2196/57271, author="Alqahtani, M. Mohammed and Alanazi, M. Abdullah M. and Algarni, S. Saleh and Aljohani, Hassan and Alenezi, K. Faraj and F Alotaibi, Tareq and Alotaibi, Mansour and K Alqahtani, Mobarak and Alahmari, Mushabbab and S Alwadeai, Khalid and M Alghamdi, Saeed and Almeshari, A. Mohammed and Alshammari, Faleh Turki and Mumenah, Noora and Al Harbi, Ebtihal and Al Nufaiei, F. Ziyad and Alhuthail, Eyas and Alzahrani, Esam and Alahmadi, Husam and Alarifi, Abdulaziz and Zaidan, Amal and T Ismaeil, Taha", title="Unveiling the Influence of AI on Advancements in Respiratory Care: Narrative Review", journal="Interact J Med Res", year="2024", month="Dec", day="20", volume="13", pages="e57271", keywords="artificial intelligence", keywords="AI", keywords="respiratory care", keywords="machine learning", keywords="digital health", keywords="narrative review", abstract="Background: Artificial intelligence is experiencing rapid growth, with continual innovation and advancements in the health care field. Objective: This study aims to evaluate the application of artificial intelligence technologies across various domains of respiratory care. Methods: We conducted a narrative review to examine the latest advancements in the use of artificial intelligence in the field of respiratory care. The search was independently conducted by respiratory care experts, each focusing on their respective scope of practice and area of interest. Results: This review illuminates the diverse applications of artificial intelligence, highlighting its use in areas associated with respiratory care. Artificial intelligence is harnessed across various areas in this field, including pulmonary diagnostics, respiratory care research, critical care or mechanical ventilation, pulmonary rehabilitation, telehealth, public health or health promotion, sleep clinics, home care, smoking or vaping behavior, and neonates and pediatrics. With its multifaceted utility, artificial intelligence can enhance the field of respiratory care, potentially leading to superior health outcomes for individuals under this extensive umbrella. Conclusions: As artificial intelligence advances, elevating academic standards in the respiratory care profession becomes imperative, allowing practitioners to contribute to research and understand artificial intelligence's impact on respiratory care. The permanent integration of artificial intelligence into respiratory care creates the need for respiratory therapists to positively influence its progression. By participating in artificial intelligence development, respiratory therapists can augment their clinical capabilities, knowledge, and patient outcomes. ", doi="10.2196/57271", url="https://www.i-jmr.org/2024/1/e57271", url="http://www.ncbi.nlm.nih.gov/pubmed/39705080" } @Article{info:doi/10.2196/56682, author="Wagh, Vaidehi and Scott, W. Matthew and Kraeutner, N. Sarah", title="Quantifying Similarities Between MediaPipe and a Known Standard to Address Issues in Tracking 2D Upper Limb Trajectories: Proof of Concept Study", journal="JMIR Form Res", year="2024", month="Dec", day="17", volume="8", pages="e56682", keywords="markerless pose estimation", keywords="procrustes analysis", keywords="artificial intelligence", keywords="motion", keywords="movement tracking", keywords="touchscreen", keywords="markerless tracking", keywords="upper limb", keywords="motor", abstract="Background: Markerless motion tracking methods have promise for use in a range of domains, including clinical settings where traditional marker-based systems for human pose estimation are not feasible. Artificial intelligence (AI)--based systems can offer a markerless, lightweight approach to motion capture. However, the accuracy of such systems, such as MediaPipe, for tracking fine upper limb movements involving the hand has not been explored. Objective: The aim of this study is to evaluate the 2D accuracy of MediaPipe against a known standard. Methods: Participants (N=10) performed a touchscreen-based shape-tracing task requiring them to trace the trajectory of a moving cursor using their index finger. Cursor trajectories created a reoccurring or random shape at 5 different speeds (500-2500 ms, in increments of 500 ms). Movement trajectories on each trial were simultaneously captured by the touchscreen and a separate video camera. Movement coordinates for each trial were extracted from the touchscreen and compared to those predicted by MediaPipe. Specifically, following resampling, normalization, and Procrustes transformations, root-mean-squared error (RMSE; primary outcome measure) was calculated between predicted coordinates and those generated by the touchscreen computer. Results: Although there was some size distortion in the frame-by-frame estimates predicted by MediaPipe, shapes were similar between the 2 methods and transformations improved the general overlap and similarity of the shapes. The resultant mean RMSE between predicted coordinates and those generated by the touchscreen was 0.28 (SD 0.06) normalized px. Equivalence testing revealed that accuracy differed between MediaPipe and the touchscreen, but that the true difference was between 0 and 0.30 normalized px (t114=?3.02; P=.002). Additional analyses revealed no differences in resultant RMSE between methods when comparing across lower frame rates (30 and 60 frames per second [FPS]), although there was greater RMSE for 120 FPS than for 60 FPS (t35.43=?2.51; P=.03). Conclusions: Overall, we quantified similarities between one AI-based approach to motion capture and a known standard for tracking fine upper limb movements, informing applications of such systems in domains such as clinical and research settings. Future work should address accuracy in 3 dimensions to further validate the use of AI-based systems, including MediaPipe, in such domains. ", doi="10.2196/56682", url="https://formative.jmir.org/2024/1/e56682" } @Article{info:doi/10.2196/60155, author="Kwan, Cho Rick Yiu and Law, Sze Queenie Pui and Tsang, Yee Jenny Tsun and Lam, Hin Siu and Wang, To Kam and Sin, Kan Olive Shuk and Cheung, Ki Daphne Sze", title="The Effect of the Mediterranean Diet--Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2024", month="Dec", day="13", volume="11", pages="e60155", keywords="cognitive frailty", keywords="gamification", keywords="health education", keywords="Mediterranean diet", keywords="home based", keywords="cognitive training", keywords="older adults", keywords="geriatric", keywords="elderly", keywords="cognitive function", keywords="intervention", keywords="nutritional education", keywords="cognitive impairment", keywords="dementia", abstract="Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=--0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=--0.728, P=.009), cognitive function (r=--0.752, P=.007), physical frailty (r=--0.668, P=.02), and walking speed (r=--0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 ", doi="10.2196/60155", url="https://rehab.jmir.org/2024/1/e60155" } @Article{info:doi/10.2196/52943, author="Guida, Stefania and Vitale, Antonino Jacopo and Swinnen, Eva and Beckw{\'e}e, David and Bargeri, Silvia and Pennestr{\`i}, Federico and Castellini, Greta and Gianola, Silvia", title="Effects of Prehabilitation With Advanced Technologies in Patients With Musculoskeletal Diseases Waiting for Surgery: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Dec", day="12", volume="26", pages="e52943", keywords="prehabilitation", keywords="advanced technologies", keywords="musculoskeletal diseases", keywords="joint arthroplasty", keywords="elective surgery", keywords="patient outcomes", keywords="mobile health", keywords="postoperative function", abstract="Background: Prehabilitation delivered with advanced technologies represents a great chance for patients to optimize pre- and postoperative outcomes, reduce costs, and overcome travel-related barriers. Objective: We aim to evaluate the effects of prehabilitation delivered with advanced technologies on clinically relevant outcomes among patients affected by musculoskeletal diseases and waiting for surgery. Methods: We searched the PubMed, EMBASE, Cochrane Library, PEDro, and CINAHL databases up to February 2, 2023. ClinicalTrials.gov was also searched for registered protocols. Randomized controlled trials and nonrandomized intervention studies with adult participants of both sexes, affected by any musculoskeletal disease, and undergoing prehabilitation with advanced technologies or standard care were included. Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. Certainty of evidence was assessed for the primary outcome with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The primary outcome was function. Secondary outcomes were pain, strength, risk of fall, autonomy in the activities of daily living, patient satisfaction, health-related quality of life, adverse events, and adherence to treatment. Results: Six studies (7 reports), focusing on patients undergoing total knee or hip arthroplasty and primary meniscal tear and spine surgery were included. We found different prehabilitation programs: mindfulness-based stress reduction, exercise, education, or a combination thereof. Prehabilitation delivered with advanced technologies proved to be more effective in improving function in candidates for knee or hip replacement (Western Ontario McMaster Osteoarthritis Index ``function'' subscale before surgery: mean difference [MD] --7.45, 95\% CI --10.71 to --4.19; I2=0\%; after surgery: MD --7.84, 95\% CI --11.80 to --3.88; I2=75.3\%), preoperative pain (MD --1.67, 95\% CI --2.50 to --0.48; I2=0\%), risk of fall (MD --2.54, 95\% CI --3.62 to --1.46; I2=0\%), and postoperative stiffness (MD --2.00, 95\% CI --2.01 to --1.99; I2=87\%). No differences were found in pain 1 month after surgery. Data from studies including participants undergoing primary meniscal tear and spinal surgery could not be pooled. Conclusions: Prehabilitation delivered with advanced technologies may be better than standard care in improving pre- and postoperative function among candidates for knee or hip arthroplasty. No quantitative results have been achieved on spine surgery candidates or other musculoskeletal diseases. Trial Registration: PROSPERO CRD42022345811; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=345811 ", doi="10.2196/52943", url="https://www.jmir.org/2024/1/e52943" } @Article{info:doi/10.2196/59136, author="Krohn, Maria and Rintala, Aki and Immonen, Jaakko and Sj{\"o}gren, Tuulikki", title="The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials", journal="J Med Internet Res", year="2024", month="Dec", day="2", volume="26", pages="e59136", keywords="stroke", keywords="chronic", keywords="virtual reality", keywords="physiotherapy", keywords="therapeutic exercise", keywords="balance", keywords="walking", abstract="Background: Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. Objective: This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. Methods: Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. Results: A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95\% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95\% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. Conclusions: Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation. ", doi="10.2196/59136", url="https://www.jmir.org/2024/1/e59136", url="http://www.ncbi.nlm.nih.gov/pubmed/39621381" } @Article{info:doi/10.2196/57661, author="Barnes, Keely and Sveistrup, Heidi and Bayley, Mark and Egan, Mary and Bilodeau, Martin and Rathbone, Michel and Taljaard, Monica and Karimijashni, Motahareh and Marshall, Shawn", title="Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study", journal="JMIR Neurotech", year="2024", month="Nov", day="27", volume="3", pages="e57661", keywords="brain injury", keywords="virtual", keywords="assessment", keywords="remote", keywords="evaluation", keywords="concussion", keywords="adult", keywords="clinician review", keywords="in-person", keywords="comparison", keywords="sensitivity", keywords="reliability", keywords="acceptability survey", keywords="feasibility study", keywords="psychometric properties", keywords="vestibular/ocular motor screening", keywords="VOMS", keywords="workplace", keywords="clinician", keywords="hospital", keywords="rehabilitation center", keywords="brain", keywords="neurology", keywords="neuroscience", keywords="neurotechnology", keywords="technology", keywords="digital intervention", keywords="digital health", keywords="psychometrics", keywords="physical assessment", keywords="clinical assessment", keywords="workplace safety", keywords="mobile phone", abstract="Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61\% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: $\kappa$=0.38?0.49) to excellent (VOMS change in symptoms: $\kappa$=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 ", doi="10.2196/57661", url="https://neuro.jmir.org/2024/1/e57661" } @Article{info:doi/10.2196/65680, author="Lancioni, E. Giulio and Alberti, Gloria and Filippini, Chiara and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Orlando, Isabella and Desideri, Lorenzo", title="A Technology System to Help People With Intellectual Disability and Blindness Find Room Destinations During Indoor Traveling: Case Series Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="27", volume="11", pages="e65680", keywords="barcode reader", keywords="barcode", keywords="blindness", keywords="intellectual disability", keywords="indoor traveling", keywords="indoor travel", keywords="digital health", keywords="travel", keywords="navigation", keywords="wayfinding", keywords="patient care", keywords="patient support", keywords="mobile health", keywords="patient assessment", keywords="health intervention", keywords="user engagement", keywords="technology use", keywords="telerehabilitation", keywords="rehabilitation", keywords="disability", keywords="support tools", keywords="mobility", keywords="orientation", keywords="mobile phone", abstract="Background: People with severe or profound intellectual disability and visual impairment tend to have serious problems in orientation and mobility and need assistance for their indoor traveling. The use of technology solutions may be critically important to help them curb those problems and achieve a level of independence. Objective: This study aimed to assess a new technology system to help people with severe to profound intellectual disability and blindness find room destinations during indoor traveling. Methods: A total of 7 adults were included in the study. The technology system entailed a barcode reader, a series of barcodes marking the room entrances, a smartphone, and a special app that controlled the presentation of different messages (instructions) for the participants. The messages varied depending on whether the participants were (1) in an area between room entrances, (2) in correspondence with a room entrance to bypass, or (3) in correspondence with a room entrance representing the destination to enter. The intervention with the technology system was implemented according to a nonconcurrent multiple baseline design across participants. Sessions included 7 traveling trials, in each of which the participants were to reach and enter a specific room (1 of the 7 or 9 available) to deliver an object they had carried (transported) during their traveling. Results: The participants' mean frequency of traveling trials completed correctly was between zero and 2 per session during the baseline (without the system). Their mean frequency increased to between about 6 and nearly 7 per session during the intervention (with the system). Conclusions: The findings suggest that the new technology system might be a useful support tool for people with severe to profound intellectual disability and blindness. ", doi="10.2196/65680", url="https://rehab.jmir.org/2024/1/e65680", url="http://www.ncbi.nlm.nih.gov/pubmed/39602792" } @Article{info:doi/10.2196/57579, author="Willinge, A. Gijs J. and Spierings, F. Jelle and Romijnders, J. Kim A. G. and Mathijssen, E. Elke G. and Twigt, A. Bas and Goslings, Carel J. and van Veen, N. Ruben", title="Feasibility of a Web-Based and Mobile-Supported Follow-Up Treatment Pathway for Adult Patients With Orthopedic Trauma in the Netherlands: Concurrent Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="26", volume="8", pages="e57579", keywords="musculoskeletal extremity injury", keywords="patient portal", keywords="follow-up treatment", keywords="healthcare utilization", keywords="patient experience", keywords="feasibility", keywords="orthopedics", keywords="trauma", keywords="Netherlands", keywords="mixed methods", keywords="resource utilization", keywords="electronic patient records", keywords="thematic analysis", keywords="qualitative data", keywords="digital treatment", keywords="mobile phone", abstract="Background: Orthopedic trauma care encounters challenges in follow-up treatment due to limited patient information provision, treatment variation, and the chaotic settings in which it is provided. Additionally, pressure on health care resources is rising worldwide. In response, digital follow-up treatment pathways were implemented for patients with orthopedic trauma, aiming to optimize health care resource use and enhance patient experiences. Objective: We aim to assess digital follow-up treatment pathway feasibility from the patient's perspective and its impact on health care resource use. Methods: A concurrent mixed methods study was conducted parallel to implementation of digital follow-up treatment pathways in an urban level-2 trauma center. Inclusion criteria were (1) minimum age of 18 years, (2) an active web-based patient portal account, (3) ability to read and write in Dutch, and (4) no cognitive or preexisting motor impairment. Data were collected via electronic patient records, and surveys at three time points: day 1?3, 4?6 weeks, and 10?12 weeks after an initial emergency department visit. Semistructured interviews were performed at 10?12 weeks post injury. Anonymous data from a pre-existing database were used to compare health care resource use between the digital treatment pathways and traditional treatment. Quantitative data were reported descriptively. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited efficacy. Results: Sixty-six patients were included for quantitative data collection. Survey response rates were 100\% (66/66) at day 1?3, 92\% (61/66) at 4?6 weeks, and 79\% (52/66) at 10?12 weeks. For qualitative data collection, 15 semistructured interviews were performed. Patients reported median satisfaction scores of 7 (IQR 6?8) with digital treatment pathways and 8 (IQR 7?9) for overall treatment, reflecting positive experiences regarding functionality, actual and intended use, and treatment safety. Digital treatment pathways reduced secondary health care use, with fewer follow-up appointments by phone (median 0, IQR 0?0) versus the control group (median 1, IQR 0?1; P<.001). Consequently, fewer physicians were involved in follow-up treatment for the intervention group (median 2, IQR 1?2) than for the control group (median 2, IQR 1?3; P<.001). Fewer radiographs were performed for the intervention group (median 1, IQR 0-1) than for the control group (P=.01). Qualitative data highlighted positive experiences with functionalities, intended use, and safety, but also identified areas for improvement, including managing patient expectations, platform usability, and protocol adherence. Conclusions: Use of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reducing health care resource use. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for health care professionals. These insights can guide clinicians and policy makers in effectively integrating similar tools into clinical practice. ", doi="10.2196/57579", url="https://formative.jmir.org/2024/1/e57579" } @Article{info:doi/10.2196/59630, author="Morrow, L. Emily and Nelson, A. Lyndsay and Duff, C. Melissa and Mayberry, S. Lindsay", title="An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="26", volume="11", pages="e59630", keywords="chronic traumatic brain injury", keywords="rehabilitation", keywords="memory", keywords="ecological momentary intervention", keywords="text messaging", keywords="mobile health", keywords="mobile application", keywords="digital health", keywords="digital intervention", abstract="Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals' behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message--based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI's usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98\%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users' preferences and plan to test the efficacy of this tool in a future clinical trial. ", doi="10.2196/59630", url="https://rehab.jmir.org/2024/1/e59630" } @Article{info:doi/10.2196/55776, author="Ricci, Sofia Fabiana and Liguori, Lorenzo and Palermo, Eduardo and Rizzo, John-Ross and Porfiri, Maurizio", title="Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="18", volume="11", pages="e55776", keywords="assistive technology", keywords="human-computer interaction", keywords="multisensory feedback", keywords="virtual reality", keywords="visual impairment", keywords="haptic", abstract="Background: Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense. Objective: This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI. Methods: The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants' answers to a questionnaire, assessing their experience and preference for feedback modalities. Results: Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72\%) and found it interesting (42/72, 58\%). However, when it came to feedback preferences, less than half of the participants (29/72, 40\%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones. Conclusions: AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users' spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI. ", doi="10.2196/55776", url="https://rehab.jmir.org/2024/1/e55776" } @Article{info:doi/10.2196/58388, author="Wei, Xijun and Zhou, Ping and Wei, Yixi and Wu, Dashuang and Qin, Ping and Zhang, Yingying and Zhu, Jing and Ren, Zhanbing and Li, Hai and Zhang, Yumei", title="Comparison of Occupational Performance in Immersive Virtual and Real Environments Among Patients With Stroke: Observational Randomized Crossover Pilot Study", journal="JMIR Serious Games", year="2024", month="Nov", day="15", volume="12", pages="e58388", keywords="instrumental activities of daily living", keywords="immersive virtual reality", keywords="occupational performance", keywords="stroke rehabilitation", keywords="occupational therapy", abstract="Background: Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. Objective: This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Methods: Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. Results: The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI ($\rho$=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment ($\rho$=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment ($\rho$=?0.58; P=.08). Conclusions: Considering the small sample size used in this study and the study's limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000041058; https://www.chictr.org.cn/showprojEN.html?proj=65714 ", doi="10.2196/58388", url="https://games.jmir.org/2024/1/e58388" } @Article{info:doi/10.2196/56158, author="Barnes, Keely and Sveistrup, Heidi and Karimijashni, Motahareh and Bayley, Mark and Egan, Mary and Bilodeau, Martin and Rathbone, Michel and Taljaard, Monica and Marshall, Shawn", title="Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study", journal="J Med Internet Res", year="2024", month="Nov", day="13", volume="26", pages="e56158", keywords="remote care", keywords="mild traumatic brain injury", keywords="telehealth", keywords="assessment", keywords="workplace injury", keywords="concussion", keywords="telemedicine", keywords="brain injury", abstract="Background: Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. Objective: This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Methods: Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. Results: A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8\%) and 9/201 (4\%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10\%) of the time for patient participants); communication (mentioned 34/162 (21\%) and 9/201 (4\%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7\%) of the time for patient and 15/201 (7\%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27\%) and 21/151 (14\%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7\%) of the time for patient participants); and having access to resources (mentioned 25/151 (17\%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Conclusions: Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. International Registered Report Identifier (IRRID): RR2-10.2196/40446 ", doi="10.2196/56158", url="https://www.jmir.org/2024/1/e56158" } @Article{info:doi/10.2196/51865, author="Lange-Drenth, Lukas and Schulz, Holger and Suck, Isabell and Bleich, Christiane", title="Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e51865", keywords="telerehabilitation", keywords="rehabilitation", keywords="eHealth development", keywords="value specification", keywords="stakeholder participation", keywords="occupational injuries", keywords="vocational rehabilitation", keywords="aftercare", keywords="mobile phone", abstract="Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. ", doi="10.2196/51865", url="https://formative.jmir.org/2024/1/e51865" } @Article{info:doi/10.2196/54451, author="Heels-Ansdell, Diane and Kelly, Laurel and O'Grady, K. Heather and Farley, Christopher and Reid, C. Julie and Berney, Sue and Pastva, M. Amy and Burns, EA Karen and D'Aragon, Fr{\'e}d{\'e}rick and Herridge, S. Margaret and Seely, Andrew and Rudkowski, Jill and Rochwerg, Bram and Fox-Robichaud, Alison and Ball, Ian and Lamontagne, Francois and Duan, H. Erick and Tsang, Jennifer and Archambault, M. Patrick and Verceles, C. Avelino and Muscedere, John and Mehta, Sangeeta and English, W. Shane and Karachi, Tim and Serri, Karim and Reeve, Brenda and Thabane, Lehana and Cook, Deborah and Kho, E. Michelle", title="Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="28", volume="13", pages="e54451", keywords="rehabilitation", keywords="mechanical ventilation", keywords="cycle ergometry", keywords="critical illness", keywords="exercise therapy", keywords="recovery of function", abstract="Background: Survivors of critical illness are at risk of developing physical dysfunction following intensive care unit (ICU) discharge. ICU-based rehabilitation interventions, such as early in-bed cycle ergometry, may improve patients' short-term physical function. Objective: Before unblinding and trial database lock, we describe a prespecified statistical analysis plan (SAP) for the CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) randomized controlled trial (RCT). Methods: CYCLE is a 360-patient, international, multicenter, open-label, parallel-group RCT (1:1 ratio) with blinded primary outcome assessment at 3 days post-ICU discharge. The principal investigator and statisticians of CYCLE prepared this SAP with approval from the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes (including adverse events) and describes the planned primary, secondary, and subgroup analyses. The primary outcome of the CYCLE trial is the Physical Function Intensive Care Unit Test-scored (PFIT-s) at 3 days post-ICU discharge. The PFIT-s is a reliable and valid performance-based measure. We plan to use a frequentist statistical framework for all analyses. We will conduct a linear regression to evaluate the primary outcome, incorporating randomization as an independent variable and adjusting for age (?65 years versus <65 years) and center. The regression results will be reported as mean differences in PFIT-s scores with corresponding 95\% CIs and P values. We consider a 1-point difference in PFIT-s score to be clinically important. Additionally, we plan to conduct 3 subgroup analyses: age (?65 years versus <65 years), frailty (Baseline Clinical Frailty Scale ?5 versus <5), and sex (male versus female). Results: CYCLE was funded in 2017, and enrollment was completed in May 2023. Data analyses are complete, and the first results were submitted for publication in 2024. Conclusions: We developed and present an SAP for the CYCLE RCT and will adhere to it for all analyses. This study will add to the growing body of evidence evaluating the efficacy and safety of ICU-based rehabilitation interventions. Trial Registration: ClinicalTrials.gov NCT03471247; https://clinicaltrials.gov/ct2/show/NCT03471247 and NCT02377830; https://clinicaltrials.gov/ct2/show/NCT02377830 International Registered Report Identifier (IRRID): RR1-10.2196/54451 ", doi="10.2196/54451", url="https://www.researchprotocols.org/2024/1/e54451" } @Article{info:doi/10.2196/55481, author="Chien, Shih-Ying and Wu, Ching-Yi and Wong, May-Kuen Alice and Chen, Chih-Kuang and Beckman, L. Sara", title="Exploring the Impact of an Interactive Electronic Pegboard on Manual Dexterity and Cognitive Skills of Patients With Stroke: Preliminary Analysis", journal="JMIR Form Res", year="2024", month="Oct", day="24", volume="8", pages="e55481", keywords="interactive electronic pegboard", keywords="stroke", keywords="hand dexterity", keywords="cognitive rehabilitation", keywords="system", abstract="Background: As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals. Objective: This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke. Methods: We explored the pegboard's clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback. Results: Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality. Conclusions: This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool. ", doi="10.2196/55481", url="https://formative.jmir.org/2024/1/e55481", url="http://www.ncbi.nlm.nih.gov/pubmed/39446480" } @Article{info:doi/10.2196/48154, author="Van Oirschot, Garett and Pomphrey, Amanda and Dunne, Caoimhe and Murphy, Kate and Blood, Karina and Doherty, Cailbhe", title="An Evaluation of the Design of Multimedia Patient Education Materials in Musculoskeletal Health Care: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2024", month="Oct", day="15", volume="11", pages="e48154", keywords="health education", keywords="patient education", keywords="patient education materials", keywords="multimedia", keywords="musculoskeletal diseases", keywords="musculoskeletal pain", keywords="eHealth", keywords="self-management", abstract="Background: Educational multimedia is a cost-effective and straightforward way to administer large-scale information interventions to patient populations in musculoskeletal health care. While an abundance of health research informs the content of these interventions, less guidance exists about optimizing their design. Objective: This study aims to identify randomized controlled trials of patient populations with musculoskeletal conditions that used multimedia-based patient educational materials (PEMs) and examine how design was reported and impacted patients' knowledge and rehabilitation outcomes. Design was evaluated using principles from the cognitive theory of multimedia learning (CTML). Methods: PubMed, CINAHL, PsycINFO, and Embase were searched from inception to September 2023 for studies examining adult patients with musculoskeletal conditions receiving multimedia PEMs compared to any other interventions. The primary outcome was knowledge retention measured via test scores. Secondary outcomes were any patient-reported measures. Retrievability was noted, and PEMs were sourced through search, purchase, and author communication. Results: A total of 160 randomized controlled trials were eligible for inclusion: 13 (8.1\%) included their educational materials and 31 (19.4\%) required a web search, purchase, or direct requests for educational materials. Of these 44 (27.5\%) studies, none fully optimized the design of their educational materials, particularly lacking in the CTML principles of coherence, redundancy, modality, and generative activities for the learner. Of the 160 studies, the remaining 116 (72.5\%) contained interventions that could not be retrieved or appraised. Learning was evaluated in 5 (3.1\%) studies. Conclusions: Musculoskeletal studies should use open science principles and provide their PEMs wherever possible. The link between providing multimedia PEMs and patient learning is largely unexamined, but engagement potential may be maximized when considering design principles such as the CTML. ", doi="10.2196/48154", url="https://rehab.jmir.org/2024/1/e48154", url="http://www.ncbi.nlm.nih.gov/pubmed/39162239" } @Article{info:doi/10.2196/56480, author="Waranski, Melina and Garbsch, Ren{\'e} and Kotewitsch, Mona and Teschler, Marc and Schmitz, Boris and Mooren, C. Frank", title="A Behavioral Change--Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial", journal="J Med Internet Res", year="2024", month="Oct", day="8", volume="26", pages="e56480", keywords="rehabilitation", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="telemedicine", keywords="cardiovascular disease", keywords="behavioral change", keywords="mobile phone", abstract="Background: Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change--based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA). Objective: This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care. Methods: A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager--assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivit{\"a}t questionnaire, were regular PA (?150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivit{\"a}t questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index). Results: Data of 105 patients (RehaPlus+: n=44, 41.9\%; usual care: n=61, 58.1\%; male patients: n=80, 76.2\%; female patients: n=25, 23.8\%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05). Conclusions: RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. Trial Registration: ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793 ", doi="10.2196/56480", url="https://www.jmir.org/2024/1/e56480" } @Article{info:doi/10.2196/57635, author="Wang, Qingling and Lee, Lai-Tong Regina and Hunter, Sharyn and Zhu, Aiyong and Chan, Wai-Chi Sally", title="Patient Engagement in a Mobile App--Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Oct", day="1", volume="12", pages="e57635", keywords="total hip arthroplasty", keywords="total knee arthroplasty", keywords="rehabilitation", keywords="mobile health", keywords="social media application", keywords="patient engagement", abstract="Background: Health care professionals use mobile apps to support patients' rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. Objective: This study aimed to investigate patient engagement in a mobile app--based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. Methods: Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])--based program to support patients' rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants' posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. Results: The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74\%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88\%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95\% CI 1.98-15.35; $\chi$21=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95\% CI 0.45-5.48; $\chi$21=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. Conclusions: Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp ", doi="10.2196/57635", url="https://mhealth.jmir.org/2024/1/e57635" } @Article{info:doi/10.2196/52563, author="Lo, Man Hermione Hin and Ng, Marques and Fong, Hugo Pak Yiu and Lai, Ki Harmony Hoi and Wang, Bo and Wong, Yeung-shan Samuel and Sit, Shan Regina Wing", title="Examining the Feasibility, Acceptability, and Preliminary Efficacy of an Immersive Virtual Reality--Assisted Lower Limb Strength Training for Knee Osteoarthritis: Mixed Methods Pilot Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Sep", day="27", volume="12", pages="e52563", keywords="virtual reality", keywords="VR", keywords="immersive", keywords="knee", keywords="joint", keywords="arthritis", keywords="arthritic", keywords="osteoarthritis", keywords="knee osteoarthritis", keywords="gerontology", keywords="geriatric", keywords="older adult", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="aging", keywords="pain", keywords="function", keywords="acceptability", keywords="user experience", keywords="RCT", keywords="randomized", keywords="controlled trial", keywords="limb", keywords="strength", keywords="muscle", keywords="muscular", keywords="physiotherapy", abstract="Background: Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology. Objective: We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee). Methods: A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays. Results: The recruitment rate was 100\% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8?66.3) years, with 76\% (n=23) being female. The response rates were 80\% and 93\% for the VRiKnee and control groups. Dropout rates were 13\% for VRiKnee and 7\% for the control group. Median exercise adherence was 77\% (IQR 37-104\%) for VRiKnee and 62\% (IQR 40-166\%) for the control group, respectively, with adherence reduction over this study's period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33\%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee. Conclusions: VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice. Trial Registration: Chinese Clinical Trial Registry CHiCTR2100046313; https://www.chictr.org.cn/showprojEN.html?proj=125404 ", doi="10.2196/52563", url="https://games.jmir.org/2024/1/e52563" } @Article{info:doi/10.2196/55730, author="Houzangbe, Samory and Lemay, Martin and Levac, E. Danielle", title="Toward Physiological Detection of a ``Just-Right'' Challenge Level for Motor Learning in Immersive Virtual Reality: Protocol for a Cross-Sectional Study", journal="JMIR Res Protoc", year="2024", month="Sep", day="23", volume="13", pages="e55730", keywords="virtual reality", keywords="pediatric rehabilitation", keywords="physiological data", keywords="engagement", keywords="just-right challenge", abstract="Background: Motor learning, a primary goal of pediatric rehabilitation, is facilitated when tasks are presented at a ``just-right'' challenge level---at the edge of the child's current abilities, yet attainable enough to motivate the child in persistent efforts for success. Immersive virtual reality (VR) may be ideally suited for ``just-right'' task challenges because it enables precise adjustments of task parameters in motivating environments. Rehabilitation-specific VR tasks often use dynamic difficulty algorithms based on task performance to personalize task difficulty. However, these approaches do not consider relevant cognitive processes that could also impact ``just-right'' challenges, such as attention and engagement. Objective physiological measurement of these cognitive processes using wearable sensors could support their integration within ``just-right'' challenge detection and prediction algorithms. As a first step, it is important to explore relationships between objectively and subjectively measured psychophysiological states at progressively challenging task difficulty levels. Objective: This study aims to (1) evaluate the performance of wearable sensors in a novel movement-based motor learning immersive VR task; (2) evaluate changes in physiological data at 3 task difficulty levels; and (3) explore the relationship between physiological data, task performance, and self-reported cognitive processes at each task difficulty level. Methods: This study uses the within-participant experimental design. Typically developing children and youth aged 8-16 years will be recruited to take part in a single 90-minute data collection session. Physiological sensors include electrodermal activity, heart rate, electroencephalography, and eye-tracking. After collecting physiological data at rest, participants will play a seated unimanual immersive VR task involving bouncing a virtual ball on a virtual racket. They will first play for 3 minutes at a predefined medium level of difficulty to determine their baseline ability level and then at a personalized choice of 3 progressive difficulty levels of 3 minutes each. Following each 3-minute session, participants will complete a short Likert-scale questionnaire evaluating engagement, attention, cognitive workload, physical effort, self-efficacy, and motivation. Data loss and data quality will be calculated for each sensor. Repeated-measures ANOVAs will evaluate changes in physiological response at each difficulty level. Correlation analyses will determine individual relationships between task performance, physiological data, and self-reported data at each difficulty level. Results: Research ethics board approval has been obtained, and data collection is underway. Data collection was conducted on December 12, 2023, and April 12, 2024, with a total of 15 typically developing children. Data analysis has been completed, and results are expected to be published in the fall of 2024. Conclusions: Wearable sensors may provide insights into the physiological effects of immersive VR task interaction at progressive difficulty levels in children and youth. Understanding the relationship between physiological and self-reported cognitive processes is a first step in better identifying and predicting ``just-right'' task challenges during immersive VR motor learning interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/55730 ", doi="10.2196/55730", url="https://www.researchprotocols.org/2024/1/e55730" } @Article{info:doi/10.2196/57588, author="Gehringer, E. James and Woodruff Jameson, Anne and Boyer, Hailey and Konieczny, Jennifer and Thomas, Ryan and Pierce III, James and Cunha, B. Andrea and Willett, Sandra", title="Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study", journal="JMIR Form Res", year="2024", month="Sep", day="6", volume="8", pages="e57588", keywords="cerebral palsy", keywords="HABIT", keywords="home intervention", keywords="virtual reality", keywords="rehabilitation", keywords="VR", keywords="case study", keywords="hand", keywords="hands", keywords="arm", keywords="arms", keywords="intensive training", keywords="feasibility", keywords="game", keywords="games", keywords="gaming", keywords="hand arm bimanual intensive training", keywords="motor", keywords="movement", keywords="home setting", keywords="home-based", keywords="child", keywords="children", keywords="male", keywords="males", keywords="men", keywords="quasi-experimental", keywords="parent", keywords="parents", keywords="intervention", keywords="interventions", doi="10.2196/57588", url="https://formative.jmir.org/2024/1/e57588" } @Article{info:doi/10.2196/47246, author="Barnes, Keely and Sveistrup, Heidi and Bayley, Mark and Egan, Mary and Bilodeau, Martin and Rathbone, Michel and Taljaard, Monica and Marshall, Shawn", title="Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study", journal="JMIR Form Res", year="2024", month="Sep", day="2", volume="8", pages="e47246", keywords="telehealth", keywords="remote care", keywords="concussion", keywords="mTBI", keywords="mild traumatic brain injury", keywords="assessment", keywords="examination", keywords="telemedicine", keywords="TBI", keywords="traumatic brain injury", keywords="brain injury", keywords="Delphi", keywords="measure", keywords="measures", keywords="measurement", keywords="mobile phone", abstract="Background: There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. Objective: This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. Methods: The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15\% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. Results: In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15\% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Conclusions: Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. International Registered Report Identifier (IRRID): RR2-10.2196/40446 ", doi="10.2196/47246", url="https://formative.jmir.org/2024/1/e47246", url="http://www.ncbi.nlm.nih.gov/pubmed/39222352" } @Article{info:doi/10.2196/54193, author="Bressler, Michael and Merk, Joachim and Gohlke, Tanja and Kayali, Fares and Daigeler, Adrien and Kolbenschlag, Jonas and Prahm, Cosima", title="A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study", journal="JMIR Serious Games", year="2024", month="Aug", day="27", volume="12", pages="e54193", keywords="video games", keywords="virtual reality", keywords="exercise therapy", keywords="physical therapy", keywords="hand rehabilitation", keywords="finger rehabilitation", abstract="Background: Restoring hand and finger function after a traumatic hand injury necessitates a regimen of consistent and conscientious exercise. However, motivation frequently wanes due to unchallenging repetitive tasks or discomfort, causing exercises to be performed carelessly or avoided completely. Introducing gamification to these repetitive tasks can make them more appealing to patients, ultimately increasing their motivation to exercise consistently. Objective: This study aims to iteratively develop a serious virtual reality game for hand and finger rehabilitation within an appealing and engaging digital environment, encouraging patient motivation for at least 2 weeks of continuous therapy. Methods: The development process comprised 3 distinct stages, each of which was subject to evaluation. Initially, a prototype was created to encompass the game's core functionalities, which was assessed by 18 healthy participants and 7 patients with impaired hand function. Subsequently, version 1 of the game was developed and evaluated with 20 patients who were divided into an investigation group and a control group. On the basis of these findings, version 2 was developed and evaluated with 20 patients who were divided into an investigation group and a control group. Motivation was assessed using the Intrinsic Motivation Inventory (IMI), while the application's quality was rated using the Mobile Application Rating Scale and the System Usability Scale. User feedback was gathered using semistructured interviews. Results: The prototype evaluation confirmed the acceptance and feasibility of the game design. Version 1 significantly increased motivation in 2 IMI subscales, effort (P<.001) and usefulness (P=.02). In version 2, a significant increase in daily performed exercises was achieved (P=.008) compared to version 1, with significantly higher motivation in the IMI subscale effort (P=.02). High Mobile Application Rating Scale scores were obtained for both versions 1 and 2, with version 2 scoring 86.9 on the System Usability Scale, indicating excellent acceptability. User feedback provided by the semistructured interviews was instrumental in the iterative development regarding improvements and the expansion of the playable content. Conclusions: This study presented a virtual reality serious game designed for hand and finger rehabilitation. The game was well received and provided an environment that effectively motivated the users. The iterative development process incorporated user feedback, confirming the game's ease of use and feasibility even for patients with severely limited hand function. ", doi="10.2196/54193", url="https://games.jmir.org/2024/1/e54193", url="http://www.ncbi.nlm.nih.gov/pubmed/39190432" } @Article{info:doi/10.2196/57227, author="Kerr, Andrew and Grealy, Madeleine and Slachetka, Milena and Wodu, Obinuchi Chioma and Sweeney, Gillian and Boyd, Fiona and Colville, David and Rowe, Philip", title="A Participatory Model for Cocreating Accessible Rehabilitation Technology for Stroke Survivors: User-Centered Design Approach", journal="JMIR Rehabil Assist Technol", year="2024", month="Aug", day="23", volume="11", pages="e57227", keywords="rehabilitation", keywords="rehabilitative", keywords="rehab", keywords="rehabilitation technology", keywords="accessibility", keywords="accessible", keywords="stroke", keywords="design", keywords="participatory", keywords="participatory design", keywords="participatory designs", keywords="participatory model", keywords="participatory models", keywords="user-centred", keywords="user-centered", keywords="user-focused", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="participatory medicine", keywords="technology", abstract="Background: Globally, 1 in 3 people live with health conditions that could be improved with rehabilitation. Ideally, this is provided by trained professionals delivering evidence-based dose, intensity, and content of rehabilitation for optimal recovery. The widely acknowledged inability of global health care providers to deliver recommended levels of rehabilitation creates an opportunity for technological innovation. Design processes that lack close consideration of users' needs and budgets, however, mean that many rehabilitation technologies are neither useful nor used. To address this problem, our multidisciplinary research group have established a cocreation center for rehabilitation technology that places the end user at the center of the innovation process. Objective: This study aims to present the participatory cocreation model that has been developed from our center and illustrate the approach with 2 cases studies. Methods: The model is built around user participation in an intensive rehabilitation program (2-hour sessions, 2?5 times per week, and 8-week duration), supervised by qualified therapists but delivered exclusively through commercial and prototype technology. This provides participants (chronic stroke survivors with movement and/or speech disability) with a rich experience of rehabilitation technology, enabling them to provide truly informed feedback, as well as creating an observatory for the research team. This process is supported by short-term focus groups for specific product development and a longer-term advisory group to consider broader issues of adoption and translation into everyday health care. Results: Our model has been active for 3 years with 92 (92\%) out of 100 participants completing the program. Five new technologies have evolved from the process with further ideas logged for future development. In addition, it has led to a set of cocreated protocols for technology-enriched rehabilitation, including recruitment, outcome measures, and intervention structure, which has allowed us to replicate this approach in an acute hospital ward. Conclusions: Suboptimal rehabilitation limits recovery from health conditions. Technology offers the potential support to increase access to recommended levels of rehabilitation but needs to be designed to suit end users and not just their impairment. Our cocreation model, built around participation in an intensive, technology-based program, has produced new accessible technology and demonstrated the feasibility of our overall approach to providing the rehabilitation that people need, for as long as needed. ", doi="10.2196/57227", url="https://rehab.jmir.org/2024/1/e57227" } @Article{info:doi/10.2196/56033, author="Santiago, Evangelista Aline and Cruz, Gazzinelli Victor Pezzi and Furtado, Souza Rafaela and C{\^a}ndido, Batista Eduardo and Brand{\~a}o, Cardoso Wladmir and Silva Filho, Lopes Agnaldo", title="Gamified Mobile App (MobERAS) for Telemonitoring Patients in the Postoperative Period Based on the Enhanced Recovery after Surgery Program: Development and Validation Study", journal="JMIR Perioper Med", year="2024", month="Aug", day="14", volume="7", pages="e56033", keywords="handheld computer", keywords="mobile phone", keywords="postoperative period", keywords="mHealth", keywords="mobile health", keywords="telemedicine", keywords="postoperative", keywords="perioperative", keywords="recovery", keywords="surgery", keywords="surgical", keywords="gamify", keywords="gamified", keywords="gamification", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="design", keywords="develop", keywords="development", keywords="gynecology", keywords="gynecological", keywords="oncology", keywords="oncological", keywords="women's health", keywords="usability", abstract="Background: Digital technology and gamified apps can be useful in the health care context. Gamification uses technology to influence users' actions and motivations through experiences that resemble games. Patient adherence to the enhanced recovery after surgery (ERAS) program is crucial for achieving early recovery after surgery and continuous monitoring is essential for obtaining good results. Objective: This study aimed to describe the development and validation of a mobile app for enhanced recovery after surgery (MobERAS), a gamified mobile health app for telemonitoring patients in the postoperative period based on the ERAS program, and to evaluate its functionality and usability and the experience of patients, health care professionals, and computer professionals with its use. Methods: We developed MobERAS for postoperative telemonitoring, with active participation of patients in the process, and offering availability of real-time information for the health team. The app development process included idealization, interdisciplinary team formation, potential needs assessment, and product deployment. Usability tests were conducted throughout the development process with improvements, technical adjustments, and updates. After finalization, comprehensive verification tests were performed. The parameters evaluated are those that can influence the length of hospital stay, such as nausea, vomiting, pain scales, return to normal gastrointestinal function, and thromboembolic events. MobERAS was designed to be downloaded by users on their phones, tablets, or other mobile devices and to provide postoperative data. The app has a GPS that monitors the patient's walking time and distance and is connected to a virtual database that stores the collected data. Results: Women undergoing medium and major gynecologic oncologic surgeries were included. We included 65 patients with an average age of 53.2 (SD 7.4, range 18-85) years. The time of use ranged from 23.4 to 70 hours (mean 45.1, SD 19.2 hours). Regarding adherence to the use of MobERAS, the mean fill rate was 56.3\% (SD 12.1\%, range 41.7\%-100\%), and ambulation data were obtained for 60 (92.3\%) of the 65 patients. The researcher had access to the data filled out by the patients in real time. There was good acceptance of the use of MobERAS by the patients, with good evaluation of the app's usability. MobERAS was easy to use and considered attractive because of its gamified design. The app was rated as good or very good in all items by health care professionals (n=20) and professionals specializing in technological innovation (n=10). Conclusions: MobERAS is easy to use, safe, well accepted by patients, and well evaluated by experts. It can be of great use in clinical surgical practice and an important tool for greater engagement of patients and health care professionals with the ERAS program. ", doi="10.2196/56033", url="https://periop.jmir.org/2024/1/e56033" } @Article{info:doi/10.2196/52310, author="Angonese, Giulia and Buhl, Mareike and Kuhlmann, Inka and Kollmeier, Birger and Hildebrandt, Andrea", title="Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment", journal="JMIR Hum Factors", year="2024", month="Aug", day="12", volume="11", pages="e52310", keywords="hearing loss", keywords="mobile health", keywords="mHealth", keywords="older adults", keywords="help seeking", keywords="mobile study", keywords="machine learning", keywords="supervised classification", keywords="feature importance", keywords="profiling", keywords="mobile phone", abstract="Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3\% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, na{\"i}ve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9\% (122/185) to 70.3\% (130/185) of cases, reaching 74.8\% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. ", doi="10.2196/52310", url="https://humanfactors.jmir.org/2024/1/e52310", url="http://www.ncbi.nlm.nih.gov/pubmed/39133539" } @Article{info:doi/10.2196/57953, author="Lee, Audrey and Wyckoff, Elijah and Farcas, Emilia and Godino, Job and Patrick, Kevin and Spiegel, Spencer and Yu, Rose and Kumar, Arun and Loh, J. Kenneth and Gombatto, Sara", title="Preliminary Validity and Acceptability of Motion Tape for Measuring Low Back Movement: Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Aug", day="2", volume="11", pages="e57953", keywords="low back pain", keywords="fabric", keywords="nanocomposite", keywords="sensor acceptability", keywords="sensor validation", keywords="skin", keywords="strain", keywords="wearable", abstract="Background: Low back pain (LBP) is a significant public health problem that can result in physical disability and financial burden for the individual and society. Physical therapy is effective for managing LBP and includes evaluation of posture and movement, interventions directed at modifying posture and movement, and prescription of exercises. However, physical therapists have limited tools for objective evaluation of low back posture and movement and monitoring of exercises, and this evaluation is limited to the time frame of a clinical encounter. There is a need for a valid tool that can be used to evaluate low back posture and movement and monitor exercises outside the clinic. To address this need, a fabric-based, wearable sensor, Motion Tape (MT), was developed and adapted for a low back use case. MT is a low-profile, disposable, self-adhesive, skin-strain sensor developed by spray coating piezoresistive graphene nanocomposites directly onto commercial kinesiology tape. Objective: The objectives of this study were to (1) validate MT for measuring low back posture and movement and (2) assess the acceptability of MT for users. Methods: A total of 10 participants without LBP were tested. A 3D optical motion capture system was used as a reference standard to measure low back kinematics. Retroreflective markers and a matrix of MTs were placed on the low back to measure kinematics (motion capture) and strain (MT) simultaneously during low back movements in the sagittal, frontal, and axial planes. Cross-correlation coefficients were calculated to evaluate the concurrent validity of MT strain in reference motion capture kinematics during each movement. The acceptability of MT was assessed using semistructured interviews conducted with each participant after laboratory testing. Interview data were analyzed using rapid qualitative analysis to identify themes and subthemes of user acceptability. Results: Visual inspection of concurrent MT strain and kinematics of the low back indicated that MT can distinguish between different movement directions. Cross-correlation coefficients between MT strain and motion capture kinematics ranged from --0.915 to 0.983, and the strength of the correlations varied across MT placements and low back movement directions. Regarding user acceptability, participants expressed enthusiasm toward MT and believed that it would be helpful for remote interventions for LBP but provided suggestions for improvement. Conclusions: MT was able to distinguish between different low back movements, and most MTs demonstrated moderate to high correlation with motion capture kinematics. This preliminary laboratory validation of MT provides a basis for future device improvements, which will also involve testing in a free-living environment. Overall, users found MT acceptable for use in physical therapy for managing LBP. ", doi="10.2196/57953", url="https://rehab.jmir.org/2024/1/e57953", url="http://www.ncbi.nlm.nih.gov/pubmed/39093610" } @Article{info:doi/10.2196/58846, author="Sweeting, Anna and Warncken, A. Katie and Patel, Martyn", title="The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future", journal="J Med Internet Res", year="2024", month="Jul", day="30", volume="26", pages="e58846", keywords="assistive technology", keywords="older adults", keywords="users", keywords="aging", keywords="aging in place", keywords="UK", keywords="cocreation", keywords="research trial", keywords="independent living", keywords="North Norfolk", keywords="disability", keywords="injury", keywords="tool", keywords="use", keywords="design", keywords="barrier", doi="10.2196/58846", url="https://www.jmir.org/2024/1/e58846" } @Article{info:doi/10.2196/56447, author="Li, K. Brian S. and Fereday, Brendan and Wang, Ellen and Rodriguez, Samuel and Forssell, Karin and Bollaert, N. Andr{\'e} and Menendez, Maria and Caruso, J. Thomas", title="Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study", journal="JMIR XR Spatial Comput", year="2024", month="Jul", day="30", volume="1", pages="e56447", keywords="immersive technology", keywords="implementation", keywords="adult learning", keywords="education", keywords="pediatric", keywords="accessibility", keywords="training", keywords="therapeutic", keywords="pediatric care", keywords="utilization", keywords="virtual reality", keywords="VR", keywords="monitoring", keywords="license", keywords="development", keywords="software", keywords="monitoring software", abstract="Background: Immersive technology provides adjuncts for pediatric care. However, accessibility and inadequate training limit implementation of this technology. Standardized instruction with no-cost software licensing may improve health care professionals' facility with immersive technologies. Objective: This descriptive feasibility study aimed to examine the applications of immersive technologies in pediatric health care, including virtual reality (VR) and projectors. Methods: We developed immersive technology instructional guides for pediatric health care. The training guides were created for multiple software content and hardware types across several clinical scenarios. Content was available in print and digital versions. The primary outcome was technology use across sites with no-cost software agreements. The secondary outcome was the specific application types used at a single site, stratified by sessions and minutes. Data were analyzed using descriptive statistics. Results: Data were collected from 19 licensed sites from January through June 2022. Among the 19 sites, 32\% (n=6) used 10 or more VR units. Among the 6 sites that had projectors, half used 5 or more units. The mean minutes of use per month of all sites combined was 2199 (IQR 51-1058). Three sites had more than 10,000 minutes of total use during the 6-month review period. Secondary results indicated that active VR (977 total sessions) and passive projector streaming (1261 total sessions) were the most popular application types by session, while active projector (66,849 total minutes) and passive projector streaming (32,711 total minutes) were the most popular types when stratified by minutes of use. The active VR application with the most minutes of use was an application often used in physical therapy. Conclusions: Context-specific technological instruction coupled to no-cost licenses may increase access to immersive technology in pediatric health care settings. ", doi="10.2196/56447", url="https://xr.jmir.org/2024/1/e56447" } @Article{info:doi/10.2196/54774, author="Greene, Leanne and Rahja, Miia and Laver, Kate and Wong, Vun Vun and Leung, Chris and Crotty, Maria", title="Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study", journal="JMIR Aging", year="2024", month="Jun", day="27", volume="7", pages="e54774", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="aged", keywords="telerehabilitation", keywords="rehabilitation", keywords="rehab", keywords="workflow", keywords="hospitalization", keywords="health services accessibility", keywords="accessibility", keywords="clinical decision-making", keywords="equipment failure", keywords="telemedicine", keywords="telehealth", keywords="tele-medicine", keywords="tele-health", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="remote consultation", keywords="telephone consultation", keywords="video consultation", keywords="remote consultations", keywords="telephone consultations", keywords="video consultations", keywords="personnel", keywords="hospital", abstract="Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW. ", doi="10.2196/54774", url="https://aging.jmir.org/2024/1/e54774" } @Article{info:doi/10.2196/54159, author="Wodu, Obinuchi Chioma and Sweeney, Gillian and Slachetka, Milena and Kerr, Andrew", title="Stroke Survivors' Interaction With Hand Rehabilitation Devices: Observational Study", journal="JMIR Biomed Eng", year="2024", month="Jun", day="26", volume="9", pages="e54159", keywords="stroke", keywords="rehabilitation", keywords="hand rehabilitation devices", keywords="accessibility", keywords="stroke survivors", keywords="rehabilitation technologies", abstract="Background: The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55\% to 75\% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. Objective: In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Methods: Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. Results: A total of 29 participants were included in this study, of whom 10 (34\%) had poor hand function, 17 (59\%) had moderate hand function, and 2 (7\%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20\%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80\%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Conclusions: Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function. ", doi="10.2196/54159", url="https://biomedeng.jmir.org/2024/1/e54159", url="http://www.ncbi.nlm.nih.gov/pubmed/38922668" } @Article{info:doi/10.2196/48129, author="Zsoldos, Isabella and Tr{\^a}n, El{\'e}onore and Fournier, Hippolyte and Tarpin-Bernard, Franck and Fruitet, Joan and Fouillen, M{\'e}lodie and Bailly, G{\'e}rard and Elisei, Fr{\'e}d{\'e}ric and Bouchot, B{\'e}atrice and Constant, Patrick and Ringeval, Fabien and Koenig, Olivier and Chainay, Hanna", title="The Value of a Virtual Assistant to Improve Engagement in Computerized Cognitive Training at Home: Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Jun", day="20", volume="11", pages="e48129", keywords="cognitive training", keywords="cognitive decline", keywords="cognitive disorders", keywords="mild cognitive impairment", keywords="Alzheimer disease", keywords="digital therapies", keywords="virtual health assistant", keywords="conversational agent", keywords="artificial intelligence", keywords="social interaction", keywords="THERADIA", abstract="Background: Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments available to counter cognitive decline have only modest effects, with significant side effects. A nonpharmacological treatment that has received considerable attention is computerized cognitive training (CCT), which aims to maintain or improve cognitive functioning through repeated practice in standardized exercises. CCT allows for more regular and thorough training of cognitive functions directly at home, which represents a significant opportunity to prevent and fight cognitive decline. However, the presence of assistance during training seems to be an important parameter to improve patients' motivation and adherence to treatment. To compensate for the absence of a therapist during at-home CCT, a relevant option could be to include a virtual assistant to accompany patients throughout their training. Objective: The objective of this exploratory study was to evaluate the interest of including a virtual assistant to accompany patients during CCT. We investigated the relationship between various individual factors (eg, age, psycho-affective functioning, personality, personal motivations, and cognitive skills) and the appreciation and usefulness of a virtual assistant during CCT. This study is part of the THERADIA (Th{\'e}rapies Digitales Augment{\'e}es par l'Intelligence Artificielle) project, which aims to develop an empathetic virtual assistant. Methods: A total of 104 participants were recruited, including 52 (50\%) young adults (mean age 21.2, range 18 to 27, SD 2.9 years) and 52 (50\%) older adults (mean age 67.9, range 60 to 79, SD 5.1 years). All participants were invited to the laboratory to answer several questionnaires and perform 1 CCT session, which consisted of 4 cognitive exercises supervised by a virtual assistant animated by a human pilot via the Wizard of Oz method. The participants evaluated the virtual assistant and CCT at the end of the session. Results: Analyses were performed using the Bayesian framework. The results suggest that the virtual assistant was appreciated and perceived as useful during CCT in both age groups. However, older adults rated the assistant and CCT more positively overall than young adults. Certain characteristics of users, especially their current affective state (ie, arousal, intrinsic relevance, goal conduciveness, and anxiety state), appeared to be related to their evaluation of the session. Conclusions: This study provides, for the first time, insight into how young and older adults perceive a virtual assistant during CCT. The results suggest that such an assistant could have a beneficial influence on users' motivation, provided that it can handle different situations, particularly their emotional state. The next step of our project will be to evaluate our device with patients experiencing mild cognitive impairment and to test its effectiveness in long-term cognitive training. ", doi="10.2196/48129", url="https://rehab.jmir.org/2024/1/e48129" } @Article{info:doi/10.2196/48126, author="Palmier, C{\'e}cilia and Rigaud, Anne-Sophie and Ogawa, Toshimi and Wieching, Rainer and Dacunha, S{\'e}bastien and Barbarossa, Federico and Stara, Vera and Bevilacqua, Roberta and Pino, Maribel", title="Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review", journal="J Med Internet Res", year="2024", month="Jun", day="18", volume="26", pages="e48126", keywords="robotic coaching solutions", keywords="ethical issues", keywords="ethical recommendations", keywords="older adults", keywords="geriatrics", keywords="guidelines", abstract="Background: Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent. Objective: The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults. Methods: We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation. Results: In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users' personal data. Conclusions: Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals' quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects. ", doi="10.2196/48126", url="https://www.jmir.org/2024/1/e48126", url="http://www.ncbi.nlm.nih.gov/pubmed/38888953" } @Article{info:doi/10.2196/59315, author="Lancioni, E. Giulio and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Alberti, Gloria and Orlando, Isabella and Chiariello, Valeria and Desideri, Lorenzo", title="Enabling People With Intellectual and Sensory Disabilities to Trigger a Tablet's Delivery of Task Instructions by Walking to the Tablet: Proof-of-Concept Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Jun", day="12", volume="11", pages="e59315", keywords="technology", keywords="tablet", keywords="task", keywords="instructions", keywords="intellectual disability, visual impairment, hearing impairment", abstract="Background: People with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people's request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. Objective: This study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). Methods: The system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the ``where'' and ``how'' the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. Results: All participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. Conclusions: The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks. ", doi="10.2196/59315", url="https://rehab.jmir.org/2024/1/e59315", url="http://www.ncbi.nlm.nih.gov/pubmed/38865701" } @Article{info:doi/10.2196/52309, author="Dalko, Katharina and Elsuson, Andri Hlynur and Kalter, Ivonne and Zilezinski, Max and Hofstetter, Sebastian and Stoevesandt, Dietrich and Paulicke, Denny and Jahn, Patrick", title="Virtual Reality Applications for the Implementation of Domestic Respiratory Rehabilitation Programs for Patients With Long COVID and Post-COVID Condition: Scoping Review", journal="JMIR Serious Games", year="2024", month="May", day="31", volume="12", pages="e52309", keywords="long COVID", keywords="post-COVID", keywords="rehabilitation", keywords="virtual reality", keywords="implementation", keywords="respiratory", keywords="respiratory rehabilitation", keywords="scoping review", keywords="development", keywords="accessibility", keywords="support", keywords="physical", keywords="psychological", keywords="motivation", keywords="compliance", keywords="usability", keywords="COVID-19", keywords="COVID", abstract="Background: Due to a high number of patients affected by long COVID or post-COVID condition, an essential step to address the long-term effects of COVID-19 lies in the development and implementation of flexible and accessible rehabilitation programs. Virtual reality (VR) technologies offer the potential to support traditional therapies with individualized at-home programs. Objective: This study aims to provide an overview of existing scientific evidence on the development and implementation of VR-assisted respiratory rehabilitation programs for patients with long COVID and post-COVID condition and to synthesize the results. Methods: We conducted a scoping review of studies from 6 databases. PubMed, CINAHL, Cochrane, ScienceDirect, Web of Science Social Sciences Citation Index, and PEDro were searched using an exploratory search strategy. The search, which was last updated in February 2024, included peer-reviewed studies on immersive VR applications providing respiratory rehabilitation programs for patients with chronic obstructive pulmonary disease and long COVID or post-COVID condition. Exclusion criteria were studies in clinical or inpatient settings, telemedicine, nonimmersive VR applications, and gray literature. Nine publications were included in this review. Findings were extracted and summarized from the studies according to the JBI (Joanna Briggs Institute) method and thematically categorized. Topics covered were study characteristics, physiotherapeutic concept, clinical parameters, as well as usability and acceptability. Results: The 9 publications included in the qualitative analysis were published in 2019-2023. Eight empirical studies were included: 4 followed a mixed methods design, 3 were qualitative studies, and 1 followed a quantitative method. One scoping review was included in the data analyses. Four of the included studies were on patients with chronic obstructive pulmonary disease. The 9 studies demonstrated that VR-supported respiratory rehabilitation programs result in positive initial outcomes in terms of physical as well as psychological parameters. Particularly noteworthy was the increased motivation and compliance of patients. However, adverse effects and lack of usability are the barriers to the implementation of this innovative approach. Conclusions: Overall, VR is a promising technology for the implementation of individualized and flexible respiratory rehabilitation programs for patients with long COVID and post-COVID condition. Nevertheless, corresponding approaches are still under development and need to be more closely adapted to the needs of users. Further, the evidence was limited to pilot studies or a small number of patients, and no randomized controlled trials or long-term studies were part of the study selection. The included studies were performed by 4 groups of researchers: 3 from Europe and 1 from the United States. ", doi="10.2196/52309", url="https://games.jmir.org/2024/1/e52309", url="http://www.ncbi.nlm.nih.gov/pubmed/38819890" } @Article{info:doi/10.2196/51546, author="Mizuno, Emi and Ogasawara, Takayuki and Mukaino, Masahiko and Yamaguchi, Masumi and Tsukada, Shingo and Sonoda, Shigeru and Otaka, Yohei", title="Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study", journal="JMIR Form Res", year="2024", month="May", day="29", volume="8", pages="e51546", keywords="activity monitoring", keywords="smart clothing system", keywords="stroke", keywords="unseen", keywords="monitoring", keywords="recovery", keywords="physical condition", keywords="deconditioning", keywords="muscle wasting", keywords="wearable technology", keywords="wearable", keywords="activity level", keywords="rehabilitation", keywords="physical therapy", keywords="heart rate", keywords="ADL", keywords="activities of daily living", keywords="training", keywords="older people", keywords="mobile phone", abstract="Background: Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. Objective: This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. Methods: In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. Results: A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission ($\rho$=0.86, P<.001) and 4 weeks post admission ($\rho$=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission ($\rho$=--0.41, P=.21) or 4 weeks post admission ($\rho$=--0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission ($\rho$=--0.82, P=.002) and 4 weeks post admission ($\rho$=--0.73, P=.01). Conclusions: Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings. ", doi="10.2196/51546", url="https://formative.jmir.org/2024/1/e51546", url="http://www.ncbi.nlm.nih.gov/pubmed/38809596" } @Article{info:doi/10.2196/54699, author="Rony, Jahangir Rahat and Amir, Shajnush and Ahmed, Nova and Atiba, Samuelson and Verdezoto, Nervo and Sparkes, Valerie and Stawarz, Katarzyna", title="Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="May", day="28", volume="11", pages="e54699", keywords="rehabilitation", keywords="wearables", keywords="upper-limb rehabilitation", keywords="user-centered design", keywords="qualitative", keywords="interviews", keywords="experiences", keywords="attitudes", keywords="perceptions", keywords="digital health", keywords="health technology", keywords="wearable", keywords="user centered design", keywords="design", keywords="home", keywords="stroke", keywords="recovery", keywords="affordable", keywords="low income", keywords="low resource", keywords="Bangladesh", keywords="physiotherapy", abstract="Background: People who survive a stroke in many cases require upper-limb rehabilitation (ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible. For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors and patients' everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directed home-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global South countries due to potential costs and limited access to technology. Objective: Our goal was to better understand physiotherapists', patients', and caregivers' experiences of rehabilitation in Bangladesh, existing rehabilitation practices, and how they differ from the rehabilitation approach in the United Kingdom. Understanding these differences and experiences would help to identify opportunities and requirements for developing affordable wearable devices that could support ULR in home settings. Methods: We conducted an exploratory study with 14 participants representing key stakeholder groups. We interviewed physiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, and technology use in this context. We also interviewed UK physiotherapists to explore the similarities and differences between the 2 countries and identify specific contextual and design requirements for low-cost wearables for ULR. Overall, we remotely interviewed 8 physiotherapists (4 in the United Kingdom, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conducted via videoconference, except for 2 interviews, and audio was recorded with consent. A total of 10 hours of discussions were transcribed. The results were analyzed using thematic analysis. Results: We identified several sociocultural factors that affect ULR and should be taken into account when developing technologies for the home: the important role of family, who may influence the treatment based on social and cultural perceptions; the impact of gender norms and their influence on attitudes toward rehabilitation and physiotherapists; and differences in approach to rehabilitation between the United Kingdom and Bangladesh, with Bangladeshi physiotherapists focusing on individual movements that are necessary to build strength in the affected parts and their British counterparts favoring a more holistic approach. We propose practical considerations and design recommendations for developing ULR devices for low-resource settings. Conclusions: Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressing sociotechnical challenges. When developing new health technologies, it is imperative to not only understand how well they could fit into patients', caregivers', and physiotherapists' everyday lives, but also how they may influence any potential tensions concerning culture, religion, and the characteristics of the local health care system. ", doi="10.2196/54699", url="https://rehab.jmir.org/2024/1/e54699" } @Article{info:doi/10.2196/52312, author="Danielsson, Lyng Marius and Vergeer, Melanie and Plasqui, Guy and Baumgart, Kathrin Julia", title="Accuracy of the Apple Watch Series 4 and Fitbit Versa for Assessing Energy Expenditure and Heart Rate of Wheelchair Users During Treadmill Wheelchair Propulsion: Cross-sectional Study", journal="JMIR Form Res", year="2024", month="May", day="7", volume="8", pages="e52312", keywords="agreement", keywords="validity", keywords="accuracy", keywords="cross sectional", keywords="physiology", keywords="disability", keywords="disabled", keywords="upper-body exercise", keywords="upper body", keywords="exercise", keywords="physical activity", keywords="ergospirometer", keywords="fitness", keywords="vital", keywords="vitals", keywords="energy", keywords="expenditure", keywords="mHealth", keywords="wearable", keywords="wearables", keywords="mobile health", keywords="smartwatch", keywords="smartwatches", keywords="apple watch", keywords="fitbit", keywords="digital health", keywords="energy expenditure", keywords="heart rate", keywords="wheelchair", keywords="wheelchairs", keywords="fitness trackers", keywords="tracker", keywords="trackers", abstract="Background: The Apple Watch (AW) Series 1 provides energy expenditure (EE) for wheelchair users but was found to be inaccurate with an error of approximately 30\%, and the corresponding error for heart rate (HR) provided by the Fitbit Charge 2 was approximately 10\% to 20\%. Improved accuracy of estimated EE and HR is expected with newer editions of these smart watches (SWs). Objective: This study aims to assess the accuracy of the AW Series 4 (wheelchair-specific setting) and the Fitbit Versa (treadmill running mode) for estimating EE and HR during wheelchair propulsion at different intensities. Methods: Data from 20 manual wheelchair users (male: n=11, female: n=9; body mass: mean 75, SD 19 kg) and 20 people without a disability (male: n=11, female: n=9; body mass: mean 75, SD 11 kg) were included. Three 4-minute wheelchair propulsion stages at increasing speed were performed on 3 separate test days (0.5\%, 2.5\%, or 5\% incline), while EE and HR were collected by criterion devices and the AW or Fitbit. The mean absolute percentage error (MAPE) was used to indicate the absolute agreement between the criterion device and SWs for EE and HR. Additionally, linear mixed model analyses assessed the effect of exercise intensity, sex, and group on the SW error. Interclass correlation coefficients were used to assess relative agreement between criterion devices and SWs. Results: The AW underestimated EE with MAPEs of 29.2\% (SD 22\%) in wheelchair users and 30\% (SD 12\%) in people without a disability. The Fitbit overestimated EE with MAPEs of 73.9\% (SD 7\%) in wheelchair users and 44.7\% (SD 38\%) in people without a disability. Both SWs underestimated HR. The device error for EE and HR increased with intensity for both SWs (all comparisons: P<.001), and the only significant difference between groups was found for HR in the AW (--5.27 beats/min for wheelchair users; P=.02). There was a significant effect of sex on the estimation error in EE, with worse accuracy for the AW (--0.69 kcal/min; P<.001) and better accuracy for the Fitbit (--2.08 kcal/min; P<.001) in female participants. For HR, sex differences were found only for the AW, with a smaller error in female participants (5.23 beats/min; P=.02). Interclass correlation coefficients showed poor to moderate relative agreement for both SWs apart from 2 stage-incline combinations (AW: 0.12-0.57 for EE and 0.11-0.86 for HR; Fitbit: 0.06-0.85 for EE and 0.03-0.29 for HR). Conclusions: Neither the AW nor Fitbit were sufficiently accurate for estimating EE or HR during wheelchair propulsion. The AW underestimated EE and the Fitbit overestimated EE, and both SWs underestimated HR. Caution is hence required when using SWs as a tool for training intensity regulation and energy balance or imbalance in wheelchair users. ", doi="10.2196/52312", url="https://formative.jmir.org/2024/1/e52312", url="http://www.ncbi.nlm.nih.gov/pubmed/38713497" } @Article{info:doi/10.2196/52922, author="Cangussu, Izabel Anna and Lucarini, Beatriz and Melo, Freitas Igor de and Diniz, Ara{\'u}jo Paula and Mancini, Marisa and Viana, Mattos Bernardo de and Romano-Silva, Aur{\'e}lio Marco and Miranda, de D{\'e}bora Marques", title="Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial", journal="JMIR Res Protoc", year="2024", month="Apr", day="30", volume="13", pages="e52922", keywords="cerebral palsy", keywords="tDCS", keywords="motor", keywords="development", keywords="randomized clinical trial", keywords="RCT", keywords="clinical trial", keywords="randomized", keywords="transcranial direct current stimulation", keywords="stimulation", keywords="children", keywords="child", keywords="brain stimulation", keywords="physical therapy", keywords="quality of life", keywords="researchers", keywords="researcher", keywords="neurological injuries", keywords="injury", keywords="injuries", keywords="gait", keywords="patient", keywords="patients", abstract="Background: Children diagnosed with cerebral palsy (CP) often experience various limitations, particularly in gross motor function and activities of daily living. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been used to improve movement, gross motor function, and activities of daily living. Objective: This study aims to evaluate the potential additional effects of physiotherapy combined with tDCS in children with CP in comparison with physiotherapy only. Methods: This is a 2-arm randomized controlled trial that will compare the effects of tDCS as an adjunctive treatment during rehabilitation sessions to rehabilitation without tDCS. Children with CP classified by the Gross Motor Function Classification System as levels I and II will be randomly assigned to either the sham + rehabilitation group or the tDCS + rehabilitation group. The primary outcome will be the motor skills assessed using the Gross Motor Function Measure domain E scores, and the secondary outcome will be the measurement scores of the children's quality of life. The intervention will consist of a 10-day stimulation protocol with tDCS spread over 2 weeks, with stimulation or sham tDCS administered for 20 minutes at a frequency of 1 Hz, in combination with physiotherapy. Physical therapy exercises will be conducted in a circuit based on each child's baseline Gross Motor Function Measure results. The participants' changes will be evaluated and compared in both groups. Intervenient features will be tested. Results: Data collection is ongoing and is expected to be completed by January 2025. A homogeneous sample and clear outcomes may be a highlight of this protocol, which may allow us to understand the potential use of tDCS and for whom it should or should not be used. Conclusions: A study with good evidence and clear outcomes in children with CP might open an avenue for the potential best use of neurostimulation. Trial Registration: Brazilian Registry of Clinical Trials RBR-104h4s4y; https://tinyurl.com/47r3x2e4 International Registered Report Identifier (IRRID): PRR1-10.2196/52922 ", doi="10.2196/52922", url="https://www.researchprotocols.org/2024/1/e52922", url="http://www.ncbi.nlm.nih.gov/pubmed/38687586" } @Article{info:doi/10.2196/51508, author="Webster, Amy and Poyade, Matthieu and Coulter, Elaine and Forrest, Lisa and Paul, Lorna", title="Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study", journal="JMIR Serious Games", year="2024", month="Apr", day="26", volume="12", pages="e51508", keywords="virtual reality", keywords="multiple sclerosis", keywords="upper limb rehabilitation", keywords="coproduction", keywords="activities of daily living", keywords="exercise games", keywords="upper limb impairment", abstract="Background: Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. Objective: This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. Methods: Separate focus groups were conducted with people with MS, recruited through the MS Society UK's research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. Results: People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. Conclusions: VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS. ", doi="10.2196/51508", url="https://games.jmir.org/2024/1/e51508", url="http://www.ncbi.nlm.nih.gov/pubmed/38669680" } @Article{info:doi/10.2196/57329, author="Maikos, T. Jason and Chomack, M. John and Herlihy, V. David and Paglia, N. David and Wetterstrand, Charlene and O'Connor, Patrick J. and Hyre, J. Michael and Loan, Peter J. and D'Andrea, E. Susan", title="Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="26", volume="13", pages="e57329", keywords="biplanar fluoroscopy", keywords="dynamic stereo x-ray", keywords="lower limb loss", keywords="transtibial limb loss", keywords="prosthetic sockets", keywords="amputation", keywords="lower extremity", abstract="Background: Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. Objective: This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. Methods: A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10\% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. Results: This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. Conclusions: The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. International Registered Report Identifier (IRRID): DERR1-10.2196/57329 ", doi="10.2196/57329", url="https://www.researchprotocols.org/2024/1/e57329", url="http://www.ncbi.nlm.nih.gov/pubmed/38669065" } @Article{info:doi/10.2196/48725, author="Gooch, J. Helen and Jarvis, A. Kathryn and Stockley, C. Rachel", title="Behavior Change Approaches in Digital Technology--Based Physical Rehabilitation Interventions Following Stroke: Scoping Review", journal="J Med Internet Res", year="2024", month="Apr", day="24", volume="26", pages="e48725", keywords="behavior change", keywords="behavior therapy", keywords="digital health technology", keywords="digital health", keywords="digital technology", keywords="health behavior", keywords="physical and rehabilitation medicine", keywords="scoping review", keywords="stroke rehabilitation", abstract="Background: Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. Objective: This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods: Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). Results: From a total of 1973 identified sources, 103 (5\%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67\%). Almost half (45/103, 44\%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56\%), and almost two-thirds (65/103, 63\%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17\%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85\%), reward and threat (56/103, 54\%), goals and planning (33/103, 32\%), and shaping knowledge (33/103, 32\%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. Conclusions: Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation. ", doi="10.2196/48725", url="https://www.jmir.org/2024/1/e48725" } @Article{info:doi/10.2196/42829, author="Guo, Qifan and Zhang, Liming and Han, Lianyi Leo and Gui, Chenfan and Chen, Guanghui and Ling, Chunyan and Wang, Wei and Gao, Qiang", title="Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Apr", day="24", volume="12", pages="e42829", keywords="virtual reality", keywords="neck pain", keywords="disability", keywords="kinematic function", keywords="rehabilitation", keywords="physiotherapy", keywords="neck", keywords="pain", keywords="chronic", keywords="therapy", keywords="kinematic", keywords="efficacy", keywords="patient", keywords="effect", abstract="Background: Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function. Objective: This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain. Methods: We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05. Results: Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research. Conclusions: The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346 ", doi="10.2196/42829", url="https://games.jmir.org/2024/1/e42829", url="http://www.ncbi.nlm.nih.gov/pubmed/38656775" } @Article{info:doi/10.2196/56348, author="Munce, EP Sarah", title="Introducing JMIR Rehabilitation and Assistive Technologies: A Venue for Publishing Interdisciplinary Research on the Development, Implementation, and Evaluation of Health Innovations and Emerging Technologies in the Field of Rehabilitation", journal="JMIR Rehabil Assist Technol", year="2024", month="Apr", day="22", volume="11", pages="e56348", keywords="rehabilitation", keywords="assistive technologies", keywords="JMIR Rehabilitation and Assistive Technologies", keywords="digital", keywords="online", doi="10.2196/56348", url="https://rehab.jmir.org/2024/1/e56348", url="http://www.ncbi.nlm.nih.gov/pubmed/38648632" } @Article{info:doi/10.2196/44025, author="Wu, Shih-Chung and Chuang, Chia-Wen and Liao, Wen-Chun and Li, Chung-Fang and Shih, Hsin-Hsin", title="Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study", journal="JMIR Serious Games", year="2024", month="Apr", day="16", volume="12", pages="e44025", keywords="breast cancer", keywords="rehabilitation", keywords="virtual reality", keywords="VR", keywords="virtual reality design process", keywords="VR design process", keywords="feasibility", keywords="accessibility", abstract="Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation. ", doi="10.2196/44025", url="https://games.jmir.org/2024/1/e44025" } @Article{info:doi/10.2196/49550, author="Rhiel, Sophia and Kl{\"a}y, Andrina and Keller, Urs and van Hedel, A. Hubertus J. and Ammann-Reiffer, Corinne", title="Comparing Walking-Related Everyday Life Tasks of Children with Gait Disorders in a Virtual Reality Setup With a Physical Setup: Cross-Sectional Noninferiority Study", journal="JMIR Serious Games", year="2024", month="Mar", day="18", volume="12", pages="e49550", keywords="adolescent", keywords="child", keywords="gait", keywords="head-mounted display", keywords="motion capture", keywords="neurological rehabilitation", keywords="noninferiority trial", keywords="physical therapy", keywords="virtual reality", keywords="walking", abstract="Background: A frequent rehabilitation goal for children with gait disorders is to practice daily-life walking activities. Unfortunately, these are often difficult to practice in a conventional therapeutic setting. Virtual reality (VR) with head-mounted displays (HMDs) could be a promising approach in neurorehabilitation to train such activities in a safe environment. First, however, we must know whether obstacles in VR are indeed mastered as obstacles. Objective: This study aimed to provide information on whether VR is feasible and motivating to induce and practice movements needed to master real obstacles in children and adolescents with gait disorders. Furthermore, this project aims to evaluate which kinds of everyday walking activities are appropriate to be practiced in VR. Methods: In this cross-sectional study, participants stepped over a bar, crossed a gap, balanced over a beam, and circumvented stationary obstructions arranged in a course under real physical and virtual conditions wearing a VR HMD. We recorded the respective primary outcomes (step height, step length, step width, and minimal shoulder-obstacle distance) with motion capture. We then calculated the mean differences and 95\% CI of the spatiotemporal parameters between the VR and physical setup and later compared them using noninferiority analysis with margins defined a priori by a clinical expert panel. Additionally, the participants responded to a standardized questionnaire while the therapists observed and evaluated their movement performance. Results: We recruited 20 participants (mean age 12.0, range 6.6-17.8 years) with various diagnoses affecting their walking ability. At 3.77 (95\% CI 1.28 to 6.26) cm, the mean difference in step height of the leading foot in the overstepping task did not exceed the predefined margin of --2 cm, thus signifying noninferiority of the VR condition compared to mastering the physical obstacles. The same was true for step length (--1.75, 95\% CI --4.91 to 1.41 cm; margin --10 cm), step width (1.05, 95\% CI 0.20 to --1.90 cm; margin 3 cm), and the minimal shoulder-obstacle distance (0.25, 95\% CI --0.85 to 0.35 cm; margin --2 cm) in the other tasks. Only the trailing foot in the overstepping task yielded inconclusive results. Conclusions: Children with gait disorders perform everyday walking tasks like overstepping, crossing, balancing, or circumventing similarly in physical and VR environments, suggesting that VR could be a feasible therapeutic tool to practice everyday walking tasks. ", doi="10.2196/49550", url="https://games.jmir.org/2024/1/e49550", url="http://www.ncbi.nlm.nih.gov/pubmed/38498048" } @Article{info:doi/10.2196/54823, author="Park, G. Linda and Chi, Serena and Pitsenbarger, Susan and Johnson, K. Julene and Shah, J. Amit and Elnaggar, Abdelaziz and von Oppenfeld, Julia and Cho, Evan and Harzand, Arash and Whooley, A. Mary", title="Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study", journal="JMIR Cardio", year="2024", month="Mar", day="14", volume="8", pages="e54823", keywords="cardiac rehabilitation", keywords="cardiac rehab", keywords="COVID-19", keywords="digital health", keywords="digital technology", keywords="physical activity", keywords="physical activity maintenance", keywords="social media", keywords="older adults", keywords="pandemic", keywords="social distancing", keywords="technology", keywords="wearables", keywords="CR", keywords="exercise", keywords="cardiovascular disease", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="hospital", keywords="medical facility", keywords="California", keywords="interview", keywords="thematic analysis", keywords="anxiety", abstract="Background: Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. Objective: This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. Methods: We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. Results: In total, 22 participants (n=9, 41\% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants' feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. Conclusions: Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR. ", doi="10.2196/54823", url="https://cardio.jmir.org/2024/1/e54823", url="http://www.ncbi.nlm.nih.gov/pubmed/38483450" } @Article{info:doi/10.2196/51116, author="Rettinger, Lena and Sch{\"o}nthaler, Erna and Kerschbaumer, Andrea and Hauser, Carina and Klupper, Carissa and Aichinger, Lea and Werner, Franz", title="Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Mar", day="7", volume="11", pages="e51116", keywords="handwriting", keywords="handwriting pressure", keywords="pen", keywords="children", keywords="occupational therapy", keywords="assistive technology", keywords="tablet", keywords="app", abstract="Background: The acquisition of handwriting skills is essential for a child's academic success, self-confidence, and general school performance. Nevertheless, an estimated 5\% to 27\% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. Objective: We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). Methods: A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. Results: The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child's awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs---usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. Conclusions: The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system's impact. ", doi="10.2196/51116", url="https://rehab.jmir.org/2024/1/e51116", url="http://www.ncbi.nlm.nih.gov/pubmed/38451584" } @Article{info:doi/10.2196/56499, author="Lai, Byron and Oster, A. Robert and Davis, Drew and Bright, Larsen and Fisher, Gordon and Wilroy, Jereme and Kim, Yumi and Young, Raven and Wright, Ashley and Sinha, Tanvee and Rimmer, H. James", title="Telehealth Movement-to-Music With Arm-Based Sprint-Intensity Interval Training to Improve Cardiometabolic Health and Cardiorespiratory Fitness in Children With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Mar", day="5", volume="13", pages="e56499", keywords="disability", keywords="high-intensity", keywords="interval training", keywords="pediatrics", keywords="physical activity", keywords="telehealth", abstract="Background: Children with mobility disabilities, including those with cerebral palsy, have limited options and limited time to exercise to manage their cardiometabolic health and cardiorespiratory fitness. Regular cardiovascular exercise during childhood is a critical health behavior for preventing health decline in adulthood. Thus, there is an urgent need for accessible, age-appropriate, convenient exercise modalities in this group. Sprint-intensity interval training (SIT), combined with telehealth procedures, may be ideal for children with disabilities. SIT includes repetitive bouts of maximal exercise effort combined with rest periods, which can be effective in eliciting comparable results to moderate-exercise training with very short training durations. Objective: This phase 1 pilot feasibility randomized controlled trial aims to investigate the potential effects of a 12-week SIT program on indicators of cardiorespiratory fitness and cardiometabolic health among children with cerebral palsy. An ancillary aim is to evaluate the feasibility of the program through several process feasibility metrics. Methods: This study uses a 2-armed parallel group design. A total of 50 physically inactive children with cerebral palsy (aged 6-17 years) will be randomly allocated into 1 of 2 groups: a 12-week SIT or a waitlist control group that continues habitual activity for 12 weeks. The SIT prescription includes 3 tele-supervised sessions per week with 30 repeated sequences of 4 seconds of maximal arm exercise, with active recovery, warm-up, and cooldown periods (for an approximately 20-minute total session). SIT includes guided videos with child-themed arm routines and music. The exercise sessions will be remotely supervised through a web-based videoconference application and include safety monitoring equipment. Outcomes are measured at pre- and postintervention (weeks 0 and 13, respectively). Health outcome measures include peak oxygen consumption (VO2 peak), measured by a graded exercise test; high-sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, and cholesterol using a finger stick dried blood spot test; blood pressure, using a sphygmomanometer; and body composition (total mass, total lean mass, tissue \% lean, and tissue \% fat) using dual x-ray absorptiometry. Feasibility will be evaluated by the following metrics: adverse events or problems experienced throughout the intervention related to participant safety; perceived enjoyment; and recruitment, enrollment, and attrition rates. Results: Recruitment procedures started in November 2023. All data are anticipated to be collected by February 2025. Full trial results are anticipated to be analyzed and submitted for publication by March 2025. Secondary analyses of data will be subsequently published. Conclusions: This trial tests an accessible and low-cost exercise program that leverages principles of high-intensity exercise to provide a convenient program for children with physical disabilities. Knowledge obtained from this study will inform the development of a larger trial for improving the cardiometabolic health, cardiorespiratory fitness, and well-being of children with physical disabilities. Trial Registration: ClinicalTrials.gov NCT05619211; https://clinicaltrials.gov/study/NCT05619211 International Registered Report Identifier (IRRID): DERR1-10.2196/56499 ", doi="10.2196/56499", url="https://www.researchprotocols.org/2024/1/e56499", url="http://www.ncbi.nlm.nih.gov/pubmed/38441939" } @Article{info:doi/10.2196/49312, author="Su, Zhenzhen and Zhang, Liyan and Lian, Xuemin and Guan, Miaomiao", title="Virtual Reality--Based Exercise Rehabilitation in Cancer-Related Dysfunctions: Scoping Review", journal="J Med Internet Res", year="2024", month="Feb", day="26", volume="26", pages="e49312", keywords="virtual reality", keywords="cancer", keywords="virtual reality--based exercise rehabilitation", keywords="cancer-related dysfunction", keywords="rehabilitation", keywords="scoping review", abstract="Background: Virtual reality--based exercise rehabilitation (VRER) is a promising intervention for patients with cancer-related dysfunctions (CRDs). However, studies focusing on VRER for CRDs are lacking, and the results are inconsistent. Objective: We aimed to review the application of VRER in patients with CRDs. Methods: This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist framework. Publications were included from the time of database establishment to October 14, 2023. The databases were PubMed, Embase, Scopus, Cochrane, Web of Science, ProQuest, arXiv, IEEE Xplore, MedRxiv, CNKI, Wanfang Data, VIP, and SinoMed. The population included patients with cancer. A virtual reality (VR) system or device was required to be provided in exercise rehabilitation as an intervention. Eligible studies focused on VRER used for CRDs. Study selection and data extraction were performed by 2 reviewers independently. Extracted data included authors, year, country, study type, groups, sample size, participant age, cancer type, existing or potential CRDs, VR models and devices, intervention programs and durations, effectiveness, compliance, satisfaction, and safety. Results: We identified 25 articles, and among these, 12 (48\%) were randomized clinical trials, 11 (44\%) were other experimental studies, and 2 (8\%) were observational studies. The total sample size was 1174 (range 6-136). Among the 25 studies, 22 (88\%), 2 (8\%), and 1 (4\%) included nonimmersive VR, immersive VR, and augmented reality, respectively, which are models of VRER. Commercial game programs (17/25, 68\%) were the most popular interventions of VRER, and their duration ranged from 3 to 12 weeks. Using these models and devices, VRER was mostly applied in patients with breast cancer (14/25, 56\%), leukemia (8/25, 32\%), and lung cancer (3/25, 12\%). Furthermore, 6 CRDs were intervened by VRER, and among these, postmastectomy syndromes were the most common (10/25, 40\%). Overall, 74\% (17/23) of studies reported positive results, including significant improvements in limb function, joint range of motion, edema rates, cognition, respiratory disturbance index, apnea, activities of daily living, and quality of life. The compliance rate ranged from 56\% to 100\%. Overall, 32\% (8/25) of studies reported on patient satisfaction, and of these, 88\% (7/8) reported satisfaction with VRER. Moreover, 13\% (1/8) reported mild sickness as an adverse event. Conclusions: We found that around half of the studies reported using VRER in patients with breast cancer and postmastectomy dysfunctions through nonimmersive models and commercial game programs having durations of 3-12 weeks. In addition, most studies showed that VRER was effective owing to virtualization and interaction. Therefore, VRER may be an alternate intervention for patients with CRDs. However, as the conclusions were drawn from data with acknowledged inconsistencies and limited satisfaction reports, studies with larger sample sizes and more outcome indictors are required. ", doi="10.2196/49312", url="https://www.jmir.org/2024/1/e49312", url="http://www.ncbi.nlm.nih.gov/pubmed/38407951" } @Article{info:doi/10.2196/50582, author="Lai, Byron and Wadsworth, Danielle and Spring, Katherine and Jones, S. Chloe and Mintz, Madison and Malone, A. Laurie and Kim, Yumi and Wilroy, Jereme and Lee, Holim", title="Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Feb", day="12", volume="11", pages="e50582", keywords="cerebral palsy", keywords="telehealth", keywords="young adults", keywords="telemonitoring", keywords="exercise", keywords="therapy", keywords="therapeutic exercise", keywords="assessment", keywords="teleassessment", keywords="reliability", keywords="usability", keywords="disability", keywords="youth", keywords="physical fitness", keywords="videoconference", abstract="Background: Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities. Objective: The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration. Methods: The study enrolled 19 ambulatory youth: 9 (47\%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53\%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots. Results: The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95\% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05). Conclusions: This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability. ", doi="10.2196/50582", url="https://rehab.jmir.org/2024/1/e50582", url="http://www.ncbi.nlm.nih.gov/pubmed/38345838" } @Article{info:doi/10.2196/52328, author="Butala, Saloni and Galido, Valentine Pearl and Woo, P. Benjamin K.", title="Consumer Perceptions of Home-Based Percussive Massage Therapy for Musculoskeletal Concerns: Inductive Thematic Qualitative Analysis", journal="JMIR Rehabil Assist Technol", year="2024", month="Feb", day="5", volume="11", pages="e52328", keywords="home-based therapy", keywords="injury prevention", keywords="massage guns", keywords="musculoskeletal pain", keywords="pain management", keywords="percussive massage therapy", keywords="rehabilitation", keywords="self-management", keywords="sports medicine", abstract="Background: Musculoskeletal pain is a prevalent concern among diverse populations, from the average individual to the elite athlete. Handheld percussive massage therapy devices like massage guns have gained much popularity in both medical and athletic settings. Its application has been prominently recognized in injury prevention and rehabilitation. The expansion of the market to provide handheld percussive therapy devices with varying features and price points has encouraged professional and novice use. While percussive therapy holds similarities to more studied therapeutic modalities, like vibration therapy and soft tissue mobilization, there is limited evidence-based information on the indications and contraindications. Objective: This study aims to use a qualitative analysis of consumer perceptions to understand the perceived therapeutic potential of percussive massage therapy as a home-based intervention for musculoskeletal concerns of everyday users and elite athletes. Additionally, we aim to gain insight on valuable characteristics supporting its therapeutic potential as well as pertinent limitations. Methods: The TOLOCO massage gun (TOLOCO) was identified as the best-selling percussive massage therapy device on Amazon. We performed an inductive thematic qualitative analysis on the top 100 positive comments and the top 100 critical comments of the device between June 2020 and April 2023 to determine 4 relevant themes. Results: The 4 themes identified upon qualitative analysis were pain management, versatility, accessibility, and safety and user education. Consumer reviews indicated use for this percussive therapy device in adolescents, adults, and older people across a spectrum of activity levels. Consumers reported the therapeutic potential of percussive massage therapy in managing wide-ranging musculoskeletal concerns like acute pain, chronic pain, nonsurgical injury rehabilitation, postsurgical injury rehabilitation, and injury prevention. Consumers highlighted the versatility of the device to address person-specific needs as a key feature in supporting its perceived therapeutic benefits. Additionally, consumers frequently commented on the affordability and availability of this device to increase accessibility to home-based care. Some critical reviews emphasized a concern for the quality of the device itself. However, this concern did not translate to the overall modality of percussive massage therapy. Of note, despite strong approval for its therapeutic potential, consumer reviews lacked evidence-based insights on appropriate usage. Conclusions: Home-based percussive massage therapy holds value with its perceived efficacy in pain management for acute and chronic conditions, as well as in injury prevention and rehabilitation. As a low-cost and readily available device for everyday users and high-performing athletes, percussive massage therapy works toward establishing increased health care accessibility and optimizing health care usage. This home-based intervention can serve to reduce the significant personal and economic burden of prevalent musculoskeletal concerns. However, the limited scientific research on percussive massage therapy raises concerns about the lack of evidence-based care and indicates the need for future studies. ", doi="10.2196/52328", url="https://rehab.jmir.org/2024/1/e52328", url="http://www.ncbi.nlm.nih.gov/pubmed/38315526" } @Article{info:doi/10.2196/49261, author="Trofimchuk, Vitaliy and Dossanov, Bolatbek and Lozovoy, Vassiliy and Khmyzov, Sergey and Dossanova, Assem and Angelov, Aleksandr and Pashenko, Andrey and Zhukenov, Olzhas", title="Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Jan", day="24", volume="11", pages="e49261", keywords="achondroplasia", keywords="external fixator", keywords="quality of life", keywords="transosseous osteosynthesis", keywords="paired limb lengthening", keywords="bone growth disorder", keywords="dwarfism", keywords="limb lengthening", keywords="circular multiaxial system", keywords="hereditary disease", keywords="limb reconstruction", keywords="children", keywords="youth", keywords="pediatric", keywords="bone disorder", keywords="orthopedics", keywords="rehabilitation", keywords="bone", keywords="growth", keywords="disorder", keywords="genetic", abstract="Background: Transosseous distraction osteosynthesis is prioritized in orthopedic care for children with achondroplasia. However, difficulties encountered during treatment and rehabilitation directly impact patients' quality of life. Using rod external fixators within a semicircular frame for osteosynthesis is less traumatic compared to spoke circular devices. Their straightforward assembly and mounting on the limb segment can help significantly reduce treatment duration, thereby improving children's quality of life during treatment and rehabilitation. Objective: This study aimed to conduct a comparative analysis of the quality of life (measured by postoperative pain syndrome, physical activity, and emotional state) among children with achondroplasia undergoing paired limb lengthening using either an external fixator with modified distraction control or a circular multiaxial system developed by the authors. Methods: This was an observational, prospective, nonrandomized, and longitudinal study with historical control. The study group consisted of 14 patients ranging from 5 to 15 (mean 7.6, SD 2.3) years old with a genetically confirmed diagnosis of achondroplasia. All patients underwent paired limb lengthening with a rod external fixator and a modified distraction control developed by the authors. A total of 28 limb segments, among them 4 (14\%) humeri, 8 (29\%) femurs, and 16 (57\%) tibias, were lengthened in 1 round. Unpublished data from the previous study served as the control group, comprising 9 patients (18 limb segments) of the same age group (mean age at surgery 8.6, SD 2.3 years), who underwent limb lengthening surgery using a circular multiaxial system---2 (11\%) humeri, 6 (33\%) femurs, and 10 (56\%) tibias. The Wong-Baker Faces Rating Scale was used to measure pain symptoms, while the Russified Pediatric Quality of Life (PedsQL) v4.0 questionnaire assessed quality of life. Results: During the latent phase (7 to 10 days after surgery), a more pronounced decrease in the indicators of physical activity and emotional state on the PedsQL v4.0 questionnaire was noted in the control group (mean 52.4, SD 4.8 versus mean 52.8, SD 5.5 points according to children's responses and their parents' responses, respectively) compared to the experimental group (mean 59.5, SD 6.8 points and mean 61.33, SD 6.5 points according to the children's responses and their parents' responses, respectively). The differences between the groups were statistically significant (P<.05 for children's responses and P<.01 for parents' responses). Importantly, 6 months after surgery, these quality-of-life indicators, as reported by children in the experimental group, averaged 70.25 (SS 4.8) points. Similarly, their parents reported a mean of 70.54 (SD 4.2) points. In the control group, the corresponding values were 69.64 (SD 5.6) and 69.35 (SD 6.2), respectively. There was no statistically significant difference between the groups. Conclusions: The external fixator with modified distraction control developed by the authors provides a higher standard of living compared with the circular multiaxial system during the latency phase. ", doi="10.2196/49261", url="https://rehab.jmir.org/2024/1/e49261", url="http://www.ncbi.nlm.nih.gov/pubmed/38265860" } @Article{info:doi/10.2196/45168, author="Brassel, Sophie and Brunner, Melissa and Campbell, Andrew and Power, Emma and Togher, Leanne", title="Exploring Discussions About Virtual Reality on Twitter to Inform Brain Injury Rehabilitation: Content and Network Analysis", journal="J Med Internet Res", year="2024", month="Jan", day="19", volume="26", pages="e45168", keywords="virtual reality", keywords="Twitter", keywords="brain injury", keywords="rehabilitation", keywords="cognitive communication", keywords="social networks", keywords="social media", keywords="brain injury rehabilitation", keywords="engagement", keywords="development", keywords="clinical practice", keywords="injury", keywords="users", abstract="Background: Virtual reality (VR) use in brain injury rehabilitation is emerging. Recommendations for VR development in this field encourage end user engagement to determine the benefits and challenges of VR use; however, existing literature on this topic is limited. Data from social networking sites such as Twitter may further inform development and clinical practice related to the use of VR in brain injury rehabilitation. Objective: This study collected and analyzed VR-related tweets to (1) explore the VR tweeting community to determine topics of conversation and network connections, (2) understand user opinions and experiences of VR, and (3) identify tweets related to VR use in health care and brain injury rehabilitation. Methods: Publicly available tweets containing the hashtags \#virtualreality and \#VR were collected up to twice weekly during a 6-week period from July 2020 to August 2020 using NCapture (QSR International). The included tweets were analyzed using mixed methods. All tweets were coded using inductive content analysis. Relevant tweets (ie, coded as ``VR in health care'' or ``talking about VR'') were further analyzed using Dann's content coding. The biographies of users who sent relevant tweets were examined descriptively. Tweet data networks were visualized using Gephi computational analysis. Results: A total of 260,715 tweets were collected, and 70,051 (26.87\%) were analyzed following eligibility screening. The sample comprised 33.68\% (23,596/70,051) original tweets and 66.32\% (46,455/70,051) retweets. Content analysis generated 10 main categories of original tweets related to VR (ie, advertising and promotion, VR content, talking about VR, VR news, general technology, VR industry, VR live streams, VR in health care, VR events, and VR community). Approximately 4.48\% (1056/23,596) of original tweets were related to VR use in health care, whereas 0.19\% (45/23,596) referred to VR in brain injury rehabilitation. In total, 14.86\% (3506/23,596) of original tweets featured commentary on user opinions and experiences of VR applications, equipment, and software. The VR tweeting community comprised a large network of 26,001 unique Twitter users. Users that posted tweets related to ``VR in health care'' (2124/26,001, 8.17\%) did not form an interconnected VR network, whereas many users ``talking about VR'' (3752/26,001, 14.43\%) were connected within a central network. Conclusions: This study provides valuable data on community-based experiences and opinions related to VR. Tweets showcased various VR applications, including in health care, and identified important user-based considerations that can be used to inform VR use in brain injury rehabilitation (eg, technical design, accessibility, and VR sickness). Limited discussions and small user networks related to VR in brain injury rehabilitation reflect the paucity of literature on this topic and the potential underuse of this technology. These findings emphasize that further research is required to understand the specific needs and perspectives of people with brain injuries and clinicians regarding VR use in rehabilitation. ", doi="10.2196/45168", url="https://www.jmir.org/2024/1/e45168", url="http://www.ncbi.nlm.nih.gov/pubmed/38241072" } @Article{info:doi/10.2196/48900, author="Villada Castillo, Felipe Julian and Montoya Vega, Fernanda Maria and Mu{\~n}oz Cardona, Edison John and Lopez, David and Qui{\~n}ones, Leonardo and Henao Gallo, Alberto Oscar and Lopez, Fernando Jose", title="Design of Virtual Reality Exergames for Upper Limb Stroke Rehabilitation Following Iterative Design Methods: Usability Study", journal="JMIR Serious Games", year="2024", month="Jan", day="11", volume="12", pages="e48900", keywords="stroke", keywords="user-centered design", keywords="exergame", keywords="design", keywords="virtual reality", keywords="playtest", keywords="upper limb rehabilitation", abstract="Background: Since the early 2000s, there has been a growing interest in using exercise video games (exergames) and virtual reality (VR)--based interventions as innovative methods to enhance physical rehabilitation for individuals with multiple disabilities. Over the past decade, researchers and exercise professionals have focused on developing specialized immersive exercise video games for various populations, including those who have experienced a stroke, revealing tangible benefits for upper limb rehabilitation. However, it is necessary to develop highly engaging, personalized games that can facilitate the creation of experiences aligned with the preferences, motivations, and challenges communicated by people who have had an episode of stroke. Objective: This study seeks to explore the customization potential of an exergame for individuals who have undergone a stroke, concurrently evaluating its usability as a technological tool in the realm of physical therapy and rehabilitation. Methods: We introduce a playtest methodology to enhance the design of a VR exergame developed using a user-centered approach for upper limb rehabilitation in stroke survivors. Over 4 playtesting sessions, stroke survivors interacted with initial game versions using VR headsets, providing essential feedback for refining game content and mechanics. Additionally, a pilot study involving 10 stroke survivors collected data through VR-related questionnaires to assess game design aspects such as mechanics, assistance, experience, motion sickness, and immersion. Results: The playtest methodology was beneficial for improving the exergame to align with user needs, consistently incorporating their perspectives and achieving noteworthy results. The pilot study revealed that users had a positive response. In the first scenario, a carpenter presents a game based on the flexion-extension movement of the elbow; the second scenario includes a tejo game (a traditional Colombian throwing game) designed around game mechanics related to the flexion-extension movement of the shoulder; and in the third scenario, a farmer challenges the player to perform a movement combining elbow flexion and extension with internal and external rotation of the shoulder. These findings suggest the potential of the studied exergame as a tool for the upper limb rehabilitation of individuals who have experienced a stroke. Conclusions: The inclusion of exergames in rehabilitation for stroke-induced hemiparesis has significantly benefited the recovery process by focusing on essential shoulder and elbow movements. These interactive games play a crucial role in helping users regain mobility and restore practical use of affected limbs. They also serve as valuable data sources for researchers, improving the system's responsiveness. This iterative approach enhances game design and markedly boosts user satisfaction, suggesting exergames have promising potential as adjunctive elements in traditional therapeutic approaches. ", doi="10.2196/48900", url="https://games.jmir.org/2024/1/e48900", url="http://www.ncbi.nlm.nih.gov/pubmed/38206670" } @Article{info:doi/10.2196/50299, author="Nan, Xiaofeng and Kuru {\c{C}}olak, Tu?ba and Ak{\c{c}}ay, Bur{\c{c}}in and Xie, Hua and Zhao, Liwei and Borysov, Maksym", title="Results of Gensingen Bracing in Patients With Adolescent Idiopathic Scoliosis: Retrospective Cross-Sectional Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Jan", day="10", volume="11", pages="e50299", keywords="scoliosis", keywords="brace treatment", keywords="feasibility study", keywords="outcome", keywords="skeletal", keywords="spine", keywords="back", keywords="musculoskeletal", keywords="curvature", keywords="spinal", keywords="database", keywords="template", keywords="design", keywords="brace", keywords="orthopedics", keywords="injury", keywords="rehabilitation", keywords="Gensingen brace", keywords="conservative brace treatment", keywords="Idiopathic Scoliosis", keywords="orthopedic", keywords="injuries", keywords="data science", keywords="data management", abstract="Background: Bracing is an essential part of scoliosis treatment. The standard of brace treatment for patients with scoliosis today is still very variable in terms of brace quality and outcome. The Gensingen brace is a further developed Ch{\^e}neau brace derivative with individual design, which can be adapted through computer-aided design. Objective: This study aims to generate a template to obtain a database for prospective multicenter studies study to analyze the results of high-corrective asymmetric Gensingen brace treatment for patients with adolescent idiopathic scoliosis (AIS). Methods: A template for the database was created, which contains the patients' basic data (age, menarcheal status, Risser Sign, curve pattern, and daily brace wearing time), the Cobb angles of curvature, and the cosmetically relevant angles of trunk rotation (ATR). A retrospective review of medical records of patients with AIS, who met the Scoliosis Research Society's inclusion criteria for brace studies, was performed to test the feasibility of the template. Template items were filled in by the researchers. Results: Out of 115 patients between 2014 and 2018, the complete data of 33 patients followed up at least 3 months after complete Gensingen brace weaning could be analyzed. The mean age was 12 years, the mean Cobb angle was 33.6{\textdegree}, and the mean Risser value was 0.7 at the beginning of the treatment. The mean improvement in the Cobb angle on in-brace x-ray imaging was --26.1? (80\% of in-brace correction). The Cobb angle of the major curvature changed as follows: curve stabilization was achieved in 7 (21.2\%) cases, and curve improvement was achieved in 26 (78.8\%) cases. None of the patients showed a curve progression. The Cobb angle was significantly reduced in the brace at the end of treatment and at follow-up evaluation (P<.001). ATR improved significantly for thoracic (P<.001) and lumbar curves (P<.001). Conclusions: The database proved to be informative in the assessment of radiological and clinical outcome parameters. The example data set we have generated can be a helpful tool for professionals who work in clinics but do not store regular patient data. Especially with regard to different patient collectives worldwide, different results may be achieved with the same standards of care. In addition, the results of this study suggest that above-average correction effects with a full-time brace application lead to significant improvements in the Cobb angle after brace treatment has been completed. ", doi="10.2196/50299", url="https://rehab.jmir.org/2024/1/e50299", url="http://www.ncbi.nlm.nih.gov/pubmed/38198197" } @Article{info:doi/10.2196/53084, author="Bass, Alec and Morin, N. Suzanne and Guidea, Michael and Lam, T. Jacqueline T. A. and Karelis, D. Antony and Aubertin-Leheudre, Myl{\`e}ne and Gagnon, H. Dany and ", title="Potential Effects of an Exoskeleton-Assisted Overground Walking Program for Individuals With Spinal Cord Injury Who Uses a Wheelchair on Imaging and Serum Markers of Bone Strength: Pre-Post Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Jan", day="1", volume="11", pages="e53084", keywords="assistive technology", keywords="bone architecture", keywords="bone turnover", keywords="osteoporosis", keywords="rehabilitation", keywords="spinal cord injuries", keywords="SCI", keywords="spinal cord injury", keywords="assistive device", keywords="wheelchair", keywords="exoskeleton device", keywords="locomotion", keywords="bone strength", keywords="risk", keywords="fracture", abstract="Background: As many as 60\% of individuals use a wheelchair long term after a spinal cord injury (SCI). This mode of locomotion leads to chronic decline in lower-extremity weight-bearing activities and contributes to the development of severe sublesional osteoporosis and high rates of fragility fracture. Overground exoskeleton-assisted walking programs provide a novel opportunity to increase lower-extremity weight bearing, with the potential to improve bone health. Objective: The aim of the study is to measure the potential effects of an exoskeleton-assisted walking program on lower-extremity bone strength and bone remodeling biomarkers in individuals with chronic (?18 months) SCI who use a wheelchair. Methods: In total, 10 participants completed a 16-week exoskeleton-assisted walking program (34 individualized 1-hour sessions, progressing from 1 to 3 per week). Bone mineral density and bone strength markers (dual-energy x-ray absorptiometry: total body, left arm, leg, total hip, and femoral neck and peripheral quantitative computed tomography: 25\% of left femur and 66\% of left tibia) as well as bone remodeling biomarkers (formation=osteocalcin and resorption=C-telopeptide) were measured before and after intervention and compared using nonparametric tests. Changes were considered significant and meaningful if the following criteria were met: P<0.1, effect size ?0.5, and relative variation >5\%. Results: Significant and meaningful increases were observed at the femur (femoral neck bone mineral content, bone strength index, and stress-strain index) and tibia (cortical cross-sectional area and polar moment of inertia) after the intervention (all P<.10). We also noted a decrease in estimated femoral cortical thickness. However, no changes in bone remodeling biomarkers were found. Conclusions: These initial results suggest promising improvements in bone strength markers after a 16-week exoskeleton-assisted walking program in individuals with chronic SCI. Additional research with larger sample sizes, longer interventions (possibly of greater loading intensity), and combined modalities (eg, pharmacotherapy or functional electrical stimulation) are warranted to strengthen current evidence. Trial Registration: ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID): RR2-10.2196/19251 ", doi="10.2196/53084", url="https://rehab.jmir.org/2024/1/e53084", url="http://www.ncbi.nlm.nih.gov/pubmed/38163294" } @Article{info:doi/10.2196/43309, author="Evans, Eric and Zengul, Ayse and Knight, Amy and Willig, Amanda and Cherrington, Andrea and Mehta, Tapan and Thirumalai, Mohanraj", title="Stakeholders' Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="18", volume="10", pages="e43309", keywords="self-management", keywords="physical disabilities", keywords="physical disability", keywords="chronic condition", keywords="chronic illness", keywords="mental health", keywords="physical activity", keywords="barrier", keywords="disability", keywords="chronic", keywords="technology", keywords="interview", keywords="data", keywords="symptom", keywords="support", keywords="digital", keywords="development", keywords="need", keywords="perspective", keywords="qualitative", keywords="focus group", keywords="assistive technology", keywords="assistive technologies", abstract="Background: While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. Objective: This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. Methods: Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders' experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. Results: A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. Conclusions: The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. Trial Registration: ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593 ", doi="10.2196/43309", url="https://rehab.jmir.org/2023/1/e43309", url="http://www.ncbi.nlm.nih.gov/pubmed/38109170" } @Article{info:doi/10.2196/48055, author="Islam, Riasat and Gooch, Daniel and Karlakki, Sudheer and Price, Blaine", title="A Device for Prehabilitation of Total Knee Replacement Surgery (Slider): Usability Study", journal="JMIR Form Res", year="2023", month="Dec", day="18", volume="7", pages="e48055", keywords="physiotherapy", keywords="rehabilitation", keywords="prehabilitation, knee replacement", keywords="community physiotherapy", keywords="outpatient", keywords="gamification", keywords="motivation", keywords="adherence", keywords="knee", keywords="exercise", keywords="preoperative", keywords="postoperative", keywords="usability", keywords="validation", keywords="software", keywords="exergames", keywords="geriatric rehabilitation", keywords="self-regulated exercise", keywords="assistive technology", keywords="telerehabilitation", keywords="digital health", keywords="healthcare delivery", abstract="Background: Rehabilitation, or ``prehabilitation,'' is essential in preparing for and recovering from knee replacement surgery. The recent demand for these services has surpassed available resources, a situation further strained by the COVID-19 pandemic, which has led to a pivot toward digital solutions such as web- or app-based videos and wearables. These solutions, however, face challenges with user engagement, calibration requirements, and skin contact issues. This study evaluated the practicality of a low-contact, gamified device designed to assist with prehabilitation exercises. Objective: The study aimed to assess the practicality and user-friendliness of a newly designed physiotherapy device (Slider) that enables exercise monitoring without the need for direct contact with the skin. Methods: A total of 17 patients awaiting knee replacement surgery at a UK National Health Service (NHS) hospital participated in this study. They used the device over a 2-week period and subsequently provided feedback through a usability and acceptability questionnaire. Results: The study was completed by all participants, with a majority (13/17, 76\%) finding the device intuitive and easy to use. The majority of patients were satisfied with the device's ability to meet their presurgery physiotherapy requirements (16/17, 94\%) and expressed a willingness to continue using it (17/17, 100\%). No safety issues or adverse effects were reported by the participants. Conclusions: The results indicate that the device was found to be a feasible option for patients to conduct presurgery physiotherapy exercises independently, away from a clinical setting. Further research involving a larger and more diverse group of participants is recommended to validate these findings more robustly. ", doi="10.2196/48055", url="https://formative.jmir.org/2023/1/e48055", url="http://www.ncbi.nlm.nih.gov/pubmed/38109191" } @Article{info:doi/10.2196/49345, author="Misra, Satish and Niazi, Karen and Swayampakala, Kamala and Blackmon, Amanda and Lang, Melissa and Davenport, Elizabeth and Saxonhouse, Sherry and Fedor, John and Powell, Brian and Thompson, Joseph and Holshouser, John and Mehta, Rohit", title="Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study", journal="JMIR Cardio", year="2023", month="Dec", day="14", volume="7", pages="e49345", keywords="atrial fibrillation", keywords="behavior modification", keywords="cardiac rehabilitation", keywords="catheter ablation", keywords="exercise", keywords="remote exercise supervision", keywords="weight loss", abstract="Background: Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. Objective: This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. Methods: A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. Results: The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [?75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92\%) participants completed the program, with 94\% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81\% and 47\%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. Conclusions: An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort. ", doi="10.2196/49345", url="https://cardio.jmir.org/2023/1/e49345", url="http://www.ncbi.nlm.nih.gov/pubmed/38096021" } @Article{info:doi/10.2196/49702, author="Alder, Gemma and Taylor, Denise and Rashid, Usman and Olsen, Sharon and Brooks, Thonia and Terry, Gareth and Niazi, Khan Imran and Signal, Nada", title="A Brain Computer Interface Neuromodulatory Device for Stroke Rehabilitation: Iterative User-Centered Design Approach", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="11", volume="10", pages="e49702", keywords="user-centered design", keywords="stroke", keywords="rehabilitation technology", keywords="wearable technology", keywords="brain computer interface", keywords="BCI", keywords="mobile app", keywords="think-aloud", keywords="near live", keywords="semistructured interviews", abstract="Background: Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite growing evidence of their efficacy, there is a lack of uptake and sustained use in stroke rehabilitation and a call for user-centered design approaches during technology design and development. This study focuses on a novel rehabilitation technology called exciteBCI, a complex neuromodulatory wearable technology in the prototype stage that augments locomotor rehabilitation for people with stroke. The exciteBCI consists of a brain computer interface, a muscle electrical stimulator, and a mobile app. Objective: This study presents the evaluation phase of an iterative user-centered design approach supported by a qualitative descriptive methodology that sought to (1) explore users' perspectives and experiences of exciteBCI and how well it fits with rehabilitation, and (2) facilitate modifications to exciteBCI design features. Methods: The iterative usability evaluation of exciteBCI was conducted in 2 phases. Phase 1 consisted of 3 sprint cycles consisting of single usability sessions with people with stroke (n=4) and physiotherapists (n=4). During their interactions with exciteBCI, participants used a ``think-aloud'' approach, followed by a semistructured interview. At the end of each sprint cycle, device requirements were gathered and the device was modified in preparation for the next cycle. Phase 2 focused on a ``near-live'' approach in which 2 people with stroke and 1 physiotherapist participated in a 3-week program of rehabilitation augmented by exciteBCI (n=3). Participants completed a semistructured interview at the end of the program. Data were analyzed from both phases using conventional content analysis. Results: Overall, participants perceived and experienced exciteBCI positively, while providing guidance for iterative changes. Five interrelated themes were identified from the data: (1) ``This is rehab'' illustrated that participants viewed exciteBCI as having a good fit with rehabilitation practice; (2) ``Getting the most out of rehab'' highlighted that exciteBCI was perceived as a means to enhance rehabilitation through increased engagement and challenge; (3) ``It is a tool not a therapist,'' revealed views that the technology could either enhance or disrupt the therapeutic relationship; and (4) ``Weighing up the benefits versus the burden'' and (5) ``Don't make me look different'' emphasized important design considerations related to device set-up, use, and social acceptability. Conclusions: This study offers several important findings that can inform the design and implementation of rehabilitation technologies. These include (1) the design of rehabilitation technology should support the therapeutic relationship between the patient and therapist, (2) social acceptability is a design priority in rehabilitation technology but its importance varies depending on the use context, and (3) there is value in using design research methods that support understanding usability in the context of sustained use. ", doi="10.2196/49702", url="https://rehab.jmir.org/2023/1/e49702", url="http://www.ncbi.nlm.nih.gov/pubmed/38079202" } @Article{info:doi/10.2196/50571, author="Ota, Hirofumi and Mukaino, Masahiko and Inoue, Yukari and Matsuura, Shoh and Yagi, Senju and Kanada, Yoshikiyo and Saitoh, Eiichi and Otaka, Yohei", title="Movement Component Analysis of Reaching Strategies in Individuals With Stroke: Preliminary Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="5", volume="10", pages="e50571", keywords="stroke", keywords="upper limb paresis", keywords="compensatory movements", keywords="three-dimensional motion analysis", keywords="reaching movement", keywords="rehabilitation", keywords="motion analysis", keywords="reaching", keywords="3D", keywords="three dimensional", keywords="motion capture", keywords="motion", keywords="movement", keywords="limb", keywords="extremity", keywords="extremities", keywords="mobility", keywords="hemiparesis", keywords="paralysis", keywords="compensate", keywords="compensatory", abstract="Background: Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. Objective: This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. Methods: A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. Results: A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5\%, SD 24.5\% vs mean 85.2\%, SD 4.5\%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0\%, SD 28.5\% vs mean 3.0\%, SD 2.8\%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8\%, SD 23.7\% vs mean 90.7\%, SD 11.8\%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5\%, SD 5.7\% vs mean 6.5\%, SD 3.0\%; P=.02 and mean 16.5\%, SD 18.7\% vs mean 3.0\%, SD 10.4\%; P=.02, respectively). Conclusions: Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation. ", doi="10.2196/50571", url="https://rehab.jmir.org/2023/1/e50571", url="http://www.ncbi.nlm.nih.gov/pubmed/38051570" } @Article{info:doi/10.2196/45307, author="van Dartel, Dieuwke and Wang, Ying and Hegeman, H. Johannes and Vollenbroek-Hutten, R. Miriam M. and ", title="Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="30", volume="10", pages="e45307", keywords="continuous ambulatory monitoring", keywords="physical activity", keywords="pattern prediction", keywords="older patients", keywords="hip fracture rehabilitation", keywords="wearable sensing", abstract="Background: Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions. Objective: This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home. Methods: The physical activity of patients aged ?70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F1-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F1-score for all physical activity patterns together. Results: The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F1-score=1) and a 100\% correct classification of the 2 most common physical activity patterns. Conclusions: Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves. ", doi="10.2196/45307", url="https://rehab.jmir.org/2023/1/e45307", url="http://www.ncbi.nlm.nih.gov/pubmed/38032703" } @Article{info:doi/10.2196/48952, author="Oduor, Michael and Korniloff, Katariina and Gasana, Juliette and Tumusiime, K. David and Aartolahti, Eeva", title="Digital Rehabilitation Interventions in Sub-Saharan Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Nov", day="23", volume="12", pages="e48952", keywords="digitalization", keywords="rehabilitation", keywords="scoping review", keywords="sub-Saharan Africa", keywords="telerehabilitation", abstract="Background: Estimations show that at least one in every 3 people in the world needs rehabilitation at some point in the course of their illness or injury. Access to rehabilitation services is an essential part of the continuum of care and is integral to achieving universal health coverage. However, most of the world's population living in low- and middle-income countries, especially in the sub-Saharan African region, does not have access to adequate rehabilitation services. Wider adoption of digital solutions offers opportunities to support and enhance access to rehabilitation services in sub-Saharan Africa. A region where there is a greater burden and need for these services. There is also little published research about digital rehabilitation in sub-Saharan Africa, as it is an underexamined topic in the region. Objective: This scoping review aims to provide a comprehensive picture of the current evidence of digital interventions in rehabilitation implemented in any health, social, educational, or community setting in the sub-Saharan Africa region. Methods: We will conduct a scoping review using Arksey and O'Malley's methodological framework and follow the Joanna Briggs Institute methodology for scoping reviews. We will develop search strategies for a selected number of web-based databases, search for peer-reviewed scientific publications until September 2023, and screen the reference lists of relevant articles. We will include research articles if they describe or report the use of digital interventions in the rehabilitation of patients with any health problem or disability in sub-Saharan Africa. For selected articles, we will extract data using a customized data extraction form and use thematic analysis to compare the findings across studies. Results: The preliminary database search in MEDLINE (EBSCO) was completed in May 2023. The research team will conduct a search of relevant articles in the autumn. The results will be synthesized and reported under the key conceptual categories of this review, and we expect the final scoping review to be ready for submission in early 2024. Conclusions: We expect to find gaps in the research and a lack of detailed information about digital rehabilitation interventions in sub-Saharan Africa, as well as potential areas for further study. We will identify opportunities to inform the development of digital rehabilitation interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/48952 ", doi="10.2196/48952", url="https://www.researchprotocols.org/2023/1/e48952", url="http://www.ncbi.nlm.nih.gov/pubmed/37995124" } @Article{info:doi/10.2196/50438, author="Smayda, Elisabeth Kirsten and Cooper, Hodsdon Sarah and Leyden, Katie and Ulaszek, Jackie and Ferko, Nicole and Dobrin, Annamaria", title="Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="20", volume="10", pages="e50438", keywords="chronic stroke", keywords="walking", keywords="InTandem", keywords="MR-001", keywords="neurorehabilitation", keywords="human factors engineering", keywords="usability", keywords="rhythmic auditory stimulation", keywords="validation", keywords="neurotherapeutic", abstract="Background: Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment. Objective: Using design best practices and human factors engineering principles, the research presented here was conducted to validate the safe and effective use of InTandem. Methods: In total, 15 participants in the chronic phase of stroke recovery (?6 months after stroke) participated in this validation study. Participants were scored on 8 simulated use tasks, 4 knowledge assessments, and 7 comprehension assessments in a simulated home environment. The number and types of use errors, close calls, and operational difficulties were evaluated. Analyses of task performances, participant behaviors, and follow-up interviews were conducted to determine the root cause of use errors and difficulties. Results: During this validation study, 93\% (14/15) of participants were able to successfully complete the critical tasks associated with the simulated use of the InTandem system. Following simulated use task assessments, participants' knowledge and comprehension of the instructions for use and key safety information were evaluated. Overall, participants were able to find and correctly interpret information in the materials in order to answer the knowledge assessment questions. During the comprehension assessment, participants understood warning statements associated with critical tasks presented in the instructions for use. Across the entire study, 3 ``use errors'' and 1 ``success with difficulty'' were recorded. No adverse events, including slips, trips, or falls, occurred in this study. Conclusions: In this validation study, people in the chronic phase of stroke recovery were able to safely and effectively use InTandem in the intended use environment. This validation study contributes to the overall understanding of residual use--related risks of InTandem in consideration of the established benefits. ", doi="10.2196/50438", url="https://rehab.jmir.org/2023/1/e50438", url="http://www.ncbi.nlm.nih.gov/pubmed/37983080" } @Article{info:doi/10.2196/47541, author="Ummels, Darcy and Cnockaert, Elise and Timmers, Inge and den Hollander, Marlies and Smeets, Rob", title="Use of Virtual Reality in Interdisciplinary Multimodal Pain Treatment With Insights From Health Care Professionals and Patients: Action Research Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="10", volume="10", pages="e47541", keywords="virtual reality", keywords="interdisciplinary multimodal pain treatment", keywords="chronic pain", keywords="pain", keywords="rehabilitation", keywords="digital health", keywords="physiotherapy", keywords="occupational therapy", keywords="physical therapy", abstract="Background: Chronic pain is a widespread global health problem. Interdisciplinary multimodal pain treatment (IMPT) is a treatment option for people with chronic pain. Virtual reality (VR) could be used to broaden IMPT programs. However, despite the advantages of VR, it is rarely used in daily clinical practice. Objective: This research aimed to explore how, when, and with whom VR can be used meaningfully during IMPT, either as an addition or substitution as a component of IMPT. Methods: This research used an action research design to help health care professionals and patients learn how, when, and with whom they can use VR. Data were collected through reflection sessions with health care professionals and semistructured interviews with patients in 2 specialized centers that provide IMPT for chronic pain. Two researchers performed direct content analyses. Results: In total, 4 physiotherapists, 1 occupational therapist, 3 psychologists, and 22 patients participated in this research. Three iteration cycles, including 9 reflection sessions and 8 semistructured interviews, were performed. Both health care professionals and patients considered VR to be useful in therapy as an addition but not a substitution. VR was used as a diagnostic and intervention tool with all patients at the rehabilitation center or home. VR was used to gain insight into patients' pain beliefs, cognitions, and irrational cognitions about additional damage and physical abilities. Considering VR as an intervention tool, the health care professionals had 3 goals: balancing relaxation and competition, grading activities, and exposure in vivo. Conclusions: VR could be a valuable addition to IMPT for both patients with chronic pain and health care professionals. More research should be performed to assess the additional effects of VR on patients' participation in daily life. ", doi="10.2196/47541", url="https://rehab.jmir.org/2023/1/e47541", url="http://www.ncbi.nlm.nih.gov/pubmed/37948109" } @Article{info:doi/10.2196/48485, author="Devittori, Giada and Ranzani, Raffaele and Dinacci, Daria and Romiti, Davide and Califfi, Antonella and Petrillo, Claudio and Rossi, Paolo and Gassert, Roger and Lambercy, Olivier", title="Progressive Transition From Supervised to Unsupervised Robot-Assisted Therapy After Stroke: Protocol for a Single-Group, Interventional Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Nov", day="9", volume="12", pages="e48485", keywords="technology-assisted rehabilitation", keywords="unsupervised therapy", keywords="self-directed therapy", keywords="stroke", keywords="neurorehabilitation", keywords="neurocognitive rehabilitation", keywords="robot-assisted therapy", keywords="rehabilitation technology", keywords="robot.", abstract="Background: Increasing the dose of therapy delivered to patients with stroke may improve functional outcomes and quality of life. Unsupervised technology-assisted rehabilitation is a promising way to increase the dose of therapy without dramatically increasing the burden on the health care system. Despite the many existing technologies for unsupervised rehabilitation, active rehabilitation robots have rarely been tested in a fully unsupervised way. Furthermore, the outcomes of unsupervised technology-assisted therapy (eg, feasibility, acceptance, and increase in therapy dose) vary widely. This might be due to the use of different technologies as well as to the broad range of methods applied to teach the patients how to independently train with a technology. Objective: This paper describes the study design of a clinical study investigating the feasibility of unsupervised therapy with an active robot and of a systematic approach for the progressive transition from supervised to unsupervised use of a rehabilitation technology in a clinical setting. The effect of unsupervised therapy on achievable therapy dose, user experience in this therapy setting, and the usability of the rehabilitation technology are also evaluated. Methods: Participants of the clinical study are inpatients of a rehabilitation clinic with subacute stroke undergoing a 4-week intervention where they train with a hand rehabilitation robot. The first week of the intervention is supervised by a therapist, who teaches participants how to interact and train with the device. The second week consists of minimally supervised therapy, where the therapist is present but intervenes only if needed as participants exercise with the device. If the participants properly learn how to train with the device, they proceed to the unsupervised phase and train without any supervision during the third and fourth weeks. Throughout the duration of the study, data on feasibility and therapy dose (ie, duration and repetitions) are collected. Usability and user experience are evaluated at the end of the second (ie, minimally supervised) and fourth (ie, unsupervised) weeks, allowing us to investigate the effect of therapist absence. Results: As of April 2023, 13 patients were recruited and completed the protocol, with no reported adverse events. Conclusions: This study will inform on the feasibility of fully unsupervised rehabilitation with an active rehabilitation robot in a clinical setting and its effect on therapy dose. Furthermore, if successful, the proposed systematic approach for a progressive transition from supervised to unsupervised technology-assisted rehabilitation could serve as a benchmark to allow for easier comparisons between different technologies. This approach could also be extended to the application of such technologies in the home environment, as the supervised and minimally supervised sessions could be performed in the clinic, followed by unsupervised therapy at home after discharge. Trial Registration: ClinicalTrials.gov NCT04388891; https://clinicaltrials.gov/study/NCT04388891 International Registered Report Identifier (IRRID): DERR1-10.2196/48485 ", doi="10.2196/48485", url="https://www.researchprotocols.org/2023/1/e48485", url="http://www.ncbi.nlm.nih.gov/pubmed/37943580" } @Article{info:doi/10.2196/46959, author="Vaezipour, Atiyeh and Aldridge, Danielle and Koenig, Sebastian and Burns, Clare and Baghaei, Nilufar and Theodoros, Deborah and Russell, Trevor", title="Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="31", volume="10", pages="e46959", keywords="communication disorders", keywords="speech and language therapy", keywords="rehabilitation", keywords="virtual reality", keywords="human-computer interaction", keywords="technology acceptance", keywords="acceptance", keywords="communication", keywords="therapy", keywords="usefulness", keywords="usability", keywords="survey", keywords="barrier", keywords="mobile phone", abstract="Background: Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. Objective: This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. Methods: Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. Results: The quantitative data regarding the usability of the system associated with participants' immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant's attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. Conclusions: Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities. ", doi="10.2196/46959", url="https://rehab.jmir.org/2023/1/e46959", url="http://www.ncbi.nlm.nih.gov/pubmed/37906228" } @Article{info:doi/10.2196/44489, author="Alaka, Benard and Shibwabo, Bernard", title="Models and Approaches for Comprehension of Dysarthric Speech Using Natural Language Processing: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="27", volume="10", pages="e44489", keywords="dysarthria", keywords="speech comprehension", keywords="speech contextualization", keywords="meaning extraction", keywords="ontology extraction", keywords="familiarity", keywords="topic knowledge", abstract="Background: Speech intelligibility and speech comprehension for dysarthric speech has attracted much attention recently. Dysarthria is characterized by irregularities in the speed, strength, pitch, breath control, range, steadiness, and accuracy of muscle movements required for articulatory aspects of speech production. Objective: This study examined the contributions made by other studies involved in dysarthric speech comprehension. We focused on the modes of meaning extraction used in generalizing speaker-listener underpinnings in light of semantic ontology extraction as a desired technique, applied method types, speech representations used, and databases sourced from. Methods: This study involved a systematic literature review using 7 electronic databases: Cochrane Database of Systematic Reviews, Web of Science Core Collection, Scopus, PubMed, ACM, IEEE Xplore, and Google Scholar. The main eligibility criterion was the extraction of meaning from dysarthric speech using natural language processing or understanding approaches to improve on dysarthric speech comprehension. In total, out of 834 search results, 30 studies that matched the eligibility requirements were acquired following screening by 2 independent reviewers, with a lack of consensus being resolved through joint discussion or consultation with a third party. In order to evaluate the studies' methodological quality, the risk of bias assessment was based on the Cochrane risk-of-bias tool version 2 (RoB2) with 23 of the studies (77\%) registering low risk of bias and 7 studies (33\%) raising some concern over the risk of bias. The overall quality assessment of the study was done using TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis). Results: Following a review of 30 primary studies, this study revealed that the reviewed studies focused on natural language understanding or clinical approaches, with an increase in proposed solutions from 2020 onwards. Most studies relied on speaker-dependent speech features, while others used speech patterns, semantic knowledge, or hybrid approaches. The prevalent use of vector representation aligned with natural language understanding models, while Mel-frequency cepstral coefficient representation and no representation approaches were applied in neural networks. Hybrid representation studies aimed to reconstruct dysarthric speech or improve comprehension. Comprehensive databases, like TORGO and UA-Speech, were commonly used in combination with other curated databases, while primary data was preferred for specific or unique research objectives. Conclusions: We found significant gaps in dysarthric speech comprehension characterized by the lack of inclusion of important listener or speech-independent features in the speech representations, mode of extraction, and data sources used. Further research is therefore proposed regarding the formulation of models that accommodate listener and speech-independent features through semantic ontologies that will be useful in the inclusion of key features of listener and speech-independent features for meaning extraction of dysarthric speech. ", doi="10.2196/44489", url="https://rehab.jmir.org/2023/1/e44489", url="http://www.ncbi.nlm.nih.gov/pubmed/37889538" } @Article{info:doi/10.2196/49813, author="Vos-Draper, L. Tamara and Morrow, B. Melissa M. and Ferguson, E. John and Mathiowetz, G. Virgil", title="Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="12", volume="10", pages="e49813", keywords="spinal cord injury", keywords="wheelchair", keywords="pressure injury prevention", keywords="self-efficacy", keywords="pressure mapping", keywords="pressure", keywords="mapping", keywords="map", keywords="interface", keywords="spine", keywords="spinal cord", keywords="feedback", keywords="real time", keywords="mobile phone", abstract="Background: Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. Objective: We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. Methods: Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. Results: Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. Conclusions: Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. Trial Registration: ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243 ", doi="10.2196/49813", url="https://rehab.jmir.org/2023/1/e49813", url="http://www.ncbi.nlm.nih.gov/pubmed/37824188" } @Article{info:doi/10.2196/50492, author="Vidal, Elizabeth and Castro-Gutierrez, Eveling and Arisaca, Robert and Paz-Valderrama, Alfredo and Albiol-P{\'e}rez, Sergio", title="Serious Game for Fine Motor Control Rehabilitation for Children With Epileptic Encephalopathy: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="3", volume="7", pages="e50492", keywords="serious game", keywords="virtual motor rehabilitation", keywords="ecologic virtual system", keywords="fine motor rehabilitation", keywords="virtual reality", keywords="rare diseases", keywords="children with epileptic encephalopathy", abstract="Background: Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living. Objective: This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE. Methods: The participants were 4 children with EE (male: n=2, 50\%; female: n=2, 50\%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction. Results: The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist's evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value. Conclusions: The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology. ", doi="10.2196/50492", url="https://formative.jmir.org/2023/1/e50492", url="http://www.ncbi.nlm.nih.gov/pubmed/37788071" } @Article{info:doi/10.2196/47114, author="Pittara, Melpo and Matsangidou, Maria and Pattichis, S. Constantinos", title="Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="2", volume="10", pages="e47114", keywords="breathing exercise", keywords="breathing exercise gaming", keywords="pulmonary rehabilitation", keywords="respiratory biofeedback", keywords="virtual reality", abstract="Background: Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients' functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. Objective: This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. Methods: The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. Results: A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health--related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. Conclusions: The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases. ", doi="10.2196/47114", url="https://rehab.jmir.org/2023/1/e47114", url="http://www.ncbi.nlm.nih.gov/pubmed/37782529" } @Article{info:doi/10.2196/46358, author="Huang, Houqiang and Huang, Min and Chen, Qi and Hayter, Mark and Watson, Roger", title="Effects of Serious Games for Patients With Chronic Obstructive Pulmonary Disease: Systematic Literature Review", journal="JMIR Serious Games", year="2023", month="Sep", day="25", volume="11", pages="e46358", keywords="chronic obstructive pulmonary disease", keywords="COPD", keywords="serious game", keywords="rehabilitation", keywords="review", keywords="mobile phone", abstract="Background: The use of serious games for rehabilitation has been an emerging intervention in health care fields, referred to as an entertaining and positive activity. Although related studies have been conducted on patients with chronic obstructive pulmonary disease (COPD), a more comprehensive study that summarizes and evaluates its effects in this area is needed. Objective: This review aimed to systematically evaluate the effects of serious games in promoting rehabilitation and related outcome measures of serious game--based engagement in patients with COPD. Methods: This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Searches were performed in the following databases: PubMed, Scopus, Embase (via Ovid), CINAHL, Science Direct, and China Biology Medicine disc. Only quantitative studies were included in this review, and the methodological quality and bias of the included studies were evaluated using related tools. Several outcomes, including clinical outcomes and serious game--based engagement outcomes, were ultimately collected in this review. The results were summarized and evaluated using descriptive methods due to significant heterogeneity. Results: In total, 11 studies were included. Serious games played a potentially positive effect on pulmonary function and exercise capacity. However, no consistent findings were reported on dyspnea and psychological status. Additionally, serious game engagement showed favorable findings on adherence, enjoyment, and acceptability. Furthermore, no serious adverse effects were identified in all included studies. Conclusions: This review preliminarily indicated the potential benefits of serious games in promoting rehabilitation for patients with COPD, despite the limited quality of the included studies. More studies with high methodological quality are needed to further explore the effects of serious games in this field. ", doi="10.2196/46358", url="https://games.jmir.org/2023/1/e46358", url="http://www.ncbi.nlm.nih.gov/pubmed/37747768" } @Article{info:doi/10.2196/43985, author="Afzal, Waqar M. and Ahmad, Ashfaq and Hanif, Bilal Hafiz Muhammad and Chaudhary, Nauman and Gilani, Amir Syed", title="Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="15", volume="10", pages="e43985", keywords="low back pain, lumbar range of motion", keywords="pain", keywords="Oswestry disability index", keywords="virtual reality", keywords="exercise", keywords="back pain", keywords="lumbar", keywords="range of motion", keywords="VR", keywords="rehabilitation", keywords="gaming", keywords="serious game", abstract="Background: Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation. Objective: This study aimed to compare the effects of VR games on chronic low back pain. Methods: This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P?.05. Results: The study comprised a sample of 40 patients with low back pain; 12 (40\%) were female and 28 (60\%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were --.60 (P=.76), --2.30 (P<.001), and --1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects. Conclusions: VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups. Trial Registration: Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916 ", doi="10.2196/43985", url="https://rehab.jmir.org/2023/1/e43985", url="http://www.ncbi.nlm.nih.gov/pubmed/37713252" } @Article{info:doi/10.2196/42067, author="Kilcioglu, Seyma and Schiltz, Beno{\^i}t and Araneda, Rodrigo and Bleyenheuft, Yannick", title="Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: Systematic Review and Meta-Analysis", journal="JMIR Serious Games", year="2023", month="Sep", day="12", volume="11", pages="e42067", keywords="cerebral palsy", keywords="virtual reality", keywords="motor skill learning", keywords="long-term effect", keywords="daily life activities", keywords="motor functions", abstract="Background: Many studies have started integrating virtual reality (VR) into neurorehabilitation for children with cerebral palsy (CP). The results of the effects of VR on motor skill learning, including the short- to long-term results of relevant studies, must be pooled in a generic framework. Objective: This systematic review and meta-analysis aimed to investigate the short- to long-term effects of therapies including VR on motor skill learning in children with CP. Methods: Two examiners followed the inclusion and exclusion criteria of the ``Participant, Intervention, Control, and Outcome'' framework. Randomized controlled trials (RCTs) and non-RCTs were considered if they compared VR-included interventions with control groups on motor functions and daily life activities in children with CP. PubMed, ScienceDirect, Embase, and IEEE Xplore databases were searched. The modified Downs and Black assessment was used to assess the methodological quality of the included studies. Meta-analyses and subgroup analyses for RCTs were conducted whenever possible. Results: A total of 7 RCTs, 2 non-RCTs, and 258 children with CP were included. The priority focus of 78\% (7/9) of the studies was upper limb functions. There was a significant short-term effect of adding VR to conventional therapies on upper limb functions when compared with conventional therapies (P=.04; standardized mean difference [SMD]=0.39, 95\% CI 0.01-0.76). The overall medium- to long-term effects showed a trend toward favoring the VR group, although the difference was not statistically significant (P=.06; SMD=0.37, 95\% CI ?0.02 to 0.77). For balance (P=.06; SMD=1.04, 95\% CI ?0.04 to 2.12), gross motor functions (P=.30; SMD=2.85, 95\% CI ?2.57 to 8.28), and daily life activities outcomes (P=.21; SMD=0.29, 95\% CI ?0.16 to 0.74), the overall effect in the short term also showed a trend toward favoring the VR group, but these results were not statistically significant. Conclusions: VR seems to have additional benefits for motor skill learning in children with CP. Studies with follow-up outcomes of VR training focusing on balance and gross motor functions in patients with CP were quite limited. Future research on balance and gross motor function outcomes should target particularly long-term results of therapies including VR on motor skill learning. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227734; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021227734 ", doi="10.2196/42067", url="https://games.jmir.org/2023/1/e42067", url="http://www.ncbi.nlm.nih.gov/pubmed/37698895" } @Article{info:doi/10.2196/51772, author="Erten, B{\"u}?ra Ay?e and Tarak{\c{c}}?, Devrim and {\c{C}}a{\c{c}}an, Akif Mehmet", title="The Effectiveness of Video-Based Game Exercise Therapy Applications in Pes Planus Rehabilitation: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="11", volume="12", pages="e51772", keywords="exergame", keywords="pes planus", keywords="rehabilitation", keywords="serious game", keywords="video-based game therapy", abstract="Background: Pes planus is one of the most common foot deformities. Although there are many studies on the effectiveness of various exercise methods in pes planus rehabilitation, the number of studies on video-based game exercise therapy applications is very limited. Objective: This study aims to evaluate the effectiveness of 2 video-based game exercise therapies and structured exercise practices in pes planus rehabilitation. Methods: This study is a 3-arm, parallel-group, single-blinded randomized controlled trial. The study will include 69 patients with flexible pes planus aged between 18 and 25 years who attend the orthopedics and traumatology clinic and meet the inclusion criteria. The primary outcomes are measures of navicular drop and pedobarographic analysis before and after the intervention, and the secondary outcomes include balance, femoral anteversion, and lower extremity muscle strength. Participants will be evaluated with a navicular drop test for medial longitudinal arch height, a pedobarographic analysis system for plantar pressure analysis, a Craig test for femoral anteversion, the Becure Balance System for balance measurement, and a myometer device for lower extremity muscle strength measurement. Participants will be randomly assigned to a structured exercise group, an exergame group, or a serious game group according to their order of arrival. The structured exercise group will use a short foot exercise, a towel-picking exercise, and various walking and balance exercises. Patients in the serious play group will play the lower extremity games in the Becure Balance System. Patients in the exergame group will play balance games on the Nintendo Wii game console. All participants will participate in 18 exercise sessions (3 days a week for 6 weeks). After the treatment, the initial measurements will be repeated. Results: The study started in January 2023. It is expected to be completed in June 2024. Conclusions: This study will be the first randomized controlled study to evaluate the effectiveness of 2 different video-based game exercise therapy applications in pes planus rehabilitation. Through this study, the use of video-based game exercise therapy in pes planus rehabilitation, together with the developing technology, will be a guide. In addition, a new exercise protocol, including serious game exercises, will be added to the literature. In the future, it is expected that our study on the development of different game systems, especially for the ankle, will provide pioneering feedback. Trial Registration: ClinicalTrials.gov NCT05679219; https://clinicaltrials.gov/study/NCT05679219 International Registered Report Identifier (IRRID): DERR1-10.2196/51772 ", doi="10.2196/51772", url="https://www.researchprotocols.org/2023/1/e51772", url="http://www.ncbi.nlm.nih.gov/pubmed/37695657" } @Article{info:doi/10.2196/46526, author="Hildebrand, D. Nicole and Wijma, G. Allard and Bongers, C. Bart and Rensen, S. Sander and den Dulk, Marcel and Klaase, M. Joost and Olde Damink, M. Steven W.", title="Supervised Home-Based Exercise Prehabilitation in Unfit Patients Scheduled for Pancreatic Surgery: Protocol for a Multicenter Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Sep", day="7", volume="12", pages="e46526", keywords="preoperative care", keywords="prehabilitation", keywords="preoperative training", keywords="high-intensity interval training", keywords="pancreatic resection", keywords="cardiorespiratory fitness", abstract="Background: Morbidity rates in pancreatic surgery are high, and frail patients with low aerobic capacity are especially at risk of complications and require prophylactic interventions. Previous studies of small patient cohorts receiving intra-abdominal surgery have shown that an exercise prehabilitation program increases aerobic capacity, leading to better treatment outcomes. Objective: In this study, we aim to assess the feasibility of a home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery on a larger scale. Methods: In this multicenter study, adult patients scheduled for elective pancreatic surgery with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ?13 mL/kg/min or a VO2 at peak exercise ?18 mL/kg/min will be recruited. A total of 30 patients will be included in the 4-week, home-based, partly supervised exercise prehabilitation program. The program comprises 25-minute high-intensity interval training on an advanced cycle ergometer 3 times a week. Training intensity will be based on steep ramp test performance (ie, a short-term maximal exercise test on a cycle ergometer), aiming to improve aerobic capacity. Twice a week, patients will perform functional task exercises to improve muscle function and functional mobility. A steep ramp test will be repeated weekly, and training intensity will be adjusted accordingly. Next to assessing the feasibility (participation rate, reasons for nonparticipation, adherence, dropout rate, reasons for dropout, adverse events, and patient and therapist appreciation) of this program, individual patients' responses to prehabilitation on aerobic capacity, functional mobility, body composition, quality of life, and immune system factors will be evaluated. Results: Recruitment for this study began in January 2022 and is expected to be completed in the summer of 2023. Conclusions: Results of this study will provide important clinical and scientific knowledge on the feasibility of a partly supervised home-based exercise prehabilitation program in a vulnerable patient population. This might ease the path to implementing prehabilitation programs in unfit patients undergoing complex abdominal surgery, such as pancreatic surgery. Trial Registration: ClinicalTrials.gov NCT05496777; https://classic.clinicaltrials.gov/ct2/show/NCT05496777 International Registered Report Identifier (IRRID): DERR1-10.2196/46526 ", doi="10.2196/46526", url="https://www.researchprotocols.org/2023/1/e46526", url="http://www.ncbi.nlm.nih.gov/pubmed/37676715" } @Article{info:doi/10.2196/47172, author="Baffert, Sandrine and Hadouiri, Nawale and Fabron, C{\'e}cile and Burgy, Floriane and Cassany, Aurelia and Kemoun, Gilles", title="Economic Evaluation of Telerehabilitation: Systematic Literature Review of Cost-Utility Studies", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="5", volume="10", pages="e47172", keywords="telerehabilitation", keywords="cost-effectiveness", keywords="quality-adjusted life year", keywords="economic evaluation", keywords="cost", keywords="rehabilitation", keywords="systematic review", abstract="Background: Telerehabilitation could benefit a large population by increasing adherence to rehabilitation protocols. Objective: Our objective was to review and discuss the use of cost-utility approaches in economic evaluations of telerehabilitation interventions. Methods: A review of the literature on PubMed, Scopus, Centres for Review and Dissemination databases (including the HTA database, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database), Cochrane Library, and ClinicalTrials.gov (last search on February 8, 2021) was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were defined in accordance with the PICOS (population, intervention, comparison, outcomes, and study design) system: the included studies had to evaluate patients in rehabilitation therapy for all diseases and disorders (population) through exercise-based telerehabilitation (intervention) and had to have a control group that received face-to-face rehabilitation (comparison), and these studies had to evaluate effectiveness through gain in quality of life (outcome) and used the design of randomized and controlled clinical studies (study). Results: We included 11 economic evaluations, of which 6 concerned cardiovascular diseases. Several types of interventions were assessed as telerehabilitation, consisting in monitoring of rehabilitation at home (monitored by physicians) or a rehabilitation program with exercise and an educational intervention at home alone. All studies were based on randomized clinical trials and used a validated health-related quality of life instrument to describe patients' health states. Four evaluations used the EQ-5D, 1 used the EQ-5D-5L, 2 used the EQ-5D-3L, 3 used the Short-Form Six-Dimension questionnaire, and 1 used the 36-item Short Form survey. The mean quality-adjusted life years gained using telerehabilitation services varied from --0.09 to 0.89. These results were reported in terms of the probability that the intervention was cost-effective at different thresholds for willingness-to-pay values. Most studies showed results about telerehabilitation as dominant (ie, more effective and less costly) together with superiority or noninferiority in outcomes. Conclusions: There is evidence to support telerehabilitation as a cost-effective intervention for a large population among different disease areas. There is a need for conducting cost-effectiveness studies in countries because the available evidence has limited generalizability in such countries. Trial Registration: PROSPERO CRD42021248785; https://tinyurl.com/4xurdvwf ", doi="10.2196/47172", url="https://rehab.jmir.org/2023/1/e47172", url="http://www.ncbi.nlm.nih.gov/pubmed/37669089" } @Article{info:doi/10.2196/46480, author="Krafft, Jelena and Barisch-Fritz, Bettina and Krell-Roesch, Janina and Trautwein, Sandra and Scharpf, Andrea and Woll, Alexander", title="A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study", journal="JMIR Aging", year="2023", month="Aug", day="22", volume="6", pages="e46480", keywords="dementia", keywords="individualized physical exercise", keywords="tailored exercise", keywords="physical activity", keywords="older adults", keywords="app", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="mobile phone", abstract="Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93\% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ``good.'' The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. ", doi="10.2196/46480", url="https://aging.jmir.org/2023/1/e46480", url="http://www.ncbi.nlm.nih.gov/pubmed/37606974" } @Article{info:doi/10.2196/45458, author="Calabr{\`o}, Salvatore Rocco and Bonanno, Mirjam and Torregrossa, William and Cacciante, Luisa and Celesti, Antonio and Rifici, Carmela and Tonin, Paolo and De Luca, Rosaria and Quartarone, Angelo", title="Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality", journal="J Med Internet Res", year="2023", month="Aug", day="21", volume="25", pages="e45458", keywords="telerehabilitation", keywords="teleneuro-VRRS", keywords="virtual reality rehabilitation system", keywords="SABI", keywords="severe acquired brain injury", keywords="acquired brain injury", keywords="virtual reality", keywords="rehabilitation", keywords="neurorehabilitation", keywords="brain injury", keywords="neurology", abstract="Background: In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). Objective: The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. Methods: In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50\%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50\%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. Results: The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Conclusions: Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers' burden distress management, mitigating distress and promoting positive aspects of caring. Trial Registration: ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875 ", doi="10.2196/45458", url="https://www.jmir.org/2023/1/e45458", url="http://www.ncbi.nlm.nih.gov/pubmed/37490017" } @Article{info:doi/10.2196/45993, author="Broderick, Michelle and O'Shea, Robert and Burridge, Jane and Demain, Sara and Johnson, Louise and Bentley, Paul", title="Examining Usability, Acceptability, and Adoption of a Self-Directed, Technology-Based Intervention for Upper Limb Rehabilitation After Stroke: Cohort Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="21", volume="10", pages="e45993", keywords="stroke rehabilitation", keywords="interactive gaming", keywords="rehabilitation technology", keywords="technology usability", keywords="technology acceptability", keywords="self-management", keywords="usability", keywords="acceptability", keywords="stroke", keywords="rehabilitation", keywords="adoption", keywords="engagement", keywords="acceptance", keywords="limb", keywords="mobility", keywords="mobile phone", abstract="Background: Upper limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose. Rehabilitation technologies present pragmatic solutions to dose enhancement, complementing therapeutic activity within conventional rehabilitation, connecting clinicians with patients remotely, and empowering patients to drive their own recovery. To date, rehabilitation technologies have been poorly adopted. Understanding the barriers to adoption may shape strategies to enhance technology use and therefore increase rehabilitation dose, thus optimizing recovery potential. Objective: We examined the usability, acceptability, and adoption of a self-directed, exercise-gaming technology within a heterogeneous stroke survivor cohort and investigated how stroke survivor characteristics, technology usability, and attitudes toward technology influenced adoption. Methods: A feasibility study of a novel exercise-gaming technology for self-directed UL rehabilitation in early subacute stroke survivors (N=30) was conducted in an inpatient, acute hospital setting. Demographic and clinical characteristics were recorded; participants' performance in using the system (usability) was assessed using a 4-point performance rating scale (adapted from the Barthel index), and adherence with the system was electronically logged throughout the trial. The technology acceptance model was used to formulate a survey examining the acceptability of the system. Spearman rank correlations were used to examine associations between participant characteristics, user performance (usability), end-point technology acceptance, and intervention adherence (adoption). Results: The technology was usable for 87\% (n=26) of participants, and the overall technology acceptance rating was 68\% (95\% CI 56\%-79\%). Participants trained with the device for a median of 26 (IQR 16-31) minutes daily over an enrollment period of 8 (IQR 5-14) days. Technology adoption positively correlated with user performance (usability) ($\rho$=0.55; 95\% CI 0.23-0.75; P=.007) and acceptability as well as domains of perceived usefulness ($\rho$=0.42; 95\% CI 0.09-0.68; P=.03) and perceived ease of use ($\rho$=0.46; 95\% CI 0.10-0.74; P=.02). Technology acceptance decreased with increased global stroke severity ($\rho$=?0.56; 95\% CI ?0.79 to ?0.22; P=.007). Conclusions: This technology was usable and acceptable for the majority of the cohort, who achieved an intervention dose with technology-facilitated, self-directed UL training that exceeded conventional care norms. Technology usability and acceptability were determinants of adoption and appear to be mediated by stroke severity. The results demonstrate the importance of selecting technologies for stroke survivors on the basis of individual needs and abilities, as well as optimizing the accessibility of technologies for the target user group. Facilitating changes in stroke survivors' beliefs and attitudes toward rehabilitation technologies may enhance adoption. Further work is needed to understand how technology can be optimized to benefit those with more severe stroke. ", doi="10.2196/45993", url="https://rehab.jmir.org/2023/1/e45993", url="http://www.ncbi.nlm.nih.gov/pubmed/37603405" } @Article{info:doi/10.2196/49673, author="Areias, C. Anabela and Janela, Dora and Molinos, Maria and Moulder, G. Robert and Bento, Virg{\'i}lio and Yanamadala, Vijay and Cohen, P. Steven and Correia, Dias Fernando and Costa, Fab{\'i}ola", title="Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e49673", keywords="aged", keywords="digital therapy", keywords="eHealth", keywords="musculoskeletal conditions", keywords="older adults", keywords="pain", keywords="physical therapy", keywords="telehealth", keywords="telerehabilitation", abstract="Background: Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). Objective: This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. Methods: We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ?44 years old (young adults), 45-64 years old (middle-aged adults), and ?65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30\%), analgesic usage, mental health, work productivity, and non--work-related activity impairment. Results: Of 16,229 patients, 12,082 started the program: 38.3\% (n=4629) were young adults, 55.7\% (n=6726) were middle-aged adults, and 6\% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95\% CI 1.45-2.06; P<.001 and OR 2.40, 95\% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95\% CI 1.03-1.45; P=.03 and OR 1.38, 95\% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6\%; middle-aged adults: 1848/2834, 65.2\%; and older adults: 241/387, 62.3\%; P=.17). Conclusions: Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population. ", doi="10.2196/49673", url="https://rehab.jmir.org/2023/1/e49673", url="http://www.ncbi.nlm.nih.gov/pubmed/37465960" } @Article{info:doi/10.2196/41359, author="Alhasani, Rehab and George, Nicole and Radman, Dennis and Auger, Claudine and Ahmed, Sara", title="Methodologies for Evaluating the Usability of Rehabilitation Technologies Aimed at Supporting Shared Decision-Making: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e41359", keywords="usability", keywords="technology", keywords="rehabilitation", keywords="shared decision-making", keywords="mobile phone", abstract="Background: The field of rehabilitation has seen a recent rise in technologies to support shared decision-making (SDM). Usability testing during the design process of SDM technologies is needed to optimize adoption and realize potential benefits. There is variability in how usability is defined and measured. Given the complexity of usability, a thorough examination of the methodologies used to measure usability to develop the SDM technologies used in rehabilitation care is needed. Objective: This scoping review aims to answer the following research questions: which methods and measures have been used to produce knowledge about the usability of rehabilitation technologies aimed at supporting SDM at the different phases of development and implementation? Which parameters of usability have been measured and reported? Methods: This review followed the Arksey and O'Malley framework. An electronic search was performed in the Ovid MEDLINE, Embase, CINAHL, and PsycINFO databases from January 2005 up to November 2020. In total, 2 independent reviewers screened all retrieved titles, abstracts, and full texts according to the inclusion criteria and extracted the data. The International Organization for Standardization framework was used to define the scope of usability (effectiveness, efficiency, and satisfaction). The characteristics of the studies were outlined in a descriptive summary. Findings were categorized based on usability parameters, technology interventions, and measures of usability. Results: A total of 38 articles were included. The most common SDM technologies were web-based aids (15/33, 46\%). The usability of SDM technologies was assessed during development, preimplementation, or implementation, using 14 different methods. The most frequent methods were questionnaires (24/38, 63\%) and semistructured interviews (16/38, 42\%). Satisfaction (27/38, 71\%) was the most common usability parameter mapped to types of SDM technologies and usability evaluation methods. User-centered design (9/15, 60\%) was the most frequently used technology design framework. Conclusions: The results from this scoping review highlight the importance and the complexity of usability evaluation. Although various methods and measures were shown to be used to evaluate the usability of technologies to support SDM in rehabilitation, very few evaluations used in the included studies were found to adequately span the selected usability domains. This review identified gaps in usability evaluation, as most studies (24/38, 63\%) relied solely on questionnaires rather than multiple methods, and most questionnaires simply focused on the usability parameter of satisfaction. The consideration of end users (such as patients and clinicians) is of particular importance for the development of technologies to support SDM, as the process of SDM itself aims to improve patient-centered care and integrate both patient and clinician voices into their rehabilitation care. ", doi="10.2196/41359", url="https://rehab.jmir.org/2023/1/e41359", url="http://www.ncbi.nlm.nih.gov/pubmed/37581911" } @Article{info:doi/10.2196/43237, author="Krag, Thea and J{\o}rgensen, H{\o}jgaard Emma and Phanareth, Klaus and Kayser, Lars", title="Experiences With In-Person and Virtual Health Care Services for People With Chronic Obstructive Pulmonary Disease: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="14", volume="10", pages="e43237", keywords="chronic obstructive pulmonary disease", keywords="telemedicine", keywords="telehealth", keywords="virtual RCC service", keywords="rehabilitation", keywords="self-management", keywords="eHealth literacy", keywords="social support", keywords="well-being", abstract="Background: The World Health Organization and the European Commission predict increased use of health technologies in the future care for patients in Europe. Studies have shown that services based on telehealth, which includes components of education, as well as rehabilitation initiatives can support the self-management of individuals living with COPD. This raises an interest in how virtual and in-person interactions and roles can best be organized in a way that suits people living with COPD in relation to their treatment and rehabilitation. Objective: This study aims to investigate how individuals living with COPD experience different combinations of virtual and in-person care, to help us better understand what aspects are valued and how to best combine elements of these services in future care. Methods: Two rounds of semistructured interviews were conducted with 13 and 4 informants, respectively. The individuals were all recruited in relation to a research project led by the telehealth initiative Epital Health. The first round of interviews included 11 informants, as 2 dropped out. Of these, 7 received the telemedicine service provided by Epital Health, 3 participated in a 12-week COPD program provided by their respective municipality, and 1 did not receive any supplementary service besides the usual care. In the second round, which included 4 informants, all had at one point received the telemedicine service and participated in a municipality-based rehabilitation program. A content analysis of the interviews was performed based on deductive coding with 4 categories, namely, (1) Self-management, (2) Health-related support, (3) Digital context, and (4) Well-being. Results: Medical and emotional support from health care professionals is a key aspect of care for individuals with COPD. Acute treatment with at-home medicine, monitoring one's own condition through technology, and having easy access and close contact with health care professionals familiar to them can promote self-management and well-being, as well as provide a feeling of security. Having regular meetings with a network of peers and health care professionals provides education, support, and tools to cope with the condition and improve own health. Furthermore, group-based activity motivates and increases the activity level of the individuals. Continued offers of services are desired as many experience a decrease in achieved benefits after the service ends. More emphasis is placed on the importance of the therapeutic and medical elements of care compared with factors such as technology. The identified barriers related to optimal utilization of the virtual service were related to differentiation in levels of contact depending on disease severity and skills related to the practical use of equipment. Conclusions: A combination of virtual and in-person services providing lasting medical and social support is suggested for the future. This should build upon the preferences and needs of individuals living with COPD and support relationships to caregivers and peers. ", doi="10.2196/43237", url="https://rehab.jmir.org/2023/1/e43237", url="http://www.ncbi.nlm.nih.gov/pubmed/37578832" } @Article{info:doi/10.2196/46252, author="Javorszky, Maria Susanne and Reiter, Raphael and Iglseder, Bernhard", title="Validation of a Geriatric Bedside Swallowing Screen (GEBS): Protocol of a Prospective Cohort Study", journal="JMIR Res Protoc", year="2023", month="Aug", day="11", volume="12", pages="e46252", keywords="dysphagia", keywords="geriatrics", keywords="swallowing disorder", keywords="assessment", keywords="screening", keywords="cohort study", keywords="multimorbidity", keywords="hospital setting", abstract="Background: Demographic changes will raise the need for specialized care of older patients. Oropharyngeal dysphagia has recently been declared a geriatric syndrome reflecting its multifactorial background. Alongside multimorbidity, sarcopenia, frailty, and disability, swallowing disorders increase with advancing age, with prevalence rates reported to be as high as 44\% in acute geriatric hospital settings and 80\% in long-term care facilities. Hence, systematic screening of older patients to diagnose dysphagia and initiate treatment is of paramount importance to prevent bolus death, aspiration pneumonia, and malnutrition and improve quality of life. Several screening tools have been evaluated in emergency and stroke units. However, no published dysphagia screening tool has been validated in the hospitalized, older adult population using a gold standard in dysphagia diagnostics as a reference test. The validation of the proposed test is a first step. Objective: The Geriatric Bedside Swallowing Screen (GEBS) study aims to validate a new screening tool developed specifically for older inpatients against an instrumental swallowing evaluation, the flexible endoscopic evaluation of swallowing (FEES), which is considered a gold standard. Primary outcomes to be evaluated are sensitivity and specificity for the GEBS in the detection of dysphagia in a mixed older adult population. The presence of dysphagia will be defined by an instrumental swallowing evaluation (FEES), analyzed by the standardized penetration-aspiration scale. Methods: To validate the GEBS, a prospective cohort study will be carried out. Two institutions, an acute geriatric department and a long-term care facility, will aim to recruit a total of 100 patients aged ?75 years. After giving their informed consent, patients will undergo the full screening protocol described in the GEBS as well as an evaluation of swallowing function using the FEES. Investigators will be blinded to the results of the respective other testing. The analysis of pseudonymized data sets will be done by a third investigator. Outcomes to be considered are sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood quotient, and the reliability of the proposed dysphagia screening tool using the $\kappa$ coefficient. Results: Recruitment started in October 2022 and will end in April 2024. Data publication is planned for early 2025. Conclusions: If proven to be a valid screening tool for the early detection of dysphagia, further studies including different older adult populations as well as studies to determine the impact of systematic dysphagia screening on parameters, such as rates of aspiration pneumonia or nutritional status, should be planned. Effective screening of dysphagia will lead to earlier detection of patients with impaired swallowing. Those who fail the screening will be referred to speech language pathology for further diagnosis, thus optimizing care while streamlining personnel resources. Trial Registration: ISCRTN Registry ISRCTN11581931; https://www.isrctn.com/ISRCTN11581931 International Registered Report Identifier (IRRID): DERR1-10.2196/46252 ", doi="10.2196/46252", url="https://www.researchprotocols.org/2023/1/e46252", url="http://www.ncbi.nlm.nih.gov/pubmed/37566452" } @Article{info:doi/10.2196/46217, author="G{\"u}nther, Florian and Schober, Fabian and Hunger, Sandra and Schellnock, Julia and Derlien, Steffen and Schleifenbaum, Stefan and Drossel, Welf-Guntram and Heyde, Christoph-Eckhard", title="Improving Home-Based Scoliosis Therapy: Findings From a Web-Based Survey", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="4", volume="10", pages="e46217", keywords="scoliosis therapy", keywords="Schroth therapy", keywords="home-based exercise", keywords="home program", keywords="physiotherapeutic scoliosis-specific exercises (PSSE)", keywords="adherence", keywords="assistive devices", keywords="exercise system", keywords="digital tools", keywords="eHealth", abstract="Background: Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (eg, Schroth, the Scientific Exercises Approach to Scoliosis). Complex exercises, lack of awareness of the importance of training, and missing supervision by therapists often lead to uncertainty and reduced motivation, which in turn reduces the success of home-based therapy. Increasing digitalization in the health care sector offers opportunities to close this gap. However, research is needed to analyze the requirements and translate the potential of digital tools into concrete solution concepts. Objective: The aim of this study is to evaluate the potential for optimizing home-based scoliosis therapy in terms of motivation, assistive devices, and digital tools. Methods: In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated to address patients with scoliosis and physical therapists. A digital questionnaire was created for each target group and distributed via physiotherapies, scoliosis forums, the Bundesverband f{\"u}r Skoliose Selbsthilfe e. V. newsletter via a link, and a quick response code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for evaluation. Results: Of 141 survey participants, 72 (51.1\%; n=62, 86.1\%, female; n=10, 13.9\%, male) patients with scoliosis with an average age of 40 (SD 17.08) years and 30 scoliosis therapists completed the respective questionnaires. The analysis of home-based therapy showed that patients with scoliosis exercise less per week (2 times or less; 45/72, 62.5\%) than they are recommended to do by therapists (at least 3 times; 53/72, 73.6\%). Patients indicated that their motivation could be increased by practicing together with friends and acquaintances (54/72, 75\%), a supporting therapy device (48/72, 66.7\%), or a digital profile (46/72, 63.9\%). The most important assistive devices, which are comparatively rarely used in home-based therapy, included balance boards (20/72, 27.8\%), wall bars (23/72, 31.9\%), mirrors (36/72, 50\%), and long bars (40/72, 55.6\%). Therapists saw the greatest benefit of digital tools for scoliosis therapy in increasing motivation (26/30, 87\%), improving home therapy (25/30, 83\%), monitoring therapy progress (25/30, 83\%), and demonstrating exercise instructions (24/30, 80\%). Conclusions: In this study, we investigated whether there is any potential for improvement in home-based scoliosis therapy. For this purpose, using online questionnaires, we asked patients with scoliosis and therapists questions about the following topics: exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The results showed that a lack of motivation, suitable training equipment, and tools for self-control leads to a low training workload. From the perspective of the patients surveyed, this problem can be addressed through community training with friends or acquaintances, a supportive therapy device, and digital elements, such as apps, with training instructions and user profiles. ", doi="10.2196/46217", url="https://rehab.jmir.org/2023/1/e46217", url="http://www.ncbi.nlm.nih.gov/pubmed/37540557" } @Article{info:doi/10.2196/41993, author="Mendonca, J. Christen and Malone, A. Laurie and Mohanraj, Sangeetha and Thirumalai, Mohanraj", title="The Usability of a Touchpad Active Video Game Controller for Individuals With Impaired Mobility: Observational Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="3", volume="10", pages="e41993", keywords="active video games", keywords="exergames", keywords="usability", keywords="enjoyment", keywords="disability", keywords="mobility limitation", keywords="mobility impairment", abstract="Background: Video games are a popular sedentary activity among people with impaired mobility; however, active video game hardware typically lacks accessibility and customization options for individuals with mobility impairments. A touchpad video game system can elicit moderate physical activity in healthy adults; however, it is unclear if this system is usable by adults with impaired mobility. Objective: The purpose of this study was to assess the usability of a touchpad video game controller system adapted for adults with impaired mobility. Additional outcomes explored were enjoyment, perceived exertion, self-efficacy, participant feedback, and researcher observations of gameplay. Methods: Participants played several video game titles for 20 minutes with a touchpad video game controller as they stood or sat in a chair or their wheelchair. Usability was assessed with the System Usability Scale (SUS) and the Health Information Technology Usability Evaluation Scale (Health-ITUES) surveys after gameplay. After each video game, participants reported enjoyment using a visual analog scale (0 to 100 mm) and a rating of perceived exertion using the OMNI 0 to 10 scale. Self-efficacy was measured before and after gameplay. Participants provided feedback at the end of their session. Results: In total, 21 adults (6 females and 15 males) with a mean age of 48.8 (SD 13.8) years with various mobility impairments participated in this study. The touchpads received mean usability scores on the SUS 80.1 (SD 18.5) and Health-ITUES 4.23 (SD 0.67). Conclusions: The SUS scores reported suggest the touchpad system is ``usable''; however, the Health-ITUES scores were slightly below a suggested benchmark. Participants reported moderate to high enjoyment but perceived the exertion as ``somewhat easy.'' Self-efficacy was moderate to high and did not differ pre- to postgame play. The participants regarded the touchpads as novel, fun, and entertaining. The generalizability of our results is limited due to the heterogenous sample; however, our participants identified several areas of improvement for future iteration. ", doi="10.2196/41993", url="https://rehab.jmir.org/2023/1/e41993", url="http://www.ncbi.nlm.nih.gov/pubmed/37535411" } @Article{info:doi/10.2196/43615, author="Arntz, Angela and Weber, Franziska and Handgraaf, Marietta and L{\"a}ll{\"a}, Kaisa and Korniloff, Katariina and Murtonen, Kari-Pekka and Chichaeva, Julija and Kidritsch, Anita and Heller, Mario and Sakellari, Evanthia and Athanasopoulou, Christina and Lagiou, Areti and Tzonichaki, Ioanna and Salinas-Bueno, Iosune and Mart{\'i}nez-Bueso, Pau and Velasco-Rold{\'a}n, Olga and Schulz, Ralf-Joachim and Gr{\"u}neberg, Christian", title="Technologies in Home-Based Digital Rehabilitation: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="27", volume="10", pages="e43615", keywords="digital rehabilitation", keywords="digital technologies", keywords="home-based rehabilitation", keywords="digital health intervention", keywords="scoping review", keywords="artificial intelligence", keywords="AI", keywords="machine learning", keywords="COVID-19 pandemic", keywords="mobile app", keywords="remote health", keywords="mobile phone", abstract="Background: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. Objective: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. Methods: The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. Results: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. Conclusions: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic. ", doi="10.2196/43615", url="https://rehab.jmir.org/2023/1/e43615", url="http://www.ncbi.nlm.nih.gov/pubmed/37253381" } @Article{info:doi/10.2196/44498, author="Pol, Margriet and Qadeer, Amarzish and van Hartingsveldt, Margo and Choukou, Mohamed-Amine", title="Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="18", volume="10", pages="e44498", keywords="aging in place", keywords="aging well", keywords="digital technology", keywords="remote monitoring", keywords="activity", keywords="sensor", keywords="mobile phone", abstract="Background: Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identi?ed as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. Objective: The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. Methods: We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. Results: The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Conclusions: Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals. ", doi="10.2196/44498", url="https://rehab.jmir.org/2023/1/e44498", url="http://www.ncbi.nlm.nih.gov/pubmed/37463040" } @Article{info:doi/10.2196/47264, author="Duran, T. Andrea and Keener-DeNoia, Adrianna and Stavrolakes, Kimberly and Fraser, Adina and Blanco, V. Luis and Fleisch, Emily and Pieszchata, Nicole and Cannone, Diane and Keys McKay, Charles and Whittman, Emma and Edmondson, Donald and Shelton, C. Rachel and Moise, Nathalie", title="Applying User-Centered Design and Implementation Science to the Early-Stage Development of a Telehealth-Enhanced Hybrid Cardiac Rehabilitation Program: Quality Improvement Study", journal="JMIR Form Res", year="2023", month="Jul", day="13", volume="7", pages="e47264", keywords="user-centered design", keywords="implementation science", keywords="cardiac rehabilitation", keywords="telemedicine", keywords="remote patient monitoring", keywords="behavioral intervention development", keywords="hybrid", abstract="Background: Cardiac rehabilitation (CR) is an evidence-based intervention that improves event-free survival in patients with cardiac conditions, yet <27\% of all eligible patients use CR in the United States. CR is traditionally delivered in clinic-based settings where implementation barriers abound. Innovative nontraditional program designs and strategies are needed to support widespread CR uptake. Objective: This study aimed to demonstrate how user-centered design (UCD) and implementation science (IS) principles and methods can be integrated into the early-stage development of nontraditional CR interventions. Methods: As part of a NewYork-Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we combined UCD and IS principles and methods to design a novel home- and clinic-based telehealth-enhanced hybrid CR (THCR) program. We co-designed this program with multilevel stakeholders using an iterative 3-step UCD process to identify user and contextual barriers and facilitators to CR uptake (using semistructured interviews and contextual inquiry [step 1]), design an intervention prototype that targets contextual and user factors and emulates the evidence-based practice (through design workshops and journey mapping [step 2]), and review and refine the prototype (according to real-world usability testing and feedback [step 3]). The UCD process was informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Results: At step 1, we conducted semistructured interviews with 9 provider- and system-level stakeholders (female: n=6, 67\%) at 3 geographically diverse academic medical centers, which revealed behavioral (eg, self-efficacy and knowledge) and contextual (eg, social distancing guidelines, physical space, staffing, and reimbursement) barriers to uptake; hybrid delivery was a key facilitator. Step 2 involved conducting 20 design workshops and 3 journey-mapping sessions with multidisciplinary NYPH stakeholders (eg, digital health team, CR clinicians, and creative director) where we identified key design elements (eg, mix of clinic- and home-based CR and synchronous remote patient monitoring), yielding an initial THCR prototype that leveraged NYPH's telehealth infrastructure. At step 3, we conducted usability testing with 2 CR clinicians (both female) administering home-based sessions to 3 CR patients (female: n=1, 33\%), which revealed usability themes (eg, ease of using remote patient monitoring devices or a telehealth platform, technology disruptions, and confidence in using the telehealth platform to safely monitor patients) and design solutions (eg, onboarding sessions, safety surveys, and fully supervised remote sessions) to be included in the final THCR prototype. Conclusions: Combining UCD and IS methods while engaging multidisciplinary stakeholders in an iterative process yielded a theory-informed THCR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process and guidance for incorporating UCD and IS principles and methods into the early-stage development of a nontraditional CR intervention. The feasibility, acceptability, appropriateness, and usability of the final THCR prototype is being evaluated in an ongoing study. ", doi="10.2196/47264", url="https://formative.jmir.org/2023/1/e47264", url="http://www.ncbi.nlm.nih.gov/pubmed/37440285" } @Article{info:doi/10.2196/46408, author="G{\aa}sv{\ae}r, Inge Jo and Jepsen, Randi and Heldal, Ilona and Sudmann, Tobba", title="Supporting Collaboration in Rehabilitation Trajectories With Information and Communication Technologies: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="11", volume="10", pages="e46408", keywords="rehabilitation", keywords="shared decision-making", keywords="ICT system", keywords="decision support systems", keywords="remote dialogue", keywords="patient participation", abstract="Background: Despite a surge in health information and communication technology (ICT), there is little evidence of lowered cost or increased quality of care. ICT may support patients, health care providers, and other stakeholders through complex rehabilitation trajectories by offering digital platforms for collaboration, shared decision-making, and safe storage of data. Yet, the questions on how ICT can become a useful tool and how the complex intersection between producers and users of ICT should be solved are challenging. Objective: This study aims to review the literature on how ICTs are used to foster collaboration among the patient, the provider, and other stakeholders. Methods: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were identified by searching MEDLINE (OVID), Embase (OVID), CINAHL (EBSCOhost), AMED (EBSCOhost), and Scopus. Unpublished studies were extracted from OAIster, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, NARIC, and Google Scholar. Eligible papers addressed or described a remote dialogue between stakeholders using ICT to address goals and means, provide decision support, or evaluate certain treatment modalities within a rehabilitation context. Due to the rapid development of ICTs, searches included studies published in the period of 2018-2022. Results: In total, 3206 papers (excluding duplicates) were screened. Three papers met all inclusion criteria. The papers varied in design, key findings, and key challenges. These 3 studies reported outcomes such as improvements in activity performance, participation, frequency of leaving the house, improved self-efficacy, change in patients' perspective on possibilities, and change in professionals' understanding of patients' priorities. However, a misfit between the participants' needs and the technology offered, complexity and lack of availability of the technology, difficulties with implementation and uptake, and lack of flexibility in setup and maintenance reduced the value of ICT for those involved in the studies. The low number of included papers is probably due to the complexity of remote collaboration with ICT. Conclusions: ICT has the potential to facilitate communication among stakeholders in the complex and collaborative context of rehabilitation trajectories. This scoping review indicates that there is a paucity of research considering remote ICT-supported collaboration in health care and rehabilitation trajectories. Furthermore, current ICT builds on eHealth literacy, which may differ among stakeholders, and the lack of sufficient eHealth literacy and ICT knowledge creates barriers for access to health care and rehabilitation. Lastly, the aim and results of this review are probably most relevant in high-income countries. ", doi="10.2196/46408", url="https://rehab.jmir.org/2023/1/e46408", url="http://www.ncbi.nlm.nih.gov/pubmed/37432715" } @Article{info:doi/10.2196/43250, author="Briggs, S. Matthew and Kolbus, Shevawn Erin and Patterson, Michael Kevin and Harmon-Matthews, Elizabeth Lindsay and McGrath, Shana and Quatman-Yates, C. Catherine and Meirelles, Cristiane and Salsberry, Jean Marka", title="Role of Oral Intake, Mobility, and Activity Measures in Informing Discharge Recommendations for Hospitalized Inmate and Noninmate Patients With COVID-19: Retrospective Analysis", journal="JMIR Rehabil Assist Technol", year="2023", month="Jun", day="27", volume="10", pages="e43250", keywords="incarceration", keywords="Functional Oral Intake", keywords="Activity Measure for Postacute Care", keywords="speech language pathology", keywords="physical therapy", keywords="occupational therapy", keywords="COVID-19", abstract="Background: Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. Objective: We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. Methods: A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95\% CIs of the odds ratios (ORs) did not include 1.0. Results: A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95\% CI 0.875-0.972 and OR 0.918, 95\% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95\% CI 1.334-20.931 and OR 6.083, 95\% CI 1.548-23.912), ``Other'' race (OR 7.596, 95\% CI 1.203-47.968 and OR 8.515, 95\% CI 1.311-55.291), and female sex (OR 4.671, 95\% CI 1.086-20.092 and OR 4.977, 95\% CI 1.146-21.615). Conclusions: The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. ", doi="10.2196/43250", url="https://rehab.jmir.org/2023/1/e43250", url="http://www.ncbi.nlm.nih.gov/pubmed/37224276" } @Article{info:doi/10.2196/45321, author="Hutchison, G. Michael and Di Battista, P. Alex and Loenhart, M. Matthew", title="A Continuous Aerobic Resistance Exercise Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App: Feasibility Study", journal="JMIR Form Res", year="2023", month="Jun", day="19", volume="7", pages="e45321", keywords="Bayesian modeling", keywords="concussion", keywords="exercise rehabilitation", keywords="mobile health", keywords="mild traumatic brain injury", keywords="persisting symptoms", abstract="Background: In recent years, several studies have consistently reported the beneficial effects of aerobic exercise in alleviating symptoms following concussion. However, exercise modality recommendations by practitioners are often limited to traditional exercise equipment (eg, treadmills and stationary bikes). Advances in digital technologies may help to overcome this limitation, as mobile apps can now provide users with high-quality instructional videos, programs, and monitoring capabilities using alternative modalities such as resistance exercises. Mobile technologies are also rapidly expanding to deliver and complement in-person clinical care. Thus, it is imperative to evaluate this emerging technology on its feasibility, safety, and clinical utility for concussion care. Objective: The objective of the study was to determine the feasibility of a mobile app to deliver a resistance exercise protocol with minimal equipment to individuals following concussion. Feasibility was defined by retention, adverse events, and achievement of a target heart rate (HR) of 60\%{\textpm}5\% (age-adjusted percentage of max: 220 -- age). HR data were collected using an Apple Watch, Series 6. Symptoms were evaluated before and after 3 exercise sessions. Methods: A 2-week, prospective, single-arm pilot study was conducted on 21 adults diagnosed with a concussion. Users were provided a continuous aerobic resistance exercise (CARE) protocol through a mobile app. Results: A total of 18 participants (14 female and 4 male) completed a 3-session exercise plan. The median age-adjusted percent of HR max for session 1 was 55.5\% (IQR 49\%-63\%), 58.1\% (IQR 50.8\%-65.2\%) for session 2, and 57.4\% (IQR 49.5\%-64.7\%) for session 3. Individual median HR\% across all sessions ranged from 46.9\% to 67.4\%; furthermore, 10 participants (55.5\%) had a total mean HR\% within the target HR\%, 7 participants had a mean HR\% below 55\%, and 1 participant had a mean HR\% above 65\%. In addition, adherence to the plan resulted in a decrease in reported symptom burden with 94\% posterior probability. Conclusions: Following concussion, a CARE protocol delivered through a mobile app resulted in no adverse effects with 14\% (n=3/21) attrition over 3 sessions. CARE was successful in achieving an aerobic exercise intensity of 55\%-65\% of age-adjusted maximum HR in the majority of participants and resulted in a decrease in reported symptom burden. The potential for this platform in concussion rehabilitation warrants further investigation. Future studies are needed to assess the use of this technology throughout concussion recovery in both individuals with acute concussion, and those with persistent symptoms. ", doi="10.2196/45321", url="https://formative.jmir.org/2023/1/e45321", url="http://www.ncbi.nlm.nih.gov/pubmed/37335605" } @Article{info:doi/10.2196/46828, author="Siegmund, Anne Lee and Bena, F. James and Morrison, L. Shannon", title="Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial", journal="JMIR Cardio", year="2023", month="Jun", day="15", volume="7", pages="e46828", keywords="cardiac rehabilitation", keywords="motivation", keywords="exercise", keywords="social media", keywords="cardiology", keywords="adherence", keywords="physical activity", keywords="satisfaction", keywords="rehabilitation", keywords="Facebook", keywords="peer support", abstract="Background: The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. Objective: The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. Methods: The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. Results: A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95\% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95\% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included ``likes'' (n=210) and ``hits'' (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. Conclusions: Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. Trial Registration: ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7554 ", doi="10.2196/46828", url="https://cardio.jmir.org/2023/1/e46828", url="http://www.ncbi.nlm.nih.gov/pubmed/37318865" } @Article{info:doi/10.2196/42901, author="Zhang, Ying and Liu, Xiaoyu and Qiao, Xiaofeng and Fan, Yubo", title="Characteristics and Emerging Trends in Research on Rehabilitation Robots from 2001 to 2020: Bibliometric Study", journal="J Med Internet Res", year="2023", month="May", day="31", volume="25", pages="e42901", keywords="rehabilitation robot", keywords="bibliometric analysis", keywords="interdisciplinary research", keywords="co-occurrence analysis", keywords="co-citation analysis", keywords="rehabilitation", abstract="Background: The past 2 decades have seen rapid development in the use of robots for rehabilitation. Research on rehabilitation robots involves interdisciplinary activities, making it a great challenge to obtain comprehensive insights in this research field. Objective: We performed a bibliometric study to understand the characteristics of research on rehabilitation robots and emerging trends in this field in the last 2 decades. Methods: Reports on the topic of rehabilitation robots published from January 1, 2001, to December 31, 2020, were retrieved from the Web of Science Core Collection on July 28, 2022. Document types were limited to ``article'' and ``meeting'' (excluding the ``review'' type), to ensure that our analysis of the evolution over time of this research had high validity. We used CiteSpace to conduct a co-occurrence and co-citation analysis and to visualize the characteristics of this research field and emerging trends. Landmark publications were identified using metrics such as betweenness centrality and burst strength. Results: Through data retrieval, cleaning, and deduplication, we retrieved 9287 publications and 110,619 references cited in these publications that were on the topic of rehabilitation robots and were published between 2001 and 2020. Results of the Mann-Kendall test indicated that the numbers of both publications (P<.001; St=175.0) and citations (P<.001; St=188.0) related to rehabilitation robots exhibited a significantly increasing yearly trend. The co-occurrence results revealed 120 categories connected with research on rehabilitation robots; we used these categories to determine research relationships. The co-citation results identified 169 co-citation clusters characterizing this research field and emerging trends in it. The most prominent label was ``soft robotic technology'' (the burst strength was 79.07), which has become a topic of great interest in rehabilitative recovery for both the upper and lower limbs. Additionally, task-oriented upper-limb training, control strategies for robot-assisted lower limb rehabilitation, and power in exoskeleton robots were topics of great interest in current research. Conclusions: Our work provides insights into research on rehabilitation robots, including its characteristics and emerging trends during the last 2 decades, providing a comprehensive understanding of this research field. ", doi="10.2196/42901", url="https://www.jmir.org/2023/1/e42901", url="http://www.ncbi.nlm.nih.gov/pubmed/37256670" } @Article{info:doi/10.2196/43008, author="Darcy, Brianne and Rashford, Lauren and Shultz, Tyler Stephen and Tsai, T. Nancey and Huizenga, David and Reed, B. Kyle and Bamberg, M. Stacy J.", title="Gait Device Treatment Using Telehealth for Individuals With Stroke During the COVID-19 Pandemic: Nonrandomized Pilot Feasibility Study", journal="JMIR Form Res", year="2023", month="May", day="19", volume="7", pages="e43008", keywords="gait device", keywords="telerehabilitation", keywords="iStride", keywords="stroke rehabilitation", keywords="walking speed", keywords="gait", keywords="gait treatment", keywords="telehealth", keywords="COVID-19", abstract="Background: During the COVID-19 pandemic, rehabilitation providers and consumers adopted telehealth practices at unprecedented rates. Multiple prepandemic studies demonstrate the feasibility and comparable efficacy between in-clinic and remote treatment for certain impairments caused by stroke, such as upper extremity weakness and impaired motor function. However, less guidance has been available regarding gait assessment and treatment. Despite this limitation, safe and effective gait treatment is fundamental to optimizing health and well-being after stroke and should be considered a treatment priority, including during the COVID-19 pandemic. Objective: This study explores the feasibility of using telehealth to deliver gait treatment using a wearable gait device, the iStride device, to stroke survivors during the 2020 pandemic. The gait device is used to treat hemiparetic gait impairments caused by stroke. The device alters the user's gait mechanics and creates a subtle destabilization of the nonparetic limb; therefore, supervision is required during its usage. Before the pandemic, treatment with the gait device had been provided in person to appropriate candidates using a combination of physical therapists and trained personnel. However, upon the emergence of the COVID-19 pandemic, in-person treatment was halted in adherence to pandemic guidelines. This study investigates the feasibility of 2 remote delivery treatment models with the gait device for stroke survivors. Methods: Participants were recruited during the first half of 2020 after the onset of the pandemic and included 5 individuals with chronic stroke (mean age 72 years; 84 months post stroke). Four participants were previous gait device users who transitioned to the telehealth delivery model to continue their gait treatment remotely. The fifth participant performed all study-related activities, from recruitment through follow-up, remotely. The protocol included virtual training for the at-home care partner, followed by 3 months of remote treatment with the gait device. Participants were instructed to wear gait sensors during all treatment activities. To assess feasibility, we monitored the safety of the remote treatment, compliance with protocol activities, acceptability of the telehealth treatment delivery, and preliminary efficacy of the gait treatment. Functional improvement was measured using the 10-Meter Walk Test, the Timed Up and Go Test, and the 6-Minute Walk Test, and quality of life was assessed using the Stroke-Specific Quality of Life Scale. Results: No serious adverse events occurred, and participants rated high acceptance of the telehealth delivery. Protocol compliance averaged 95\% of treatment sessions, 100\% of assessments, and 85\% of sensor usage during treatment. After 3 months of treatment, the average improvement in each functional outcome exceeded the minimal clinically important difference or minimal detectable change value. Conclusions: Remote treatment delivery with the gait device appeared feasible with care partner support. Gait treatment using telehealth may be useful to offset negative immobility impacts for those requiring or preferring remote care during the pandemic or otherwise. Trial Registration: ClinicalTrials.gov NCT04434313; https://clinicaltrials.gov/ct2/show/NCT04434313 ", doi="10.2196/43008", url="https://formative.jmir.org/2023/1/e43008", url="http://www.ncbi.nlm.nih.gov/pubmed/37204830" } @Article{info:doi/10.2196/45247, author="Ashikaga, Kohei and Doi, Shunichi and Yoneyama, Kihei and Suzuki, Norio and Kuwata, Shingo and Koga, Masashi and Takeichi, Naoya and Watanabe, Satoshi and Izumo, Masaki and Kida, Keisuke and Akashi, J. Yoshihiro", title="Efficacy and Safety of Home-Based Cardiac Telemonitoring Rehabilitation in Patients After Transcatheter Aortic Valve Implantation: Single-Center Usability and Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2023", month="May", day="17", volume="10", pages="e45247", keywords="transcatheter aortic valve implantation", keywords="telerehabilitation", keywords="cardiac rehabilitation", keywords="remote", keywords="telemonitoring", abstract="Background: No consensus exists on the efficacy of home-based cardiac rehabilitation (CR) in patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, there are no reports on home-based cardiac telemonitoring rehabilitation (HBTR) in patients after TAVI. Objective: We aimed to investigate the efficacy of HBTR in patients who have undergone TAVI. Methods: This single-center preliminary study introduced HBTR to patients after TAVI, and the efficacy outcomes of the rehabilitation method were compared to that of a historical control cohort. The historical control cohort (control group) consisted of 6 consecutive patients who underwent ordinary outpatient CR after TAVI from February 2016 to March 2020. Patients who participated in the HBTR program were only recruited after the TAVI procedure and before discharge between April 2021 and May 2022. In the first 2 weeks after TAVI, patients underwent outpatient CR and were trained using telemonitoring rehabilitation systems. Thereafter, patients underwent HBTR twice a week for 12 weeks. The control group performed standard outpatient CR at least once a week for 12 to 16 weeks. Efficacy was assessed using peak oxygen uptake (VO2) prior to and after CR. Results: Eleven patients were included in the HBTR group. All patients underwent 24 HBTR sessions during the 12-week training period, and no adverse events were observed. The control group participants performed 19 (SD 7) sessions during the training period, and no adverse events were observed. Participants in the HBTR and control groups had a mean age of 80.4 (SD 6.0) years and 79.0 (SD 3.9) years, respectively. In the HBTR group, preintervention and postintervention peak VO2 values were 12.0 (SD 1.7) mL/min/kg and 14.3 (SD 2.7) mL/min/kg (P=.03), respectively. The peak VO2 changes in the HBTR and control groups were 2.4 (SD 1.4) mL/min/kg and 1.3 (SD 5.0) mL/min/kg (P=.64), respectively. Conclusions: Home-based CR using a telemonitoring system is a safe outpatient rehabilitation method. Its efficacy is not inferior to that of standard CR in patients who have undergone TAVI. Trial Registration: Japan Registry of Clinical Trials jRCTs032200122; https://jrct.niph.go.jp/latest-detail/jRCTs032200122 ", doi="10.2196/45247", url="https://rehab.jmir.org/2023/1/e45247", url="http://www.ncbi.nlm.nih.gov/pubmed/37195764" } @Article{info:doi/10.2196/38884, author="Sobantu, Appears Ntombenkosi and Tshabalala, Daniel Muziwakhe and Chetty, Verusia", title="Rehabilitation Approaches and Strategies in the Management of Adult Patients Following Pelvic Fractures: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="May", day="3", volume="12", pages="e38884", keywords="rehabilitation approaches", keywords="rehabilitation strategies", keywords="adult patients", keywords="pelvic fractures", keywords="polytrauma", keywords="integrated health care", keywords="early intervention", abstract="Background: Pelvic fractures can lead to disability and a poor health-related quality of life, thereby contributing to the burden of disease in South Africa. Rehabilitation plays an important role in improving the functional outcomes in patients with pelvic fractures. However, there is limited published research that presents optimal interventions and guidelines to improve outcomes in affected individuals. Objective: The purpose of this study is to examine and map the range of and gaps in rehabilitation approaches and strategies used by health care professionals globally in the management of adult patients with pelvic fractures. Methods: The synthesis of evidence will follow the framework outlined by Arksey and O'Malley and supported by the Joanna Briggs Institute. The identification of research questions; the identification of relevant studies; the selection of eligible studies; charting data; collating, summarizing, and reporting of the results; and consultation with relevant stakeholders will be undertaken. Peer-reviewed articles written in English; from quantitative, qualitative, and mixed methods studies; and searched through Google Scholar, MEDLINE, PubMed, and Cochrane Library will be considered. Studies eligible for selection will be full-text articles written in English about adult patients with pelvic fractures. Studies on children with pelvic fractures and on interventions following pathological pelvic fractures as well as opinion papers and commentaries will be excluded from the study. Rayyan software will be used for title and abstract screening to determine inclusion in the study and to improve collaboration between the reviewers. The Mixed Methods Appraisal Tool (version 2018) will be used to appraise the quality of the studies. Results: This protocol will guide a scoping review to examine and map the range of and gaps in rehabilitation approaches and strategies used by health care professionals globally in the management of adult patients with pelvic fractures, irrespective of level of care. Impairments, activity limitations, and participation restrictions in patients with pelvic fractures will be highlighted, which will give an indication of the rehabilitation needs of the affected individuals. Results of this review might provide evidence for health care professionals, policy makers, and scholars to aid rehabilitative care and further integration of patients into health care systems and community. Conclusions: The rehabilitation needs of patients with pelvic fractures will be drawn from this review and will be presented in a flow diagram. Rehabilitation approaches and strategies in the management of patients with pelvic fractures will be identified to guide health care professionals in the promotion of quality health care for these patients. Trial Registration: OSF Registries osf.io/k6eg8; https://osf.io/k6eg8 International Registered Report Identifier (IRRID): PRR1-10.2196/38884 ", doi="10.2196/38884", url="https://www.researchprotocols.org/2023/1/e38884", url="http://www.ncbi.nlm.nih.gov/pubmed/37133918" } @Article{info:doi/10.2196/42094, author="Tropea, Peppino and Infarinato, Francesco and Sterpi, Irma and Ottaviani, Marco and Antoniotti, Paola and Romano, Paola and Picardi, Michela and Goffredo, Michela and Re, Riccardo and Pournajaf, Sanaz and Seregni, Agnese and Caronni, Antonio and Franceschini, Marco and Corbo, Massimo", title="Action Observation Treatment for Upper Limb Rehabilitation in Patients With Stroke: Protocol for a Multicenter Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Apr", day="20", volume="12", pages="e42094", keywords="action observation treatment", keywords="stroke rehabilitation", keywords="upper limb kinematics", keywords="EEG", keywords="electroencephalography", keywords="qEEG", keywords="quantitative electroencephalography", abstract="Background: In the last few years, new noninvasive strategies have emerged as rehabilitative treatments for patients with stroke. Action observation treatment (AOT) is a rehabilitation approach based on the properties of the mirror neuron system with a positive impact on modifying cortical activation patterns and improving the upper limb kinematics. AOT involves the dynamic process of observing purposeful actions with the intention of imitating and then practicing those actions. In recent years, several clinical studies suggested the effectiveness of AOT in patients with stroke to improve motor recovery and autonomy in activities of daily living. However, a deeper knowledge of the behavior of the sensorimotor cortex during AOT seems to be essential. Objective: The aim of this clinical trial, conducted in 2 neurorehabilitation centers and in patients' homes, is to investigate the effectiveness of AOT in patients with stroke, confirming the translational power of a tailored treatment. Particular emphasis will be placed on the predictive value of neurophysiological biomarkers. In addition, the feasibility and impact of a home-based AOT program will be investigated. Methods: A 3-arm, assessor-blinded, randomized controlled trial will be performed by enrolling patients with stroke in the chronic stage. A total of 60 participants will be randomly allocated to receive 15 sessions of AOT with different protocols (AOT at the hospital, AOT at home, and sham AOT), 3 sessions per week. The primary outcome will be assessed using the Fugl-Meyer Assessment-Upper Extremity scores. Secondary outcomes will be clinical, biomechanical, and neurophysiological assessment. Results: The study protocol is part of a project (project code GR-2016--02361678) approved and funded by the Italian Ministry of Health. The study began with the recruitment phase in January 2022, and enrollment was expected to end in October 2022. Recruitment is now closed (December 2022). The results of this study are expected to be published in spring 2023. Upon completion of the analyses, we will examine the preliminary effectiveness of the intervention and neurophysiological outcomes. Conclusions: This study will be used to evaluate the effectiveness of 2 different AOT scenarios (ie, AOT at the hospital and AOT at home) in patients with chronic stroke and to assess the predictive value of neurophysiological biomarkers. Specifically, we will attempt to induce the functional modification of the cortical components by exploiting the features of the mirror neuron system, demonstrating relevant clinical, kinematic, and neurophysiological changes after AOT. With our study, we also want to provide, for the first time in Italy, the AOT home-based program while assessing its feasibility and impact. Trial Registration: ClinicalTrials.gov NCT04047134; https://clinicaltrials.gov/ct2/show/NCT04047134 International Registered Report Identifier (IRRID): DERR1-10.2196/42094 ", doi="10.2196/42094", url="https://www.researchprotocols.org/2023/1/e42094", url="http://www.ncbi.nlm.nih.gov/pubmed/37079364" } @Article{info:doi/10.2196/43861, author="Davoody, Nadia and Eghdam, Aboozar and Koch, Sabine and H{\"a}gglund, Maria", title="Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="17", volume="10", pages="e43861", keywords="usability testing", keywords="stroke", keywords="aphasia", keywords="eHealth", keywords="rehabilitation", keywords="co-design", keywords="evaluation", keywords="user-centered design", keywords="effectiveness", keywords="user satisfaction", keywords="mobile phone", abstract="Background: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. Objective: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. Methods: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. Results: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients' disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. Conclusions: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group. ", doi="10.2196/43861", url="https://humanfactors.jmir.org/2023/1/e43861", url="http://www.ncbi.nlm.nih.gov/pubmed/37067848" } @Article{info:doi/10.2196/44285, author="Epalte, Klinta and Grjadovojs, Aleksandrs and B?rzi?a, Guna", title="Use of the Digital Assistant Vigo in the Home Environment for Stroke Recovery: Focus Group Discussion With Specialists Working in Neurorehabilitation", journal="JMIR Rehabil Assist Technol", year="2023", month="Apr", day="14", volume="10", pages="e44285", keywords="stroke", keywords="rehabilitation", keywords="digital therapeutic", keywords="focus group", keywords="home-based rehabilitation", keywords="recovery", keywords="efficacy", keywords="application", keywords="rehabilitation program", keywords="functionality", keywords="usability", keywords="development", abstract="Background: There is a lack of resources for the provision of adequate rehabilitation after a stroke, thus creating a challenge to provide the necessary high-quality, patient-centered, and cost-efficient rehabilitation services at a time when they are needed the most. Tablet-based therapeutic programs present an alternative way to access rehabilitation services and show a new paradigm for providing therapeutic interventions following a stroke anytime and anywhere. The digital assistant Vigo is an artificial intelligence--based app that provides an opportunity for a new, more integrative way of carrying out a home-based rehabilitation program. Considering the complexity of the stroke recovery process, factors such as a suitable population, appropriate timing, setting, and the necessary patient-specialist support structure need to be thoroughly researched. There is a lack of qualitative research exploring the perspectives of professionals working in neurorehabilitation of the content and usability of the digital tool for the recovery of patients after a stroke. Objective: The aim of this study is to identify the requirements for a tablet-based home rehabilitation program for stroke recovery from the perspective of a specialist working in stroke rehabilitation. Methods: The focus group study method was chosen to explore specialists' attitudes, experience, and expectations related to the use of the digital assistant Vigo as a home-based rehabilitation program for stroke recovery in domains of the app's functionality, compliance, usability, and content. Results: In total, 3 focus groups were conducted with a participant count of 5-6 per group and the duration of the discussion ranging from 70 to 80 minutes. In total, 17 health care professionals participated in the focus group discussions. The participants represented physiotherapists (n=7, 41.2\%), occupational therapists (n=7, 41.2\%), speech and language therapists (n=2, 11.8\%), and physical medicine and rehabilitation physicians (n=1, 5.9\%). Audio and video recordings of each discussion were created for further transcription and analysis. In total, 4 themes were identified: (1) the clinician's views on using Vigo as a home-based rehabilitation system, (2) patient-related circumstances facilitating and limiting the use of Vigo; (3) Vigo's functionality and use process (program creation, individual use, remote support); and (4) complementary and alternative Vigo use perspectives. The last 3 themes were divided further into 10 subthemes, and 2 subthemes had 2 sub-subthemes each. Conclusions: Health care professionals expressed a positive attitude toward the usability of the Vigo app. It is important that the content and use of the app be coherent with the aim to avoid (1) misunderstanding its practical use and the need for integration in practice and (2) misusing the app. In all focus groups, the importance of close involvement of rehabilitation specialists in the process of app development and research was highlighted. ", doi="10.2196/44285", url="https://rehab.jmir.org/2023/1/e44285", url="http://www.ncbi.nlm.nih.gov/pubmed/37058334" } @Article{info:doi/10.2196/40806, author="Ersin, Kerem and G{\"u}rlek, Emre and G{\"u}ler, Hakan and Kalayc?k Ertugay, {\c{C}}i?dem and ?erbet{\c{c}}io?lu, B{\"u}lent Mustafa", title="Appropriate Image Selection With Virtual Reality in Vestibular Rehabilitation: Cross-sectional Study", journal="JMIR Serious Games", year="2023", month="Apr", day="13", volume="11", pages="e40806", keywords="balance", keywords="computerized dynamic posturography", keywords="stress", keywords="vestibular rehabilitation", keywords="vestibular system", keywords="virtual reality", abstract="Background: While vestibular rehabilitation with virtual reality (VR) is becoming more popular every day, the disadvantages of this method are not yet clear. Objective: The aim of this study is to examine the effect of the image to be used in vestibular rehabilitation with VR on the systems that provide body posture. Methods: The study was carried out with 36 participants (18 women and 18 men) aged 18 to 30 years. To assess balance control components separately, a sensory organization test was administered to the participants in the presence of stressful and relaxing environment images with VR technology. The State-Trait Anxiety Inventory survey was also used to measure the stress values in the created environments. Results: The State-Trait Anxiety Inventory survey revealed that while stressful videos significantly increased stress, relaxing videos reduced stress. Among measurements obtained in the presence of VR, significant decreases were observed mostly in the visual system data. A significant increase in vestibular system data (P=.01) was observed with a decrease in visual system data (P<.001) when the relaxing image was presented. Additionally, there was a significant difference in the somatosensory (P=.001), composite (P=.002), and visual system (P<.001) data in the presence of stressful videos. Conclusions: Although the use of a VR system for vestibular rehabilitation is relatively new, no extant studies have examined how the image type used in VR can affect the integration of visual system data. Therefore, this study is unique in terms of showing the effects of the stress created by the change in the type of the image used in VR. When VR technology is used for therapeutic vestibular rehabilitation for patients whose balance disorder is due to the vestibular system, stress-free videos should be used. However, the use of stressful videos in VR technology will be beneficial in the rehabilitation of those with balance disorders due to the somatosensory system. ", doi="10.2196/40806", url="https://games.jmir.org/2023/1/e40806", url="http://www.ncbi.nlm.nih.gov/pubmed/37052976" } @Article{info:doi/10.2196/35757, author="Parel, Ilaria and Candoli, Valeria and Filippi, Vittoria Maria and Padolino, Antonio and Merolla, Giovanni and Sanniti, Stefano and Galassi, Riccardo and Paladini, Paolo and Cutti, Giovanni Andrea", title="Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program", journal="JMIR Res Protoc", year="2023", month="Mar", day="22", volume="12", pages="e35757", keywords="rotator cuff tear repair", keywords="wearable sensor", keywords="biomechanic", keywords="eHealth", keywords="rehabilitation", keywords="scapula", keywords="biofeedback", keywords="kinematic", keywords="exercise", keywords="shoulder", abstract="Background: The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. Objective: The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. Methods: For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. Results: We describe various applications of the ISEO exercise program in terms of frequency and intensity. Conclusions: An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. International Registered Report Identifier (IRRID): DERR1-10.2196/35757 ", doi="10.2196/35757", url="https://www.researchprotocols.org/2023/1/e35757", url="http://www.ncbi.nlm.nih.gov/pubmed/36947146" } @Article{info:doi/10.2196/43436, author="Churchill, Laura and Morrow, Mary and Capin, J. Jacob and Jolley, E. Sarah and Hare, Kristine and MaWhinney, Samantha and Stevens-Lapsley, E. Jennifer and Erlandson, M. Kristine", title="Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="20", volume="10", pages="e43436", keywords="Fitbit", keywords="steps", keywords="COVID-19", keywords="hospitalization", keywords="rehabilitation", keywords="digital health intervention", keywords="physical activity", keywords="step count", keywords="mHealth application", keywords="tele-rehabilitation", abstract="Background: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed. Objective: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period. Methods: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value. Results: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95\% CI 547-1312; P<.001) steps per week, culminating in an average daily step count of 7658 (95\% CI 6257-9059; P<.001) at the end of week 3. During the remaining 9 weeks of the study, weekly step counts increased by an average of 67 (95\% CI ?30 to 163; P<.001) steps per week, resulting in a final estimate of 8258 (95\% CI 6933-9584; P<.001) steps. Conclusions: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship. Trial Registration: ClinicalTrials.gov NCT04663945; https://tinyurl.com/2p969ced ", doi="10.2196/43436", url="https://rehab.jmir.org/2023/1/e43436", url="http://www.ncbi.nlm.nih.gov/pubmed/36939818" } @Article{info:doi/10.2196/41091, author="Fan, Ting and Wang, Xiaobei and Song, Xiaoxi and Zhao, Gang and Zhang, Zhichang", title="Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study", journal="JMIR Serious Games", year="2023", month="Mar", day="6", volume="11", pages="e41091", keywords="mobility", keywords="rehabilitation", keywords="virtual reality", keywords="bibliometric", keywords="technology", keywords="training", keywords="interactive", keywords="research", keywords="exercise", keywords="resources", keywords="cerebral palsy", keywords="adult", keywords="video games", abstract="Background: Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new de?nitions of VR technologies in rehabilitation, which reveal new situations and requirements. Objective: Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation. Methods: The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots. Results: A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021). Conclusions: Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation. ", doi="10.2196/41091", url="https://games.jmir.org/2023/1/e41091", url="http://www.ncbi.nlm.nih.gov/pubmed/36877556" } @Article{info:doi/10.2196/39543, author="Randriambelonoro, Mirana and Perrin Franck, Caroline and Herrmann, Fran{\c{c}}ois and Carmona, Antonio Gorki and Geissbuhler, Antoine and Graf, Christophe and Frangos, Emilia", title="Gamified Physical Rehabilitation for Older Adults With Musculoskeletal Issues: Pilot Noninferiority Randomized Clinical Trial", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="6", volume="10", pages="e39543", keywords="rehabilitation", keywords="gamification", keywords="emerging technologies", keywords="experimental", keywords="randomized controlled trial", keywords="mobility", keywords="device", keywords="musculoskeletal", keywords="older patients", keywords="elderly", keywords="aging", keywords="functionality", keywords="physical therapy", keywords="computer-aided", keywords="intervention", keywords="serious games", abstract="Background: Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization. Objective: The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues. Methods: A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps. Results: A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group{\texttimes}time interaction (SPPB\_I\_t1=--0.77, 95\% CI --2.03 to 0.50, P=.23; SPPB\_I\_t2=0.21, 95\% CI --1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95\% CI --0.72 to 5.37, P=.13; Left: 2.43 kg, 95\% CI --0.18 to 4.23, P=.07) for the patient from the intervention group was observed. Conclusions: Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities. Trial Registration: ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454 ", doi="10.2196/39543", url="https://rehab.jmir.org/2023/1/e39543", url="http://www.ncbi.nlm.nih.gov/pubmed/36877563" } @Article{info:doi/10.2196/40651, author="Stammler, Britta and Flammer, Kathrin and Schuster, Thomas and Lambert, Marian and Karnath, Hans-Otto", title="Negami: An Augmented Reality App for the Treatment of Spatial Neglect After Stroke", journal="JMIR Serious Games", year="2023", month="Feb", day="27", volume="11", pages="e40651", keywords="spatial neglect", keywords="gamification", keywords="augmented reality", keywords="visual exploration training", keywords="stroke rehabilitation", keywords="serious games", keywords="rehabilitation", keywords="stroke", abstract="Background: A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is ``visual exploration training.'' Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. Objective: This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. Methods: The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. Results: Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. Conclusions: The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants' natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients' motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation. ", doi="10.2196/40651", url="https://games.jmir.org/2023/1/e40651", url="http://www.ncbi.nlm.nih.gov/pubmed/36848215" } @Article{info:doi/10.2196/40416, author="Guo, Liquan and Wang, Jiping and Wu, Qunqiang and Li, Xinming and Zhang, Bochao and Zhou, Linfu and Xiong, Daxi", title="Clinical Study of a Wearable Remote Rehabilitation Training System for Patients With Stroke: Randomized Controlled Pilot Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Feb", day="23", volume="11", pages="e40416", keywords="remote rehabilitation", keywords="wearable devices", keywords="human-computer interaction", keywords="rehabilitation training", keywords="stroke", abstract="Background: In contrast to the large and increasing number of patients with stroke, clinical rehabilitation resources cannot meet their rehabilitation needs. Especially for those discharged, ways to carry out effective rehabilitation training without the supervision of physicians and receive guidance from physicians remain urgent problems to be solved in clinical rehabilitation and have become a research hot spot at home and abroad. At present, there are many studies on home rehabilitation training based on wearable devices, Kinect, among others, but these have disadvantages (eg, complex systems, high price, and unsatisfactory rehabilitation effects). Objective: This study aims to design a remote intelligent rehabilitation training system based on wearable devices and human-computer interaction training tasks, and to evaluate the effectiveness and safety of the remote rehabilitation training system for nonphysician-supervised motor rehabilitation training of patients with stroke through a clinical trial study. Methods: A total of 120 inpatients with stroke having limb motor dysfunction were enrolled via a randomized, parallel-controlled method in the rehabilitation institutions, and a 3-week clinical trial was conducted in the rehabilitation hall with 60 patients in the experimental group and 60 in the control group. The patients in the experimental group used the remote rehabilitation training system for rehabilitation training and routine clinical physical therapy (PT) training and received routine drug treatment every day. The patients in the control group received routine clinical occupational therapy (OT) training and routine clinical PT training and routine drug treatment every day. At the beginning of the training (baseline) and after 3 weeks, the Fugl-Meyer Motor Function Rating scale was scored by rehabilitation physicians, and the results were compared and analyzed. Results: Statistics were performed using SAS software (version 9.4). The total mean Fugl-Meyer score improved by 11.98 (SD 8.46; 95\% CI 9.69-14.27) in the control group and 17.56 (SD 11.65; 95\% CI 14.37-20.74) in the experimental group, and the difference between the 2 groups was statistically significant (P=.005). Among them, the mean Fugl-Meyer upper extremity score improved by 7.45 (SD 7.24; 95\% CI 5.50-9.41) in the control group and 11.28 (SD 8.59; 95\% CI 8.93-13.62) in the experimental group, and the difference between the 2 groups was statistically significant (P=.01). The mean Fugl-Meyer lower extremity score improved by 4.53 (SD 4.42; 95\% CI 3.33-5.72) in the control group and 6.28 (SD 5.28; 95\% CI 4.84-7.72) in the experimental group, and there was no significant difference between the 2 groups (P=.06). The test results showed that the experimental group was better than the control group, and that the patients' motor ability was improved. Conclusions: The remote rehabilitation training system designed based on wearable devices and human-computer interaction training tasks can replace routine clinical OT training. In the future, through medical device registration certification, the system will be used without the participation of physicians or therapists, such as in rehabilitation training halls, and in remote environments, such as communities and homes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200061310; https://tinyurl.com/34ka2725 ", doi="10.2196/40416", url="https://mhealth.jmir.org/2023/1/e40416", url="http://www.ncbi.nlm.nih.gov/pubmed/36821348" } @Article{info:doi/10.2196/45448, author="Giesbrecht, Edward and Major, E. Mel and Fricke, Moni and Wener, Pamela and van Egmond, Maarten and Aarden, J. Jesse and Brown, L. Cara and Pol, Margriet and van der Schaaf, Marike", title="Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Feb", day="20", volume="10", pages="e45448", keywords="telerehabilitation", keywords="digital health", keywords="telehealth", keywords="eHealth", keywords="competencies", keywords="capabilities", keywords="mobile phone", abstract="Background: Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care. Objective: This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice. Methods: A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions. Results: Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1\%) and occupational therapists (n=434, 60\%). Only 28.1\% (203/723) reported receiving specific training in TR, with 1.2\% (9/723) indicating that it was part of their professional education. Approximately 19.5\% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4\%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1\% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers. Conclusions: Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7\%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education. ", doi="10.2196/45448", url="https://rehab.jmir.org/2023/1/e45448", url="http://www.ncbi.nlm.nih.gov/pubmed/36806194" } @Article{info:doi/10.2196/41691, author="Han, Dong and Ding, Y. Eric and Cho, Chaeho and Jung, Haewook and Dickson, L. Emily and Mohagheghian, Fahimeh and Peitzsch, G. Andrew and DiMezza, Danielle and Tran, Khanh-Van and McManus, D. David and Chon, H. Ki", title="A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study", journal="JMIR Cardio", year="2023", month="Feb", day="13", volume="7", pages="e41691", keywords="atrial fibrillation", keywords="stroke", keywords="smartwatch app", keywords="smartphone apps", keywords="wearable devices", keywords="user experience", keywords="older adults", keywords="mobile phone", abstract="Background: The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. Objective: This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. Methods: The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. Results: We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64\%) endorsed that the smartwatch app is ``easy to use.'' For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. Conclusions: This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system's usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. Trial Registration: ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 ", doi="10.2196/41691", url="https://cardio.jmir.org/2023/1/e41691", url="http://www.ncbi.nlm.nih.gov/pubmed/36780211" } @Article{info:doi/10.2196/40094, author="Miozzo, Paula Aline and Camponogara Righi, Natiele and Yumi Shizukuishi, Luiza Maria and Marques Ferreira Aguilar, H{\'e}rica and Florian, Juliessa and da Costa Machado, Scheila and Schardong, Jociane and Della M{\'e}a Plentz, Rodrigo", title="A Telerehabilitation Program for Maintaining Functional Capacity in Patients With Chronic Lung Diseases During a Period of COVID-19 Social Isolation: Quasi-Experimental Retrospective Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Dec", day="22", volume="9", number="4", pages="e40094", keywords="telerehabilitation", keywords="lung diseases", keywords="social isolation", keywords="COVID-19", keywords="pulmonary rehabilitation", keywords="pulmonary", keywords="rehabilitation", keywords="quality of life", keywords="chronic disease", keywords="mental health", keywords="social functioning", keywords="patient outcome", abstract="Background: Pulmonary diseases represent a great cause of disability and mortality in the world, and given the progression of these pathologies, pulmonary rehabilitation programs have proven to be effective for people with chronic respiratory diseases. During the COVID-19 pandemic, telerehabilitation has become an alternative for patients with such diseases. Objective: The aim of this study was to compare the outcomes (ie, functional capacity and quality of life) of telerehabilitation to those of usual care among patients who previously participated in face-to-face pulmonary rehabilitation programs. Methods: We conducted a quasi-experimental retrospective study from April 2020 to August 2021. A total of 32 patients with chronic lung diseases were included and divided into the control and intervention groups. The intervention group performed telerehabilitation synchronously twice per week and was supervised by a physical therapist during breathing, strengthening, and aerobic exercises. Changes in the degree of dyspnea and leg discomfort were assessed based on changes in Borg scale scores. The control group did not perform any activities during the period of social isolation. Functional capacity was assessed with the 6-minute walk test, and quality of life was assessed with the Medical Outcomes Study 36-item Short Form Health Survey. Results: The telerehabilitation group's mean 6-minute walk distance decreased by 39 m, while that of the control group decreased by 120 m. There was a difference of 81 m between the groups' mean 6-minute walk distances (P=.02). In relation to the quality of life, telerehabilitation was shown to improve the following two domains: social functioning and mental health. Conclusions: Telerehabilitation programs for patients with chronic lung diseases can ease the deleterious effects of disease progression, be used to maintain functional capacity, and improve aspects of quality of life. ", doi="10.2196/40094", url="https://rehab.jmir.org/2022/4/e40094", url="http://www.ncbi.nlm.nih.gov/pubmed/36473024" } @Article{info:doi/10.2196/39984, author="Ahmadi, Reihaneh and Lim, Hajin and Mutlu, Bilge and Duff, Melissa and Toma, Catalina and Turkstra, Lyn", title="Facebook Experiences of Users With Traumatic Brain Injury: A Think-Aloud Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Dec", day="16", volume="9", number="4", pages="e39984", keywords="traumatic brain injury", keywords="rehabilitation", keywords="disability", keywords="cognitive communication", keywords="social media", abstract="Background: A critical gap in our knowledge about social media is whether we can alleviate accessibility barriers and challenges for individuals with traumatic brain injury (TBI), to improve their social participation and health. To do this, we need real-time information about these barriers and challenges, to design appropriate aids. Objective: The aim of this study was to characterize the ways people with TBI accessed and used social media websites and understand unique challenges they faced. Methods: We invited 8 adults with moderate to severe TBI to log onto their own Facebook page and use it as they regularly would while thinking aloud. Their comments were recorded and transcribed for qualitative analysis. We first analyzed participants' utterances using a priori coding based on a framework proposed by Meshi et al to classify adults' motives for accessing social media. We next used an open coding method to understand the challenges that people with TBI faced while using Facebook. In other words, we analyzed participants' needs for using Facebook and then identified Facebook features that made it challenging for them to meet those needs. Results: Participants used all categories of codes in the framework by Meshi et al and provided detailed feedback about the Facebook user interface. A priori coding revealed 2 dimensions that characterized participants' Facebook use: whether they were active or passive about posting and self-disclosure on Facebook and their familiarity and fluency in using Facebook. The open coding analysis revealed 6 types of challenges reported by participants with TBI, including difficulty with language production and interpretation, attention and information overload, perceptions of negativity and emotional contagion, insufficient guidance to use Facebook, concerns about web-based scams and frauds, and general accessibility concerns. Conclusions: Results showed that individuals with TBI used Facebook for the same reasons typical adults do, suggesting that it can help increase social communication and reduce isolation and loneliness. Participants also identified barriers, and we propose modifications that could improve access for individuals with brain injury. On the basis of identified functions and challenges, we conclude by proposing design ideas for social media support tools that can promote more active use of social media sites by adults with TBI. ", doi="10.2196/39984", url="https://rehab.jmir.org/2022/4/e39984", url="http://www.ncbi.nlm.nih.gov/pubmed/36525296" } @Article{info:doi/10.2196/39687, author="Fahr, Annina and Balzer, Julia and Keller, W. Jeffrey and van Hedel, A. Hubertus J.", title="Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Dec", day="16", volume="9", number="4", pages="e39687", keywords="selective motor control", keywords="mirror movements", keywords="neurorehabilitation", keywords="validity", keywords="reliability", keywords="interactive computer play", keywords="eHealth", keywords="digital health", keywords="rehabilitation", keywords="cerebral palsy", keywords="movement", keywords="child", keywords="pediatric", keywords="game", keywords="accelerometer", keywords="motor", keywords="avatar", keywords="assessment", keywords="limb", keywords="joint", keywords="physiotherapy", keywords="physiotherapist", keywords="lower extremity", keywords="lower extremities", abstract="Background: Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers. Objective: This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP). Methods: Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame's scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists' opinions, and relative and absolute test-retest reliability. Results: We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame's involuntary movement score and the therapist's rating of the occurrence of involuntary movements during the game were moderate (Spearman $\rho$=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|$\rho$|?0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25\% (accuracy) and 44\% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100\% (17/17) for the accuracy score and 94\% (16/17) for the involuntary movement score. Conclusions: The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist's opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment's gamelike character demanded various other motor control aspects that are less considered in current clinical assessments. ", doi="10.2196/39687", url="https://rehab.jmir.org/2022/4/e39687", url="http://www.ncbi.nlm.nih.gov/pubmed/36525299" } @Article{info:doi/10.2196/40374, author="Kamalakannan, Sureshkumar and Karunakaran, Vijay and Kaliappan, Balaji Ashwin and Nagarajan, Ramakumar", title="Systematic Development of the ReWin Application: A Digital Therapeutic Rehabilitation Innovation for People With Stroke-related Disabilities in India", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="24", volume="9", number="4", pages="e40374", keywords="stroke", keywords="telerehabilitation", keywords="neurological rehabilitation", keywords="disability", keywords="India", keywords="rehabilitation", keywords="recovery", keywords="stroke care", keywords="patient care", keywords="digital technology", keywords="feasibility", keywords="acceptability", keywords="digital therapy", doi="10.2196/40374", url="https://rehab.jmir.org/2022/4/e40374", url="http://www.ncbi.nlm.nih.gov/pubmed/36422867" } @Article{info:doi/10.2196/42385, author="Rios Rincon, M. Adriana and Guptill, Christine and Guevara Salamanca, David Juan and Liubaoerjijin, Yilina and Figeys, Mathieu and Gregson, Geoff and Miguel-Cruz, Antonio", title="Understanding the Technology Acceptance and Usability of a New Device for Hand Therapy: Qualitative Descriptive Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="10", volume="9", number="4", pages="e42385", keywords="usability", keywords="technology acceptance", keywords="hand therapy, rehabilitation, disability", keywords="medical device", keywords="limb disorder", keywords="chronic disorder", keywords="health care system", abstract="Background: Upper extremity function plays a critical role in completing activities of daily living, employment, and participating in recreational activities. The FEPSim device is a medical device for hand and wrist rehabilitation that can be adjusted according to the patient's requirements in rehabilitation. Furthermore, the FEPSim can be used to assess the patient's strength and range of motion of the forearm, wrist, and hand. At present, the acceptance and usability of the FEPSim have not been tested in a clinical setting, with limited perspectives from rehabilitation-providing clinicians. Objective: This study aims to understand the factors related to the acceptance and usability of the FEPSim device. Upper limb disorders are prevalent across populations. The impact of upper limb disorders, both acute and chronic, puts a significant burden on the Canadian health care system. Methods: A qualitative descriptive study was conducted that involved face-to-face semistructured interviews with hand therapists from hand therapy services who used the FEPSim device. We used purposive sampling to recruit 10 participants over a period of 14 months. Semistructured interview questions (topic-guided) examined the technology acceptance and usability of the FEPSim device. Results: We found 6 factors to be critical aspects of the acceptance and usability of the FEPSim device. These factors were (1) useful for therapy, (2) effortlessness, (3) environmental conditions, (4) internal encouragement, (5) technological aesthetics, and (6) use. Conclusions: The FEPSim device was widely accepted by the therapists. The use of the FEPSim device is a feasible alternative for supporting hand therapy. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 ", doi="10.2196/42385", url="https://rehab.jmir.org/2022/4/e42385", url="http://www.ncbi.nlm.nih.gov/pubmed/36355405" } @Article{info:doi/10.2196/41313, author="van Dam, Kirstin and Gielissen, Marieke and Reijnders, Rachelle and van der Poel, Agnes and Boon, Brigitte", title="Experiences of Persons With Executive Dysfunction in Disability Care Using a Social Robot to Execute Daily Tasks and Increase the Feeling of Independence: Multiple-Case Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="3", volume="9", number="4", pages="e41313", keywords="executive dysfunction", keywords="disability care", keywords="social robots", keywords="assistive technology", keywords="independence", keywords="daily tasks", keywords="executive function", keywords="rehabilitation", keywords="disability support", keywords="daily care", keywords="implementation", abstract="Background: Executive functions are essential for independently navigating nearly all of our daily activities. Executive dysfunction often occurs as a result of a neurodevelopmental disorder. Persons with executive dysfunction experience challenges regarding independent execution of daily tasks. Social robots might support persons with executive dysfunction to execute daily tasks and promote their feeling of independence. Objective: This study aimed to study the impact of interacting with social robot Tessa on goal attainment in the execution of daily tasks and perceived independence of persons with executive dysfunction. Methods: In this multiple-case study, 18 participant--caregiver couples were followed up while using Tessa in the home environment for 3 months. Goal attainment on independently performing a self-determined goal was measured by the Goal Attainment Scale, and participant--caregiver couples were interviewed about their experience with their interaction with Tessa and how they perceived Tessa's impact on their independence. Results: In total, 11 (61\%) participants reached their goal after 6 weeks and maintained their goal after 3 months. During the study period, 2 participant--caregiver couples withdrew because of mismatch with Tessa. Participants set goals in the following domains: execution of household tasks; intake of food, water, or medication; being ready in time for an appointment; going to bed or getting out of bed on time; personal care; and exercise. Participants perceived that Tessa increased the feeling of independence by generating more structure, stimulation, and self-direction. Participant--caregiver couples reported that the auditive information provided by Tessa was more effective in coping with executive dysfunction compared to their initial approaches using visual information, and the use of Tessa had a positive impact on their relationship. Conclusions: This study paid ample time and attention to the implementation of a social robot in daily care practice. The encouraging findings support the use of social robot Tessa for the execution of daily tasks and increasing independence of persons with executive dysfunction in disability care. ", doi="10.2196/41313", url="https://rehab.jmir.org/2022/4/e41313", url="http://www.ncbi.nlm.nih.gov/pubmed/36326800" } @Article{info:doi/10.2196/37714, author="Franklin, D. Patricia and Oatis, A. Carol and Zheng, Hua and Westby, D. Marie and Peter, Wilfred and Laraque-Two Elk, Jeremie and Rizk, Joseph and Benbow, Ellen and Li, Wenjun", title="Web-Based System to Capture Consistent and Complete Real-world Data of Physical Therapy Interventions Following Total Knee Replacement: Design and Evaluation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Oct", day="27", volume="9", number="4", pages="e37714", keywords="structured data", keywords="web-based clinical data capture", keywords="physical therapy", keywords="total knee replacement", keywords="electronic health records", keywords="real-world evidence", keywords="real-world data", keywords="data", keywords="therapy", keywords="knee", keywords="knee replacement", keywords="clinical intervention", abstract="Background: Electronic health records (EHRs) have the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform health care system and its data to a ``learning health care system'' generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. Objective: The purpose of this paper was to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case was ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (or dose) used to treat patients with knee arthritis following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing physical therapists and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 physical therapists agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 physical therapists. No technical problems with data entry were reported, and data entry required less than 2 minutes per visit. A total of 42 (2\%) interventions could not be categorized and were recorded using free text. Conclusions: The use of user-centered design principles provides a road map for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and disseminate knowledge to practice. ", doi="10.2196/37714", url="https://rehab.jmir.org/2022/4/e37714", url="http://www.ncbi.nlm.nih.gov/pubmed/36301608" } @Article{info:doi/10.2196/38315, author="He, Danni and Cao, Shihua and Le, Yuchao and Wang, Mengxin and Chen, Yanfei and Qian, Beiying", title="Virtual Reality Technology in Cognitive Rehabilitation Application: Bibliometric Analysis", journal="JMIR Serious Games", year="2022", month="Oct", day="19", volume="10", number="4", pages="e38315", keywords="virtual reality", keywords="cognitive rehabilitation", keywords="bibliometric analysis", keywords="CiteSpace", keywords="gCLUTO", keywords="rehabilitation", keywords="cognitive disorder", keywords="visual content analysis", abstract="Background: In recent years, with the development of computer science and medical science, virtual reality (VR) technology has become a promising tool for improving cognitive function. Research on VR-based cognitive training has garnered increasing attention. Objective: This study aimed to investigate the application status, research hot spots, and emerging trends of VR in cognitive rehabilitation over the past 20 years. Methods: Articles on VR-based cognitive rehabilitation from 2001 to 2021 were retrieved from the Web of Science Core Collection. CiteSpace software was used for the visual analysis of authors and countries or regions, and Scimago Graphica software was used for the geographic visualization of published countries or regions. Keywords were clustered using the gCLUTO software. Results: A total of 1259 papers were included. In recent years, research on the application of VR in cognitive rehabilitation has been widely conducted, and the annual publication of relevant literature has shown a positive trend. The main research areas include neuroscience and neurology, psychology, computer science, and rehabilitation. The United States ranked first with 328 papers, and Italy ranked second with 140 papers. Giuseppe Riva, an Italian academic, was the most prolific author with 29 publications. The most frequently cited reference was ``Using Reality to Characterize Episodic Memory Profiles in Amnestic Mild Cognitive Impairment and Alzheimer's Disease: Influence of Active and Passive Encoding.'' The most common keywords used by researchers include ``virtual reality,'' ``cognition,'' ``rehabilitation,'' ``performance,'' and ``older adult.'' The largest source of research funding is from the public sector in the United States. Conclusions: The bibliometric analysis provided an overview of the application of VR in cognitive rehabilitation. VR-based cognitive rehabilitation can be integrated into multiple disciplines. We conclude that, in the context of the COVID-19 pandemic, the development of VR-based telerehabilitation is crucial, and there are still many problems that need to be addressed, such as the lack of consensus on treatment methods and the existence of safety hazards. ", doi="10.2196/38315", url="https://games.jmir.org/2022/4/e38315", url="http://www.ncbi.nlm.nih.gov/pubmed/36260388" } @Article{info:doi/10.2196/39140, author="Drisdelle, Sara and Power, Liam and Thieu, Scott and Sheriko, Jordan", title="Developing an Immersive Virtual Reality Training System for Novel Pediatric Power Wheelchair Users: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2022", month="Oct", day="6", volume="11", number="10", pages="e39140", keywords="immersive virtual reality", keywords="power wheelchair", keywords="training", keywords="pediatric rehabilitation", keywords="feasibility", abstract="Background: Power wheelchairs can empower children with physical limitations to gain independence in their everyday lives; however, traditional methods of power wheelchair training are often limited by poor accessibility and safety concerns. Immersive virtual reality technology (IVRT) uses advanced display technology to place users in a fully immersive web-based environment that can support real-time skills training, often requiring less resources and fewer safety concerns than real-world methods. IVRT interventions have shown to be a feasible training option among adult power wheelchair users; however, there is still a need to understand the technical and clinical feasibility of developing an IVRT power wheelchair training tool for the pediatric population. Objective: This proposed study aims to use expert feedback and an iterative design process to develop an IVRT training intervention for pediatric power wheelchair skill development. Methods: This 3-phase feasibility study will be conducted within the assistive technology unit of a public pediatric hospital. Separate participant groups will be recruited for each phase, consisting of approximately 10 to 15 clinicians (phase 1), 10 pediatric power wheelchair users (phase 2), and 15 to 20 additional pediatric power wheelchair users (phase 3). Phase 1 will be conducted to gather feedback on the baseline IVRT training intervention. Clinicians will test the intervention and assess its usability and acceptability using qualitative and quantitative methods. Phase 1 participants will also be invited back for a subsequent session to reassess a revised version of the training intervention that has been updated based on their previous feedback. Phase 2 and phase 3 will also use mixed methods to gather feedback on the usability, acceptability, and user experience of the IVRT training intervention from current pediatric power wheelchair users. In addition, phase 3 participants will perform a skills transfer assessment to compare power mobility skill performance between the virtual reality and real-life environments. Data gathered in phase 2 will be used to further refine the IVRT intervention, whereas phase 3 data will be used to statistically evaluate the final version. Results: This study was approved by the Izaak Walton Killam Health Centre research ethics board in August 2021. Phase 1 testing began in February 2022. The entire study is expected to be completed by 2023. Conclusions: The results of this study will be used to create an IVRT training intervention for pediatric power wheelchair skill development through an iterative and collaborative design process. Results may also assist in directing future studies in this area. International Registered Report Identifier (IRRID): DERR1-10.2196/39140 ", doi="10.2196/39140", url="https://www.researchprotocols.org/2022/10/e39140", url="http://www.ncbi.nlm.nih.gov/pubmed/36201405" } @Article{info:doi/10.2196/38489, author="Murakami, Tatsunori and Higuchi, Yumi and Ueda, Tetsuya and Kozuki, Wataru and Gen, Aki", title="Internet-Based Information Sharing With Families of Patients With Stroke in a Rehabilitation Hospital During the COVID-19 Pandemic: Case-Control Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Sep", day="20", volume="9", number="3", pages="e38489", keywords="COVID-19", keywords="internet-based", keywords="health information", keywords="stroke", keywords="family", keywords="rehabilitation", keywords="case-control", keywords="activities of daily living", keywords="information communication technology", keywords="physical function", keywords="recovery", abstract="Background: The spread of COVID-19 has affected stroke rehabilitation. Given that inpatient visits are restricted in most institutions, alternative ways of providing information to family members are imperative. Informing families about patients' rehabilitation progress via the web may help involve families in the rehabilitation process, enhance patients' motivation to continue rehabilitation, and contribute overall to patients' improvement in activities of daily living (ADL). Objective: We aimed to investigate the feasibility of the Internet-Based Rehabilitation Information Sharing (IRIS) intervention for families of patients with stroke at a rehabilitation hospital and examine the effect of IRIS on patients' ADL improvement. Methods: In this case-control study, participants were inpatients at a rehabilitation hospital between March 2020 and April 2021. The intervention group (information and communication technology [ICT] group) included patients and families who requested IRIS, which consisted of a progress report on patients' rehabilitation using text, photos, and videos. Those who did not receive internet-based information were included in the non-ICT group. The control group, matched with the ICT group based on a 1:1 propensity score, was selected from the non-ICT group. The covariates for calculating the propensity score were patients' age, sex, and motor and cognitive scores on the Functional Independence Measure at admission. The main outcome was the degree of ADL improvement during hospitalization. Multiple regression analysis (forced entry method) was performed to confirm the impact of ICT use on ADL improvement. The independent variables were the presence of intervention, length of hospital stay, and number of days from onset to hospitalization. Results: In total, 16 groups of patients and families participated in the IRIS. The mean age of patients was 78.6 (SD 7.2) and 78.6 (SD 8.2) years in the ICT and control groups, respectively. The median total Functional Independence Measure difference was 28.5 (IQR 20.3-53.0) and 11.0 (IQR 2.8-30.0) in the ICT and control groups, respectively, and the ICT group showed significant improvement in ADL function (P=.02). In the multiple regression analysis of the ICT and control groups, the unstandardized regression coefficient was 11.97 (95\% CI 0.09-23.84) for ICT use. These results indicate that ICT use was independently and significantly associated with improvement in ADL. Conclusions: This study examined the effect of IRIS on family members to improve ADL in patients with stroke who are hospitalized. The results showed that IRIS promotes the improvement of patients' ADL regardless of age, sex, motor and cognitive functions at admission, and the length of hospital stay. ", doi="10.2196/38489", url="https://rehab.jmir.org/2022/3/e38489", url="http://www.ncbi.nlm.nih.gov/pubmed/35960841" } @Article{info:doi/10.2196/31305, author="Allegue, Rakia Dorra and Sweet, Norman Shane and Higgins, Johanne and Archambault, S. Philippe and Michaud, Francois and Miller, C. William and Tousignant, Michel and Kairy, Dahlia", title="Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Sep", day="15", volume="9", number="3", pages="e31305", keywords="stroke", keywords="rehabilitation", keywords="virtual reality", keywords="video games", keywords="telerehabilitation", keywords="upper extremity", keywords="motivation", abstract="Background: In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician. Objective: We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians. Methods: This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors' use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory. Results: Three stroke survivors (n=2, 67\%, women and n=1, 33\%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors' safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts. Conclusions: This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions. International Registered Report Identifier (IRRID): RR2-10.2196/14629 ", doi="10.2196/31305", url="https://rehab.jmir.org/2022/3/e31305", url="http://www.ncbi.nlm.nih.gov/pubmed/36107484" } @Article{info:doi/10.2196/39883, author="Brehon, Katelyn and Niemel{\"a}inen, Riikka and Hall, Mark and Bostick, P. Geoff and Brown, A. Cary and Wieler, Marguerite and Gross, P. Douglas", title="Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Sep", day="14", volume="9", number="3", pages="e39883", keywords="compensation and redress", keywords="postacute COVID-19 syndrome", keywords="long COVID", keywords="COVID-19", keywords="rehabilitation", keywords="return-to-work", keywords="health outcome", keywords="occupational health", keywords="patient-reported outcome", keywords="anxiety disorder", abstract="Background: Emerging evidence suggests that worldwide, between 30\% and 50\% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed. Objective: This study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program. Methods: A cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW. Results: The sample consisted of 81 workers. Most workers were female (n=52, 64\%) and from health-related occupations (n=43, 53\%). Only 43 (53\%) individuals returned to work at program discharge, with 40 (93\%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=--3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95\% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95\% CI 0.99-1.00) predicted RTW even when controlling for age and gender. Conclusions: Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53\%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation. ", doi="10.2196/39883", url="https://rehab.jmir.org/2022/3/e39883", url="http://www.ncbi.nlm.nih.gov/pubmed/36094442" } @Article{info:doi/10.2196/41152, author="Athanasiou, Alkinoos and Mitsopoulos, Konstantinos and Praftsiotis, Apostolos and Astaras, Alexander and Antoniou, Panagiotis and Pandria, Niki and Petronikolou, Vasileia and Kasimis, Konstantinos and Lyssas, George and Terzopoulos, Nikos and Fiska, Vasilki and Kartsidis, Panagiotis and Savvidis, Theodoros and Arvanitidis, Athanasios and Chasapis, Konstantinos and Moraitopoulos, Alexandros and Nizamis, Kostas and Kalfas, Anestis and Iakovidis, Paris and Apostolou, Thomas and Magras, Ioannis and Bamidis, Panagiotis", title="Neurorehabilitation Through Synergistic Man-Machine Interfaces Promoting Dormant Neuroplasticity in Spinal Cord Injury: Protocol for a Nonrandomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Sep", day="13", volume="11", number="9", pages="e41152", keywords="body-machine interface", keywords="brain-computer interface", keywords="neural rehabilitation", keywords="serious games", keywords="spinal cord injury", keywords="wearable robotics", abstract="Background: Spinal cord injury (SCI) constitutes a major sociomedical problem, impacting approximately 0.32-0.64 million people each year worldwide; particularly, it impacts young individuals, causing long-term, often irreversible disability. While effective rehabilitation of patients with SCI remains a significant challenge, novel neural engineering technologies have emerged to target and promote dormant neuroplasticity in the central nervous system. Objective: This study aims to develop, pilot test, and optimize a platform based on multiple immersive man-machine interfaces offering rich feedback, including (1) visual motor imagery training under high-density electroencephalographic recording, (2) mountable robotic arms controlled with a wireless brain-computer interface (BCI), (3) a body-machine interface (BMI) consisting of wearable robotics jacket and gloves in combination with a serious game (SG) application, and (4) an augmented reality module. The platform will be used to validate a self-paced neurorehabilitation intervention and to study cortical activity in chronic complete and incomplete SCI at the cervical spine. Methods: A 3-phase pilot study (clinical trial) was designed to evaluate the NeuroSuitUp platform, including patients with chronic cervical SCI with complete and incomplete injury aged over 14 years and age-/sex-matched healthy participants. Outcome measures include BCI control and performance in the BMI-SG module, as well as improvement of functional independence, while also monitoring neuropsychological parameters such as kinesthetic imagery, motivation, self-esteem, depression and anxiety, mental effort, discomfort, and perception of robotics. Participant enrollment into the main clinical trial is estimated to begin in January 2023 and end by December 2023. Results: A preliminary analysis of collected data during pilot testing of BMI-SG by healthy participants showed that the platform was easy to use, caused no discomfort, and the robotics were perceived positively by the participants. Analysis of results from the main clinical trial will begin as recruitment progresses and findings from the complete analysis of results are expected in early 2024. Conclusions: Chronic SCI is characterized by irreversible disability impacting functional independence. NeuroSuitUp could provide a valuable complementary platform for training in immersive rehabilitation methods to promote dormant neural plasticity. Trial Registration: ClinicalTrials.gov NCT05465486; https://clinicaltrials.gov/ct2/show/NCT05465486 International Registered Report Identifier (IRRID): PRR1-10.2196/41152 ", doi="10.2196/41152", url="https://www.researchprotocols.org/2022/9/e41152", url="http://www.ncbi.nlm.nih.gov/pubmed/36099009" } @Article{info:doi/10.2196/33858, author="Mena-Moreno, Teresa and Mungu{\'i}a, Lucero and Granero, Rosario and Lucas, Ignacio and S{\'a}nchez-G{\'o}mez, Almudena and C{\'a}mara, Ana and Compta, Yaroslau and Valldeoriola, Francesc and Fernandez-Aranda, Fernando and Sauvaget, Anne and Mench{\'o}n, M. Jos{\'e} and Jim{\'e}nez-Murcia, Susana", title="Cognitive Behavioral Therapy Plus a Serious Game as a Complementary Tool for a Patient With Parkinson Disease and Impulse Control Disorder: Case Report", journal="JMIR Serious Games", year="2022", month="Sep", day="9", volume="10", number="3", pages="e33858", keywords="Parkinson disease", keywords="impulse control disorder", keywords="hypersexuality", keywords="multidisciplinary approach", keywords="serious game", abstract="Background: Impulse control disorders (ICDs) are commonly developed among patients who take dopamine agonist drugs as a treatment for Parkinson disease (PD). Gambling disorder and hypersexuality are more frequent in male patients with PD, with a prevalence over 4\% in dopamine agonists users. Although impulsive-compulsive behaviors are related to antiparkinsonian medication, and even though ICD symptomatology, such as hypersexuality, often subsides when the dopaminergic dose is reduced, sometimes ICD persists in spite of drug adjustment. Consequently, a multidisciplinary approach should be considered to address these comorbidities and to explore new forms of complementary interventions, such as serious games or therapies adapted to PD. Objective: The aim of this study is to present the case of a patient with ICD (ie, hypersexuality) triggered by dopaminergic medication for PD. A combined intervention was carried out using cognitive behavioral therapy (CBT) for ICD adapted to PD, plus an intervention using a serious game---e-Estesia---whose objective is to improve emotion regulation and impulsivity. The aim of the combination of these interventions was to reduce the harm of the disease. Methods: After 20 CBT sessions, the patient received the e-Estesia intervention over 15 sessions. Repeated measures, before and after the combined intervention, were administered to assess emotion regulation, general psychopathology, and emotional distress and impulsivity. Results: After the intervention with CBT techniques and e-Estesia, the patient presented fewer difficulties to regulate emotion, less emotional distress, and lower levels of impulsivity in comparison to before the treatment. Moreover, the frequency and severity of the relapses also decreased. Conclusions: The combined intervention---CBT and a serious game---showed positive results in terms of treatment outcomes. ", doi="10.2196/33858", url="https://games.jmir.org/2022/3/e33858", url="http://www.ncbi.nlm.nih.gov/pubmed/36083621" } @Article{info:doi/10.2196/36028, author="Jirasakulsuk, Nathaphon and Saengpromma, Pattaridaporn and Khruakhorn, Santhanee", title="Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis", journal="JMIR Rehabil Assist Technol", year="2022", month="Sep", day="1", volume="9", number="3", pages="e36028", keywords="telerehabilitation", keywords="internet-based intervention", keywords="older adults", keywords="physical performance", keywords="physical therapy", abstract="Background: Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers. Objective: We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness. Methods: A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane's risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95\% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR's effectiveness based on different treatments, controls, and outcome measures. Results: The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95\% CI 0.36-0.9; I2=58.5\%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95\% CI 0.1-0.46; I2=0\%) and muscle strength (SMD 0.76, 95\% CI 0.32-1.2; I2=59.60\%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95\% CI 0.56-1.29; I2=45.8\%), whereas the use of personal computers (SMD 0.25, 95\% CI --0.16 to 0.66; I2=0\%) had no effect on improving balance and was comparable to conventional treatment. Conclusions: We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. Trial Registration: PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=287289 ", doi="10.2196/36028", url="https://rehab.jmir.org/2022/3/e36028", url="http://www.ncbi.nlm.nih.gov/pubmed/36048520" } @Article{info:doi/10.2196/37229, author="Tsakanikas, Vassilios and Gatsios, Dimitris and Pardalis, Athanasios and Tsiouris, M. Kostas and Georga, Eleni and Bamiou, Doris-Eva and Pavlou, Marousa and Nikitas, Christos and Kikidis, Dimitrios and Walz, Isabelle and Maurer, Christoph and Fotiadis, Dimitrios", title="Automated Assessment of Balance Rehabilitation Exercises With a Data-Driven Scoring Model: Algorithm Development and Validation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="31", volume="9", number="3", pages="e37229", keywords="balance rehabilitation exercises", keywords="scoring model", keywords="exercise evaluation", keywords="persuasive coaching system", abstract="Background: Balance rehabilitation programs represent the most common treatments for balance disorders. Nonetheless, lack of resources and lack of highly expert physiotherapists are barriers for patients to undergo individualized rehabilitation sessions. Therefore, balance rehabilitation programs are often transferred to the home environment, with a considerable risk of the patient misperforming the exercises or failing to follow the program at all. Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance involves several modules, from rehabilitation program management to augmented reality coach presentation. Objective: The aim of this study was to design, implement, test, and evaluate a scoring model for the accurate assessment of balance rehabilitation exercises, based on data-driven techniques. Methods: The data-driven scoring module is based on an extensive data set (approximately 1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. It can be used as a training and testing data set for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. In that direction, for creating the data set, 2 independent experts monitored (in the clinic) 19 patients performing 1313 balance rehabilitation exercises and scored their performance based on a predefined scoring rubric. On the collected data, preprocessing, data cleansing, and normalization techniques were applied before deploying feature selection techniques. Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. Results: The results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9\% for sitting exercises, 20.8\% for standing exercises, and 26.8\% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. Conclusions: The proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. Trial Registration: ClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829 ", doi="10.2196/37229", url="https://rehab.jmir.org/2022/3/e37229", url="http://www.ncbi.nlm.nih.gov/pubmed/36044258" } @Article{info:doi/10.2196/38689, author="Alfakir, Abdalrahman and Arrowsmith, Colin and Burns, David and Razmjou, Helen and Hardisty, Michael and Whyne, Cari", title="Detection of Low Back Physiotherapy Exercises With Inertial Sensors and Machine Learning: Algorithm Development and Validation", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="23", volume="9", number="3", pages="e38689", keywords="low back pain", keywords="rehabilitation", keywords="wearables", keywords="inertial measurement units", keywords="machine learning", keywords="activity recognition", abstract="Background: Physiotherapy is a critical element in the successful conservative management of low back pain (LBP). A gold standard for quantitatively measuring physiotherapy participation is crucial to understanding physiotherapy adherence in managing recovery from LBP. Objective: This study aimed to develop and evaluate a system with wearable inertial sensors to objectively detect the performance of unsupervised exercises for LBP comprising movement in multiple planes and sitting postures. Methods: A quantitative classification design was used within a machine learning framework to detect exercise performance and posture in a cohort of healthy participants. A set of 8 inertial sensors were placed on the participants, and data were acquired as they performed 7 McKenzie low back exercises and 3 sitting posture positions. Engineered time series features were extracted from the data and used to train 9 models by using a 6-fold cross-validation approach, from which the best 2 models were selected for further study. In addition, a convolutional neural network was trained directly on the time series data. A feature importance analysis was performed to identify sensor locations and channels that contributed the most to the models. Finally, a subset of sensor locations and channels was included in a hyperparameter grid search to identify the optimal sensor configuration and best performing algorithms for exercise and posture classification. The final models were evaluated using the F1 score in a 10-fold cross-validation approach. Results: In total, 19 healthy adults with no history of LBP each completed at least one full session of exercises and postures. Random forest and XGBoost (extreme gradient boosting) models performed the best out of the initial set of 9 engineered feature models. The optimal hardware configuration was identified as a 3-sensor setup---lower back, left thigh, and right ankle sensors with acceleration, gyroscope, and magnetometer channels. The XGBoost model achieved the highest exercise (F1 score: mean 0.94, SD 0.03) and posture (F1 score: mean 0.90, SD 0.11) classification scores. The convolutional neural network achieved similar results with the same sensor locations, using only the accelerometer and gyroscope channels for exercise classification (F1 score: mean 0.94, SD 0.02) and the accelerometer channel alone for posture classification (F1 score: mean 0.88, SD 0.07). Conclusions: This study demonstrates the potential of a 3-sensor lower body wearable solution (eg, smart pants) that can identify exercises in multiple planes and proper sitting postures, which is suitable for the treatment of LBP. This technology has the potential to improve the effectiveness of LBP rehabilitation by facilitating quantitative feedback, early problem diagnosis, and possible remote monitoring. ", doi="10.2196/38689", url="https://rehab.jmir.org/2022/3/e38689", url="http://www.ncbi.nlm.nih.gov/pubmed/35998014" } @Article{info:doi/10.2196/38101, author="Bird, Marie-Louise and Peel, Felix and Schmidt, Matt and Fini, A. Natalie and Ramage, Emily and Sakakibara, M. Brodie and Simpson, B. Dawn and Mather, Carey and Cadilhac, A. Dominique and Ahuja, K. Kiran D. and Bridgman, Heather and English, Coralie", title="Mobility-Focused Physical Outcome Measures Over Telecommunication Technology (Zoom): Intra and Interrater Reliability Trial", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="22", volume="9", number="3", pages="e38101", keywords="reliability", keywords="mobile health", keywords="telemedicine", keywords="telehealth", keywords="rehabilitation", keywords="mobility", keywords="consultation", keywords="physical function", keywords="assessment", keywords="Zoom", abstract="Background: Rehabilitation provided via telehealth offers an alternative to currently limited in-person health care. Effective rehabilitation depends on accurate and relevant assessments that reliably measure changes in function over time. The reliability of a suite of relevant assessments to measure the impact of rehabilitation on physical function is unknown. Objective: We aimed to measure the intrarater reliability of mobility-focused physical outcome measures delivered via Zoom (a commonly used telecommunication platform) and interrater reliability, comparing Zoom with in-person measures. Methods: In this reliability trial, healthy volunteers were recruited to complete 7 mobility-focused outcome measures in view of a laptop, under instructions from a remotely based researcher who undertook the remote evaluations. An in-person researcher (providing the benchmark scores) concurrently recorded their scores. Interrater and intrarater reliability were assessed for Grip Strength, Functional Reach Test, 5-Time Sit to Stand, 3- and 4-Meter Walks and Timed Up and Go, using intraclass correlation coefficients (ICC) and Bland-Altman plots. These tests were chosen because they cover a wide array of physical mobility, strength, and balance constructs; require little to no assistance from a clinician; can be performed in the limits of a home environment; and are likely to be feasible over a telehealth delivery mode. Results: A total of 30 participants (mean age 36.2, SD 12.5 years; n=19, 63\% male) completed all assessments. Interrater reliability was excellent for Grip Strength (ICC=0.99) and Functional Reach Test (ICC=0.99), good for 5-Time Sit to Stand (ICC=0.842) and 4-Meter Walk (ICC=0.76), moderate for Timed Up and Go (ICC=0.64), and poor for 3-Meter Walk (ICC=--0.46). Intrarater reliability, accessed by the remote researcher, was excellent for Grip Strength (ICC=0.91); good for Timed Up and Go, 3-Meter Walk, 4-Meter Walk, and Functional Reach (ICC=0.84-0.89); and moderate for 5-Time Sit to Stand (ICC=0.67). Although recorded simultaneously, the following time-based assessments were recorded as significantly longer via Zoom: 5-Time Sit to Stand (1.2 seconds), Timed Up and Go (1.0 seconds), and 3-Meter Walk (1.3 seconds). Conclusions: Untimed mobility-focused physical outcome measures have excellent interrater reliability between in-person and telehealth measurements. Timed outcome measures took approximately 1 second longer via Zoom, reducing the reliability of tests with a shorter duration. Small time differences favoring in-person attendance are of a similar magnitude to clinically important differences, indicating assessments undertaken using telecommunications technology (Zoom) cannot be compared directly with face-to-face delivery. This has implications for clinicians using blended (ie, some face-to-face and some via the internet) assessments. High intrarater reliability of mobility-focused physical outcome measures has been demonstrated in this study. ", doi="10.2196/38101", url="https://rehab.jmir.org/2022/3/e38101", url="http://www.ncbi.nlm.nih.gov/pubmed/35994327" } @Article{info:doi/10.2196/36836, author="Groenveld, Tjitske and Achttien, Retze and Smits, Merlijn and de Vries, Marjan and van Heerde, Ron and Staal, Bart and van Goor, Harry and ", title="Feasibility of Virtual Reality Exercises at Home for Post--COVID-19 Condition: Cohort Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="15", volume="9", number="3", pages="e36836", keywords="virtual reality", keywords="rehabilitation", keywords="COVID-19", keywords="long COVID", keywords="feasibility", keywords="physical function", keywords="quality of life", keywords="pandemic", keywords="multimodal virtual reality", keywords="outpatient care", keywords="physiotherapy", keywords="digital health", keywords="patient care", abstract="Background: Between 30\% to 76\% of COVID-19 patients have persistent physical and mental symptoms, sometimes up to 9 months after acute COVID-19. Current rehabilitation is mostly focused on the physical symptoms, whereas experts have agreed on the need for a biopsychosocial approach. A novel approach such as virtual reality (VR) rehabilitation at home might benefit patients and therapists, especially considering the expected rush of patients with post--COVID-19 condition needing rehabilitation. Objective: The aim of this study was to investigate the feasibility of self-administered VR exercises at home for post--COVID-19 condition. Methods: This was a single-arm feasibility study in an outpatient care setting. Patients who needed physiotherapy because of post--COVID-19 condition were included as determined by the treating physiotherapist. Participants performed VR physical exercises at home for a period of 6 weeks and were allowed to perform VR mental exercise through applications available on the VR platform to reduce stress and anxiety and promote cognitive functioning. The main outcomes were related to feasibility (ie, duration and frequency of VR use), safety (ie, adverse events), patient satisfaction, and reasons to withdraw. Physical performance, daily activities, cognitive functioning, anxiety and depression, and the quality of life were measured before and after. Results: In total, 48 patients were included; 1 (2\%) patient did not start VR, and 7 (15\%) patients withdrew, mostly due to dizziness. Almost 70\% (33/47) of participants reported experiencing any adverse event during VR exercising. However, only 25\% (9/36) recalled these events at the end of the intervention period. The majority (27/36, 75\%) of the patients described VR as having a positive influence on their recovery, and the global satisfaction score was 67\%. The average VR use was 30 minutes per session, 3-4 times a week for 3-6 weeks. The overall use of VR applications was almost equally distributed over the 3 sets of VR exercises (physical, relaxing, and cognitive). However, the use frequency of physical exercises seemed to decrease over time, whereas the use of cognitive and relaxation exercises remained stable. Physical performance and quality of life outcomes were significantly improved after 6 weeks. Conclusions: VR physical exercises at home is feasible and safe with good acceptance in a significant percentage of patient with post--COVID-19 condition. Trial Registration: ClinicalTrials.gov NCT04505761; https://clinicaltrials.gov/ct2/show/NCT04505761 ", doi="10.2196/36836", url="https://rehab.jmir.org/2022/3/e36836", url="http://www.ncbi.nlm.nih.gov/pubmed/35858254" } @Article{info:doi/10.2196/34821, author="Pinard, St{\'e}phanie and Bottari, Carolina and Lalibert{\'e}, Catherine and Pigot, H{\'e}l{\`e}ne and Olivares, Marisnel and Couture, M{\'e}lanie and Aboujaoud{\'e}, Aline and Giroux, Sylvain and Bier, Nathalie", title="Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study", journal="JMIR Hum Factors", year="2022", month="Aug", day="4", volume="9", number="3", pages="e34821", keywords="user-centered design", keywords="needs assessment", keywords="assistive technology", keywords="brain injury", keywords="activities of daily living", keywords="cognitive rehabilitation", keywords="meal preparation", keywords="mobile phone", abstract="Background: Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. Objective: This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users' profiles and establishing the clinical requirements of the ATC. Methods: In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. Results: The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. Conclusions: This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability. ", doi="10.2196/34821", url="https://humanfactors.jmir.org/2022/3/e34821", url="http://www.ncbi.nlm.nih.gov/pubmed/35925663" } @Article{info:doi/10.2196/35494, author="Reeve, Julie and Mooney, Sarah and Jepsen, Nicola and White, David", title="The Utility and Acceptability of a New Noninvasive Ventilatory Assist Device, Rest-Activity Cycler-Positive Airways Pressure, During Exercise in a Population of Healthy Adults: Cohort Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="1", volume="9", number="3", pages="e35494", keywords="noninvasive ventilation", keywords="exercise", keywords="feasibility", keywords="humans", keywords="COPD", keywords="physiotherapy", keywords="pulmonary rehabilitation", keywords="rehabilitation", abstract="Background: Noninvasive ventilation has been demonstrated to benefit people who have moderate to severe chronic obstructive pulmonary disease during acute exacerbations. Studies have begun to investigate the effectiveness of noninvasive ventilation during pulmonary rehabilitation to improve outcomes for people with chronic obstructive pulmonary disease; however, the lack of portability and humidification of these devices means their use is limited, especially when performing activities of daily living. A new prototype device, RACer-PAP (rest-activity cycler-positive airways pressure), delivers battery-operated positive airway pressure via a nasal interface while regulating nasal airway apportionment bias, removing the need for supplementary humidification. This device may offer people with chronic obstructive pulmonary disease an improved ability to participate in pulmonary rehabilitation and activities of daily living. Objective: To assess the feasibility of exercising with the RACer-PAP in situ and the acceptability of the device during exercise in normal, healthy individuals. Methods: A total of 15 healthy adults were invited to attend 2 exercise sessions, each 1 week apart. Sessions lasted approximately 1 hour and included 2 baseline 6-minute walk distance assessments, once with and once without the RACer-PAP in situ. Vital signs and spirometry results were monitored throughout, and spirometry was performed pre- and posttesting with RACer-PAP. Subjective questionnaires ascertained participant feedback on exercising with the device in situ. Results: Of the 15 initial participants, 14 (93\%) completed both sessions. There were no adverse events associated with exercising with the device in situ. There were no differences in vital signs or 6-minute walk distance whether exercising with or without the device in situ. There were small increases in maximum dyspnea score (on the Borg scale) when exercising with the device in situ (median score 2.0, IQR 0.5-3.0, vs 3.0, IQR 2.0-3.25). There were small increases in forced vital capacity following exercise with the RACer-PAP. None of the participants reported symptoms associated with airway drying. Participant feedback provided recommendations for modifications for the next iteration of the device prior to piloting the device with people with chronic obstructive pulmonary disease. Conclusions: This study has shown RACer-PAP to be safe and feasible to use during exercise and has provided feedback for modifications to the device to improve its use during exercise. We now propose to consider the application of the device in a small pilot feasibility study to assess the safety, feasibility, and utility of the device in a population of people with moderate to severe chronic obstructive pulmonary disease. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000478112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375477 ", doi="10.2196/35494", url="https://rehab.jmir.org/2022/3/e35494", url="http://www.ncbi.nlm.nih.gov/pubmed/35916705" } @Article{info:doi/10.2196/38704, author="Hu, Xiaolei and Jonz{\'e}n, Karolina and Lindahl, A. Olof and Karlsson, Marcus and Norstr{\"o}m, Fredrik and Lundstr{\"o}m, Erik and Sunnerhagen, Stibrant Katharina", title="Digital Graphic Follow-up Tool (Rehabkompassen) for Identifying Rehabilitation Needs Among People After Stroke: Randomized Clinical Feasibility Study", journal="JMIR Hum Factors", year="2022", month="Jul", day="29", volume="9", number="3", pages="e38704", keywords="stroke", keywords="rehabilitation", keywords="needs assessment", keywords="outcome assessment", keywords="structured follow-up: follow-up", keywords="digital tool", keywords="digital health", keywords="eHealth", keywords="feasibility", keywords="randomized controlled trial", keywords="RCT", keywords="adherence", keywords="acceptability", keywords="clinical setting", keywords="Rankin scale", keywords="outpatient", abstract="Background: Stroke is a leading cause of disability among adults, with heavy social and economic burden worldwide. A cost-effective solution is urgently needed to facilitate the identification of individual rehabilitation needs and thereby provide tailored rehabilitations to reduce disability among people who have had a stroke. A novel digital graphic follow-up tool Rehabkompassen has recently been developed to facilitate capturing the multidimensional rehabilitation needs of people who have had a stroke. Objective: The aim of this study was to evaluate the feasibility and acceptability of conducting a definitive trial to evaluate Rehabkompassen as a digital follow-up tool among people who have had a stroke in outpatient clinical settings. Methods: This pilot study of Rehabkompassen was a parallel, open-label, 2-arm prospective, proof-of-concept randomized controlled trial (RCT) with an allocation ratio of 1:1 in a single outpatient clinic. Patients who have had a stroke within the 3 previous months, aged ?18 years, and living in the community were included. The trial compared usual outpatient visits with Rehabkompassen (intervention group) and without Rehabkompassen (control group) at the 3-month follow-up as well as usual outpatient visit with Rehabkompassen at the 12-month follow-up. Information on the recruitment rate, delivery, and uptake of Rehabkompassen; assessment and outcome measures completion rates; the frequency of withdrawals; the loss of follow-up; and satisfaction scores were obtained. The key outcomes were evaluated in both groups. Results: In total, 28 patients (14 control, 14 Rehabkompassen) participated in this study, with 100 patients screened. The overall recruitment rate was 28\% (28/100). Retention in the trial was 86\% (24/28) at the 12-month follow-up. All participants used the tool as planned during their follow-ups, which provided a 100\% (24/24) task completion rate of using Rehabkompassen and suggested excellent feasibility. Both patient- and physician-participants reported satisfaction with the instrument (19/24, 79\% and 2/2, 100\%, respectively). In all, 2 (N=2, 100\%) physicians and 18 (N=24, 75\%) patients were willing to use the tool in the future. Furthermore, modified Rankin Scale as the primary outcome and various stroke impacts as secondary outcomes were both successfully collected and compared in this study. Conclusions: This study demonstrated the high feasibility and adherence of the study protocol as well as the high acceptability of Rehabkompassen among patients who have had a stroke and physicians in an outpatient setting in comparison to the predefined criterion. The information collected in this feasibility study combined with the amendments of the study protocol may improve the future definitive RCT. The results of this trial support the feasibility and acceptability of conducting a large definitive RCT. Trial Registration: ClinicalTrials.gov NCT04915027; https://clinicaltrials.gov/ct2/show/NCT04915027 ", doi="10.2196/38704", url="https://humanfactors.jmir.org/2022/3/e38704", url="http://www.ncbi.nlm.nih.gov/pubmed/35904867" } @Article{info:doi/10.2196/38509, author="Ammann-Reiffer, Corinne and Kl{\"a}y, Andrina and Keller, Urs", title="Virtual Reality as a Therapy Tool for Walking Activities in Pediatric Neurorehabilitation: Usability and User Experience Evaluation", journal="JMIR Serious Games", year="2022", month="Jul", day="14", volume="10", number="3", pages="e38509", keywords="rehabilitation", keywords="pediatric", keywords="child", keywords="adolescent", keywords="walking", keywords="feasibility study", keywords="virtual reality", keywords="head-mounted display", keywords="therapy", keywords="tool", keywords="user", keywords="usability", keywords="visual", keywords="auditory", keywords="feedback", keywords="youth", abstract="Background: Many essential walking activities in daily life, such as crossing a street, are challenging to practice in conventional therapeutic settings. Virtual environments (VEs) delivered through a virtual reality (VR) head-mounted display (HMD) would allow training such activities in a safe and attractive environment. Furthermore, the game-like character and high degree of immersion in these applications might help maintain or increase children's motivation and active participation during the rehabilitation process. Objective: This study aimed to investigate the usability, user experience, and acceptability of an immersive VE experienced through a VR HMD to train everyday life walking activities in pediatric neurorehabilitation. Methods: In a cross-sectional study, 21 youths (median age 12.1 years; range 6.8-17.7 years) with a neuromotor impairment undergoing inpatient or outpatient neurorehabilitation tested a VE experienced through the VR HMD Oculus Quest. The participants, accompanied by their physiotherapists, moved freely around a 4.4 by 10-meter VE, displaying a magical forest and featuring various gamified everyday activities in different game designs. Using their hands, represented in the VE, the participants could interact with the virtual objects placed throughout the VE and trigger visual and auditory feedback. Symptoms of cybersickness were checked, and usability, user experience, and acceptability were evaluated using customized questionnaires with a visual analog scale for youths and a 5-point Likert scale for their therapists. Results: None of the participants reported any signs of cybersickness after 20 minutes of VR HMD exposure time. They rated comfort (median 10/10) and movement ability (median 10/10) with the VR HMD as high. The VE was perceived as being really there by the majority (median 8/10), and the participants had a strong feeling of spatial presence in the VE (median 9.5/10). They enjoyed exploring the virtual world (median 10/10) and liked this new therapy approach (median 10/10). Therapists' acceptance of the VR HMD was high (4/5). There were 5 patients that needed more support than usual, mainly for supervision, when moving around with the VR HMD. Otherwise, therapists felt that the VR HMD hardly affected their patients' movement behavior (median 4.75/5), whereas it seemed to increase their level of therapy engagement (median 4/5) compared to conventional physiotherapy sessions. Conclusions: This study demonstrates the usability of an immersive VE delivered through a VR HMD to engage youths in the training of everyday walking activities.The participants' and therapists' positive ratings on user experience and acceptance further support the promising application of this technology as a future therapeutic tool in pediatric neurorehabilitation. ", doi="10.2196/38509", url="https://games.jmir.org/2022/3/e38509", url="http://www.ncbi.nlm.nih.gov/pubmed/35834316" } @Article{info:doi/10.2196/38465, author="Chang, Chien-Hsiang and Yeh, Chung-Hsing and Chang, Chien-Cheng and Lin, Yang-Cheng", title="Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study", journal="JMIR Serious Games", year="2022", month="Jul", day="14", volume="10", number="3", pages="e38465", keywords="dementia", keywords="elderly", keywords="usability", keywords="gesture recognition", keywords="card recognition rehabilitation", keywords="interactive somatosensory game", abstract="Background: In aging societies, dementia risk increases with advancing age, increasing the incidence of dementia-related degenerative diseases and other complications, especially fall risk. Dementia also escalates the care burden, impacting patients, their families, social welfare institutions, and the social structure and medical system. Objective: In elderly dementia, traditional card recognition rehabilitation (TCRR) does not effectively increase one's autonomy. Therefore, from the usability perspective, we used the Tetris game as a reference to develop an interactive somatosensory game rehabilitation (ISGR) with nostalgic style for elders with mild cognitive impairment (MCI). Through intuitive gesture-controlled interactive games, we evaluated subjective feelings concerning somatosensory game integration into rehabilitation to explore whether the ISGR could improve the willingness to use and motivation for rehabilitation among elders with MCI. Methods: A total of 15 elders with MCI (7 males and 8 females with an average age of 78.4 years) underwent 2 experiments for 15 minutes. During experiment 1, TCRR was performed, followed by completing the questionnaire of the System Usability Scale (SUS). After 3-5 minutes, the second experiment (the ISGR) was conducted, followed by completing another SUS. We used SUS to explore differences in impacts of TCRR and ISGR on willingness to use among elders with MCI. In addition, we further investigated whether the factor of gender or prior rehabilitation experience would affect the rehabilitation willingness or not. Results: The novel ISGR made the elderly feel interested and improved their willingness for continuous rehabilitation. According to the overall SUS score, the ISGR had better overall usability performance (73.7) than the TCRR (58.0) (t28=--4.62, P<.001). Furthermore, the ISGR individual item scores of ``Willingness to Use'' (t28=--8.27, P<.001), ``Easy to Use'' (t28=--3.17, P<.001), ``System Integration'' (t28=--5.07, P<.001), and ``Easy to Learn'' (t28=--2.81, P<.001) were better than TCRR. The somatosensory game was easier to learn and master for females than for males (t13=2.71, P=.02). Besides, the ISGR was easier to use (t12=--2.50, P=.02) and learn (t14=--3.33, P<.001) for those without prior rehabilitation experience. The result indicates that for elders with no rehabilitation experience ISGR was easier to use and simpler to learn than TCRR. Conclusions: Regardless of prior rehabilitation experience, the ISGR developed in this study was easy to learn and effective in continuously improving willingness to use. Furthermore, the adoption of a nostalgic game design style served the function of cognitive training and escalated interest in rehabilitation. The ISGR also improved user stickiness by introducing different game scenarios and difficulties, increasing long-term interest and motivation for rehabilitation. For future research on the adoption of interactive somatosensory games in rehabilitation, additional rehabilitation movements can be developed to benefit the elderly with MCI. ", doi="10.2196/38465", url="https://games.jmir.org/2022/3/e38465", url="http://www.ncbi.nlm.nih.gov/pubmed/35834303" } @Article{info:doi/10.2196/33755, author="Leng, Yan and Lo, Ambrose Wai Leung and Mao, Rong Yu and Bian, Ruihao and Zhao, Li Jiang and Xu, Zhiqin and Li, Le and Huang, Feng Dong", title="The Impact of Cognitive Function on Virtual Reality Intervention for Upper Extremity Rehabilitation of Patients With Subacute Stroke: Prospective Randomized Controlled Trial With 6-Month Follow-up", journal="JMIR Serious Games", year="2022", month="Jul", day="8", volume="10", number="3", pages="e33755", keywords="stroke", keywords="motor function of upper extremity", keywords="virtual reality", keywords="cognitive function", abstract="Background: Stroke is among the leading causes of long-term disability worldwide. Motor impairments after stroke not only impact the individuals quality of life but also lay substantial burdens on the society. Motor planning is a key component of cognitive function that impacts motor control. Hand movements such as grasping or reaching to grasp require the application of correct force and the coordination of multiple limb segments. Successful completion of hand motor task requires a certain degree of cognitive function to anticipate the requirement of the task. Cognitive function may thus be a confounding factor to rehabilitation outcomes. Objective: This study aims to explore the impact of cognitive function on functional outcomes in people with subacute stroke after VR intervention. Methods: Patients with stroke were first stratified into cognitively normal (CN) and cognitively impaired (CI), followed by allocation to the VR or control group (CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Barthel Index (BI), and Instrumental Activities of Daily Living (IADL) were recorded at baseline, 3 weeks after the intervention, and 3 and 6 months after the intervention. The between-group and within-group differences were assessed by repeated-measures analysis of variance (ANOVA). Results: The between-group comparison indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) scores improved significantly in both groups after the intervention. Repeated-measures ANOVA indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) were significantly different in each subgroup after the intervention. For BI score, the ANOVA results showed obvious interaction effects (treatment {\texttimes} time {\texttimes} cognitive effect, P=.04). Conclusions: VR intervention was as effective as traditional conventional therapy in improving upper limb function regardless of the cognitive functional level. Patients with stroke with impaired cognitive function may gain more improvement in upper limb function and independency in performing activities of daily living after a VR-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOC-15006064; https://tinyurl.com/4c9vkrrn ", doi="10.2196/33755", url="https://games.jmir.org/2022/3/e33755", url="http://www.ncbi.nlm.nih.gov/pubmed/35802415" } @Article{info:doi/10.2196/33745, author="Allegue, Rakia Dorra and Higgins, Johanne and Sweet, N. Shane and Archambault, S. Philippe and Michaud, Francois and Miller, William and Tousignant, Michel and Kairy, Dahlia", title="Rehabilitation of Upper Extremity by Telerehabilitation Combined With Exergames in Survivors of Chronic Stroke: Preliminary Findings From a Feasibility Clinical Trial", journal="JMIR Rehabil Assist Technol", year="2022", month="Jun", day="22", volume="9", number="2", pages="e33745", keywords="stroke", keywords="rehabilitation", keywords="virtual reality", keywords="video games", keywords="telerehabilitation", keywords="upper extremity", keywords="motivation", keywords="mHealth", keywords="mobile health", keywords="personalized care", keywords="stroke rehabilitation", abstract="Background: Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician. Objective: This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy. Methods: This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention). Results: A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9\% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50\% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60\%), hand function (5/5, 100\%), and mobility (2/5, 40\%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75\% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9\% (1/11) of participants. Conclusions: The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae. International Registered Report Identifier (IRRID): RR2-10.2196/14629 ", doi="10.2196/33745", url="https://rehab.jmir.org/2022/2/e33745", url="http://www.ncbi.nlm.nih.gov/pubmed/35731560" } @Article{info:doi/10.2196/24111, author="Chen, Jiayin and Or, Kalun Calvin and Chen, Tianrong", title="Effectiveness of Using Virtual Reality--Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials", journal="J Med Internet Res", year="2022", month="Jun", day="20", volume="24", number="6", pages="e24111", keywords="virtual reality", keywords="stroke", keywords="rehabilitation", keywords="upper extremity", keywords="meta-analysis", abstract="Background: In recent years, efforts have been made to implement virtual reality (VR) to support the delivery of poststroke upper extremity motor rehabilitation exercises. Therefore, it is important to review and analyze the existing research evidence of its effectiveness. Objective: Through a systematic review and meta-analysis of randomized controlled trials, this study examined the effectiveness of using VR-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke. Methods: This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CINAHL Plus, MEDLINE, Web of Science, Embase, and Cochrane Library databases were searched on December 31, 2021. Changes in outcomes related to impairments in upper extremity functions and structures, activity limitations, and participation restrictions in life situations from baseline to after intervention, after intervention to follow-up assessment, and baseline to follow-up assessment were examined. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were performed to determine whether the differences in treatment outcomes depended on age, stroke recovery stage, VR program type, therapy delivery format, similarities in intervention duration between study groups, intervention duration in VR groups, and trial length. Results: A total of 42 publications representing 43 trials (aggregated sample size=1893) were analyzed. Compared with the control groups that used either conventional therapy or no therapy, the intervention groups that used VR to support exercise therapy showed significant improvements in upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity; SMD 0.45, 95\% CI 0.21-0.68; P<.001), range of motion (goniometer; SMD 1.01, 95\% CI 0.50-1.52; P<.001), muscle strength (Manual Muscle Testing; SMD 0.79, 95\% CI 0.28-1.30; P=.002), and independence in day-to-day activities (Functional Independence Measure; SMD 0.23, 95\% CI 0.06-0.40; P=.01, and modified Rankin Scale; SMD 0.57, 95\% CI 0.01-1.12; P=.046). Significant subgroup differences were observed in hand dexterity (Box and Block Test), spasticity (Ashworth Scale or modified Ashworth Scale), arm and hand motor ability (Wolf Motor Function Test and Manual Function Test), hand motor ability (Jebsen Hand Function Test), and quality of life (Stroke Impact Scale). There was no evidence that the benefits of VR-supported exercise therapy were maintained after the intervention ended. Conclusions: VR-supported upper extremity exercise therapy can be effective in improving motor rehabilitation results. Our review showed that of the 12 rehabilitation outcomes examined during the course of VR-based therapy, significant improvements were detected in 2 (upper extremity motor function and range of motion), and both significant and nonsignificant improvements were observed in another 2 (muscle strength and independence in day-to-day activities), depending on the measurement tools or methods used. Trial Registration: PROSPERO CRD42021256826; https://tinyurl.com/2uarftbh ", doi="10.2196/24111", url="https://www.jmir.org/2022/6/e24111", url="http://www.ncbi.nlm.nih.gov/pubmed/35723907" } @Article{info:doi/10.2196/33489, author="Shah, Nirali and Costello, Kerry and Mehta, Akshat and Kumar, Deepak", title="Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review", journal="JMIR Rehabil Assist Technol", year="2022", month="Jun", day="8", volume="9", number="2", pages="e33489", keywords="digital health", keywords="knee osteoarthritis", keywords="knee replacement", keywords="mobile health", keywords="telemedicine", keywords="mobile phone", abstract="Background: With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR). Objective: This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR. Methods: In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included. Results: Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively. Conclusions: For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes. ", doi="10.2196/33489", url="https://rehab.jmir.org/2022/2/e33489", url="http://www.ncbi.nlm.nih.gov/pubmed/35675102" } @Article{info:doi/10.2196/33521, author="Rose, J. Michael and Costello, E. Kerry and Eigenbrot, Samantha and Torabian, Kaveh and Kumar, Deepak", title="Inertial Measurement Units and Application for Remote Health Care in Hip and Knee Osteoarthritis: Narrative Review", journal="JMIR Rehabil Assist Technol", year="2022", month="Jun", day="2", volume="9", number="2", pages="e33521", keywords="wearable technology", keywords="accelerometer", keywords="gyroscope", keywords="magnetometer", keywords="remote monitoring", keywords="biofeedback", abstract="Background: Measuring and modifying movement-related joint loading is integral to the management of lower extremity osteoarthritis (OA). Although traditional approaches rely on measurements made within the laboratory or clinical environments, inertial sensors provide an opportunity to quantify these outcomes in patients' natural environments, providing greater ecological validity and opportunities to develop large data sets of movement data for the development of OA interventions. Objective: This narrative review aimed to discuss and summarize recent developments in the use of inertial sensors for assessing movement during daily activities in individuals with hip and knee OA and to identify how this may translate to improved remote health care for this population. Methods: A literature search was performed in November 2018 and repeated in July 2019 and March 2021 using the PubMed and Embase databases for publications on inertial sensors in hip and knee OA published in English within the previous 5 years. The search terms encompassed both OA and wearable sensors. Duplicate studies, systematic reviews, conference abstracts, and study protocols were also excluded. One reviewer screened the search result titles by removing irrelevant studies, and 2 reviewers screened study abstracts to identify studies using inertial sensors as the main sensing technology and a primary outcome related to movement quality. In addition, after the March 2021 search, 2 reviewers rescreened all previously included studies to confirm their relevance to this review. Results: From the search process, 43 studies were determined to be relevant and subsequently included in this review. Inertial sensors have been successfully implemented for assessing the presence and severity of OA (n=11), assessing disease progression risk and providing feedback for gait retraining (n=7), and remotely monitoring intervention outcomes and identifying potential responders and nonresponders to interventions (n=14). In addition, studies have validated the use of inertial sensors for these applications (n=8) and analyzed the optimal sensor placement combinations and data input analysis for measuring different metrics of interest (n=3). These studies show promise for remote health care monitoring and intervention delivery in hip and knee OA, but many studies have focused on walking rather than a range of activities of daily living and have been performed in small samples (<100 participants) and in a laboratory rather than in a real-world environment. Conclusions: Inertial sensors show promise for remote monitoring, risk assessment, and intervention delivery in individuals with hip and knee OA. Future opportunities remain to validate these sensors in real-world settings across a range of activities of daily living and to optimize sensor placement and data analysis approaches. ", doi="10.2196/33521", url="https://rehab.jmir.org/2022/2/e33521", url="http://www.ncbi.nlm.nih.gov/pubmed/35653180" } @Article{info:doi/10.2196/12506, author="Ahmed, Sara and Archambault, Philippe and Auger, Claudine and Durand, Audrey and Fung, Joyce and Kehayia, Eva and Lamontagne, Anouk and Majnemer, Annette and Nadeau, Sylvie and Pineau, Joelle and Ptito, Alain and Swaine, Bonnie", title="Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for Evaluation and Rehabilitation of Mobility Across Continuums of Care", journal="JMIR Res Protoc", year="2022", month="Jun", day="1", volume="11", number="6", pages="e12506", keywords="health informatics", keywords="digital health", keywords="individualized care", keywords="acquired brain injury", keywords="community mobility", keywords="participation", keywords="physical rehabilitation", keywords="virtual reality", keywords="artificial intelligence", keywords="predictive analytics", keywords="biomedical", keywords="learning health system", abstract="Background: Rapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI). Objective: This study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative. Methods: A cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI. Results: The biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022. Conclusions: The program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community. International Registered Report Identifier (IRRID): PRR1-10.2196/12506 ", doi="10.2196/12506", url="https://www.researchprotocols.org/2022/6/e12506", url="http://www.ncbi.nlm.nih.gov/pubmed/35648455" } @Article{info:doi/10.2196/34884, author="Knobel, Johannes Samuel Elia and Kaufmann, Charlotte Brigitte and Geiser, Nora and Gerber, Moreno Stephan and M{\"u}ri, M. Ren{\'e} and Nef, Tobias and Nyffeler, Thomas and Cazzoli, Dario", title="Effects of Virtual Reality--Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study", journal="JMIR Serious Games", year="2022", month="May", day="25", volume="10", number="2", pages="e34884", keywords="virtual reality", keywords="search task", keywords="stroke", keywords="neglect, multimodal cueing", keywords="bird search task", abstract="Background: Virtual reality (VR) devices are increasingly being used in medicine and other areas for a broad spectrum of applications. One of the possible applications of VR involves the creation of an environment manipulated in a way that helps patients with disturbances in the spatial allocation of visual attention (so-called hemispatial neglect). One approach to ameliorate neglect is to apply cross-modal cues (ie, cues in sensory modalities other than the visual one, eg, auditory and tactile) to guide visual attention toward the neglected space. So far, no study has investigated the effects of audio-tactile cues in VR on the spatial deployment of visual attention in neglect patients. Objective: This pilot study aimed to investigate the feasibility and usability of multimodal (audio-tactile) cueing, as implemented in a 3D VR setting, in patients with neglect, and obtain preliminary results concerning the effects of different types of cues on visual attention allocation compared with noncued conditions. Methods: Patients were placed in a virtual environment using a head-mounted display (HMD). The inlay of the HMD was equipped to deliver tactile feedback to the forehead. The task was to find and flag appearing birds. The birds could appear at 4 different presentation angles (lateral and paracentral on the left and right sides), and with (auditory, tactile, or audio-tactile cue) or without (no cue) a spatially meaningful cue. The task usability and feasibility, and 2 simple in-task measures (performance and early orientation) were assessed in 12 right-hemispheric stroke patients with neglect (5 with and 7 without additional somatosensory impairment). Results: The new VR setup showed high usability (mean score 10.2, SD 1.85; maximum score 12) and no relevant side effects (mean score 0.833, SD 0.834; maximum score 21). A repeated measures ANOVA on task performance data, with presentation angle, cue type, and group as factors, revealed a significant main effect of cue type (F30,3=9.863; P<.001) and a significant 3-way interaction (F90,9=2.057; P=.04). Post-hoc analyses revealed that among patients without somatosensory impairment, any cue led to better performance compared with no cue, for targets on the left side, and audio-tactile cues did not seem to have additive effects. Among patients with somatosensory impairment, performance was better with both auditory and audio-tactile cueing than with no cue, at every presentation angle; conversely, tactile cueing alone had no significant effect at any presentation angle. Analysis of early orientation data showed that any type of cue triggered better orientation in both groups for lateral presentation angles, possibly reflecting an early alerting effect. Conclusions: Overall, audio-tactile cueing seems to be a promising method to guide patient attention. For instance, in the future, it could be used as an add-on method that supports attentional orientation during established therapeutic approaches. ", doi="10.2196/34884", url="https://games.jmir.org/2022/2/e34884", url="http://www.ncbi.nlm.nih.gov/pubmed/35612894" } @Article{info:doi/10.2196/23887, author="Ramezani, Ramin and Zhang, Wenhao and Roberts, Pamela and Shen, John and Elashoff, David and Xie, Zhuoer and Stanton, Annette and Eslami, Michelle and Wenger, S. Neil and Trent, Jacqueline and Petruse, Antonia and Weldon, Amelia and Ascencio, Andy and Sarrafzadeh, Majid and Naeim, Arash", title="Physical Activity Behavior of Patients at a Skilled Nursing Facility: Longitudinal Cohort Study", journal="JMIR Mhealth Uhealth", year="2022", month="May", day="23", volume="10", number="5", pages="e23887", keywords="physical medicine and rehabilitation", keywords="geriatrics", keywords="remote sensing technology", keywords="physical activity", keywords="frailty", keywords="health care delivery models", keywords="wearable sensors", keywords="indoor localization", keywords="Bluetooth low energy beacons", keywords="smartwatches", abstract="Background: On-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation. Objective: The aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients' changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility. Methods: From June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting.A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission. Results: Of the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72\%) were female and 31 (28\%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities ($\beta$=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities ($\beta$=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities ($\beta$=--.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time ($\beta$=--.13; SE 0.06; P=.04) was associated with toileting activities. Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients' progress or decline. ", doi="10.2196/23887", url="https://mhealth.jmir.org/2022/5/e23887", url="http://www.ncbi.nlm.nih.gov/pubmed/35604762" } @Article{info:doi/10.2196/25494, author="Hunter, Alex and Leckie, Todd and Coe, Oliver and Hardy, Benjamin and Fitzpatrick, Daniel and Gon{\c{c}}alves, Ana-Carolina and Standing, Mary-Kate and Koulouglioti, Christina and Richardson, Alan and Hodgson, Luke", title="Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study", journal="JMIR Rehabil Assist Technol", year="2022", month="May", day="2", volume="9", number="2", pages="e25494", keywords="COVID-19", keywords="telemedicine", keywords="rehabilitation", keywords="critical illness", keywords="smartphone", keywords="digital health", keywords="mobile health", keywords="remote therapy", keywords="device usability", abstract="Background: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site---the MDT site (n=19)---had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results: Of the 50 participants recruited, 35 (70\%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74\% (14/19) of smartwatch users uploaded smartwatch data, whereas 68\% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup's mean step count increased more than that of the control group (176\% increase vs 42\% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71\% (10/14) of smartwatch users at the MDT site and 48\% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86\% (12/14) and 48\% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post--critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID): RR2-10.12968/ijtr.2020.0102 ", doi="10.2196/25494", url="https://rehab.jmir.org/2022/2/e25494", url="http://www.ncbi.nlm.nih.gov/pubmed/35417402" } @Article{info:doi/10.2196/34819, author="Brocki, Cristina Barbara and Andreasen, Jesper Jan and Aaroe, Jens and Andreasen, Jane and Thorup, Brun Charlotte", title="Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Apr", day="26", volume="9", number="2", pages="e34819", keywords="telerehabilitation", keywords="transcatheter aortic valve implantation", keywords="cardiac surgery", keywords="cardiac rehabilitation", keywords="exercise training", keywords="older adults", keywords="tablet", abstract="Background: The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. Objective: In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. Methods: This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers' observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. Results: Of the initially included 13 patients, 5 (40\%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants' limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. Conclusions: Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60\% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients' information technology skills. ", doi="10.2196/34819", url="https://rehab.jmir.org/2022/2/e34819", url="http://www.ncbi.nlm.nih.gov/pubmed/35471263" } @Article{info:doi/10.2196/33681, author="Jones, Chelsea and Miguel Cruz, Antonio and Smith-MacDonald, Lorraine and Brown, G. Matthew R. and Vermetten, Eric and Br{\'e}mault-Phillips, Suzette", title="Technology Acceptance and Usability of a Virtual Reality Intervention for Military Members and Veterans With Posttraumatic Stress Disorder: Mixed Methods Unified Theory of Acceptance and Use of Technology Study", journal="JMIR Form Res", year="2022", month="Apr", day="21", volume="6", number="4", pages="e33681", keywords="PTSD", keywords="UTAUT", keywords="technology acceptance model", keywords="trauma", keywords="mental health", keywords="therapy", keywords="rehabilitation", keywords="digital health", keywords="psychotherapy", keywords="military", keywords="veteran", keywords="3MDR", keywords="technology acceptability", keywords="technology acceptance", keywords="Canadian Armed Forces", keywords="virtual reality", abstract="Background: Military members and veterans exhibit higher rates of injuries and illnesses such as posttraumatic stress disorder (PTSD) because of their increased exposure to combat and other traumatic scenarios. Novel treatments for PTSD are beginning to emerge and increasingly leverage advances in gaming and other technologies, such as virtual reality. Without assessing the degree of technology acceptance and perception of usability to the end users, including the military members, veterans, and their attending therapists and staff, it is difficult to determine whether a technology-based treatment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in 5 domains. Objective: Using the Unified Theory of Acceptance and Use of Technology model, the purpose of this study was to determine the technology acceptance and usability of multimodal motion-assisted memory desensitization and reconsolidation (3MDR) on a virtual reality system in the primary user group (military members and veterans with treatment-resistant PTSD, 3MDR therapists, and virtual reality environment operators). Methods: This mixed methods embedded pilot study included military members (n=3) and veterans (n=8) with a diagnosis of combat-related PTSD, as well as their therapists (n=13) and operators (n=5) who completed pre-post questionnaires before and on completion of 6 weekly sessions of 3MDR. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data from the interviews were assessed using thematic analysis. Results: Effort expectancy, which was the most notable predictor of behavioral intention, increased after a course of 3MDR with the virtual reality system, whereas all other constructs demonstrated no significant change. Participants' expectations of the technology were met, as demonstrated by the nonsignificant differences in the pre-post scores. The key qualitative themes included feasibility and function, technical support, and tailored immersion. Conclusions: 3MDR via a virtual reality environment appears to be a feasible, usable, and accepted technology for delivering 3MDR to military members and veterans who experience PTSD and 3MDR therapists and operators who facilitate their treatment. ", doi="10.2196/33681", url="https://formative.jmir.org/2022/4/e33681", url="http://www.ncbi.nlm.nih.gov/pubmed/35451971" } @Article{info:doi/10.2196/26990, author="Burdea, Grigore and Kim, Nam and Polistico, Kevin and Kadaru, Ashwin and Grampurohit, Namrata and Hundal, Jasdeep and Pollack, Simcha", title="Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports", journal="JMIR Rehabil Assist Technol", year="2022", month="Apr", day="13", volume="9", number="2", pages="e26990", keywords="subacute stroke", keywords="virtual reality", keywords="gamification", keywords="therapeutic game controller", keywords="integrative rehabilitation", keywords="BrightArm Duo", keywords="BrightArm Compact", keywords="upper extremity", keywords="cognition", keywords="depression", abstract="Background: BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. Objective: The aim of this study is to design and test a robotic rehabilitation table--based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. Methods: A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. Results: The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225\% and 100\% increase), grasp strength (27\% and 16\% increase), and pinch strength (31\% and 15\% increase). The shoulder flexion range increased by 17\% and 18\% and elbow supination range by 75\% and 58\%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). Conclusions: The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. Trial Registration: ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170 ", doi="10.2196/26990", url="https://rehab.jmir.org/2022/2/e26990", url="http://www.ncbi.nlm.nih.gov/pubmed/35416787" } @Article{info:doi/10.2196/35217, author="Lancioni, E. Giulio and Singh, N. Nirbhay and O'Reilly, Mark and Sigafoos, Jeff and Alberti, Gloria and Desideri, Lorenzo", title="Programs Using Stimulation-Regulating Technologies to Promote Physical Activity in People With Intellectual and Multiple Disabilities: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2022", month="Apr", day="7", volume="9", number="2", pages="e35217", keywords="technology", keywords="intellectual disabilities", keywords="sensory impairments", keywords="multiple disabilities", keywords="physical activity", keywords="video games", keywords="exergames", keywords="response-contingent stimulation", keywords="mobile phone", abstract="Background: People with intellectual and multiple disabilities tend to engage in very low levels of physical activity. Objective: This review paper aims to provide a comprehensive picture of intervention programs using stimulation-regulating technologies to promote forms of physical activity in people with intellectual and multiple disabilities. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, a scoping review was conducted to identify and provide a synthesis of eligible studies published in English between 2010 and 2021. Studies were identified by searching PubMed, Web of Science, PsycINFO, ERIC, and CINAHL as well as by using Google Scholar and manual searches. Studies were included if they involved individuals with intellectual or multiple disabilities, used stimulation-regulating technology systems to help participants engage in physical activity, and reported data on the impact of the intervention. Results: A total of 42 studies met the inclusion criteria. These studies were divided into 2 groups based on whether they pursued the increase in physical activity through technology-aided delivery of brief periods of preferred stimulation contingent on specific responses or the use of video games (exergames) and related auditory and visual stimulation. Subsequently, a narrative synthesis of the studies was provided. Conclusions: The evidence reported by the 2 groups of studies is encouraging. However, further research is needed to compare the overall applicability and impact of the intervention strategies proposed by these groups of studies. ", doi="10.2196/35217", url="https://rehab.jmir.org/2022/2/e35217", url="http://www.ncbi.nlm.nih.gov/pubmed/35389365" } @Article{info:doi/10.2196/26825, author="R{\"o}hling, Marie Hanna and Althoff, Patrik and Arsenova, Radina and Drebinger, Daniel and Gigengack, Norman and Chorschew, Anna and Kroneberg, Daniel and R{\"o}nnefarth, Maria and Ellermeyer, Tobias and Rosenkranz, Cath{\'e}rine Sina and Heesen, Christoph and Behnia, Behnoush and Hirano, Shigeki and Kuwabara, Satoshi and Paul, Friedemann and Brandt, Ulrich Alexander and Schmitz-H{\"u}bsch, Tanja", title="Proposal for Post Hoc Quality Control in Instrumented Motion Analysis Using Markerless Motion Capture: Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="Apr", day="1", volume="9", number="2", pages="e26825", keywords="instrumented motion analysis", keywords="markerless motion capture", keywords="visual perceptive computing", keywords="quality control", keywords="quality reporting", keywords="gait analysis", abstract="Background: Instrumented assessment of motor symptoms has emerged as a promising extension to the clinical assessment of several movement disorders. The use of mobile and inexpensive technologies such as some markerless motion capture technologies is especially promising for large-scale application but has not transitioned into clinical routine to date. A crucial step on this path is to implement standardized, clinically applicable tools that identify and control for quality concerns. Objective: The main goal of this study comprises the development of a systematic quality control (QC) procedure for data collected with markerless motion capture technology and its experimental implementation to identify specific quality concerns and thereby rate the usability of recordings. Methods: We developed a post hoc QC pipeline that was evaluated using a large set of short motor task recordings of healthy controls (2010 recordings from 162 subjects) and people with multiple sclerosis (2682 recordings from 187 subjects). For each of these recordings, 2 raters independently applied the pipeline. They provided overall usability decisions and identified technical and performance-related quality concerns, which yielded respective proportions of their occurrence as a main result. Results: The approach developed here has proven user-friendly and applicable on a large scale. Raters' decisions on recording usability were concordant in 71.5\%-92.3\% of cases, depending on the motor task. Furthermore, 39.6\%-85.1\% of recordings were concordantly rated as being of satisfactory quality whereas in 5.0\%-26.3\%, both raters agreed to discard the recording. Conclusions: We present a QC pipeline that seems feasible and useful for instant quality screening in the clinical setting. Results confirm the need of QC despite using standard test setups, testing protocols, and operator training for the employed system and by extension, for other task-based motor assessment technologies. Results of the QC process can be used to clean existing data sets, optimize quality assurance measures, as well as foster the development of automated QC approaches and therefore improve the overall reliability of kinematic data sets. ", doi="10.2196/26825", url="https://humanfactors.jmir.org/2022/2/e26825", url="http://www.ncbi.nlm.nih.gov/pubmed/35363150" } @Article{info:doi/10.2196/25224, author="{\"O}gmundsd{\'o}ttir Michelsen, Halld{\'o}ra and Sj{\"o}lin, Ingela and B{\"a}ck, Maria and Gonzalez Garcia, Manuel and Olsson, Anneli and Sandberg, Camilla and Schiopu, Alexandru and Le{\'o}sd{\'o}ttir, Margr{\'e}t", title="Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Mar", day="31", volume="24", number="3", pages="e25224", keywords="eHealth", keywords="cardiac rehabilitation", keywords="cardiovascular", keywords="mobile device app", keywords="risk factors", keywords="web-based application", keywords="mobile phone", abstract="Background: Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. Objective: This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). Methods: All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. Results: There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic ?27.7 vs ?16.4 mm?Hg; P=.006) and at 6 to 10 weeks (systolic ?25.3 vs ?16.4 mm Hg; P=.02, and diastolic ?13.4 vs ?9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64\% (14/22) versus 46\% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55\% (12/22) versus 36\% (4/11). However, the number of smokers in the study was low (33/149, 21.9\%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96\% (96/100) of patients in the intervention group and 98\% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1\% (87/101). Adherence (logging data at least twice weekly) was 91\% (79/87) in week 1 and 56\% (49/87) in week 25. Conclusions: Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation. Trial Registration: ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3118-1 ", doi="10.2196/25224", url="https://www.jmir.org/2022/3/e25224", url="http://www.ncbi.nlm.nih.gov/pubmed/35357316" } @Article{info:doi/10.2196/32027, author="Peebles, T. Alexander and van der Veen, Susanne and Stamenkovic, Alexander and France, R. Christopher and Pidcoe, E. Peter and Thomas, S. James", title="A Virtual Reality Game Suite for Graded Rehabilitation in Patients With Low Back Pain and a High Fear of Movement: Within-Subject Comparative Study", journal="JMIR Serious Games", year="2022", month="Mar", day="23", volume="10", number="1", pages="e32027", keywords="virtual reality", keywords="reaching", keywords="intervention", keywords="rehabilitation", keywords="exergaming", keywords="biomechanics", keywords="serious games", keywords="gamification", keywords="movement", keywords="physiotherapy", keywords="lumbar", abstract="Background: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality--based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. Objective: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. Methods: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. Results: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. Conclusions: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement. ", doi="10.2196/32027", url="https://games.jmir.org/2022/1/e32027", url="http://www.ncbi.nlm.nih.gov/pubmed/35319471" } @Article{info:doi/10.2196/31974, author="Sawa, Ryuichi and Saitoh, Masakazu and Morisawa, Tomoyuki and Takahashi, Tetsuya and Morimoto, Yuh and Kagiyama, Nobuyuki and Kasai, Takatoshi and Dinesen, Birthe and Daida, Hiroyuki", title="The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review", journal="JMIR Serious Games", year="2022", month="Mar", day="18", volume="10", number="1", pages="e31974", keywords="active video game", keywords="cardiac rehabilitation", keywords="physical exercise", keywords="rehabilitation", keywords="serious games", keywords="CVD", keywords="AVG", keywords="cardiovascular disease", keywords="exercise", keywords="safety", keywords="adherence", abstract="Background: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results: Among 120 nonduplicate articles reviewed, 5 (4.2\%) were eligible for inclusion, of which 3 (2.5\%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited. ", doi="10.2196/31974", url="https://games.jmir.org/2022/1/e31974", url="http://www.ncbi.nlm.nih.gov/pubmed/35302503" } @Article{info:doi/10.2196/31164, author="Gulde, Philipp and Rieckmann, Peter", title="The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="17", volume="9", number="1", pages="e31164", keywords="multiple sclerosis", keywords="actigraphy", keywords="cluster analysis", keywords="fatigue", keywords="physical activity", keywords="neurology", keywords="neurorehabilitation", keywords="rehabilitation", keywords="digital health", keywords="health technology", keywords="digital tools", abstract="Background: Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment. Objective: The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability. Methods: We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis. Results: Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants' reported levels of fatigue (d=0.99-1.28). Conclusions: Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology. ", doi="10.2196/31164", url="https://rehab.jmir.org/2022/1/e31164", url="http://www.ncbi.nlm.nih.gov/pubmed/35297774" } @Article{info:doi/10.2196/33609, author="Agnew, R. Jonathon M. and Hanratty, E. Catherine and McVeigh, G. Joseph and Nugent, Chris and Kerr, P. Daniel", title="An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="11", volume="9", number="1", pages="e33609", keywords="physiotherapy", keywords="musculoskeletal", keywords="mHealth", keywords="rehabilitation", keywords="scoping review", keywords="mobile phone", abstract="Background: Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. Objective: The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. Methods: A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. Results: Of the 1393 studies, 28 (2.01\%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18\%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50\%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. Conclusions: mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available. ", doi="10.2196/33609", url="https://rehab.jmir.org/2022/1/e33609", url="http://www.ncbi.nlm.nih.gov/pubmed/35275089" } @Article{info:doi/10.2196/28875, author="Chaplin, Emma and Barnes, Amy and Newby, Chris and Houchen-Wolloff, Linzy and Singh, J. Sally", title="Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="10", volume="9", number="1", pages="e28875", keywords="SPACE for COPD", keywords="internet", keywords="web-based", keywords="chronic obstructive pulmonary disease", keywords="pulmonary rehabilitation", keywords="physical activity", keywords="exercise", keywords="chronic disease", keywords="COPD", keywords="rehabilitation", abstract="Background: Pulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease. Objective: The objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA. Methods: Patients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ?2, ?5, ?10, and ?20 minutes. Measures were derived for patients with ?8 hours of data per day for ?4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity. Results: Baseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1\%, although this was not significant (P=.07). At baseline, age (r=--0.21, P=.04), BMI (r=--0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; \% predicted; r=--0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention. Conclusions: The analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR---the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions. Trial Registration: International Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb ", doi="10.2196/28875", url="https://rehab.jmir.org/2022/1/e28875", url="http://www.ncbi.nlm.nih.gov/pubmed/35266871" } @Article{info:doi/10.2196/34537, author="Bernaerts, Sylvie and De Witte, J. Nele A. and Van der Auwera, Vicky and Bonroy, Bert and Muraru, Luiza and Bamidis, Panagiotis and Frantzidis, Christos and Kourtidou-Papadeli, Chrysoula and Azevedo, Nancy and Garatea, Jokin and Mu{\~n}oz, Idoia and Almeida, Rosa and Losada, Raquel and Fung, Joyce and Kehayia, Eva and Lamontagne, Anouk and de Guise, Elaine and Duclos, Cyril and Higgins, Johanne and Nadeau, Sylvie and Beaudry, Lucie and Konstantinidis, Evdokimos", title="Rehabilitation Supported by Technology: Protocol for an International Cocreation and User Experience Study", journal="JMIR Res Protoc", year="2022", month="Mar", day="10", volume="11", number="3", pages="e34537", keywords="cocreation", keywords="harmonization", keywords="living lab", keywords="rehabilitation", keywords="small-scale real-life testing", keywords="technology", abstract="Background: Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. Objective: With this joint research activity, this study primarily aims to gain insight into each living lab's infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. Methods: This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. Results: Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. Conclusions: The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/34537 ", doi="10.2196/34537", url="https://www.researchprotocols.org/2022/3/e34537", url="http://www.ncbi.nlm.nih.gov/pubmed/35266874" } @Article{info:doi/10.2196/31504, author="Meyer, Amanda and Hrdlicka, Charles Henry and Cutler, Erica and Hellstrand, Jill and Meise, Emily and Rudolf, Kaitlyn and Grevelding, Pete and Nankin, Matthew", title="A Novel Body Weight--Supported Postural Perturbation Module for Gait and Balance Rehabilitation After Stroke: Preliminary Evaluation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="1", volume="9", number="1", pages="e31504", keywords="stroke rehabilitation", keywords="postural balance", keywords="gait and ambulation", keywords="balance perturbation", keywords="postural perturbation", keywords="body weight support system", keywords="occupational therapy", keywords="physical therapy", keywords="long-term acute care hospital, Berg Balance Scale", keywords="Activities-Specific Balance Confidence Scale", abstract="Background: Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective: This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods: This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results: The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95\% (SD 43.78\%) and that for the BWSS control sample (n=15) was 53.29\% (SD 24.13\%). These values were greater than those for the standard of care group (n=30; mean 28.31\%, SD 17.25\%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions: Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration: ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161 ", doi="10.2196/31504", url="https://rehab.jmir.org/2022/1/e31504", url="http://www.ncbi.nlm.nih.gov/pubmed/35080495" } @Article{info:doi/10.2196/31395, author="Bu, Xiaofan and Ng, F. Peter H. and Xu, Wenjing and Cheng, Qinqin and Chen, Q. Peter and Cheng, K. Andy S. and Liu, Xiangyu", title="The Effectiveness of Virtual Reality--Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis", journal="JMIR Serious Games", year="2022", month="Feb", day="28", volume="10", number="1", pages="e31395", keywords="virtual reality", keywords="rehabilitation management", keywords="symptom", keywords="motor function", keywords="systematic review", keywords="meta-analysis", abstract="Background: Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs. Objective: This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs. Methods: A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95\% CIs were used to calculate continuous variables. Results: Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95\% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95\% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95\% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95\% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95\% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95\% CI 0.62 to 1.29; P<.001), anxiety (MD ?6.47; 95\% CI ?7.21 to ?5.73; P<.001), depression (MD ?4.27; 95\% CI ?4.64 to ?3.91; P<.001), pain (MD ?1.32; 95\% CI ?2.56 to ?0.09; P=.04), and cognitive function (MD 8.80; 95\% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95\% CI --0.93 to 4.85; P=.18). Conclusions: Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well?designed, large, high?quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk ", doi="10.2196/31395", url="https://games.jmir.org/2022/1/e31395", url="http://www.ncbi.nlm.nih.gov/pubmed/35225817" } @Article{info:doi/10.2196/31020, author="Garc{\'i}a-Mu{\~n}oz, Cristina and Cort{\'e}s-Vega, Mar{\'i}a-Dolores and Hern{\'a}ndez-Rodr{\'i}guez, Juan-Carlos and Fern{\'a}ndez-Segu{\'i}n, M. Lourdes and Escobio-Prieto, Isabel and Casuso-Holgado, Jes{\'u}s Mar{\'i}a", title="Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report", journal="JMIR Serious Games", year="2022", month="Feb", day="16", volume="10", number="1", pages="e31020", keywords="immersive virtual reality", keywords="vestibular rehabilitation", keywords="multiple sclerosis", keywords="exergames", abstract="Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16\% in the physical health area at T2; 33.56\% in the mental health area at T2). The patient rated the usability of the system as 90\%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. ", doi="10.2196/31020", url="https://games.jmir.org/2022/1/e31020", url="http://www.ncbi.nlm.nih.gov/pubmed/34766551" } @Article{info:doi/10.2196/31349, author="Beresford, Lauren and Norwood, Todd", title="The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Feb", day="2", volume="9", number="1", pages="e31349", keywords="physical therapy", keywords="mobile apps", keywords="engagement", keywords="health care delivery", abstract="Background: Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes. Objective: Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients' engagement in their recovery. Methods: We conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain ($\Delta$Visual Analogue Scale ??1.5) and function ($\Delta$Patient Specific Functional Scale ?1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction---participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program. Results: The odds that participants (N=814) had a pain MCID increased by 13\% (odds ratio [OR] 1.13, 95\% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4\% (OR 1.04, 95\% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain ($\Delta$ Visual Analogue Scale ??3.5) were 1.85 (95\% CI 1.17-2.93; P=.01) and 2.84 times (95\% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist's message increased weekly workouts by 11\% (OR 1.11, 95\% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16\% (OR 1.16, 95\% CI 1.04-1.29; P=.01) and weeks in the program at least 8\% (OR 1.08, 95\% CI 1.01-1.14; P=.02). Access was associated with a 14\% increase (OR 1.14, 95\% CI 1.05-1.24; P=.003) in weekly workouts. Conclusions: Similar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement. ", doi="10.2196/31349", url="https://rehab.jmir.org/2022/1/e31349", url="http://www.ncbi.nlm.nih.gov/pubmed/35107436" } @Article{info:doi/10.2196/28701, author="Gagnon-Roy, Mireille and Pinard, St{\'e}phanie and Bottari, Carolina and Le Morellec, Fanny and Lalibert{\'e}, Catherine and Ben Lagha, Rym and Yaddaden, Amel and Pigot, H{\'e}l{\`e}ne and Giroux, Sylvain and Bier, Nathalie", title="Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jan", day="26", volume="9", number="1", pages="e28701", keywords="usability testing and evaluation", keywords="user experience", keywords="qualitative methods", keywords="assistive technologies", keywords="rehabilitation", keywords="patient safety", abstract="Background: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. Objective: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. Methods: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. Results: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). Conclusions: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology. ", doi="10.2196/28701", url="https://rehab.jmir.org/2022/1/e28701", url="http://www.ncbi.nlm.nih.gov/pubmed/35080496" } @Article{info:doi/10.2196/27637, author="Hoevenaars, Dirk and Yocarini, E. Iris and Paraschiakos, Stylianos and Holla, M. Jasmijn F. and de Groot, Sonja and Kraaij, Wessel and Janssen, J. Thomas W.", title="Accuracy of Heart Rate Measurement by the Fitbit Charge 2 During Wheelchair Activities in People With Spinal Cord Injury: Instrument Validation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jan", day="19", volume="9", number="1", pages="e27637", keywords="Fitbit Charge 2", keywords="heart rate", keywords="accuracy", keywords="photoplethysmography", keywords="spinal cord injury", abstract="Background: Heart rate (HR) is an important and commonly measured physiological parameter in wearables. HR is often measured at the wrist with the photoplethysmography (PPG) technique, which determines HR based on blood volume changes, and is therefore influenced by blood pressure. In individuals with spinal cord injury (SCI), blood pressure control is often altered and could therefore influence HR accuracy measured by the PPG technique. Objective: The objective of this study is to investigate the HR accuracy measured with the PPG technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with SCI, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level. Methods: The HR of participants with (38/48, 79\%) and without (10/48, 21\%) SCI was measured during 11 wheelchair activities and a 30-minute strength exercise block. In addition, a 5-minute seated rest period was measured in people with SCI. HR was measured with a Fitbit Charge 2, which was compared with the HR measured by a Polar H7 HR monitor used as a reference device. Participants were grouped into 4 groups---the no SCI group and based on lesion level into the T1 (cervical) group. Mean absolute percentage error (MAPE) and concordance correlation coefficient were determined for each group for each activity type, that is, rest, wheelchair activities, and strength exercise. Results: With an overall MAPEall lesions of 12.99\%, the accuracy fell below the standard acceptable MAPE of --10\% to +10\% with a moderate agreement (concordance correlation coefficient=0.577). The HR accuracy of Fitbit Charge 2 seems to be reduced in those with cervical lesion level in all activities (MAPEno SCI=8.09\%; MAPET1=20.43\%). The accuracy of the Fitbit Charge 2 decreased with increasing intensity in all lesions (MAPErest=6.5\%, MAPEactivity=12.97\%, and MAPEstrength=14.2\%). Conclusions: HR measured with the PPG technique showed lower accuracy in people with SCI than in those without SCI. The accuracy was just above the acceptable level in people with paraplegia, whereas in people with tetraplegia, a worse accuracy was found. The accuracy seemed to worsen with increasing intensities. Therefore, high-intensity HR data, especially in people with cervical lesions, should be used with caution. ", doi="10.2196/27637", url="https://rehab.jmir.org/2022/1/e27637", url="http://www.ncbi.nlm.nih.gov/pubmed/35044306" } @Article{info:doi/10.2196/24174, author="Rivers, T. John and Smith, Carla and Smith, Ian and Cameron, James", title="The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study", journal="JMIR Cardio", year="2022", month="Jan", day="17", volume="6", number="1", pages="e24174", keywords="cardiac rehabilitation", keywords="digital health", keywords="smartphone app", keywords="Cardihab", keywords="participation rates", keywords="rehabilitation", keywords="cardiology", keywords="heart", keywords="app", keywords="barrier", abstract="Background: Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective: We evaluated the impact on CR participation rates associated with the addition of the option of mobile app--based CR (Cardihab) for patients declining conventional CR. Methods: A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results: CR participation improved from 21\% (95\% CI 14\%-30\%) to 63\% (95\% CI 53\%-71\%) with the addition of the app (P<.001). Approximately 25\% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions: Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake. ", doi="10.2196/24174", url="https://cardio.jmir.org/2022/1/e24174", url="http://www.ncbi.nlm.nih.gov/pubmed/35037891" } @Article{info:doi/10.2196/34657, author="Ramachandran, Joann Hadassah and Jiang, Ying and Teo, Claire Jun Yi and Yeo, Joo Tee and Wang, Wenru", title="Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review", journal="J Med Internet Res", year="2022", month="Jan", day="7", volume="24", number="1", pages="e34657", keywords="technology acceptance", keywords="coronary heart disease", keywords="home-based", keywords="telerehabilitation", keywords="web-based", keywords="mobile application", keywords="acceptance", keywords="heart", keywords="rehabilitation", keywords="app", keywords="review", keywords="evaluation", keywords="cardiac", keywords="cardiology", keywords="perspective", keywords="usability", keywords="acceptability", abstract="Background: An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective: We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients' perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods: We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results: The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions: Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians. ", doi="10.2196/34657", url="https://www.jmir.org/2022/1/e34657", url="http://www.ncbi.nlm.nih.gov/pubmed/34994711" } @Article{info:doi/10.2196/29249, author="Kulkarni, Pranav and Duffy, Orla and Synnott, Jonathan and Kernohan, George W. and McNaney, Roisin", title="Speech and Language Practitioners' Experiences of Commercially Available Voice-Assisted Technology: Web-Based Survey Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jan", day="5", volume="9", number="1", pages="e29249", keywords="speech and language therapy", keywords="voice-assisted technology", keywords="professional practice", keywords="rehabilitation", keywords="speech therapy", keywords="health technology", keywords="mobile phone", abstract="Background: Speech and language therapy involves the identification, assessment, and treatment of children and adults who have difficulties with communication, eating, drinking, and swallowing. Globally, pressing needs outstrip the availability of qualified practitioners who, of necessity, focus on individuals with advanced needs. The potential of voice-assisted technology (VAT) to assist people with speech impairments is an emerging area of research but empirical work exploring its professional adoption is limited. Objective: This study aims to explore the professional experiences of speech and language therapists (SaLTs) using VAT with their clients to identify the potential applications and barriers to VAT adoption and thereby inform future directions of research. Methods: A 23-question survey was distributed to the SaLTs from the United Kingdom using a web-based platform, eliciting both checkbox and free-text responses, to questions on perceptions and any use experiences of VAT. Data were analyzed descriptively with content analysis of free text, providing context to their specific experiences of using VAT in practice, including barriers and opportunities for future use. Results: A total of 230 UK-based professionals fully completed the survey; most were technologically competent and were aware of commercial VATs (such as Alexa and Google Assistant). However, only 49 (21.3\%) SaLTs had used VAT with their clients and described 57 use cases. They reported using VAT with 10 different client groups, such as people with dysarthria and users of augmentative and alternative communication technologies. Of these, almost half (28/57, 49\%) used the technology to assist their clients with day-to-day tasks, such as web browsing, setting up reminders, sending messages, and playing music. Many respondents (21/57, 37\%) also reported using the technology to improve client speech, to facilitate speech practice at home, and to enhance articulation and volume. Most reported a positive impact of VAT use, stating improved independence (22/57, 39\%), accessibility (6/57, 10\%), and confidence (5/57, 8\%). Some respondents reported increased client communication (5/57, 9\%) and sociability (3/57, 5\%). Reasons given for not using VAT in practice included lack of opportunity (131/181, 72.4\%) and training (63/181, 34.8\%). Most respondents (154/181, 85.1\%) indicated that they would like to try VAT in the future, stating that it could have a positive impact on their clients' speech, independence, and confidence. Conclusions: VAT is used by some UK-based SaLTs to enable communication tasks at home with their clients. However, its wider adoption may be limited by a lack of professional opportunity. Looking forward, additional benefits are promised, as the data show a level of engagement, empowerment, and the possibility of achieving therapeutic outcomes in communication impairment. The disparate responses suggest that this area is ripe for the development of evidence-based clinical practice, starting with a clear definition, outcome measurement, and professional standardization. ", doi="10.2196/29249", url="https://rehab.jmir.org/2022/1/e29249", url="http://www.ncbi.nlm.nih.gov/pubmed/34989694" } @Article{info:doi/10.2196/33104, author="Sreekumar, Saranya and Janakiram, Chandrashekar and Mathew, Anil", title="Effects of Prosthetic Rehabilitation on Temporomandibular Disorders: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="24", volume="10", number="12", pages="e33104", keywords="orofacial pain", keywords="joint pain", keywords="prosthesis, edentulism", keywords="TMD", keywords="temporomandibular disorder", keywords="prosthetic rehabilitation", abstract="Background: Loss of teeth or occlusal imbalance is one of the proposed dental risk factors for temporomandibular disorders (TMDs). Losing some non--free-end teeth cause the original occluding tooth/teeth to supraerupt from the original upright position and causes neighboring tooth/teeth to shift in an angle, causing biomechanical imbalance on the mandible. Based on these sequelae, rehabilitation of missing teeth is the first step in managing TMD in edentulous patients. Even though the prevalence of TMD in association with edentulism and in rehabilitated patients has been increasing, proper guidelines for the management of such cases have not been established. This study describes the protocol to analyze the effect of prosthetic rehabilitation on patients with TMD. Objective: This study aims to determine the effectiveness of prosthetic rehabilitation in the reduction of pain in edentulous patients with TMD and to determine the effect of the span of edentulism, the number of quadrants involved, pathological migration, the type of Kennedy classification, and the prosthetic status on temporomandibular joint dysfunction signs and symptoms. Methods: In this randomized controlled trial, 300 patients diagnosed with TMD will be grouped into one of the three interventional groups based on the type of their edentulous state. The interventional groups are (1) partially edentulous arch: Kennedy Class I and II (prosthetic rehabilitation without splint); (2) partially edentulous arch: Kennedy Class III and IV (prosthetic rehabilitation with a splint); and (3) completely edentulous arches (prosthetic rehabilitation without splint). All three of the mentioned interventional groups have corresponding control groups that will receive symptomatic treatment and comprehensive counseling. The measured primary outcomes are pain and electromyogram, and the secondary outcomes include pain drawing, Graded Chronic Pain Scale, Jaw Functional Limitation Scale, Oral Behaviours Checklist, depression, physical symptoms, and anxiety. The outcome measurements will be recorded at baseline and at the end of 24 hours, 7 days, 28 days, and 3 months. Results: Ethical approval was obtained from the Institutional Review Board of Amrita Institute of Medical Sciences, Kochi, India. Study participants' recruitment began in May 2021 and is expected to conclude in March 2023. This clinical trial protocol was developed based on the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 Statement. Conclusions: The purpose of this study is to gather data on prosthetic rehabilitation as a treatment for TMD. Obtaining this goal will aid in the development of evidence-based therapy protocols for prosthetic rehabilitation in TMD management. Trial Registration: Clinical Trials Registry - India CTRI/2020/06/026169; http://ctri.nic.in/Clinicaltrials/pdf\_generate.php?trialid=42381 International Registered Report Identifier (IRRID): DERR1-10.2196/33104 ", doi="10.2196/33104", url="https://www.researchprotocols.org/2021/12/e33104", url="http://www.ncbi.nlm.nih.gov/pubmed/34951603" } @Article{info:doi/10.2196/30985, author="Vinolo Gil, Jesus Maria and Gonzalez-Medina, Gloria and Lucena-Anton, David and Perez-Cabezas, Veronica and Ruiz-Molinero, Carmen Mar{\'i}a Del and Mart{\'i}n-Valero, Roc{\'i}o", title="Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis", journal="JMIR Serious Games", year="2021", month="Dec", day="15", volume="9", number="4", pages="e30985", keywords="augmented reality", keywords="physical therapy", keywords="rehabilitation", keywords="functionality", abstract="Background: Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective: This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods: A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta?Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation. The Cochrane Collaboration tool was used to evaluate the risk of bias. Results: In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36\%) contributed information to the meta-analysis. Overall, 64\% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95\% CI ?0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change ?1.211, 95\% CI ?3.2005 to 0.7768; z=?1.194; P=.23). Conclusions: AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020180766; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=180766 ", doi="10.2196/30985", url="https://games.jmir.org/2021/4/e30985", url="http://www.ncbi.nlm.nih.gov/pubmed/34914611" } @Article{info:doi/10.2196/27186, author="O'Neil, Jennifer and Barnes, Keely and Morgan Donnelly, Erin and Sheehy, Lisa and Sveistrup, Heidi", title="Identification and Description of Balance, Mobility, and Gait Assessments Conducted via Telerehabilitation for Individuals With Neurological Conditions: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Dec", day="9", volume="10", number="12", pages="e27186", keywords="telerehabilitation", keywords="remote assessment", keywords="outcome measures", keywords="neurology", keywords="rehabilitation", abstract="Background: The COVID-19 global pandemic pushed many rehabilitation practitioners to pivot their in-person practice to adopt telerehabilitation as their main method of delivery. In addition to documenting information on interventions used with clients, it is best practice for therapists to use reliable and validated outcome measures to inform their interventions. Objective: Through this scoping review, we aim to identify (1) which outcomes are being used remotely to assess balance, mobility, and gait in patients with neurological conditions, and (2) what psychometric data (validity, reliability, etc.) for remotely administered outcomes are available. Methods: Three main concepts will be included in our search: (1) neurological conditions; (2) administration by telerehabilitation; and (3) outcome measures for balance, mobility, and gait. Studies reporting remote assessment of neurological conditions published since 1990 will be included. The database search will be completed in MEDLINE (Ovid), CINAHL, PubMed, PsycINFO, EMBASE, and Cochrane. Gray literature including dissertations, conference papers, and protocol papers will also be sourced. Two reviewers will independently screen each title and abstract using pre-established inclusion and exclusion criteria. Manuscripts that appear to meet the criteria will be subject to further review, and full-text extraction using a pre-piloted extraction sheet if all criteria are met. The data will be categorized by assessment types describing impairments (such as balance, strength, and mobility) or activity limitations or participation restriction (such as functional mobility, ambulatory functions, and activities of daily living). Results: This scoping review will document outcome measures currently used in the remote assessment of neurological conditions. To date, 235 titles and abstracts were screened. We are in the process of finalizing the full text screening for the inclusion of articles. We expect the full screening to be completed in November 2021 and data analysis in January 2022. Our results are expected to be published in early 2022. Conclusions: The optimal use of telerehabilitation as a mode to deliver rehabilitation intervention should be coupled with the completion of validated outcome measures. Therefore, it is crucial to further our knowledge on remote outcome measures and therapeutic assessments. International Registered Report Identifier (IRRID): PRR1-10.2196/27186 ", doi="10.2196/27186", url="https://www.researchprotocols.org/2021/12/e27186", url="http://www.ncbi.nlm.nih.gov/pubmed/34889765" } @Article{info:doi/10.2196/18972, author="Maier, Andr{\'e} and Eicher, Cornelia and Kiselev, Joern and Klebbe, Robert and Greu{\`e}l, Marius and Kettemann, Dagmar and Gaudlitz, Marcel and Walter, Bertram and Oleimeulen, Ursula and M{\"u}nch, Christoph and Meyer, Thomas and Spittel, Susanne", title="Acceptance of Enhanced Robotic Assistance Systems in People With Amyotrophic Lateral Sclerosis--Associated Motor Impairment: Observational Online Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Dec", day="6", volume="8", number="4", pages="e18972", keywords="amyotrophic lateral sclerosis", keywords="assistive robotics", keywords="technology commitment", keywords="robotic arm assistance", abstract="Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive paresis of the extremities and the loss of manual functioning. Due to the severe functional impairment that the disease entails, ALS requires the provision of comprehensive nursing care and a complex set of assistive technology devices. To relieve caregivers and promote autonomy of people with ALS, robotic assistance systems are being developed. This trial aims to evaluate the acceptance of technology, in general, and of robotic arm assistance among people with ALS in order to lay the groundwork for the development of a semiautomatic robotic arm that can be controlled by humans via a multimodal user interface and that will allow users to handle objects and attend to their own bodies. Objective: The aim of this study was to perform a systematic analysis of technology commitment and acceptance of robotic assistance systems from the perspective of physically limited people living with ALS. Methods: The investigation was conducted as a study of a prospective cohort. Participants were only included if they had received a medical diagnosis of ALS. Data collection took place via an online questionnaire on the Ambulanzpartner Soziotechnologie internet platform. Technological commitment was measured using the Neyer short scale. Furthermore, a multidimensional questionnaire was specially developed to analyze participant acceptance of robotic arm assistance: the Acceptance Measure of Robotic Arm Assistance (AMRAA). This questionnaire was accompanied by a video introducing the robot arm. ALS severity was ascertained using the ALS Functional Rating Scale--Extended (ALSFRS-EX). Results: A total of 268 people with ALS participated in the survey. Two-thirds of the participants were male. The overall mean ALS severity score was 42.9 (SD 11.7) points out of 60 on the ALSFRS-EX, with the most relevant restrictions on arms and legs (<60\% of normal functioning). Technological commitment ranked high, with the top third scoring 47.2 points out of 60. Younger participants and males showed significantly higher values. The AMRAA score was, again, significantly higher among younger participants. However, the gender difference within the overall cohort was not significant. The more limited the arm functioning of participants according to the ALSFRS-EX subscale, the higher the acceptance rate of robotic assistance. This relationship proved significant. Conclusions: People with ALS display high technological commitment and feel positive about using technological assistance systems. In our study, younger participants were more open to technology use, in general, and robotic assistance, in particular. Self-appraisal of technology acceptance, competence, and control conviction were generally higher among men. However, any presumed gender difference vanished when users were asked to rate the anticipated usefulness of the technology, in particular the robotic arm. The acceptance was also reflected in users' increased willingness to use a robotic arm as the functionality of their own arms decreased. From the perspective of people with ALS, robotic assistance systems are critical to promoting individual autonomy. Another key consideration in the development of future assistive technologies should be the reduction of caregiver burden. Trial Registration: German Clinical Trials Register DRKS00012803; https://tinyurl.com/w9yzduhd ", doi="10.2196/18972", url="https://rehab.jmir.org/2021/4/e18972", url="http://www.ncbi.nlm.nih.gov/pubmed/34874891" } @Article{info:doi/10.2196/31213, author="Greenstein, Jay and Topp, Robert and Etnoyer-Slaski, Jena and Staelgraeve, Michael and McNulty, John", title="Effect of a Mobile Health App on Adherence to Physical Health Treatment: Retrospective Analysis", journal="JMIR Rehabil Assist Technol", year="2021", month="Dec", day="2", volume="8", number="4", pages="e31213", keywords="adherence", keywords="self-discharge", keywords="phone app", keywords="physical therapy", keywords="chiropractor", keywords="mobile phone", abstract="Background: Adherence to prescribed medical interventions can predict the efficacy of the treatment. In physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps, have been introduced for patients to increase their adherence to attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending chiropractic and rehabilitation clinic visits. Objective: This study aims to compare adherence to prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. Methods: The medical records of new patients who presented for care during 2019 and 2020 at 5 community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and to determine whether the patient was provider-discharged or self-discharged. During this 24-month study, 36.28\% (1497/4126) of patients seen in the targeted clinics had downloaded the Kanvas app on their mobile phone, whereas the remaining patients chose not to download the app (usual care group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits, which could be redeemed as an incentive. Results: During both 2019 and 2020, the Kanvas app group was provider-discharged at a greater rate than the usual care group. The Kanvas app group kept a similar number of appointments compared with the usual care group in 2019 but kept significantly more appointments than the usual care group in 2020. During 2019, both groups exhibited a similar number of no-show appointments; however, in 2020, the Kanvas app group demonstrated more no-show appointments than the usual care group. When collapsed across years and self-discharged, the Kanvas app group had a greater number of kept appointments compared with the usual care group. When provider-discharged, both groups exhibited a similar number of kept appointments. The Kanvas app group and the usual care group were similar in the number of no-show appointments when provider-discharged, and when self-discharged, the Kanvas app group had more no-show appointments compared with the usual care group. Conclusions: Patients who did or did not have access to the Kanvas app and were provider-discharged exhibited a similar number of kept appointments and no-show appointments. When patients were self-discharged and received the Kanvas app, they exhibited 3.2 more kept appointments and 0.94 more no-show appointments than the self-discharged usual care group. ", doi="10.2196/31213", url="https://rehab.jmir.org/2021/4/e31213", url="http://www.ncbi.nlm.nih.gov/pubmed/34655468" } @Article{info:doi/10.2196/30184, author="Li, Chong and Song, Xinyu and Chen, Shugeng and Wang, Chuankai and He, Jieying and Zhang, Yongli and Xu, Shuo and Yan, Zhijie and Jia, Jie and Shull, Peter", title="Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System on Patients with Stroke: Randomized Controlled Trial", journal="JMIR Serious Games", year="2021", month="Nov", day="23", volume="9", number="4", pages="e30184", keywords="stroke", keywords="augmented reality", keywords="serious game", keywords="upper limb motor function", keywords="cognitive function", keywords="home-based rehabilitation", abstract="Background: A serious game--based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training. Objective: This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient's acceptance of the proposed system. Methods: A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients' adoption of the system in the experimental group after the final intervention. Results: All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group's FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation. Conclusions: The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz ", doi="10.2196/30184", url="https://games.jmir.org/2021/4/e30184", url="http://www.ncbi.nlm.nih.gov/pubmed/34817390" } @Article{info:doi/10.2196/33027, author="Strubbia, Carla and Levack, MM William and Grainger, Rebecca and Takahashi, Kayoko and Tomori, Kounosuke", title="Use of an iPad App (Aid for Decision-making in Occupational Choice) for Collaborative Goal Setting in Interprofessional Rehabilitation: Qualitative Descriptive Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="18", volume="8", number="4", pages="e33027", keywords="rehabilitation", keywords="goals", keywords="digital technology", keywords="mobile health", keywords="mobile phone", abstract="Background: Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective: This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods: We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results: A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients' perspective on what is possible, changing health professionals' perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions: Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings. ", doi="10.2196/33027", url="https://rehab.jmir.org/2021/4/e33027", url="http://www.ncbi.nlm.nih.gov/pubmed/34792475" } @Article{info:doi/10.2196/33481, author="Lancioni, E. Giulio and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Alberti, Gloria and Chiariello, Valeria and Campodonico, Francesca and Desideri, Lorenzo", title="Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="17", volume="8", number="4", pages="e33481", keywords="technology", keywords="smartphone", keywords="motion sensors", keywords="intellectual disability", keywords="visual impairments", keywords="occupational engagement", keywords="mobility", keywords="mobile phone", abstract="Background: Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. Objective: This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. Methods: The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. Results: During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. Conclusions: A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment. ", doi="10.2196/33481", url="https://rehab.jmir.org/2021/4/e33481", url="http://www.ncbi.nlm.nih.gov/pubmed/34787588" } @Article{info:doi/10.2196/29610, author="Oladele, Ayo Daniel and Markus, Didam Elisha and Abu-Mahfouz, M. Adnan", title="Adaptability of Assistive Mobility Devices and the Role of the Internet of Medical Things: Comprehensive Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="15", volume="8", number="4", pages="e29610", keywords="internet of medical things framework", keywords="internet of things", keywords="adaptability", keywords="multisensor fusion", keywords="mobility aids", keywords="user system interface", keywords="assistive mobility devices", keywords="mobile phone", abstract="Background: With the projected upsurge in the percentage of people with some form of disability, there has been a significant increase in the need for assistive mobility devices. However, for mobility aids to be effective, such devices should be adapted to the user's needs. This can be achieved by improving the confidence of the acquired information (interaction between the user, the environment, and the device) following design specifications. Therefore, there is a need for literature review on the adaptability of assistive mobility devices. Objective: In this study, we aim to review the adaptability of assistive mobility devices and the role of the internet of medical things in terms of the acquired information for assistive mobility devices. We review internet-enabled assistive mobility technologies and non--internet of things (IoT) assistive mobility devices. These technologies will provide awareness of the status of adaptive mobility technology and serve as a source and reference regarding information to health care professionals and researchers. Methods: We performed a literature review search on the following databases of academic references and journals: Google Scholar, ScienceDirect, Institute of Electrical and Electronics Engineers, Springer, and websites of assistive mobility and foundations presenting studies on assistive mobility found through a generic Google search (including the World Health Organization website). The following keywords were used: assistive mobility OR assistive robots, assistive mobility devices, internet-enabled assistive mobility technologies, IoT Framework OR IoT Architecture AND for Healthcare, assisted navigation OR autonomous navigation, mobility AND aids OR devices, adaptability of assistive technology, adaptive mobility devices, pattern recognition, autonomous navigational systems, human-robot interfaces, motor rehabilitation devices, perception, and ambient assisted living. Results: We identified 13,286 results (excluding titles that were not relevant to this study). Then, through a narrative review, we selected 189 potential studies (189/13,286, 1.42\%) from the existing literature on the adaptability of assistive mobility devices and IoT frameworks for assistive mobility and conducted a critical analysis. Of the 189 potential studies, 82 (43.4\%) were selected for analysis after meeting the inclusion criteria. On the basis of the type of technologies presented in the reviewed articles, we proposed a categorization of the adaptability of smart assistive mobility devices in terms of their interaction with the user (user system interface), perception techniques, and communication and sensing frameworks. Conclusions: We discussed notable limitations of the reviewed literature studies. The findings revealed that an improvement in the adaptation of assistive mobility systems would require a reduction in training time and avoidance of cognitive overload. Furthermore, sensor fusion and classification accuracy are critical for achieving real-world testing requirements. Finally, the trade-off between cost and performance should be considered in the commercialization of these devices. ", doi="10.2196/29610", url="https://rehab.jmir.org/2021/4/e29610", url="http://www.ncbi.nlm.nih.gov/pubmed/34779786" } @Article{info:doi/10.2196/24950, author="Sylcott, Brian and Lin, Chia-Cheng and Williams, Keith and Hinderaker, Mark", title="Investigating the Use of Virtual Reality Headsets for Postural Control Assessment: Instrument Validation Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="15", volume="8", number="4", pages="e24950", keywords="postural sway", keywords="virtual reality", keywords="force plate", keywords="center of pressure", abstract="Background: Accurately measuring postural sway is an important part of balance assessment and rehabilitation. Although force plates give accurate measurements, their costs and space requirements make their use impractical in many situations. Objective: The work presented in this paper aimed to address this issue by validating a virtual reality (VR) headset as a relatively low-cost alternative to force plates for postural sway measurement. The HTC Vive (HTC Corporation) VR headset has built-in sensors that allow for position and orientation tracking, making it a potentially e?ective tool for balance assessments. Methods: Participants in this study were asked to stand upright on a force plate (NeuroCom; Natus Medical Incorporated) while wearing the HTC Vive. Position data were collected from the headset and force plate simultaneously as participants experienced a custom-built VR environment that covered their entire field of view. The intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of the postural control variables, which included the normalized path length, root mean square (RMS), and peak-to-peak (P2P) value. These were computed from the VR position output data and the center of pressure (COP) data from the force plate. Linear regression was used to investigate the correlations between the VR and force plate measurements. Results: Our results showed that the test-retest reliability of the RMS and P2P value of VR headset outputs (ICC: range 0.285-0.636) was similar to that of the RMS and P2P value of COP outputs (ICC: range 0.228-0.759). The linear regression between VR and COP measures showed significant correlations in RMSs and P2P values. Conclusions: Based on our results, the VR headset has the potential to be used for postural control measurements. However, the further development of software and testing protocols for balance assessments is needed. ", doi="10.2196/24950", url="https://rehab.jmir.org/2021/4/e24950", url="http://www.ncbi.nlm.nih.gov/pubmed/34779789" } @Article{info:doi/10.2196/25831, author="Ambros-Antemate, Fernando Jorge and Beristain-Colorado, Pilar Mar{\'i}a Del and Vargas-Trevi{\~n}o, Marciano and Guti{\'e}rrez-Guti{\'e}rrez, Jaime and Hern{\'a}ndez-Cruz, Antonio Pedro and Gallegos-Velasco, Belem Itandehui and Moreno-Rodr{\'i}guez, Adriana", title="Software Engineering Frameworks Used for Serious Games Development in Physical Rehabilitation: Systematic Review", journal="JMIR Serious Games", year="2021", month="Nov", day="11", volume="9", number="4", pages="e25831", keywords="serious game", keywords="physical rehabilitation", keywords="framework", keywords="methodology", abstract="Background: Serious games are a support in the rehabilitation process for treating people with physical disabilities. However, many of these serious games are not adapted to the patient's needs because they are not developed with a software engineering framework with a set of activities, actions, and tasks that must be executed when creating a software product. Better serious games for rehabilitation will be developed if the patient and therapist requirements are identified, the development is planned, and system improvements and feedback are involved. The goal is that the serious game must offer a more attractive environment, while maintaining patient interest in the rehabilitation process. Objective: This paper submits the results of a systematic review of serious games in physical rehabilitation identifying the benefits of using a software engineering framework. Methods: A systematic research was conducted using PubMed, PEDro (Physiotherapy Evidence Database), IEEE Xplore, ScienceDirect, ACM Digital Library, Mary Ann Liebert, Taylor \& Francis Online, Wiley Online Library, and Springer databases. The initial search resulted in 701 papers. After assessing the results according to the inclusion criteria, 83 papers were selected for this study. Results: From the 83 papers reviewed, 8 used a software engineering framework for its development. Most of them focused their efforts on 1 or more aspects, such as data acquisition and processing, game levels, motivation, therapist supervision. Conclusions: This systematic review proves that most of the serious games do not use a software engineering framework for their development. As a result, development systems overlook several aspects and do not have a standardized process, eventually omitting important implementation aspects, which impact the patient's recovery time. ", doi="10.2196/25831", url="https://games.jmir.org/2021/4/e25831", url="http://www.ncbi.nlm.nih.gov/pubmed/34762052" } @Article{info:doi/10.2196/25745, author="Kaelin, C. Vera and Valizadeh, Mina and Salgado, Zurisadai and Parde, Natalie and Khetani, A. Mary", title="Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review", journal="J Med Internet Res", year="2021", month="Nov", day="4", volume="23", number="11", pages="e25745", keywords="health care", keywords="pediatric rehabilitation", keywords="technology", keywords="young persons", keywords="robotics", keywords="human-machine interaction", keywords="personalization", keywords="customization", keywords="goal-setting", keywords="natural language processing", keywords="machine learning", abstract="Background: In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. Objective: The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. Methods: We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. Results: The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77\%) and human-machine interaction (51/94, 54\%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89\%), and only 11\% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99\%). Only 1\% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1\%) described individual goal-setting as part of their therapy process or intervention planning. Conclusions: There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families. ", doi="10.2196/25745", url="https://www.jmir.org/2021/11/e25745", url="http://www.ncbi.nlm.nih.gov/pubmed/34734833" } @Article{info:doi/10.2196/26629, author="Gagnon Shaigetz, Vincent and Proulx, Catherine and Cabral, Anne and Choudhury, Nusrat and Hewko, Mark and Kohlenberg, Elicia and Segado, Melanie and Smith, D. Michael S. and Debergue, Patricia", title="An Immersive and Interactive Platform for Cognitive Assessment and Rehabilitation (bWell): Design and Iterative Development Process", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="3", volume="8", number="4", pages="e26629", keywords="virtual reality", keywords="clinical psychology", keywords="cognitive assessment", keywords="neuropsychology", keywords="mental health", keywords="cognitive rehabilitation", keywords="digital therapeutics", keywords="mobile phone", keywords="cognitive training", abstract="Background: Immersive technologies like virtual reality can enable clinical care that meaningfully aligns with real-world deficits in cognitive functioning. However, options in immersive 3D environments are limited, partly because of the unique challenges presented by the development of a clinical care platform. These challenges include selecting clinically relevant features, enabling tasks that capture the full breadth of deficits, ensuring longevity in a rapidly changing technology landscape, and performing the extensive technical and clinical validation required for digital interventions. Complicating development, is the need to integrate recommendations from domain experts at all stages. Objective: The Cognitive Health Technologies team at the National Research Council Canada aims to overcome these challenges with an iterative process for the development of bWell, a cognitive care platform providing multisensory cognitive tasks for adoption by treatment providers. Methods: The team harnessed the affordances of immersive technologies while taking an interdisciplinary research and developmental approach, obtaining active input from domain experts with iterative deliveries of the platform. The process made use of technology readiness levels, agile software development, and human-centered design to advance four main activities: identification of basic requirements and key differentiators, prototype design and foundational research to implement components, testing and validation in lab settings, and recruitment of external clinical partners. Results: bWell was implemented according to the findings from the design process. The main features of bWell include multimodal (fully, semi, or nonimmersive) and multiplatform (extended reality, mobile, and PC) implementation, configurable exercises that pair standardized assessment with adaptive and gamified variants for therapy, a therapist-facing user interface for task administration and dosing, and automated activity data logging. bWell has been designed to serve as a broadly applicable toolkit, targeting general aspects of cognition that are commonly impacted across many disorders, rather than focusing on 1 disorder or a specific cognitive domain. It comprises 8 exercises targeting different domains: states of attention (Egg), visual working memory (Theater), relaxation (Tent), inhibition and cognitive control (Mole), multitasking (Lab), self-regulation (Butterfly), sustained attention (Stroll), and visual search (Cloud). The prototype was tested and validated with healthy adults in a laboratory environment. In addition, a cognitive care network (5 sites across Canada and 1 in Japan) was established, enabling access to domain expertise and providing iterative input throughout the development process. Conclusions: Implementing an interdisciplinary and iterative approach considering technology maturity brought important considerations for the development of bWell. Altogether, this harnesses the affordances of immersive technology and design for a broad range of applications, and for use in both cognitive assessment and rehabilitation. The technology has attained a maturity level of prototype implementation with preliminary validation carried out in laboratory settings, with next steps to perform the validation required for its eventual adoption as a clinical tool. ", doi="10.2196/26629", url="https://rehab.jmir.org/2021/4/e26629", url="http://www.ncbi.nlm.nih.gov/pubmed/34730536" } @Article{info:doi/10.2196/30337, author="Bradwell, Louise Hannah and Edwards, Katie and Shenton, Deborah and Winnington, Rhona and Thill, Serge and Jones, B. Ray", title="User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="1", volume="8", number="4", pages="e30337", keywords="companion robots", keywords="social robots", keywords="Paro", keywords="older adults", keywords="dementia", keywords="care homes", keywords="engagement", keywords="acceptability", keywords="gerontology", keywords="Joy for All", keywords="social care", keywords="user-centered design", abstract="Background: Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective: In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods: We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results: Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions: This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations. ", doi="10.2196/30337", url="https://rehab.jmir.org/2021/4/e30337", url="http://www.ncbi.nlm.nih.gov/pubmed/34723825" } @Article{info:doi/10.2196/32134, author="Gaboury, Isabelle and Tousignant, Michel and Corriveau, H{\'e}l{\`e}ne and Menear, Matthew and Le Dorze, Guylaine and Rochefort, Christian and Vachon, Brigitte and Rochette, Annie and Gosselin, Sylvie and Michaud, Fran{\c{c}}ois and Bollen, Jessica and Dean, Sarah", title="Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="28", volume="10", number="10", pages="e32134", keywords="adherence", keywords="interprofessional shared decision making", keywords="rehabilitation", keywords="stroke", keywords="telerehabilitation", abstract="Background: Strong evidence supports beginning stroke rehabilitation as soon as the patient's medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients' adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. Methods: In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). Results: Our Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. Conclusions: This study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. Trial Registration: ClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215 International Registered Report Identifier (IRRID): DERR1-10.2196/32134 ", doi="10.2196/32134", url="https://www.researchprotocols.org/2021/10/e32134", url="http://www.ncbi.nlm.nih.gov/pubmed/34709196" } @Article{info:doi/10.2196/29769, author="Khaksar, Siavash and Pan, Huizhu and Borazjani, Bita and Murray, Iain and Agrawal, Himanshu and Liu, Wanquan and Elliott, Catherine and Imms, Christine and Campbell, Amity and Walmsley, Corrin", title="Application of Inertial Measurement Units and Machine Learning Classification in Cerebral Palsy: Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2021", month="Oct", day="20", volume="8", number="4", pages="e29769", keywords="inertial measurement unit", keywords="wearable sensors", keywords="biomedical sensors", keywords="machine learning", keywords="human joint measurement", keywords="occupational therapy", keywords="range of motion", keywords="wearable", keywords="sensor", keywords="children", keywords="cerebral palsy", keywords="therapy", keywords="disability", keywords="", abstract="Background: Cerebral palsy (CP) is a physical disability that affects movement and posture. Approximately 17 million people worldwide and 34,000 people in Australia are living with CP. In clinical and kinematic research, goniometers and inclinometers are the most commonly used clinical tools to measure joint angles and positions in children with CP. Objective: This paper presents collaborative research between the School of Electrical Engineering, Computing and Mathematical Sciences at Curtin University and a team of clinicians in a multicenter randomized controlled trial involving children with CP. This study aims to develop a digital solution for mass data collection using inertial measurement units (IMUs) and the application of machine learning (ML) to classify the movement features associated with CP to determine the effectiveness of therapy. The results were calculated without the need to measure Euler, quaternion, and joint measurement calculation, reducing the time required to classify the data. Methods: Custom IMUs were developed to record the usual wrist movements of participants in 2 age groups. The first age group consisted of participants approaching 3 years of age, and the second age group consisted of participants approaching 15 years of age. Both groups consisted of participants with and without CP. The IMU data were used to calculate the joint angle of the wrist movement and determine the range of motion. A total of 9 different ML algorithms were used to classify the movement features associated with CP. This classification can also confirm if the current treatment (in this case, the use of wrist extension) is effective. Results: Upon completion of the project, the wrist joint angle was successfully calculated and validated against Vicon motion capture. In addition, the CP movement was classified as a feature using ML on raw IMU data. The Random Forrest algorithm achieved the highest accuracy of 87.75\% for the age range approaching 15 years, and C4.5 decision tree achieved the highest accuracy of 89.39\% for the age range approaching 3 years. Conclusions: Anecdotal feedback from Minimising Impairment Trial researchers was positive about the potential for IMUs to contribute accurate data about active range of motion, especially in children, for whom goniometric methods are challenging. There may also be potential to use IMUs for continued monitoring of hand movements throughout the day. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001276640, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367398; ANZCTR ACTRN12614001275651, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367422 ", doi="10.2196/29769", url="https://rehab.jmir.org/2021/4/e29769", url="http://www.ncbi.nlm.nih.gov/pubmed/34668870" } @Article{info:doi/10.2196/31855, author="Giggins, M. Oonagh and Doyle, Julie and Smith, Suzanne and Moran, Orla and Gavin, Shane and Sojan, Nisanth and Boyle, Gordon", title="Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="7", volume="10", number="10", pages="e31855", keywords="cardiac rehabilitation", keywords="exercise", keywords="cardiovascular disease", keywords="virtual rehabilitation", keywords="digital health", keywords="self-management", keywords="pilot study", keywords="platform", keywords="feasibility", abstract="Background: Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective: The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering -- Cardiac Rehabilitation (ECME-CR) platform. Methods: A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results: Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. Conclusions: This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID): PRR1-10.2196/31855 ", doi="10.2196/31855", url="https://www.researchprotocols.org/2021/10/e31855", url="http://www.ncbi.nlm.nih.gov/pubmed/34617908" } @Article{info:doi/10.2196/30725, author="Itoh, Hidetaka and Amiya, Eisuke and Narita, Koichi and Shimbo, Mai and Taya, Masanobu and Komuro, Issei and Hasegawa, Takashi and Makita, Shigeru and Kimura, Yutaka", title="Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="4", volume="10", number="10", pages="e30725", keywords="cardiac rehabilitation", keywords="remote system", keywords="e-learning", keywords="exercise capacity", keywords="rehabilitation", keywords="cardiovascular disease", keywords="monitoring system", keywords="disease prevention", keywords="cardiology", abstract="Background: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration: University Hospital Medical Information Network---Clinical Trials Registry UMIN--CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID): DERR1-10.2196/30725 ", doi="10.2196/30725", url="https://www.researchprotocols.org/2021/10/e30725", url="http://www.ncbi.nlm.nih.gov/pubmed/34407925" } @Article{info:doi/10.2196/25017, author="Miguel-Cruz, Antonio and Ladurner, Anna-Maria and Kohls-Wiebe, Megan and Rawani, David", title="The Effects of 3D Immersion Technology (3Scape) on Mental Health in Outpatients From a Short-Term Assessment, Rehabilitation, and Treatment Program: Feasibility Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Sep", day="14", volume="10", number="9", pages="e25017", keywords="technology assessment", keywords="mental health", keywords="technology for rehabilitation", keywords="clinical engineering", keywords="biomedical engineering", abstract="Background: Mental health conditions are prevalent among Canadians and are a leading cause of disability. Each year, 1 in 5 Canadians experiences a mental health issue. A total of 5\% of people aged ?65 years perceive their mental health as fair or poor, and 6.3\% of them have mood disorders. Regarding older adults with cognitive impairments such as dementia, up to 40\%-50\% of them experience depression at some point. We believe that older adults can benefit significantly from information and telecommunication technologies as a strategy for improving mental health conditions such as depression and anxiety, while simultaneously improving their quality of life. 3Scape Systems Inc is an Alberta-based private company that has produced a series of specialized 3D videos designed to simulate real-life events and engage individuals living with mental health disorders and cognitive impairments such as dementia. Objective: This study aims to explore the trial design and effects of 3Scape videos on older adults' symptoms of depression and anxiety and the efficacy of this technology in improving the quality of life of patients attending the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital and to provide data to estimate the parameters required to design a definitive randomized controlled trial. Methods: The trial will use a randomized controlled design comprising 15 intervention participants and 15 control group participants. The participants will be adults aged ?65 years who are cognitively intact or have minimal cognitive impairment (ie, Montreal Cognitive Assessment score ?18), and are clients of the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital. This study's primary outcome variables are related to clients' depressive and anxiety symptoms and their quality of life. The control group will receive the standard of care (ie, the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital). The intervention group will receive the same standard of care as the control group and will use 3Scape Systems videos for therapeutic activities. Results: Our study is currently on hold because of the COVID-19 pandemic. The recruitment process is expected to resume by November 2021, and the primary impact analysis is expected to be conducted by February 2022. Conclusions: This study will provide valuable information such as the measurement of comparative intervention effects, perception of older adults and mental health therapists about the 3Scape Systems, the associated costs of treatment, and product costs. This will contribute to the evidence planning process, which will be crucial for the future adoption of 3Scape Systems. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 93685907; https://www.isrctn.com/ISRCTN93685907. International Registered Report Identifier (IRRID): PRR1-10.2196/25017 ", doi="10.2196/25017", url="https://www.researchprotocols.org/2021/9/e25017", url="http://www.ncbi.nlm.nih.gov/pubmed/34519669" } @Article{info:doi/10.2196/25356, author="Elnaggar, Abdelaziz and von Oppenfeld, Julia and Whooley, A. Mary and Merek, Stephanie and Park, G. Linda", title="Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study", journal="JMIR Hum Factors", year="2021", month="Sep", day="2", volume="8", number="3", pages="e25356", keywords="physical activity", keywords="cardiac rehabilitation", keywords="digital health", keywords="mobile app", keywords="wearable device, mHealth", keywords="mobile phone", abstract="Background: Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. Objective: This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. Methods: We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. Results: Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23\% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. Conclusions: By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults. ", doi="10.2196/25356", url="https://humanfactors.jmir.org/2021/3/e25356", url="http://www.ncbi.nlm.nih.gov/pubmed/34473064" } @Article{info:doi/10.2196/26153, author="Allegue, Rakia Dorra and Kairy, Dahlia and Higgins, Johanne and Archambault, S. Philippe and Michaud, Francois and Miller, C. William and Sweet, N. Shane and Tousignant, Michel", title="A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study", journal="JMIR Serious Games", year="2021", month="Aug", day="31", volume="9", number="3", pages="e26153", keywords="stroke", keywords="rehabilitation", keywords="virtual reality", keywords="video games", keywords="telerehabilitation", keywords="upper extremity", keywords="motivation", abstract="Background: In Canada, only 11\% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. Objective: This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. Methods: A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment--upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. Results: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. Conclusions: VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. International Registered Report Identifier (IRRID): RR2-10.2196/14629 ", doi="10.2196/26153", url="https://games.jmir.org/2021/3/e26153", url="http://www.ncbi.nlm.nih.gov/pubmed/34132649" } @Article{info:doi/10.2196/27195, author="McClincy, Michael and Seabol, G. Liliana and Riffitts, Michelle and Ruh, Ethan and Novak, E. Natalie and Wasilko, Rachel and Hamm, E. Megan and Bell, M. Kevin", title="Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach", journal="JMIR Serious Games", year="2021", month="Aug", day="27", volume="9", number="3", pages="e27195", keywords="IHT", keywords="pediatric", keywords="sports medicine", keywords="ACL", keywords="orthopaedics", keywords="rehabilitation", keywords="health technology", keywords="gamification", abstract="Background: Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements. Objective: This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods: In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post--ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70\% (7/10) were female. Most participants (7/10, 70\%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75\%-100\% in 40\% (4/10), 50\%-75\% in 40\% (4/10), and 25\%-50\% of prescribed exercises in 20\% (2/10) of the participants. Results: The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions: The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting. ", doi="10.2196/27195", url="https://games.jmir.org/2021/3/e27195", url="http://www.ncbi.nlm.nih.gov/pubmed/34448715" } @Article{info:doi/10.2196/19946, author="Ku, Shing Benny Pang and Tse, Shan Ada Wai and Pang, Hang Benny Chu and Cheung, Tseung Ngai and Pang, Wa Joanna Yuk and Chan, Yin Joyce Ka and Hui, Loi Hing and Chu, Dave and Choi, Wa Kevin Hoi", title="Tele-Rehabilitation to Combat Rehabilitation Service Disruption During COVID-19 in Hong Kong: Observational Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Aug", day="19", volume="8", number="3", pages="e19946", keywords="health information technology", keywords="mobile app", keywords="allied health", keywords="tele-rehabilitation", keywords="telehealth", keywords="rehabilitation", keywords="app", keywords="COVID-19", abstract="Background: A tele-rehabilitation platform was developed to improve access to ambulatory rehabilitation services in Hong Kong. The development was completed in October 2019 and rolled out for use to occupational therapists, physiotherapists, and speech therapists. During the COVID-19 pandemic, rehabilitation services were severely interrupted. Tele-rehabilitation was used extensively to meet the demand for rehabilitation service delivery. Objective: The aims of this study were to (1) describe the design and development process of a tele-rehabilitation service, and (2) study how the tele-rehabilitation platform was used to overcome the disruption of rehabilitation service during the COVID-19 pandemic. Methods: Tele-rehabilitation was developed utilizing 4 core determinants of Unified Theory of Acceptance and Use of Technology as guiding principles. A generic prescription platform, called the activity-based prescription system, and a mobile app, called the Rehabilitation App, were built. Five outcomes were used to examine the utilization of tele-rehabilitation both before and during the pandemic: throughput, patient demographic, patient conditions, workforce, and satisfaction from patients and staff. Results: There was a tremendous increase in the use of tele-rehabilitation during pandemic. The total number of patients (up until July 2020) was 9101, and the main age range was between 51 to 70 years old. Tele-rehabilitation was used for a much wider scope of patient conditions than originally planned. More than 1112 therapists, which constituted 50.6\% of the total workforce (1112/2196), prescribed tele-rehabilitation to their patients. Moreover, there was a high satisfaction rate from patients, with a mean rating of 4.2 out of 5, and a high adherence rate to prescribed rehabilitation activities (107840/131995, 81.7\%). Conclusions: The findings of our study suggested that tele-rehabilitation in the form of a generic prescription platform and mobile app can be an effective means to provide rehabilitation to patient. During the COVID-19 pandemic, tele-rehabilitation has been used extensively and effectively to mitigate service disruption. Our findings also provide support that there is a high level of satisfaction with tele-rehabilitation; however, a longer duration study is required to demonstrate the sustained use of tele-rehabilitation, especially after the pandemic. ", doi="10.2196/19946", url="https://rehab.jmir.org/2021/3/e19946", url="http://www.ncbi.nlm.nih.gov/pubmed/34254945" } @Article{info:doi/10.2196/31183, author="Moussavi, Zahra and Koski, Lisa and Fitzgerald, B. Paul and Millikin, Colleen and Lithgow, Brian and Jafari-Jozani, Mohammad and Wang, Xikui", title="Repeated Transcranial Magnetic Stimulation for Improving Cognition in Alzheimer Disease: Protocol for an Interim Analysis of a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Aug", day="9", volume="10", number="8", pages="e31183", keywords="interim analysis, treatment efficacy, repetitive transcranial magnetic stimulation", keywords="Alzheimer disease", keywords="double blind", keywords="treatment", keywords="placebo controlled", keywords="randomized", abstract="Background: Many clinical trials investigating treatment efficacy require an interim analysis. Recently we have been running a large, multisite, randomized, placebo-controlled, double-blind clinical trial investigating the effect of repetitive transcranial magnetic stimulation (rTMS) treatment for improving or stabilizing the cognition of patients diagnosed with Alzheimer disease. Objective: The objectives of this paper are to report on recruitment, adherence, and adverse events (AEs) to date, and to describe in detail the protocol for interim analysis of the clinical trial data. The protocol will investigate whether the trial is likely to reach its objectives if continued to the planned maximum sample size. Methods: The specific requirements of the analytic protocol are to (1) ensure the double-blind nature of the data while doing the analysis, (2) estimate the predictive probabilities of success (PPoSs), (3) estimate the numbers needed to treat, (4) re-estimate the initial required sample size. The initial estimate of sample size was 208. The interim analysis will be based on 150 patients who will be enrolled in the study and finish at least 8 weeks of the study. Our protocol for interim analysis, at the very first stage, is to determine the response rate for each participant to the treatment (either sham or active), while ensuring the double-blind nature of the data. The blinded data will be analyzed by a statistician to investigate the treatment efficacy. We will use Bayesian PPoS to predict the success rate and determine whether the study should continue. Results: The enrollment has been slowed significantly due to the COVID-19 pandemic and lockdown. Nevertheless, so far 133 participants have been enrolled, while 22 of these have been withdrawn or dropped out for various reasons. In general, rTMS has been found tolerable with no serious AE. Only 2 patients dropped out of the study due to their intolerability to rTMS pulses. Conclusions: Overall, the study with the same protocol is going as expected with no serious AE or any major protocol deviation. Trial Registration: ClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815 International Registered Report Identifier (IRRID): DERR1-10.2196/31183 ", doi="10.2196/31183", url="https://www.researchprotocols.org/2021/8/e31183", url="http://www.ncbi.nlm.nih.gov/pubmed/34383681" } @Article{info:doi/10.2196/26344, author="Brassel, Sophie and Power, Emma and Campbell, Andrew and Brunner, Melissa and Togher, Leanne", title="Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review", journal="J Med Internet Res", year="2021", month="Jul", day="30", volume="23", number="7", pages="e26344", keywords="virtual reality", keywords="acquired brain injury", keywords="traumatic brain injury", keywords="rehabilitation", keywords="systematic review", keywords="recommendations", keywords="cognitive communication", keywords="mobile phone", abstract="Background: Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective: This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods: This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results: In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions: There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area. ", doi="10.2196/26344", url="https://www.jmir.org/2021/7/e26344", url="http://www.ncbi.nlm.nih.gov/pubmed/34328434" } @Article{info:doi/10.2196/18130, author="Ding, Y. Eric and Erskine, Nathaniel and Stut, Wim and McManus, D. David and Peterson, Amy and Wang, Ziyue and Escobar Valle, Jorge and Albuquerque, Daniella and Alonso, Alvaro and Botkin, F. Naomi and Pack, R. Quinn", title="MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study", journal="JMIR Hum Factors", year="2021", month="Jul", day="8", volume="8", number="3", pages="e18130", keywords="cardiac rehabilitation", keywords="telerehabilitation", keywords="health watch", keywords="mHealth", keywords="exercise", abstract="Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch--informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33\%) were women, and 6 (33\%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86\% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch--based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. ", doi="10.2196/18130", url="https://humanfactors.jmir.org/2021/3/e18130", url="http://www.ncbi.nlm.nih.gov/pubmed/34255660" } @Article{info:doi/10.2196/30621, author="Kim, S. Esther and Laird, Laura and Wilson, Carlee and Bieg, Till and Mildner, Philip and M{\"o}ller, Sebastian and Schatz, Raimund and Schwarz, Stephanie and Spang, Robert and Voigt-Antons, Jan-Niklas and Rochon, Elizabeth", title="Implementation and Effects of an Information Technology--Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="2", volume="10", number="7", pages="e30621", keywords="aphasia", keywords="rehabilitation", keywords="speech-language pathology", keywords="app-based therapy", keywords="user-centered design", keywords="mHealth", keywords="adaptive software", abstract="Background: Mobile app--based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. Objective: VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods: A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. Results: Recruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. Conclusions: The results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. Trial Registration: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364 International Registered Report Identifier (IRRID): DERR1-10.2196/30621 ", doi="10.2196/30621", url="https://www.researchprotocols.org/2021/7/e30621", url="http://www.ncbi.nlm.nih.gov/pubmed/34255727" } @Article{info:doi/10.2196/20299, author="Hakala, Sanna and Kivist{\"o}, Heikki and Paajanen, Teemu and Kankainen, Annaliisa and Anttila, Marjo-Riitta and Heinonen, Ari and Sj{\"o}gren, Tuulikki", title="Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Jun", day="18", volume="8", number="2", pages="e20299", keywords="cardiac rehabilitation", keywords="rehabilitation", keywords="cardiovascular diseases", keywords="technology", keywords="exercise", keywords="randomized controlled trial", keywords="clinical trial", abstract="Background: Physical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. Objective: The aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology--based treatment in 12 months of cardiac rehabilitation. Methods: The cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. Results: During the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95\% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95\% CI --90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95\% CI --585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD --87.9 minutes per week, 95\% CI --379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95\% CI --75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95\% CI --2099.6 to 3833.9; P=.55). Conclusions: The use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods. Trial Registration: ISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589 ", doi="10.2196/20299", url="https://rehab.jmir.org/2021/2/e20299", url="http://www.ncbi.nlm.nih.gov/pubmed/34142970" } @Article{info:doi/10.2196/12029, author="Rennick-Egglestone, Stefan and Mawson, Sue", title="Homes of Stroke Survivors Are a Challenging Environment for Rehabilitation Technologies", journal="JMIR Rehabil Assist Technol", year="2021", month="Jun", day="17", volume="8", number="2", pages="e12029", keywords="domestic rehabilitation technology", keywords="brain injury", keywords="stroke", keywords="research through design", doi="10.2196/12029", url="https://rehab.jmir.org/2021/2/e12029", url="http://www.ncbi.nlm.nih.gov/pubmed/34137728" } @Article{info:doi/10.2196/28020, author="Herbuela, Marquez Von Ralph Dane and Karita, Tomonori and Furukawa, Yoshiya and Wada, Yoshinori and Yagi, Yoshihiro and Senba, Shuichiro and Onishi, Eiko and Saeki, Tatsuo", title="Integrating Behavior of Children with Profound Intellectual, Multiple, or Severe Motor Disabilities With Location and Environment Data Sensors for Independent Communication and Mobility: App Development and Pilot Testing", journal="JMIR Rehabil Assist Technol", year="2021", month="Jun", day="7", volume="8", number="2", pages="e28020", keywords="profound intellectual and multiple disabilities", keywords="severe motor and intellectual disabilities", keywords="mobile app development", keywords="augmentative and alternative communication", keywords="AAC", keywords="smartphone-based data collection", keywords="behavior", keywords="child", keywords="sensor", keywords="communication", keywords="mobility", keywords="development", keywords="pilot", keywords="app", abstract="Background: Children with profound intellectual and multiple disabilities (PIMD) or severe motor and intellectual disabilities (SMID) only communicate through movements, vocalizations, body postures, muscle tensions, or facial expressions on a pre- or protosymbolic level. Yet, to the best of our knowledge, there are few systems developed to specifically aid in categorizing and interpreting behaviors of children with PIMD or SMID to facilitate independent communication and mobility. Further, environmental data such as weather variables were found to have associations with human affects and behaviors among typically developing children; however, studies involving children with neurological functioning impairments that affect communication or those who have physical and/or motor disabilities are unexpectedly scarce. Objective: This paper describes the design and development of the ChildSIDE app, which collects and transmits data associated with children's behaviors, and linked location and environment information collected from data sources (GPS, iBeacon device, ALPS Sensor, and OpenWeatherMap application programming interface [API]) to the database. The aims of this study were to measure and compare the server/API performance of the app in detecting and transmitting environment data from the data sources to the database, and to categorize the movements associated with each behavior data as the basis for future development and analyses. Methods: This study utilized a cross-sectional observational design by performing multiple single-subject face-to-face and video-recorded sessions among purposively sampled child-caregiver dyads (children diagnosed with PIMD/SMID, or severe or profound intellectual disability and their primary caregivers) from September 2019 to February 2020. To measure the server/API performance of the app in detecting and transmitting data from data sources to the database, frequency distribution and percentages of 31 location and environment data parameters were computed and compared. To categorize which body parts or movements were involved in each behavior, the interrater agreement $\kappa$ statistic was used. Results: The study comprised 150 sessions involving 20 child-caregiver dyads. The app collected 371 individual behavior data, 327 of which had associated location and environment data from data collection sources. The analyses revealed that ChildSIDE had a server/API performance >93\% in detecting and transmitting outdoor location (GPS) and environment data (ALPS sensors, OpenWeatherMap API), whereas the performance with iBeacon data was lower (82.3\%). Behaviors were manifested mainly through hand (22.8\%) and body movements (27.7\%), and vocalizations (21.6\%). Conclusions: The ChildSIDE app is an effective tool in collecting the behavior data of children with PIMD/SMID. The app showed high server/API performance in detecting outdoor location and environment data from sensors and an online API to the database with a performance rate above 93\%. The results of the analysis and categorization of behaviors suggest a need for a system that uses motion capture and trajectory analyses for developing machine- or deep-learning algorithms to predict the needs of children with PIMD/SMID in the future. ", doi="10.2196/28020", url="https://rehab.jmir.org/2021/2/e28020", url="http://www.ncbi.nlm.nih.gov/pubmed/34096878" } @Article{info:doi/10.2196/25996, author="Malik, Raza Ahmed and Boger, Jennifer", title="Zero-Effort Ambient Heart Rate Monitoring Using Ballistocardiography Detected Through a Seat Cushion: Prototype Development and Preliminary Study", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="31", volume="8", number="2", pages="e25996", keywords="ballistocardiography", keywords="heart rate", keywords="ambient health monitoring", keywords="zero-effort technology", keywords="continuous wavelet transform", abstract="Background: Cardiovascular diseases are a leading cause of death worldwide and result in significant economic costs to health care systems. The prevalence of cardiovascular conditions that require monitoring is expected to increase as the average age of the global population continues to rise. Although an accurate cardiac assessment can be performed at medical centers, frequent visits for assessment are not feasible for most people, especially those with limited mobility. Monitoring of vital signs at home is becoming an increasingly desirable, accessible, and practical alternative. As wearable devices are not the ideal solution for everyone, it is necessary to develop parallel and complementary approaches. Objective: This research aims to develop a zero-effort, unobtrusive, cost-effective, and portable option for home-based ambient heart rate monitoring. Methods: The prototype seat cushion uses load cells to acquire a user's ballistocardiogram (BCG). The analog signal from the load cells is amplified and filtered by a signal-conditioning circuit before being digitally recorded. A pilot study with 20 participants was conducted to analyze the prototype's ability to capture the BCG during five real-world tasks: sitting still, watching a video on a computer screen, reading, using a computer, and having a conversation. A novel algorithm based on the continuous wavelet transform was developed to extract the heart rate by detecting the largest amplitude values (J-peaks) in the BCG signal. Results: The pilot study data showed that the BCG signals from all five tasks had sufficiently large portions to extract heart rate. The continuous wavelet transform--based algorithm for J-peak detection demonstrated an overall accuracy of 91.4\% compared with electrocardiography. Excluding three outliers that had significantly noisy BCG data, the algorithm achieved 94.6\% accuracy, which was aligned with that of wearable devices. Conclusions: This study suggests that BCG acquired through a seat cushion is a viable alternative to wearable technologies. The prototype seat cushion presented in this study is an example of a relatively accessible, affordable, portable, and unobtrusive zero-effort approach to achieve frequent home-based ambient heart rate monitoring. ", doi="10.2196/25996", url="https://rehab.jmir.org/2021/2/e25996", url="http://www.ncbi.nlm.nih.gov/pubmed/34057420" } @Article{info:doi/10.2196/24337, author="Kanitkar, Anuprita and Parmar, Tejraj Sanjay and Szturm, J. Tony and Restall, Gayle and Rempel, Gina and Sepehri, Nariman", title="Parents' Perspectives on a Computer Game--Assisted Rehabilitation Program for Manual Dexterity in Children With Cerebral Palsy: Qualitative Analysis of Expectations, Child Engagement, and Benefits", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="31", volume="8", number="2", pages="e24337", keywords="cerebral palsy", keywords="parents' expectations", keywords="fine motor function", keywords="object manipulation", keywords="computer game--based treatment protocol", keywords="parents", keywords="motor function", keywords="computer games, rehabilitation", keywords="game-based rehabilitation", keywords="gross movement", keywords="children", abstract="Background: Children with motor impairments affecting the upper extremity benefit from task-specific therapy, such as constraint-induced movement therapy. However, there is a need to improve engagement and compliance with task-specific exercise programs that target manual dexterity for children with cerebral palsy (CP). A computer game--based rehabilitation (GRP) platform was developed that combines fine manipulation and gross movement exercises with engaging game activities appropriate for young children with CP. Objective: The objectives of this qualitative analysis were to compare parents' perspectives and opinions about expectations, challenges, and benefits between 2 interventions. Methods: A mixed methods, randomized controlled trial (RCT) was conducted to examine the feasibility and estimate the effect size of 2 exercise programs for rehabilitation of manual dexterity of children with CP using either GRP or conventional therapy. Parents of 26 of the children who completed the GRP program (n=33) and parents of 15 of the children who completed the conventional therapy program (n=27) participated in the interviews. A general conductive approach was used to analyze the data recorded during the parents' interviews. Results: Five themes captured the range of the parent's experiences, viewpoints, and ideas: (1) parents' expectations, (2) child's engagement with therapy, (3) positive effects of the interventions, (4) challenges, and (5) improving the protocol. Conclusions: Parents from both groups recognized that their expectations related to improving children's object handling and manipulation skills including participation in activities of daily life were addressed during the 16-week therapy program. Parents perceived a change in the children's level of independence in their daily tasks at home, school, and leisure activities. Trial Registration: ClinicalTrials.gov NCT02728375; https://clinicaltrials.gov/ct2/show/NCT02728375 ", doi="10.2196/24337", url="https://rehab.jmir.org/2021/2/e24337", url="http://www.ncbi.nlm.nih.gov/pubmed/34057424" } @Article{info:doi/10.2196/28210, author="Lai, Byron and Powell, Maegen and Clement, Grace Anne and Davis, Drew and Swanson-Kimani, Erin and Hayes, Leslie", title="Examining the Feasibility of Early Mobilization With Virtual Reality Gaming Using Head-Mounted Display and Adaptive Software With Adolescents in the Pediatric Intensive Care Unit: Case Report", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="27", volume="8", number="2", pages="e28210", keywords="physical activity", keywords="active video gaming", keywords="exergaming", keywords="early mobility", keywords="rehabilitation", abstract="Background: Early rehabilitative mobilization for adolescents is safe and feasible. However, there is a lack of published rehabilitation strategies and treatments that can maximize engagement and outcomes among adolescents in the pediatric intensive care unit (PICU). Virtual reality (VR) gaming using a head-mounted display (HMD) and adaptive software can allow active and nonactive gameplay at the bedside for people with limited arm mobility, making it a potentially inclusive and enjoyable treatment modality for adolescents in the PICU. Objective: The purpose of this brief case study is to report on the preliminary feasibility of incorporating adaptive VR gaming using an HMD with 2 adolescents who received early mobility treatment within the PICU. Methods: This study was a mini-ethnographic investigation of 2 adolescents (a 15-year-old male and a 13-year old male) in the PICU who underwent VR gaming sessions as part of their early mobilization care, using an Oculus Rift HMD and adaptive software (WalkinVR) that promoted full gameplay in bed. The Rift was plugged into a gaming laptop that was set up on a table within the patient's room before each session. The intervention was delivered by an adapted exercise professional and supervised by a physical therapist. Patients had access to a variety of active games (eg, boxing, rhythmic movement to music, and exploratory adventure) and nonactive games (eg, racing and narrative adventure). Gaming sessions were scheduled between usual care, when tolerable and requested by the participant. The interventionist and therapists took audio-recorded and written notes after completing each gaming session. These data were analyzed and presented in a narrative format from the perspective of the research team. Results: Case 1 participated in 4 gaming sessions, with an average of 18 minutes (SD 11) per session. Case 2 participated in 2 sessions, with an average of 35 minutes (SD 7) per session. Both cases were capable of performing active gaming at a moderate level of exercise intensity, as indicated by their heart rate. However, their health and symptoms fluctuated on a daily basis, which prompted the gameplay of adventure or nonactive games. Gameplay appeared to improve participants' affect and alertness and motivate them to be more engaged in early mobilization therapy. Gameplay without the WalkinVR software caused several usability issues. There were no serious adverse events, but both cases experienced symptoms based on their condition. Conclusions: The findings of this study suggest that VR gaming with HMDs and adaptive software is likely a feasible supplement to usual care for adolescents within the PICU, and these findings warrant further investigation. Recommendations for future studies aimed at incorporating VR gaming during early mobilization are presented herein. ", doi="10.2196/28210", url="https://rehab.jmir.org/2021/2/e28210", url="http://www.ncbi.nlm.nih.gov/pubmed/34042602" } @Article{info:doi/10.2196/22145, author="Miguel-Cruz Sr, Antonio and Guptill, Christine and Gregson, Geoffrey and Ladurner, Anna-Maria and Holmes, Cindy and Yeung, Daniel and Siebert, Justine and Dziwenko, Gwen and R{\'i}os Rinc{\'o}n, Adriana", title="Determining the Effectiveness of a New Device for Hand Therapy (The FEPSim Device): Feasibility Protocol for a Randomized Controlled Trial Study", journal="JMIR Res Protoc", year="2021", month="May", day="27", volume="10", number="5", pages="e22145", keywords="technology assessment", keywords="hand therapy", keywords="technology for rehabilitation", keywords="clinical engineering", keywords="biomedical engineering", abstract="Background: Impairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted. Objective: This study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device. Methods: The trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age?18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study's primary outcome variables are related to patients' range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients' perceived wrist pain and disability in activities of daily living. The patients' perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10). Results: The FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020. Conclusions: This study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim. Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 International Registered Report Identifier (IRRID): PRR1-10.2196/22145 ", doi="10.2196/22145", url="https://www.researchprotocols.org/2021/5/e22145", url="http://www.ncbi.nlm.nih.gov/pubmed/34042597" } @Article{info:doi/10.2196/24669, author="Guay, Manon and Labb{\'e}, Mathieu and S{\'e}guin-Tremblay, No{\'e}mie and Auger, Claudine and Goyer, Genevi{\`e}ve and Veloza, Emily and Chevalier, Natalie and Polgar, Jan and Michaud, Fran{\c{c}}ois", title="Adapting a Person's Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App's Acceptability", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="11", volume="8", number="2", pages="e24669", keywords="occupational therapy", keywords="mobile phone", keywords="aging", keywords="disability", keywords="telehealth", keywords="3D visualization", keywords="universal design", keywords="built environment", keywords="camera", keywords="remote assessment", keywords="assistive technology", abstract="Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT's work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT's work when conducting assessments in which home representations are essential to fit a person's needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology's co-design over a span of 4 years. Fueled by the objective to enhance MapIt's acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders' perception was favorable regarding MapIt's acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person's occupational engagement. ", doi="10.2196/24669", url="https://rehab.jmir.org/2021/2/e24669", url="http://www.ncbi.nlm.nih.gov/pubmed/33973867" } @Article{info:doi/10.2196/21924, author="Hendrickx, Roel and van der Avoird, Tim and Pilot, Peter and Kerkhoffs, Gino and Schotanus, Martijn", title="Exergaming as a Functional Test Battery in Patients Who Received Arthroscopic Ankle Arthrodesis: Cross-sectional Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="5", volume="8", number="2", pages="e21924", keywords="arthroscopic ankle arthrodesis", keywords="exergaming", keywords="functional test battery", keywords="exergames", keywords="serious games", keywords="ankle", keywords="function", keywords="game", keywords="exercise", keywords="physical activity", keywords="rehabilitation", keywords="gait", keywords="quality of care", abstract="Background: Recently, movement-based videogames (exergames) have gained popularity in improving the rehabilitation process after surgery. During exergaming, participants are physically challenged as the game component stimulates adherence to the training program. There is no literature on the effect of exergame training interventions in patients who received arthroscopic ankle arthrodesis. Objective: This pilot study assessed the potency of an existing exergaming tool for the rehabilitation program of patients who received arthroscopic ankle arthrodesis. Methods: A cross-sectional pilot study was performed, in which patients who received arthroscopic ankle arthrodesis (n=8) were subjected to an exergaming protocol. Gait analysis was performed with a treadmill system. A healthy age-matched control group (n=10) was used as the control group. Results: The patient group was capable of performing exergaming exercises and they showed no floor or ceiling effect. Only in case of the overall stability, the patient group performed significantly less better than the control group (P=.03). Gait analysis showed equal step length with increased external rotation of the affected limb. Conclusions: Exergaming seems to be a valuable tool for measuring the ability of patients who received AAA to perform activities of daily living and it has the potential to individualize rehabilitation programs. When exergaming is systematically integrated with patient-reported outcome measures and activity tracking, it has the potential to improve the quality of care. ", doi="10.2196/21924", url="https://rehab.jmir.org/2021/2/e21924", url="http://www.ncbi.nlm.nih.gov/pubmed/33949311" } @Article{info:doi/10.2196/27640, author="Chau, Hing Pui and Kwok, Jojo Yan Yan and Chan, Maggie Mee Kie and Kwan, Daniel Ka Yu and Wong, Lun Kam and Tang, Ho Ying and Chau, Peter Kan Lung and Lau, Matthew Sheung Wa and Yiu, Yannex Yan Yan and Kwong, Fanny Mei Yan and Lai, Thomas Wai Ting and Leung, Kit Mun", title="Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study", journal="J Med Internet Res", year="2021", month="May", day="4", volume="23", number="5", pages="e27640", keywords="virtual reality", keywords="rehabilitation", keywords="older adults, people with disabilities", keywords="evaluation", abstract="Background: Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. Objective: This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. Methods: A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. Results: A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9\%) completed at least one follow-up. Additionally, 76.3\% (103/135) of the participants could attend at least 70\% of the proposed 18 sessions, and 72.5\% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4\% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. Conclusions: A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients. ", doi="10.2196/27640", url="https://www.jmir.org/2021/5/e27640", url="http://www.ncbi.nlm.nih.gov/pubmed/33944795" } @Article{info:doi/10.2196/24299, author="Gately, E. Megan and Tickle-Degnen, Linda and Voydetich, J. Deborah and Ward, Nathan and Ladin, Keren and Moo, R. Lauren", title="Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Apr", day="27", volume="8", number="2", pages="e24299", keywords="occupational therapy", keywords="telemedicine", keywords="health services", keywords="older adults", abstract="Background: Occupational therapy (OT) is a vital service that supports older adults' ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood. Objective: This study examines VHA OT practice using video telehealth with older veterans using an implementation framework. Methods: A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth. Results: Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0\% response rate). Most were female (196/259, 75.7\%) occupational therapists (281/305, 92.1\%) with a master's degree (147/259, 56.8\%) and 10 years or fewer (165/305, 54.1\%) of VHA OT practice. Less than half (125/305, 41.0\%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2\%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6\%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84\%) and willingness to try innovative approaches (76/92, 83\%). Conclusions: Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians' attitudes to understand how they are driving the implementation of video telehealth. ", doi="10.2196/24299", url="https://rehab.jmir.org/2021/2/e24299", url="http://www.ncbi.nlm.nih.gov/pubmed/33904825" } @Article{info:doi/10.2196/23882, author="Gulick, Victoria and Graves, Daniel and Ames, Shannon and Krishnamani, Parimala Pavitra", title="Effect of a Virtual Reality--Enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Apr", day="15", volume="23", number="4", pages="e23882", keywords="virtual reality", keywords="VR", keywords="cardiac rehabilitation", keywords="patient experience", keywords="patient education", keywords="outpatient therapy", keywords="exercise", abstract="Background: Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients' lack of understanding of the importance of their care and a lack of motivation to maintain attendance. Objective: This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions. Methods: New CR patients were enrolled and randomized on a rolling basis to either the control group or intervention group. Intervention patients completed their time on the treadmill with VR walking trails, which included audio-recorded education, whereas control patients completed the standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing 6-minute walk test improvement. In addition, secondary outcomes of patients' cardiac knowledge and satisfaction were assessed via a computer-based questionnaire; patient adherence to the recommended number of sessions was also monitored. Cardiac knowledge assessment included a prerehabilitation education quiz, and the same quiz was repeated at patients' final visit and again at the 2-month follow-up. The satisfaction questionnaire was completed at the final visit. Results: Between January 2018 and May 2019, 72 patients were enrolled---41 in the intervention group and 31 in the control group. On the basis of the results of the prerehabilitation and postrehabilitation 6-minute walk test, no significant differences were observed between the intervention and control groups (P=.64). No statistical differences were observed between groups in terms of education (P=.86) or satisfaction (P=.32) at any time point. The control group had statistically more favorable rates of attendance, as determined by the risk group comparison (P=.02) and the comparison of the rates for completing the minimum number of sessions (P=.046), but no correlation was observed between the study group and reasons for ending treatment. Conclusions: Although no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, the qualitative information suggests that patients may have indeed enjoyed their experience with VR, even though quantitative satisfaction data did not capture this. Further considerations for how and when VR should be applied to CR are suggested in this paper. Trial Registration: ClinicalTrials.gov NCT03945201; https://clinicaltrials.gov/ct2/show/NCT03945201 ", doi="10.2196/23882", url="https://www.jmir.org/2021/4/e23882", url="http://www.ncbi.nlm.nih.gov/pubmed/33856355" } @Article{info:doi/10.2196/20916, author="Xu, Yangfan and Tong, Meiqinzi and Ming, Wai-Kit and Lin, Yangyang and Mai, Wangxiang and Huang, Weixin and Chen, Zhuoming", title="A Depth Camera--Based, Task-Specific Virtual Reality Rehabilitation Game for Patients With Stroke: Pilot Usability Study", journal="JMIR Serious Games", year="2021", month="Mar", day="24", volume="9", number="1", pages="e20916", keywords="virtual reality", keywords="rehabilitation", keywords="stroke", keywords="lower extremity", keywords="rehabilitation game", abstract="Background: The use of virtual reality is popular in clinical rehabilitation, but the effects of using commercial virtual reality games in patients with stroke have been mixed. Objective: We developed a depth camera--based, task-specific virtual reality game, Stomp Joy, for poststroke rehabilitation of the lower extremities. This study aims to assess its feasibility and clinical efficacy. Methods: We carried out a feasibility test for Stomp Joy within representative user groups. Then, a clinical efficacy experiment was performed with a randomized controlled trial, in which 22 patients with stroke received 10 sessions (2 weeks) of conventional physical therapy only (control group) or conventional physical therapy plus 30 minutes of the Stomp Joy intervention (experimental group) in the clinic. The Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index (MBI), Berg Balance Scale (BBS) score, single-leg stance (SLS) time, dropout rate, and adverse effects were recorded. Results: This feasibility test showed that Stomp Joy improved interest, pressure, perceived competence, value, and effort using the Intrinsic Motivation Inventory. The clinical efficacy trial showed a significant time-group interaction effect for the FMA-LE (P=.006), MBI (P=.001), BBS (P=.004), and SLS time (P=.001). A significant time effect was found for the FMA-LE (P=.001), MBI (P<.001), BBS (P<.001), and SLS time (P=.03). These indicated an improvement in lower extremity motor ability, basic activities of daily living, balance ability, and single-leg stance time in both groups after 2 weeks of the intervention. However, no significant group effects were found for the FMA-LE (P=.06), MBI (P=.76), and BBS (P=.38), while a significant group interaction was detected for SLS time (P<.001). These results indicated that the experimental group significantly improved more in SLS time than did the control group. During the study, 2 dropouts, including 1 participant who fell, were reported. Conclusions: Stomp Joy is an effective depth camera--based virtual reality game for replacing part of conventional physiotherapy, achieving equally effective improvement in lower extremity function among stroke survivors. High-powered randomized controlled studies are now needed before recommending the routine use of Stomp Joy in order to confirm these findings by recruiting a large sample size. ", doi="10.2196/20916", url="https://games.jmir.org/2021/1/e20916", url="http://www.ncbi.nlm.nih.gov/pubmed/33759795" } @Article{info:doi/10.2196/18739, author="Cornelis, Nils and Buys, Roselien and Dewit, Tijl and Benoit, Dries and Claes, Jomme and Fourneau, Inge and Cornelissen, V{\'e}ronique", title="Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="22", volume="8", number="1", pages="e18739", keywords="eHealth", keywords="telerehabilitation", keywords="intermittent claudication", keywords="pilot", abstract="Background: Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice. Objective: The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. Methods: A total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests. Results: All patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients' questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered. Conclusions: Patients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking. Trial Registration: ClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546 ", doi="10.2196/18739", url="https://rehab.jmir.org/2021/1/e18739", url="http://www.ncbi.nlm.nih.gov/pubmed/33749616" } @Article{info:doi/10.2196/20405, author="V{\"o}lter, Christiane and St{\"o}ckmann, Carolin and Schirmer, Christiane and Dazert, Stefan", title="Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="12", volume="8", number="1", pages="e20405", keywords="computer-based auditory training", keywords="correction of hearing impairment", keywords="cochlear implant", keywords="effectivity", keywords="intervention study", keywords="telerehabilitation", keywords="pandemic", abstract="Background: Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people's access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic's impact on health care, the need for new therapeutic settings has intensified. Objective: The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic. Methods: In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants' subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists. Results: Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program's usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment. Conclusions: The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics. ", doi="10.2196/20405", url="https://rehab.jmir.org/2021/1/e20405", url="http://www.ncbi.nlm.nih.gov/pubmed/33709934" } @Article{info:doi/10.2196/21374, author="Burns, David and Boyer, Philip and Razmjou, Helen and Richards, Robin and Whyne, Cari", title="Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="11", volume="8", number="1", pages="e21374", keywords="rehabilitation", keywords="treatment adherence and compliance", keywords="wearable electronic devices", keywords="machine learning", keywords="rotator cuff", abstract="Background: Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown. Objective: The purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation. Methods: We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses. Results: Mean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41\% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation. Conclusions: There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders. International Registered Report Identifier (IRRID): RR2-10.2196/17841 ", doi="10.2196/21374", url="https://rehab.jmir.org/2021/1/e21374", url="http://www.ncbi.nlm.nih.gov/pubmed/33704076" } @Article{info:doi/10.2196/25340, author="Koh, Qi Wei and Ang, Hui Faith Xin and Casey, Dympna", title="Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Feb", day="12", volume="8", number="1", pages="e25340", keywords="social robot", keywords="assistive technology", keywords="robotic animals", keywords="pet robots", keywords="older adults", keywords="dementia", keywords="low-cost robot", keywords="psychosocial intervention", keywords="intervention", keywords="robot", keywords="review", abstract="Background: Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost and familiarly and realistically designed pet robots. Objective: The aim of this review is to synthesize evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia. Methods: The Arksey and O'Malley framework was used to guide this review. First, the research question was identified. Second, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorized, and presented narratively. Results: A total of 9 studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost. Conclusions: Overall, the findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets. ", doi="10.2196/25340", url="http://rehab.jmir.org/2021/1/e25340/", url="http://www.ncbi.nlm.nih.gov/pubmed/33497349" } @Article{info:doi/10.2196/24339, author="Hendriks, S. Maartje M. and van Lotringen, H. Jaap and Vos-van der Hulst, Marije and Keijsers, W. No{\"e}l L.", title="Bed Sensor Technology for Objective Sleep Monitoring Within the Clinical Rehabilitation Setting: Observational Feasibility Study", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="8", volume="9", number="2", pages="e24339", keywords="continuous sleep monitoring device", keywords="bed sensor technology", keywords="mHealth", keywords="nocturnal heart rate", keywords="nocturnal respiratory rate", keywords="nocturnal movement activity", keywords="neurological disorders", keywords="incomplete spinal cord injury", keywords="stroke", keywords="inpatient rehabilitation", keywords="clinical application", abstract="Background: Since adequate sleep is essential for optimal inpatient rehabilitation, there is an increased interest in sleep assessment. Unobtrusive, contactless, portable bed sensors show great potential for objective sleep analysis. Objective: The aim of this study was to investigate the feasibility of a bed sensor for continuous sleep monitoring overnight in a clinical rehabilitation center. Methods: Patients with incomplete spinal cord injury (iSCI) or stroke were monitored overnight for a 1-week period during their in-hospital rehabilitation using the Emfit QS bed sensor. Feasibility was examined based on missing measurement nights, coverage percentages, and missing periods of heart rate (HR) and respiratory rate (RR). Furthermore, descriptive data of sleep-related parameters (nocturnal HR, RR, movement activity, and bed exits) were reported. Results: In total, 24 participants (12 iSCI, 12 stroke) were measured. Of the 132 nights, 5 (3.8\%) missed sensor data due to Wi-Fi (2), slipping away (1), or unknown (2) errors. Coverage percentages of HR and RR were 97\% and 93\% for iSCI and 99\% and 97\% for stroke participants. Two-thirds of the missing HR and RR periods had a short duration of ?120 seconds. Patients with an iSCI had an average nocturnal HR of 72 (SD 13) beats per minute (bpm), RR of 16 (SD 3) cycles per minute (cpm), and movement activity of 239 (SD 116) activity points, and had 86 reported and 84 recorded bed exits. Patients with a stroke had an average nocturnal HR of 61 (SD 8) bpm, RR of 15 (SD 1) cpm, and movement activity of 136 (SD 49) activity points, and 42 reported and 57 recorded bed exits. Patients with an iSCI had significantly higher nocturnal HR (t18=?2.1, P=.04) and movement activity (t18=?1.2, P=.02) compared to stroke patients. Furthermore, there was a difference between self-reported and recorded bed exits per night in 26\% and 38\% of the nights for iSCI and stroke patients, respectively. Conclusions: It is feasible to implement the bed sensor for continuous sleep monitoring in the clinical rehabilitation setting. This study provides a good foundation for further bed sensor development addressing sleep types and sleep disorders to optimize care for rehabilitants. ", doi="10.2196/24339", url="http://mhealth.jmir.org/2021/2/e24339/", url="http://www.ncbi.nlm.nih.gov/pubmed/33555268" } @Article{info:doi/10.2196/17017, author="Hashim, A. N. and Abd Razak, A. N. and Gholizadeh, H. and Abu Osman, A. N.", title="Video Game--Based Rehabilitation Approach for Individuals Who Have Undergone Upper Limb Amputation: Case-Control Study", journal="JMIR Serious Games", year="2021", month="Feb", day="4", volume="9", number="1", pages="e17017", keywords="box and block test", keywords="Intrinsic Motivation Inventory", keywords="maximum voluntary contraction", keywords="motor rehabilitation", keywords="upper limb amputee", keywords="video games", abstract="Background: Brain plasticity is an important factor in prosthesis usage. This plasticity helps with brain adaptation to learn new movement and coordination patterns needed to control a prosthetic hand. It can be achieved through repetitive muscle training that is usually very exhausting and often results in considerable reduction in patient motivation. Previous studies have shown that a playful concept in rehabilitation can increase patient engagement and perseverance. Objective: This study investigated whether the inclusion of video games in the upper limb amputee rehabilitation protocol could have a beneficial impact for muscle preparation, coordination, and patient motivation among individuals who have undergone transradial upper limb amputation. Methods: Ten participants, including five amputee participants and five able-bodied participants, were enrolled in 10 1-hour sessions within a 4-week rehabilitation program. In order to investigate the effects of the rehabilitation protocol used in this study, virtual reality box and block tests and electromyography (EMG) assessments were performed. Maximum voluntary contraction was measured before, immediately after, and 2 days after interacting with four different EMG-controlled video games. Participant motivation was assessed with the Intrinsic Motivation Inventory (IMI) questionnaire and user evaluation survey. Results: Survey analysis showed that muscle strength and coordination increased at the end of training for all the participants. The results of Pearson correlation analysis indicated that there was a significant positive association between the training period and the box and block test score (r8=0.95, P<.001). The maximum voluntary contraction increment was high before training (6.8\%) and in the follow-up session (7.1\%), but was very small (2.1\%) shortly after the training was conducted. The IMI assessment showed high scores for the subscales of interest, perceived competence, choice, and usefulness, but low scores for pressure and tension. Conclusions: This study demonstrated that video games enhance motivation and adherence in an upper limb amputee rehabilitation program. The use of video games could be seen as a complementary approach for physical training in upper limb amputee rehabilitation. ", doi="10.2196/17017", url="https://games.jmir.org/2021/1/e17017", url="http://www.ncbi.nlm.nih.gov/pubmed/33538698" } @Article{info:doi/10.2196/25291, author="Garcia, M. Laura and Darnall, D. Beth and Krishnamurthy, Parthasarathy and Mackey, G. Ian and Sackman, Josh and Louis, G. Robert and Maddox, Todd and Birckhead, J. Brandon", title="Self-Administered Behavioral Skills--Based At-Home Virtual Reality Therapy for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jan", day="19", volume="10", number="1", pages="e25291", keywords="chronic pain", keywords="virtual reality", keywords="behavioral medicine", keywords="behavioral health", keywords="pain treatment", keywords="randomized controlled trial", abstract="Background: Chronic pain is one of the most common and debilitating health conditions. Treatments for chronic low back pain typically focus on biomedical treatment approaches. While psychosocial treatments exist, multiple barriers prevent broad access. There is a significant unmet need for integrative, easily accessible, non-opioid solutions for chronic pain. Virtual reality (VR) is an immersive technology allowing innovation in the delivery of behavioral pain treatments. Behavioral skills-based VR is effective at facilitating pain management and reducing pain-related concerns. Continued research on these emerging approaches is needed. Objective: In this randomized controlled trial, we seek to test the efficacy of a self-administered behavioral skills-based VR program as a nonpharmacological home-based pain management treatment for people with chronic low back pain (cLBP). Methods: We will randomize 180 individuals with cLBP to 1 of 2 VR programs: (1) EaseVRx (8-week skills-based VR program); or (2) Sham VR (control condition). All participants will receive a VR headset to minimize any biases related to the technology's novelty. The Sham VR group had 2D neutral content in a 3D theater-like environment. Our primary outcome is average pain intensity and pain-related interference with activity, stress, mood, and sleep. Our secondary outcomes include patient-reported physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, health utilization, medication use, and user satisfaction. We hypothesize superiority for the skills-based VR program in all of these measures compared to the control condition. Team statisticians blinded to treatment assignment will assess outcomes up to 6 months posttreatment using an approach suitable for the longitudinal nature of the data. Results: The study was approved by the Western Institutional Review Board on July 2, 2020. The protocol (NCT04415177) was registered on May 27, 2020. Recruitment for this study was completed in July 2020, and data collection will remain active until March 2021. In total, 186 participants were recruited. Multiple manuscripts will be generated from this study. The primary manuscript will be submitted for publication in the winter of 2020. Conclusions: Effectively delivering behavioral treatments in VR could overcome barriers to care and provide scalable solutions to chronic pain's societal burden. Our study could help shape future research and development of these innovative approaches. Trial Registration: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID): RR1-10.2196/25291 ", doi="10.2196/25291", url="https://www.researchprotocols.org/2021/1/e25291", url="http://www.ncbi.nlm.nih.gov/pubmed/33464215" } @Article{info:doi/10.2196/19580, author="Wittstein, William Matthew and Crider, Anthony and Mastrocola, Samantha and Guerena Gonzalez, Mariana", title="Use of Virtual Reality to Assess Dynamic Posturography and Sensory Organization: Instrument Validation Study", journal="JMIR Serious Games", year="2020", month="Dec", day="16", volume="8", number="4", pages="e19580", keywords="postural control", keywords="virtual reality", keywords="sensory organization test", keywords="intraclass correlations", abstract="Background: The Equitest system (Neurocom) is a computerized dynamic posturography device used by health care providers and clinical researchers to safely test an individual's postural control. While the Equitest system has evaluative and rehabilitative value, it may be limited owing to its cost, lack of portability, and reliance on only sagittal plane movements. Virtual reality (VR) provides an opportunity to reduce these limitations by providing more mobile and cost-effective tools while also observing a wider array of postural characteristics. Objective: This study aimed to test the plausibility of using VR as a feasible alternative to the Equitest system for conducting a sensory organization test. Methods: A convenience sample of 20 college-aged healthy individuals participated in the study. Participants completed the sensory organization test using the Equitest system as well as using a VR environment while standing atop a force plate (Bertec Inc). The Equitest system measures the equilibrium index. During VR trials, the estimated equilibrium index, 95\% ellipse area, path length, and anterior-posterior detrended fluctuation analysis scaling exponent alpha were calculated from center of pressure data. Pearson correlation coefficients were used to assess the relationship between the equilibrium index and center of pressure--derived balance measures. Intraclass correlations for absolute agreement and consistency were calculated to compare the equilibrium index and estimated equilibrium index. Results: Intraclass correlations demonstrated moderate consistency and absolute agreement (0.5 < intraclass correlation coefficient < 0.75) between the equilibrium index and estimated equilibrium index from the Equitest and VR sensory organization test (SOT), respectively, in four of six tested conditions. Additionally, weak to moderate correlations between force plate measurements and the equilibrium index were noted in several of the conditions. Conclusions: This research demonstrated the plausibility of using VR as an alternative method to conduct the SOT. Ongoing development and testing of virtual environments are necessary before employing the technology as a replacement to current clinical tests. ", doi="10.2196/19580", url="http://games.jmir.org/2020/4/e19580/", url="http://www.ncbi.nlm.nih.gov/pubmed/33325830" } @Article{info:doi/10.2196/21576, author="Baeza-Barrag{\'a}n, Rosa Maria and Labajos Manzanares, Teresa Maria and Ruiz Vergara, Carmen and Casuso-Holgado, Jes{\'u}s Mar{\'i}a and Mart{\'i}n-Valero, Roc{\'i}o", title="The Use of Virtual Reality Technologies in the Treatment of Duchenne Muscular Dystrophy: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="8", volume="8", number="12", pages="e21576", keywords="Duchenne muscular dystrophy", keywords="virtual reality", keywords="upper limb", keywords="physical therapy", keywords="muscular dystrophy", keywords="mutation", keywords="muscle", keywords="degeneration", abstract="Background: Duchenne muscular dystrophy is a serious and progressive disease affecting one in 3500-6000 live male births. The use of new virtual reality technologies has revolutionized the world of youth rehabilitation. Objective: We performed a systematic review to study the effectiveness of the use of virtual reality systems applied in the rehabilitation of the upper limbs of individuals with Duchenne muscular dystrophy. Methods: Between June 2018 and September 2019, we carried out a series of searches in 5 scientific databases: (1) PubMed, (2) Web of Science, (3) Scopus, (4) The Cochrane Library, and (5) MEDLINE via EBSCO. Two evaluators independently conducted the searches following the PRISMA recommendations for systematic reviews for articles. Two independent evaluators collated the results. Article quality was determined using the PEDro scale. Results: A total of 7 clinical trials were included in the final review. These studies used new technologies as tools for physiotherapeutic rehabilitation of the upper limbs of patients with Duchenne muscular dystrophy. Collectively, the studies showed improvement in functionality, quality of life, and motivation with the use of virtual reality technologies in the rehabilitation of upper limbs of individuals with Duchenne muscular dystrophy. Conclusions: The treatment of neuromuscular diseases has changed in recent years, from palliative symptom management to preventive methods for capacity building. The use of virtual reality is beginning to be necessary in the treatment of progressive diseases involving movement difficulties, as it provides freedom and facilitates the improvement of results in capacity training. Given that new technologies are increasingly accessible, rehabilitation and physiotherapy programs can use these technologies more frequently, and virtual reality environments can be used to improve task performance, which is essential for people with disabilities. Ultimately, virtual reality can be a great tool for physiotherapy and can be used for Duchenne muscular dystrophy rehabilitation programs to improve patient performance during training. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018102548; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=102548 ", doi="10.2196/21576", url="http://mhealth.jmir.org/2020/12/e21576/", url="http://www.ncbi.nlm.nih.gov/pubmed/33289679" } @Article{info:doi/10.2196/18649, author="Georgiou, Theodoros and Holland, Simon and van der Linden, Janet", title="Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study", journal="JMIR Biomed Eng", year="2020", month="Nov", day="24", volume="5", number="1", pages="e18649", keywords="hemiparetic gait", keywords="stroke", keywords="technology assisted rehabilitation", keywords="quantitative study", keywords="gait analysis", keywords="gait asymmetry", keywords="gait", keywords="neurology", keywords="hemiparesis", keywords="rehabilitation", keywords="brain injury", abstract="Background: Rhythm, brain, and body are closely linked. Humans can synchronize their movement to auditory rhythms in ways that can improve the regularity of movement while reducing perceived effort. However, the ability to perform rhythmic movement may be disrupted by various neurological conditions. Many such conditions impair mechanisms that control movement, such as gait, but typically without rhythmic perception being affected. This paper focuses on hemiparetic stroke, a neurological condition that affects one side of the body. Hemiparetic stroke can cause severe asymmetries in gait, leading to numerous physical problems ranging from muscle degeneration to bone fractures. Movement synchronization via entrainment to auditory metronomes is known to improve asymmetry and related gait problems; this paper presents the first systematic study of entrainment for gait rehabilitation via the haptic modality. Objective: This paper explores the gait rehabilitation of people with hemiparesis following a stroke or brain injury, by a process of haptic entrainment to rhythmic cues. Various objective measures, such as stride length and stride time, are considered. Methods: This study is a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. We designed wearable devices to deliver the haptic rhythm, called Haptic Bracelets, which were placed on the leg near the knee. Spatial data were recorded using a Qualisys optical motion capturing system, consisting of 8 optoelectronic cameras, and 20 markers placed on anatomical lower limb landmarks and 4 additional tracking clusters placed on the right and left shank and thigh. Gait characteristics were measured before, during, and after cueing. Results: All 11 successfully screened participants were able to synchronize their steps to a haptically presented rhythm. Specifically, 6 participants demonstrated immediate improvements regarding their temporal gait characteristics, and 3 of the 6 improved their gait in terms of spatial characteristics. Conclusions: Considering the great variability between survivors of stroke and brain injury and the limited number of available participants in our study, there is no claim of statistical evidence that supports a formal experimental result of improved gait. However, viewing this empirical gait investigation as a set of 11 case studies, more modest empirical claims can be made. All participants were able to synchronize their steps to a haptically presented rhythm. For a substantial proportion of participants, an immediate (though not necessarily lasting) improvement of temporal gait characteristics was found during cueing. Some improvements over baseline occurred immediately after, rather than during, haptic cueing. Design issues and trade-offs are identified, and interactions between perception, sensory deficit, attention, memory, cognitive load, and haptic entrainment are noted. ", doi="10.2196/18649", url="http://biomedeng.jmir.org/2020/1/e18649/" } @Article{info:doi/10.2196/22620, author="Griffin, Anya and Wilson, Luke and Feinstein, B. Amanda and Bortz, Adeline and Heirich, S. Marissa and Gilkerson, Rachel and Wagner, FM Jenny and Menendez, Maria and Caruso, J. Thomas and Rodriguez, Samuel and Naidu, Srinivas and Golianu, Brenda and Simons, E. Laura", title="Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2020", month="Nov", day="23", volume="7", number="2", pages="e22620", keywords="digital health care", keywords="virtual reality", keywords="immersive technology", keywords="chronic pain management", keywords="adolescents", abstract="Background: In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. Objective: We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. Methods: We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. Results: This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. Conclusions: The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun. ", doi="10.2196/22620", url="http://rehab.jmir.org/2020/2/e22620/", url="http://www.ncbi.nlm.nih.gov/pubmed/33226346" } @Article{info:doi/10.2196/19251, author="Bass, Alec and Aubertin-Leheudre, Myl{\`e}ne and Vincent, Claude and Karelis, D. Antony and Morin, N. Suzanne and McKerral, Michelle and Duclos, Cyril and Gagnon, H. Dany", title="Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study", journal="JMIR Res Protoc", year="2020", month="Sep", day="24", volume="9", number="9", pages="e19251", keywords="assistive technology", keywords="locomotion", keywords="spinal cord injury", keywords="rehabilitation", keywords="robotics", keywords="osteoporosis", abstract="Background: In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity---typically linked to this mode of mobility---contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. Objective: This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton--assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. Methods: A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton--assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. Results: This study is currently underway with active recruitment in Montr{\'e}al, Qu{\'e}bec, Canada. Results are expected in the spring of 2021. Conclusions: The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton--assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. Trial Registration: ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID): DERR1-10.2196/19251 ", doi="10.2196/19251", url="http://www.researchprotocols.org/2020/9/e19251/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663160" } @Article{info:doi/10.2196/18169, author="Backman, Chantal and Harley, Anne and Kuziemsky, Craig and Mercer, Jay and Peyton, Liam", title="MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruy{\`e}re Continuing Care: User-Centered Design and Feasibility Testing Study", journal="JMIR Form Res", year="2020", month="Sep", day="14", volume="4", number="9", pages="e18169", keywords="geriatric rehabilitation", keywords="care transition", keywords="technology", keywords="hip fracture", abstract="Background: When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. Objective: The overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. Methods: This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. Results: In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91\% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. Conclusions: We were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11031 ", doi="10.2196/18169", url="http://formative.jmir.org/2020/9/e18169/", url="http://www.ncbi.nlm.nih.gov/pubmed/32924953" } @Article{info:doi/10.2196/22208, author="Seo, Minseok and Shin, Myung-Jun and Park, Sung Tae and Park, Jong-Hwan", title="Clinometric Gait Analysis Using Smart Insoles in Patients With Hemiplegia After Stroke: Pilot Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="10", volume="8", number="9", pages="e22208", keywords="stroke", keywords="hemiplegia", keywords="gait", keywords="smart insole", keywords="medical informatics", keywords="rehabilitation", keywords="observational", keywords="wearable", keywords="assessment", abstract="Background: For effective rehabilitation after stroke, it is essential to conduct an objective assessment of the patient's functional status. Several stroke severity scales have been used for this purpose, but such scales have various limitations. Objective: Gait analysis using smart insole technology can be applied continuously, objectively, and quantitatively, thereby overcoming the shortcomings of other assessment tools. Methods: To confirm the reliability of gait analysis using smart insole technology, normal healthy controls wore insoles in their shoes during the Timed Up and Go (TUG) test. The gait parameters were compared with the manually collected data. To determine the gait characteristics of patients with hemiplegia due to stroke, they were asked to wear insoles and take the TUG test; gait parameters were calculated and compared with those of control subjects. To investigate whether the gait analysis accurately reflected the patients' clinical condition, we analyzed the relationships of 22 gait parameters on 4 stroke severity scales. Results: The smart insole gait parameter data were similar to those calculated manually. Among the 18 gait parameters tested, 14 were significantly effective at distinguishing patients from healthy controls. The smart insole data revealed that the stance duration on both sides was longer in patients than controls, which has proven difficult to show using other methods. Furthermore, the sound side in patients showed a markedly longer stance duration. Regarding swing duration, that of the sound side was shorter in patients than controls, whereas that of the hemiplegic side was longer. We identified 10 significantly correlated gait parameters on the stroke severity scales. Notably, the difference in stance duration between the sound and hemiplegic sides was significantly correlated with the Fugl-Meyer Assessment (FMA) lower extremity score. Conclusions: This study confirmed the feasibility and applicability of the smart insole as a device to assess the gait of patients with hemiplegia due to stroke. In addition, we demonstrated that the FMA score was significantly correlated with the smart insole data. Providing an environment where stroke patients can easily measure walking ability helps to maintain chronic functions as well as acute rehabilitation. Trial Registration: UMIN Clinical Trials Registry UMIN000041646, https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000047538 ", doi="10.2196/22208", url="http://mhealth.jmir.org/2020/9/e22208/", url="http://www.ncbi.nlm.nih.gov/pubmed/32909949" } @Article{info:doi/10.2196/14178, author="Jung, Timothy and Moorhouse, Natasha and Shi, Xin and Amin, Farhan Muhammad", title="A Virtual Reality--Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Jul", day="7", volume="22", number="7", pages="e14178", keywords="virtual reality", keywords="COPD", keywords="rehabilitation", abstract="Background: The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. Objective: This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. Methods: This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. Results: In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. Conclusions: Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale. ", doi="10.2196/14178", url="https://www.jmir.org/2020/7/e14178", url="http://www.ncbi.nlm.nih.gov/pubmed/32673224" } @Article{info:doi/10.2196/14139, author="Wijnen, Annet and Hoogland, Jildou and Munsterman, Tjerk and Gerritsma, LE Carina and Dijkstra, Baukje and Zijlstra, P. Wierd and Dekker, S. Johan and Annegarn, Janneke and Ibarra, Francisco and Slager, EC Geranda and Zijlstra, Wiebren and Stevens, Martin", title="Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls", journal="JMIR Rehabil Assist Technol", year="2020", month="Apr", day="27", volume="7", number="1", pages="e14139", keywords="remote coaching", keywords="internet", keywords="osteoarthritis", keywords="total hip arthroplasty", keywords="home-based rehabilitation program", keywords="physiotherapy", keywords="usual care", keywords="tablet app", keywords="total hip replacement", keywords="rehabilitation", abstract="Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up \& Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales ``function in sport and recreational activities'' and ``hip-related quality of life'' of HOOS, and on the subscale ``physical role limitations'' of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes. Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. Trial Registration: ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo ", doi="10.2196/14139", url="http://rehab.jmir.org/2020/1/e14139/", url="http://www.ncbi.nlm.nih.gov/pubmed/32338621" } @Article{info:doi/10.2196/16650, author="Wang, Jingying and Gong, Dawei and Luo, Huichun and Zhang, Wenbin and Zhang, Lei and Zhang, Han and Zhou, Junhong and Wang, Shouyan", title="Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson's Disease by Wearable Sensors: Controlled Study", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="20", volume="8", number="3", pages="e16650", keywords="Parkinson's disease", keywords="gait", keywords="angular velocity", keywords="inertial sensor", keywords="step angle", keywords="deep brain stimulation", keywords="acute levodopa challenge test", abstract="Background: Gait impairments including shuffling gait and hesitation are common in people with Parkinson's disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. Objective: This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). Methods: A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. Results: The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=--0.60, P<.001; dual task: r=--0.52, P<.001), initial step angle (single task: r=--0.35, P=.006; dual task: r=--0.35, P=.01), and last step angle (single task: r=--0.43, P=.001; dual task: r=--0.41, P=.002). Conclusions: This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort. ", doi="10.2196/16650", url="http://mhealth.jmir.org/2020/3/e16650/", url="http://www.ncbi.nlm.nih.gov/pubmed/32196458" } @Article{info:doi/10.2196/13889, author="Mate, KV Kedar and Abou-Sharkh, Ahmed and Morais, A. Jos{\'e} and Mayo, E. Nancy", title="Real-Time Auditory Feedback--Induced Adaptation to Walking Among Seniors Using the Heel2Toe Sensor: Proof-of-Concept Study", journal="JMIR Rehabil Assist Technol", year="2019", month="Dec", day="11", volume="6", number="2", pages="e13889", keywords="angular velocity", keywords="auditory feedback", keywords="walking", keywords="older adults", abstract="Background: Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first. Objective: This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor. Methods: A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience. Results: All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping. Conclusions: Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated. ", doi="10.2196/13889", url="http://rehab.jmir.org/2019/2/e13889/", url="http://www.ncbi.nlm.nih.gov/pubmed/31825320" } @Article{info:doi/10.2196/15429, author="Sapci, Hasan A. and Sapci, Aylin H.", title="Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review", journal="JMIR Aging", year="2019", month="Nov", day="29", volume="2", number="2", pages="e15429", keywords="innovative assisted living tools for aging society", keywords="artificially intelligent home monitoring", keywords="older adults", keywords="robotic technologies", keywords="smart home", abstract="Background: The increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults' daily activities and health-related issues might prevent medical emergencies. Objective: The primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems. Methods: A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people's care, independent living, and novel assistive technologies were included in the study. Results: A total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal. Conclusions: The use of ubiquitous in-home monitoring and smart technologies for aged people's care will increase their independence and the health care services available to them as well as improve frail elderly people's health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults. ", doi="10.2196/15429", url="http://aging.jmir.org/2019/2/e15429/", url="http://www.ncbi.nlm.nih.gov/pubmed/31782740" } @Article{info:doi/10.2196/12010, author="Mubin, Omar and Alnajjar, Fady and Jishtu, Nalini and Alsinglawi, Belal and Al Mahmud, Abdullah", title="Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients' Rehabilitation: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2019", month="Sep", day="8", volume="6", number="2", pages="e12010", keywords="stroke", keywords="robot", keywords="exoskeleton", keywords="virtual reality", keywords="augmented reality", keywords="gamification", keywords="rehabilitation", abstract="Background: Robot-assisted therapy has become a promising technology in the field of rehabilitation for poststroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for most stroke survivors. With current advancements in technology there has been the introduction of virtual reality (VR), augmented reality (AR), customizable games, or a combination thereof, that aid robotic therapy in retaining, or increasing the interests of, patients so they keep performing their exercises. However, there are gaps in the evidence regarding the transition from clinical rehabilitation to home-based therapy which calls for an updated synthesis of the literature that showcases this trend. The present review proposes a categorization of these studies according to technologies used, and details research in both upper limb and lower limb applications. Objective: The goal of this work was to review the practices and technologies implemented in the rehabilitation of poststroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies (VR, AR, or gamification) in improving activity and participation in poststroke survivors. Methods: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies of interest (VR, AR, or gamification) was performed in the following databases: MEDLINE, EMBASE, Science Direct \& The Cochrane Library. Exoskeleton-based studies that did not include any VR, AR or gamification elements were excluded, but publications from the years 2010 to 2017 were included. Results in the form of improvements in the patients' condition were also recorded and taken into consideration in determining the effectiveness of any of the therapies on the patients. Results: Thirty studies were identified based on the inclusion criteria, and this included randomized controlled trials as well as exploratory research pieces. There were a total of about 385 participants across the various studies. The use of technologies such as VR-, AR-, or gamification-based exoskeletons could fill the transition from the clinic to a home-based setting. Our analysis showed that there were general improvements in the motor function of patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps with understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation. Conclusions: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the individual therapies. ", doi="10.2196/12010", url="https://rehab.jmir.org/2019/2/e12010", url="http://www.ncbi.nlm.nih.gov/pubmed/31586360" } @Article{info:doi/10.2196/12291, author="Shum, C. Leia and Vald{\'e}s, A. Bulmaro and Van der Loos, Machiel H. F.", title="Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study", journal="JMIR Biomed Eng", year="2019", month="Jun", day="06", volume="4", number="1", pages="e12291", keywords="upper extremity", keywords="kinematics", keywords="physical medicine and rehabilitation", keywords="validation studies", keywords="virtual reality", abstract="Background: As commercial motion tracking technology becomes more readily available, it is necessary to evaluate the accuracy of these systems before using them for biomechanical and motor rehabilitation applications. Objective: This study aimed to evaluate the relative position accuracy of the Oculus Touch controllers in a 2.4 x 2.4 m play-space. Methods: Static data samples (n=180) were acquired from the Oculus Touch controllers at step sizes ranging from 5 to 500 mm along 16 different points on the play-space floor with graph paper in the x (width), y (height), and z (depth) directions. The data were compared with reference values using measurements from digital calipers, accurate to 0.01 mm; physical blocks, for which heights were confirmed with digital calipers; and for larger step sizes (300 and 500 mm), a ruler with hatch marks to millimeter units. Results: It was found that the maximum position accuracy error of the system was 3.5 {\textpm} 2.5 mm at the largest step size of 500 mm along the z-axis. When normalized to step size, the largest error found was 12.7 {\textpm} 9.9\% at the smallest step size in the y-axis at 6.23 mm. When the step size was <10 mm in any direction, the relative position accuracy increased considerably to above 2\% (approximately 2 mm at maximum). An average noise value of 0.036 mm was determined. A comparison of these values to cited visual, goniometric, and proprioceptive resolutions concludes that this system is viable for tracking upper-limb movements for biomechanical and rehabilitation applications. The accuracy of the system was also compared with accuracy values from previous studies using other commercially available devices and a multicamera, marker-based professional motion tracking system. Conclusions: The study found that the linear position accuracy of the Oculus Touch controllers was within an agreeable range for measuring human kinematics in rehabilitative upper-limb exercise protocols. Further testing is required to ascertain acceptable repeatability in multiple sessions and rotational accuracy. ", doi="10.2196/12291", url="http://biomedeng.jmir.org/2019/1/e12291/" } @Article{info:doi/10.2196/13111, author="Correia, Dias Fernando and Nogueira, Andr{\'e} and Magalh{\~a}es, Ivo and Guimar{\~a}es, Joana and Moreira, Maria and Barradas, Isabel and Molinos, Maria and Teixeira, Laetitia and Tulha, Jos{\'e} and Seabra, Rosmaninho and Lains, Jorge and Bento, Virg{\'i}lio", title="Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2019", month="Feb", day="28", volume="6", number="1", pages="e13111", keywords="knee", keywords="TKA", keywords="home-based telerehabilitation", keywords="digital physiotherapist", keywords="artificial intelligence", keywords="eHealth", abstract="Background: Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. Objective: This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. Methods: The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. Results: A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82\% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95\% CI 1.85-7.47), in favor of the digital intervention group. Conclusions: The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources. Trial Registration: ClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252 ", doi="10.2196/13111", url="http://rehab.jmir.org/2019/1/e13111/", url="http://www.ncbi.nlm.nih.gov/pubmed/30816849" } @Article{info:doi/10.2196/12339, author="Mizuno, Katsuhiro and Abe, Takayuki and Ushiba, Junichi and Kawakami, Michiyuki and Ohwa, Tomomi and Hagimura, Kazuto and Ogura, Miho and Okuyama, Kohei and Fujiwara, Toshiyuki and Liu, Meigen", title="Evaluating the Effectiveness and Safety of the Electroencephalogram-Based Brain-Machine Interface Rehabilitation System for Patients With Severe Hemiparetic Stroke: Protocol for a Randomized Controlled Trial (BEST-BRAIN Trial)", journal="JMIR Res Protoc", year="2018", month="Dec", day="06", volume="7", number="12", pages="e12339", keywords="brain-computer interfaces", keywords="neurofeedback", keywords="neural plasticity", keywords="electroencephalography", keywords="hemiplegia", keywords="electric stimulation", keywords="robotics", abstract="Background: We developed a brain-machine interface (BMI) system for poststroke patients with severe hemiplegia to detect event-related desynchronization (ERD) on scalp electroencephalogram (EEG) and to operate a motor-driven hand orthosis combined with neuromuscular electrical stimulation. ERD arises when the excitability of the ipsi-lesional sensorimotor cortex increases. Objective: The aim of this study was to evaluate our hypothesis that motor training using this BMI system could improve severe hemiparesis that is resistant to improvement by conventional rehabilitation. We, therefore, planned and implemented a randomized controlled clinical trial (RCT) to evaluate the effectiveness and safety of intensive rehabilitation using the BMI system. Methods: We conducted a single blind, multicenter RCT and recruited chronic poststroke patients with severe hemiparesis more than 90 days after onset (N=40). Participants were randomly allocated to the BMI group (n=20) or the control group (n=20). Patients in the BMI group repeated 10-second motor attempts to operate EEG-BMI 40 min every day followed by 40 min of conventional occupational therapy. The interventions were repeated 10 times in 2 weeks. Control participants performed a simple motor imagery without servo-action of the orthosis, and electrostimulation was given for 10 seconds for 40 min, similar to the BMI intervention. Overall, 40 min of conventional occupational therapy was also given every day after the control intervention, which was also repeated 10 times in 2 weeks. Motor functions and electrophysiological phenotypes of the paretic hands were characterized before (baseline), immediately after (post), and 4 weeks after (follow-up) the intervention. Improvement in the upper extremity score of the Fugl-Meyer assessment between baseline and follow-up was the main outcome of this study. Results: Recruitment started in March 2017 and ended in July 2018. This trial is currently in the data correcting phase. This RCT is expected to be completed by October 31, 2018. Conclusions: No widely accepted intervention has been established to improve finger function of chronic poststroke patients with severe hemiparesis. The results of this study will provide clinical data for regulatory approval and novel, important understanding of the role of sensory-motor feedback based on BMI to induce neural plasticity and motor recovery. Trial Registration: UMIN Clinical Trials Registry UMIN000026372; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi? recptno=R000030299 (Archived by WebCite at http://www.webcitation.org/743zBJj3D) International Registered Report Identifier (IRRID): DERR1-10.2196/12339 ", doi="10.2196/12339", url="http://www.researchprotocols.org/2018/12/e12339/", url="http://www.ncbi.nlm.nih.gov/pubmed/30522993" } @Article{info:doi/10.2196/10307, author="Levac, Danielle and Dumas, M. Helene and Meleis, Waleed", title="A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation", journal="JMIR Rehabil Assist Technol", year="2018", month="Nov", day="26", volume="5", number="2", pages="e10307", keywords="equipment design", keywords="rehabilitation", keywords="pediatrics", keywords="tablets", keywords="software", abstract="Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69\% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. ", doi="10.2196/10307", url="http://rehab.jmir.org/2018/2/e10307/", url="http://www.ncbi.nlm.nih.gov/pubmed/30478025" } @Article{info:doi/10.2196/10522, author="Applegate, E. Megan and France, R. Christopher and Russ, W. David and Leitkam, T. Samuel and Thomas, S. James", title="Determining Physiological and Psychological Predictors of Time to Task Failure on a Virtual Reality S{\o}rensen Test in Participants With and Without Recurrent Low Back Pain: Exploratory Study", journal="JMIR Serious Games", year="2018", month="Sep", day="10", volume="6", number="3", pages="e10522", keywords="fatigue", keywords="low back pain", keywords="S{\o}rensen test", keywords="trunk mass", keywords="virtual reality", abstract="Background: S{\o}rensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the S{\o}rensen test performance. Objective: The objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality S{\o}rensen test in participants with and without a history of recurrent low back pain. Methods: We recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index--matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality S{\o}rensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials. Results: A two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality S{\o}rensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=?.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=?.67, P<.001), Tampa Scale for Kinesiophobia (beta=?.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF. Conclusions: Trunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain. ", doi="10.2196/10522", url="http://games.jmir.org/2018/3/e10522/", url="http://www.ncbi.nlm.nih.gov/pubmed/30201604" } @Article{info:doi/10.2196/jmir.9739, author="Vugts, AP Miel and Joosen, CW Margot and Mert, Agali and Zedlitz, ME Aglaia and Vrijhoef, JM Hubertus", title="Effectiveness of Serious Gaming During the Multidisciplinary Rehabilitation of Patients With Complex Chronic Pain or Fatigue: Natural Quasi-Experiment", journal="J Med Internet Res", year="2018", month="Aug", day="15", volume="20", number="8", pages="e250", keywords="behavioral intervention", keywords="chronic pain", keywords="serious games", keywords="musculoskeletal disease", keywords="rehabilitation", keywords="therapy", abstract="Background: Current evidence for the effectiveness of specialist multidisciplinary programs for burdensome chronic pain and functional somatic syndromes drives the effort to improve approaches, strategies, and delivery modes. It remains unknown to what extent and in what respect serious gaming during the regular outpatient rehabilitation can contribute to health outcomes. Objective: The objectives of our study were to determine the effect of additional serious gaming on (1) physical and emotional functioning in general; (2) particular outcome domains; and (3) patient global impressions of change, general health, and functioning and to determine (4) the dependency of serious gaming effects on adherence. Methods: We conducted a naturalistic quasi-experiment using embedded qualitative methods. The intervention group patients received an additional guided (mindfulness-based) serious gaming intervention during weeks 9-12 of a 16-week rehabilitation program at 2 sites of a Dutch rehabilitation clinic. Simultaneously, 119 control group patients followed the same program without serious gaming at 2 similar sites of the same clinic. Data consisted of 10 semistructured patient interviews and routinely collected patient self-reported outcomes. First, multivariate linear mixed modeling was used to simultaneously estimate a group effect on the outcome change between weeks 8 and 16 in 4 primary outcomes: current pain intensity, fatigue, pain catastrophizing, and psychological distress. Second, similar univariate linear mixed models were used to estimate effects on particular (unstandardized) outcomes. Third, secondary outcomes (ie, global impression of change, general health, functioning, and treatment satisfaction) were compared between the groups using independent t tests. Finally, subgroups were established according to the levels of adherence using log data. Influences of observed confounding factors were considered throughout analyses. Results: Of 329 eligible patients, 156 intervention group and 119 control group patients (N=275) with mostly chronic back pain and concomitant psychosocial problems participated in this study. Of all, 119 patients played ?75\% of the game. First, the standardized means across the 4 primary outcomes showed a significantly more favorable degree of change during the second part of the treatment for the intervention group than for the control group (beta=?0.119, SE=0.046, P=.009). Second, the intervention group showed a greater outcome change in depressive mood (b=?2.748, SE=1.072, P=.011) but not in ``insufficiency'' or concentration problems. Third, no significant group effects on secondary outcomes were found. Fourth, adherence was generally high and invariant. Conclusions: The findings of this study suggest a very small favorable average effect on relevant health outcomes of additional serious gaming during multidisciplinary rehabilitation. The indication that serious gaming could be a relatively time-efficient component warrants further research into if, when, how, and for which patients serious gaming could be cost-effective in treatment and why. Trial Registration: Netherlands Trial Registry NTR6020; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6020 (Archived by WebCite at http://www.webcitation.org/71IIoTXkj) ", doi="10.2196/jmir.9739", url="http://www.jmir.org/2018/8/e250/", url="http://www.ncbi.nlm.nih.gov/pubmed/30111527" } @Article{info:doi/10.2196/mhealth.8518, author="Argent, Rob and Daly, Ailish and Caulfield, Brian", title="Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence?", journal="JMIR Mhealth Uhealth", year="2018", month="Mar", day="01", volume="6", number="3", pages="e47", keywords="patient compliance", keywords="rehabilitation", keywords="exercise therapy", keywords="biomedical technology", keywords="review", doi="10.2196/mhealth.8518", url="https://mhealth.jmir.org/2018/3/e47/", url="http://www.ncbi.nlm.nih.gov/pubmed/29496655" } @Article{info:doi/10.2196/resprot.8334, author="Rasmussen, Skovgaard Rune and Schaarup, Heltoft Anne Marie and Overgaard, Karsten", title="Therapist-Assisted Rehabilitation of Visual Function and Hemianopia after Brain Injury: Intervention Study on the Effect of the Neuro Vision Technology Rehabilitation Program", journal="JMIR Res Protoc", year="2018", month="Feb", day="27", volume="7", number="2", pages="e65", keywords="stroke", keywords="vision", keywords="rehabilitation", keywords="brain injury", abstract="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) ", doi="10.2196/resprot.8334", url="http://www.researchprotocols.org/2018/2/e65/", url="http://www.ncbi.nlm.nih.gov/pubmed/29487042" } @Article{info:doi/10.2196/jmir.8640, author="Broadbent, Elizabeth and Garrett, Jeff and Jepsen, Nicola and Li Ogilvie, Vickie and Ahn, Seok Ho and Robinson, Hayley and Peri, Kathryn and Kerse, Ngaire and Rouse, Paul and Pillai, Avinesh and MacDonald, Bruce", title="Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Feb", day="13", volume="20", number="2", pages="e45", keywords="robotics", keywords="chronic obstructive pulmonary disease", keywords="hospitalization", keywords="medication adherence", keywords="telehealth", keywords="rehabilitation exercise", abstract="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) ", doi="10.2196/jmir.8640", url="https://www.jmir.org/2018/2/e45/", url="http://www.ncbi.nlm.nih.gov/pubmed/29439942" } @Article{info:doi/10.2196/periop.7874, author="Lu, Keyin and Chermside-Scabbo, J. Christopher and Marino, Evan Nikolas and Concepcion, Angela and Yugawa, Craig and Aladegbami, Bola and Paar, Theodora and St John, A. Theresa and Ross, Will and Clohisy, C. John and Kirby, P. John", title="Accessible Communication Tools for Surgical Site Infection Monitoring and Prevention in Joint Reconstruction: Feasibility Study", journal="JMIR Perioper Med", year="2018", month="Jan", day="17", volume="1", number="1", pages="e1", keywords="communication tool", keywords="decolonization", keywords="mobile health", keywords="surgical site infection", keywords="automated", keywords="messaging", abstract="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. ", doi="10.2196/periop.7874", url="http://periop.jmir.org/2018/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/33401369" } @Article{info:doi/10.2196/resprot.8047, author="Sweet, Norman Shane and Rocchi, Meredith and Arbour-Nicitopoulos, Kelly and Kairy, Dahlia and Fillion, Brigitte", title="A Telerehabilitation Approach to Enhance Quality of Life Through Exercise Among Adults With Paraplegia: Study Protocol", journal="JMIR Res Protoc", year="2017", month="Oct", day="19", volume="6", number="10", pages="e202", keywords="telehealth", keywords="spinal cord injuries", keywords="exercise", keywords="motivation", keywords="telerehabilitation", abstract="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) ", doi="10.2196/resprot.8047", url="http://www.researchprotocols.org/2017/10/e202/", url="http://www.ncbi.nlm.nih.gov/pubmed/29051134" } @Article{info:doi/10.2196/games.7969, author="Ling, Yun and Ter Meer, P. Louis and Yumak, Zerrin and Veltkamp, C. Remco", title="Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study", journal="JMIR Serious Games", year="2017", month="Oct", day="12", volume="5", number="4", pages="e19", keywords="rehabilitation exercise", keywords="computer games", keywords="hip replacement", keywords="elderly", keywords="physical therapists", abstract="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. ", doi="10.2196/games.7969", url="http://games.jmir.org/2017/4/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/29025696" } @Article{info:doi/10.2196/rehab.7259, author="O'Reilly, Martin and Duffin, Joe and Ward, Tomas and Caulfield, Brian", title="Mobile App to Streamline the Development of Wearable Sensor-Based Exercise Biofeedback Systems: System Development and Evaluation", journal="JMIR Rehabil Assist Technol", year="2017", month="Aug", day="21", volume="4", number="2", pages="e9", keywords="exercise therapy", keywords="biomedical technology", keywords="lower extremity", keywords="physical therapy specialty", abstract="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. ", doi="10.2196/rehab.7259", url="http://rehab.jmir.org/2017/2/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/28827210" } @Article{info:doi/10.2196/rehab.7511, author="Peretti, Alessandro and Amenta, Francesco and Tayebati, Khosrow Seyed and Nittari, Giulio and Mahdi, Sarosh Syed", title="Telerehabilitation: Review of the State-of-the-Art and Areas of Application", journal="JMIR Rehabil Assist Technol", year="2017", month="Jul", day="21", volume="4", number="2", pages="e7", keywords="telerehabilitation", keywords="rehabilitation", keywords="telemedicine", keywords="health care", keywords="remote rehabilitation assistance", abstract="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. ", doi="10.2196/rehab.7511", url="http://rehab.jmir.org/2017/2/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28733271" } @Article{info:doi/10.2196/games.7284, author="Idriss, Mohamad and Tannous, Halim and Istrate, Dan and Perrochon, Anaick and Salle, Jean-Yves and Ho Ba Tho, Marie-Christine and Dao, Tien-Tuan", title="Rehabilitation-Oriented Serious Game Development and Evaluation Guidelines for Musculoskeletal Disorders", journal="JMIR Serious Games", year="2017", month="Jul", day="04", volume="5", number="3", pages="e14", keywords="rehabilitation exercise", keywords="virtual rehabilitation", keywords="rehabilitation", keywords="user computer interface", keywords="musculoskeletal diseases", abstract="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. ", doi="10.2196/games.7284", url="http://games.jmir.org/2017/3/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/28676468" } @Article{info:doi/10.2196/mental.6022, author="Simblett, K. Sara and Yates, Matthew and Wagner, P. Adam and Watson, Peter and Gracey, Fergus and Ring, Howard and Bateman, Andrew", title="Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial", journal="JMIR Ment Health", year="2017", month="May", day="31", volume="4", number="2", pages="e16", keywords="cognitive therapy", keywords="technology", keywords="stroke", keywords="depression", keywords="anxiety", abstract="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. ", doi="10.2196/mental.6022", url="http://mental.jmir.org/2017/2/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/28566265" } @Article{info:doi/10.2196/resprot.6846, author="Kanitkar, Anuprita and Szturm, Tony and Parmar, Sanjay and Gandhi, BC Dorcas and Rempel, Ruth Gina and Restall, Gayle and Sharma, Monika and Narayan, Amitesh and Pandian, Jeyaraj and Naik, Nilashri and Savadatti, R. Ravi and Kamate, Appasaheb Mahesh", title="The Effectiveness of a Computer Game-Based Rehabilitation Platform for Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial", journal="JMIR Res Protoc", year="2017", month="May", day="18", volume="6", number="5", pages="e93", keywords="repetitive task practice", keywords="cerebral palsy", keywords="fine motor skills", keywords="game-based exercise", keywords="randomized controlled trial", keywords="upper extremity function", abstract="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) ", doi="10.2196/resprot.6846", url="http://www.researchprotocols.org/2017/5/e93/", url="http://www.ncbi.nlm.nih.gov/pubmed/28526673" } @Article{info:doi/10.2196/rehab.6901, author="Xiao, Gang Zhen and Menon, Carlo", title="Counting Grasping Action Using Force Myography: An Exploratory Study With Healthy Individuals", journal="JMIR Rehabil Assist Technol", year="2017", month="May", day="16", volume="4", number="1", pages="e5", keywords="myography", keywords="classification", keywords="upper extremity", keywords="grasp", keywords="rehabilitation", abstract="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. ", doi="10.2196/rehab.6901", url="http://rehab.jmir.org/2017/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582263" } @Article{info:doi/10.2196/humanfactors.5443, author="Harte, Richard and Glynn, Liam and Rodr{\'i}guez-Molinero, Alejandro and Baker, MA Paul and Scharf, Thomas and Quinlan, R. Leo and {\'O}Laighin, Gear{\'o}id", title="A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase Methodology", journal="JMIR Hum Factors", year="2017", month="Mar", day="16", volume="4", number="1", pages="e8", keywords="human-centered design", keywords="user-centered design", keywords="usability testing", keywords="user interface design", keywords="connected health", keywords="human factors", keywords="mHealth", abstract="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. ", doi="10.2196/humanfactors.5443", url="http://humanfactors.jmir.org/2017/1/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28302594" } @Article{info:doi/10.2196/games.6026, author="Prahm, Cosima and Vujaklija, Ivan and Kayali, Fares and Purgathofer, Peter and Aszmann, C. Oskar", title="Game-Based Rehabilitation for Myoelectric Prosthesis Control", journal="JMIR Serious Games", year="2017", month="Feb", day="09", volume="5", number="1", pages="e3", keywords="upper limb prosthesis control", keywords="upper extremity amputees", keywords="gaming", keywords="serious games", keywords="neuromuscular rehabilitation", keywords="intrinsic motivation", keywords="EMG control", abstract="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. ", doi="10.2196/games.6026", url="https://games.jmir.org/2017/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28183689" } @Article{info:doi/10.2196/jmir.5951, author="Cranen, Karlijn and Groothuis-Oudshoorn, GM Catharina and Vollenbroek-Hutten, MR Miriam and IJzerman, J. Maarten", title="Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients' Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment", journal="J Med Internet Res", year="2017", month="Jan", day="20", volume="19", number="1", pages="e26", keywords="patient preference", keywords="patient acceptance of health care", keywords="telerehabilitation", keywords="choice behavior", keywords="decision making", keywords="decision support techniques", keywords="patient compliance", keywords="chronic disease", keywords="exercise therapy", keywords="chronic pain", abstract="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. ", doi="10.2196/jmir.5951", url="http://www.jmir.org/2017/1/e26/", url="http://www.ncbi.nlm.nih.gov/pubmed/28108429" } @Article{info:doi/10.2196/rehab.5449, author="Davies, John Richard and Parker, Jack and McCullagh, Paul and Zheng, Huiru and Nugent, Chris and Black, David Norman and Mawson, Susan", title="A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole", journal="JMIR Rehabil Assist Technol", year="2016", month="Nov", day="08", volume="3", number="2", pages="e11", keywords="ambulatory monitoring", keywords="gait", keywords="rehabilitation", keywords="self-management", keywords="smart insole", keywords="stroke", abstract="Background: In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of {\textsterling}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. ", doi="10.2196/rehab.5449", url="http://rehab.jmir.org/2016/2/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582260" } @Article{info:doi/10.2196/jmir.5891, author="Powell, Lauren and Parker, Jack and Martyn St-James, Marrissa and Mawson, Susan", title="The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review", journal="J Med Internet Res", year="2016", month="Oct", day="07", volume="18", number="10", pages="e259", keywords="wearable technology", keywords="stroke", keywords="gait", keywords="rehabilitation", abstract="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. ", doi="10.2196/jmir.5891", url="http://www.jmir.org/2016/10/e259/", url="http://www.ncbi.nlm.nih.gov/pubmed/27717920" } @Article{info:doi/10.2196/jmir.5634, author="Nordin, A. Catharina and Michaelson, Peter and Gard, Gunvor and Eriksson, K. Margareta", title="Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial", journal="J Med Internet Res", year="2016", month="Oct", day="05", volume="18", number="10", pages="e265", keywords="coping behavior", keywords="pain", keywords="patient compliance", keywords="patient satisfaction", keywords="rehabilitation", keywords="self-efficacy", keywords="Web-based intervention", abstract="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) ", doi="10.2196/jmir.5634", url="http://www.jmir.org/2016/10/e265/", url="http://www.ncbi.nlm.nih.gov/pubmed/27707686" } @Article{info:doi/10.2196/rehab.6182, author="Ploderer, Bernd and Fong, Justin and Klaic, Marlena and Nair, Siddharth and Vetere, Frank and Cofr{\'e} Lizama, Eduardo L. and Galea, Pauline Mary", title="How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information", journal="JMIR Rehabil Assist Technol", year="2016", month="Oct", day="05", volume="3", number="2", pages="e9", keywords="stroke", keywords="upper-limb rehabilitation", keywords="therapy", keywords="information visualization", keywords="dashboard", keywords="wearable technology", abstract="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. ", doi="10.2196/rehab.6182", url="http://rehab.jmir.org/2016/2/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582257" } @Article{info:doi/10.2196/games.6476, author="Thomas, S. James and France, R. Christopher and Applegate, E. Megan and Leitkam, T. Samuel and Pidcoe, E. Peter and Walkowski, Stevan", title="Effects of Visual Display on Joint Excursions Used to Play Virtual Dodgeball", journal="JMIR Serious Games", year="2016", month="Sep", day="15", volume="4", number="2", pages="e16", keywords="virtual reality", keywords="avatar presentation", keywords="joint kinematics", abstract="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. ", doi="10.2196/games.6476", url="http://games.jmir.org/2016/2/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/27634561" } @Article{info:doi/10.2196/resprot.4985, author="Dedov, N. Vadim and Dedova, V. Irina", title="Application of a Web-Enabled Leg Training System for the Objective Monitoring and Quantitative Analysis of Exercise-Induced Fatigue", journal="JMIR Res Protoc", year="2016", month="Aug", day="22", volume="5", number="3", pages="e171", keywords="exercise intervention", keywords="cardiac rehabilitation", keywords="training equipment", keywords="online monitoring", keywords="exercise dose", keywords="muscle fatigue", keywords="heart rate", keywords="leg work output", keywords="fatigability", abstract="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 ($\Delta$t{\textdegree}). Since $\Delta$t{\textdegree} 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 $\Delta$t{\textdegree} 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 $\Delta$t{\textdegree} values reached during 30-minute fatigue-free exercise of moderate intensity resulting in a mean of 8.1{\textdegree}C (SD 1.5{\textdegree}C, N=7). These $\Delta$t{\textdegree} 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 $\Delta$t{\textdegree} 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. ", doi="10.2196/resprot.4985", url="http://www.researchprotocols.org/2016/3/e171/", url="http://www.ncbi.nlm.nih.gov/pubmed/27549345" } @Article{info:doi/10.2196/rehab.4340, author="Pande, Amit and Mohapatra, Prasant and Nicorici, Alina and Han, J. Jay", title="Machine Learning to Improve Energy Expenditure Estimation in Children With Disabilities: A Pilot Study in Duchenne Muscular Dystrophy", journal="JMIR Rehabil Assist Technol", year="2016", month="Jul", day="19", volume="3", number="2", pages="e7", keywords="accelerometry", keywords="physical activity", keywords="heart rate", keywords="neuromuscular disease", keywords="children", abstract="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. ", doi="10.2196/rehab.4340", url="http://rehab.jmir.org/2016/2/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582264" } @Article{info:doi/10.2196/rehab.5524, author="Lai, Byron and Rimmer, James and Barstow, Beth and Jovanov, Emil and Bickel, Scott C.", title="Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series", journal="JMIR Rehabil Assist Technol", year="2016", month="Jul", day="14", volume="3", number="2", pages="e8", keywords="exercise", keywords="physical activity", keywords="telehealth", keywords="spinal cord injury", keywords="persons with disabilities", abstract="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. ", doi="10.2196/rehab.5524", url="http://rehab.jmir.org/2016/2/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582252" } @Article{info:doi/10.2196/jmir.5191, author="Thorup, Charlotte and Hansen, John and Gr{\o}nkj{\ae}r, Mette and Andreasen, Jesper Jan and Nielsen, Gitte and S{\o}rensen, Elgaard Erik and Dinesen, Irene Birthe", title="Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial", journal="J Med Internet Res", year="2016", month="Apr", day="04", volume="18", number="4", pages="e69", keywords="heart disease", keywords="rehabilitation", keywords="step counters", keywords="physical activity", keywords="telerehabilitation", abstract="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) ", doi="10.2196/jmir.5191", url="http://www.jmir.org/2016/4/e69/", url="http://www.ncbi.nlm.nih.gov/pubmed/27044310" } @Article{info:doi/10.2196/games.5088, author="Vugts, P. Miel A. and Joosen, W. Margot C. and van Bergen, M. Alfonsus H. M. and Vrijhoef, M. Hubertus J.", title="Feasibility of Applied Gaming During Interdisciplinary Rehabilitation for Patients With Complex Chronic Pain and Fatigue Complaints: A Mixed-Methods Study", journal="JMIR Serious Games", year="2016", month="Apr", day="01", volume="4", number="1", pages="e2", keywords="behavioral medicine", keywords="therapy", keywords="computer-assisted", keywords="computer games", keywords="mind-body therapies", keywords="patient acceptance of health care", keywords="feasibility studies", keywords="fatigue syndrome, chronic", keywords="fibromyalgia", keywords="musculoskeletal pain", abstract="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 $\rho$=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. ", doi="10.2196/games.5088", url="http://games.jmir.org/2016/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/27036094" } @Article{info:doi/10.2196/rehab.4812, author="Dedov, N. Vadim and Dedova, V. Irina", title="Automated Management of Exercise Intervention at the Point of Care: Application of a Web-Based Leg Training System", journal="JMIR Rehabil Assist Technol", year="2015", month="Nov", day="23", volume="2", number="2", pages="e11", keywords="digital intervention", keywords="exercise intervention", keywords="cardiac rehabilitation", keywords="training equipment", keywords="online monitoring", keywords="exercise dose", keywords="telerehabilitation", keywords="leg mobilization", keywords="Web-based apps", keywords="eHealth recordings", abstract="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 ($\Delta$t{\textdegree}). 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 $\Delta$t{\textdegree} in training machine temperatures. Participants self-controlled their activities on smart devices, while a supervisor monitored them over the Internet. Individual $\Delta$t{\textdegree} reached during 30 minutes of moderate-intensity continuous training averaged 7.8{\textdegree}C (SD 1.6). These $\Delta$t{\textdegree} 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. ", doi="10.2196/rehab.4812", url="http://rehab.jmir.org/2015/2/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582243" } @Article{info:doi/10.2196/rehab.4776, author="Shubert, E. Tiffany and Basnett, Jeanna and Chokshi, Anang and Barrett, Mark and Komatireddy, Ravi", title="Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera", journal="JMIR Rehabil Assist Technol", year="2015", month="Nov", day="05", volume="2", number="2", pages="e10", keywords="aging, fall prevention, technology, evidence-based, Kinect, falls", abstract="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 ({\textpm} 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 {\textpm} 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. ", doi="10.2196/rehab.4776", url="http://rehab.jmir.org/2015/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582244" } @Article{info:doi/10.2196/resprot.4743, author="Szturm, Tony and Hochman, Jordan and Wu, Christine and Lisa, Lix and Reimer, Karen and Wonneck, Beth and Giacobbo, Andrea", title="Games and Telerehabilitation for Balance Impairments and Gaze Dysfunction: Protocol of a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2015", month="Oct", day="21", volume="4", number="4", pages="e118", keywords="balance-exercises", keywords="gaze-exercises", keywords="home therapy", keywords="telerehabilitation", keywords="therapeutic-gaming", keywords="vestibular rehabilitation", abstract="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) ", doi="10.2196/resprot.4743", url="http://www.researchprotocols.org/2015/4/e118/", url="http://www.ncbi.nlm.nih.gov/pubmed/26490109" } @Article{info:doi/10.2196/rehab.3832, author="Bonnech{\`e}re, Bruno and Jansen, Bart and Omelina, Lubos and Rooze, Marcel and Van Sint Jan, Serge", title="Interchangeability of the Wii Balance Board for Bipedal Balance Assessment", journal="JMIR Rehabil Assist Technol", year="2015", month="Aug", day="27", volume="2", number="2", pages="e8", keywords="force plate", keywords="balance board", keywords="balance performance", keywords="validity", keywords="repeatability", abstract="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 $\rho$ =.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). ", doi="10.2196/rehab.3832", url="http://rehab.jmir.org/2015/2/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582237" } @Article{info:doi/10.2196/humanfactors.4129, author="Morrison, Cecily and D'Souza, Marcus and Huckvale, Kit and Dorn, F. Jonas and Burggraaff, Jessica and Kamm, Philipp Christian and Steinheimer, Marie Saskia and Kontschieder, Peter and Criminisi, Antonio and Uitdehaag, Bernard and Dahlke, Frank and Kappos, Ludwig and Sellen, Abigail", title="Usability and Acceptability of ASSESS MS: Assessment of Motor Dysfunction in Multiple Sclerosis Using Depth-Sensing Computer Vision", journal="JMIR Human Factors", year="2015", month="Jun", day="24", volume="2", number="1", pages="e11", keywords="depth-sensing computer vision", keywords="information interfaces and presentation", keywords="Kinect", keywords="motor skills", keywords="multiple sclerosis", keywords="rehabilitation", abstract="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. ", doi="10.2196/humanfactors.4129", url="http://humanfactors.jmir.org/2015/1/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025782" } @Article{info:doi/10.2196/jmir.3802, author="Vermeulen, Joan and Neyens, CL Jacques and Spreeuwenberg, D. Marieke and van Rossum, Erik and Boessen, BCG April and Sipers, Walther and de Witte, P. Luc", title="The Relationship Between Balance Measured With a Modified Bathroom Scale and Falls and Disability in Older Adults: A 6-Month Follow-Up Study", journal="J Med Internet Res", year="2015", month="May", day="27", volume="17", number="5", pages="e131", keywords="telemonitoring", keywords="balance", keywords="bathroom scale", keywords="older adults", keywords="falls", keywords="disability", keywords="validity", abstract="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. ", doi="10.2196/jmir.3802", url="http://www.jmir.org/2015/5/e131/", url="http://www.ncbi.nlm.nih.gov/pubmed/26018423" } @Article{info:doi/10.2196/rehab.4084, author="Piau, Antoine and Charlon, Yoann and Campo, Eric and Vellas, Bruno and Nourhashemi, Fati", title="A Smart Insole to Promote Healthy Aging for Frail Elderly Individuals: Specifications, Design, and Preliminary Results", journal="JMIR Rehabil Assist Technol", year="2015", month="May", day="25", volume="2", number="1", pages="e5", keywords="frail elderly", keywords="gait", keywords="healthy aging", keywords="wearable sensors", abstract="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). ", doi="10.2196/rehab.4084", url="http://rehab.jmir.org/2015/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582238" } @Article{info:doi/10.2196/rehab.4274, author="Giesbrecht, Mark Edward and Miller, C. William and Jin, Tom Boyang and Mitchell, M. Ian and Eng, J. Janice", title="Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults", journal="JMIR Rehabil Assist Technol", year="2015", month="Apr", day="30", volume="2", number="1", pages="e3", keywords="wheelchairs", keywords="telemedicine", keywords="self-efficacy", keywords="aged", keywords="pilot projects", abstract="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). ", doi="10.2196/rehab.4274", url="http://rehab.jmir.org/2015/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582240" } @Article{info:doi/10.2196/resprot.4285, author="Brewer, C. LaPrincess and Kaihoi, Brian and Zarling, K. Kathleen and Squires, W. Ray and Thomas, Randal and Kopecky, Stephen", title="The Use of Virtual World-Based Cardiac Rehabilitation to Encourage Healthy Lifestyle Choices Among Cardiac Patients: Intervention Development and Pilot Study Protocol", journal="JMIR Res Protoc", year="2015", month="Apr", day="08", volume="4", number="2", pages="e39", keywords="cardiac rehabilitation", keywords="cardiovascular diseases", keywords="eHealth", keywords="telemedicine", keywords="Internet", keywords="health behavior", abstract="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. ", doi="10.2196/resprot.4285", url="http://www.researchprotocols.org/2015/2/e39/", url="http://www.ncbi.nlm.nih.gov/pubmed/25857331" } @Article{info:doi/10.2196/jmir.3844, author="Tousignant, Michel and Moffet, H{\'e}l{\`e}ne and Nadeau, Sylvie and M{\'e}rette, Chantal and Boissy, Patrick and Corriveau, H{\'e}l{\`e}ne and Marquis, Fran{\c{c}}ois and Cabana, Fran{\c{c}}ois and Ranger, Pierre and Belzile, L. {\'E}tienne and Dimentberg, Ronald", title="Cost Analysis of In-Home Telerehabilitation for Post-Knee Arthroplasty", journal="J Med Internet Res", year="2015", month="Mar", day="31", volume="17", number="3", pages="e83", keywords="telemedicine", keywords="economics", keywords="cost analysis", keywords="knee arthroplasty", abstract="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). ", doi="10.2196/jmir.3844", url="http://www.jmir.org/2015/3/e83/", url="http://www.ncbi.nlm.nih.gov/pubmed/25840501" } @Article{info:doi/10.2196/rehab.3633, author="Rawstorn, C. Jonathan and Gant, Nicholas and Warren, Ian and Doughty, Neil Robert and Lever, Nigel and Poppe, K. Katrina and Maddison, Ralph", title="Measurement and Data Transmission Validity of a Multi-Biosensor System for Real-Time Remote Exercise Monitoring Among Cardiac Patients", journal="JMIR Rehabil Assist Technol", year="2015", month="Mar", day="20", volume="2", number="1", pages="e2", keywords="telemedicine", keywords="remote sensing technology", keywords="telemetry", keywords="smartphone", keywords="mHealth", keywords="rehabilitation", keywords="cardiac rehabilitation", abstract="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. ", doi="10.2196/rehab.3633", url="http://rehab.jmir.org/2015/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582235" } @Article{info:doi/10.2196/games.3401, author="Tatla, K. Sandy and Shirzad, Navid and Lohse, R. Keith and Virji-Babul, Naznin and Hoens, M. Alison and Holsti, Liisa and Li, C. Linda and Miller, J. Kimberly and Lam, Y. Melanie and Van der Loos, Machiel H. F.", title="Therapists' Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation", journal="JMIR Serious Games", year="2015", month="Mar", day="10", volume="3", number="1", pages="e2", keywords="virtual reality", keywords="technology adoption", keywords="rehabilitation", keywords="therapy", keywords="social media", keywords="gaming", keywords="stroke", keywords="cerebral palsy", keywords="hemiplegia", abstract="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. ", doi="10.2196/games.3401", url="http://games.jmir.org/2015/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/25759148" } @Article{info:doi/10.2196/resprot.4034, author="Merch{\'a}n-Baeza, Antonio Jose and Gonzalez-Sanchez, Manuel and Cuesta-Vargas, Antonio", title="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", journal="JMIR Res Protoc", year="2015", month="Mar", day="10", volume="4", number="1", pages="e33", keywords="stroke", keywords="ADL", keywords="environment", keywords="patient adherence", keywords="mobile apps", keywords="mobile health", abstract="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). ", doi="10.2196/resprot.4034", url="http://www.researchprotocols.org/2015/1/e33/", url="http://www.ncbi.nlm.nih.gov/pubmed/25757808" } @Article{info:doi/10.2196/resprot.4031, author="Imam, Bita and Miller, C. William and Finlayson, C. Heather and Eng, J. Janice and Payne, WC Michael and Jarus, Tal and Goldsmith, H. Charles and Mitchell, M. Ian", title="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", journal="JMIR Res Protoc", year="2014", month="Dec", day="22", volume="3", number="4", pages="e80", keywords="amputation", keywords="adult", keywords="aged", keywords="randomized controlled trial", keywords="telemedicine", keywords="walking", abstract="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). ", doi="10.2196/resprot.4031", url="http://www.researchprotocols.org/2014/4/e80/", url="http://www.ncbi.nlm.nih.gov/pubmed/25533902" }