@Article{info:doi/10.2196/mhealth.8256, author="Selter, Aliza and Tsangouri, Christina and Ali, B. Sana and Freed, Diana and Vatchinsky, Adrian and Kizer, James and Sahuguet, Arnaud and Vojta, Deneen and Vad, Vijay and Pollak, JP and Estrin, Deborah", title="An mHealth App for Self-Management of Chronic Lower Back Pain (Limbr): Pilot Study", journal="JMIR Mhealth Uhealth", year="2018", month="Sep", day="17", volume="6", number="9", pages="e179", keywords="low back pain", keywords="chronic disease", keywords="self-assessment", keywords="telemedicine", keywords="self-management", keywords="activities of daily living", keywords="pain", keywords="rehabilitation", abstract="Background: Although mobile health (mHealth) interventions can help improve outcomes among patients with chronic lower back pain (CLBP), many available mHealth apps offer content that is not evidence based. Limbr was designed to enhance self-management of CLBP by packaging self-directed rehabilitation tutorial videos, visual self-report tools, remote health coach support, and activity tracking into a suite of mobile phone apps, including Your Activities of Daily Living, an image-based tool for quantifying pain-related disability. Objective: The aim is to (1) describe patient engagement with the Limbr program, (2) describe patient-perceived utility of the Limbr program, and (3) assess the validity of the Your Activities of Daily Living module for quantifying functional status among patients with CLBP. Methods: This was a single-arm trial utilizing a convenience sample of 93 adult patients with discogenic back pain who visited a single physiatrist from January 2016 to February 2017. Eligible patients were enrolled in 3-month physical therapy program and received the Limbr mobile phone app suite for iOS or Android. The program included three daily visual self-reports to assess pain, activity level, and medication/coping mechanisms; rehabilitation video tutorials; passive activity-level measurement; and chat-based health coaching. Patient characteristics, patient engagement, and perceived utility were analyzed descriptively. Associations between participant characteristics and program interaction were analyzed using multiple linear regression. Associations between Your Activities of Daily Living and Oswestry Disability Index (ODI) assessments were examined using Pearson correlation and hierarchical linear modeling. Results: A total of 93 participants were enrolled; of these, 35 (38\%) completed the program (age: mean 46, SD 16 years; female: 22/35, 63\%). More than half of completers finished assessments at least every 3 days and 70\% (19/27) used the rehabilitation component at least once a week. Among respondents to a Web-based feedback survey, 76\% (16/21) found the daily notifications helped them remember to complete their exercises, 81\% (17/21) found the system easy to use, and 62\% (13/21) rated their overall experience good or excellent. Baseline Your Activities of Daily Living score was a significant predictor of baseline ODI score, with ODI increasing by 0.30 units for every 1-unit increase in Your Activities of Daily Living (P<.001). Similarly, hierarchical linear modeling analysis indicated that Your Activities of Daily Living daily assessment scores were significant predictors of ODI scores over the course of the study (P=.01). Conclusions: Engagement among participants who completed the Limbr program was high, and program utility was rated positively by most respondents. Your Activities of Daily Living was significantly associated with ODI scores, supporting the validity of this novel tool. Future studies should assess the effect of Limbr on clinical outcomes, evaluate its use among a wider patient sample, and explore strategies for reducing attrition. Trial Registration: ClinicalTrials.gov NCT03040310; https://clinicaltrials.gov/ct2/show/NCT03040310 (Archived by WebCite at http://www.webcitation.org/722mEvAiv) ", doi="10.2196/mhealth.8256", url="http://mhealth.jmir.org/2018/9/e179/", url="http://www.ncbi.nlm.nih.gov/pubmed/30224333" } @Article{info:doi/10.2196/rehab.8638, author="van Reijen, Miriam and Asscheman, Marianne and Vriend, Ingrid and van Mechelen, Willem and Verhagen, Evert", title="Users' Perspectives, Opportunities, and Barriers of the Strengthen Your Ankle App for Evidence-Based Ankle Sprain Prevention: Mixed-Methods Process Evaluation for a Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2018", month="Jul", day="06", volume="5", number="2", pages="e13", keywords="injury prevention", keywords="ankle injury", keywords="eHealth", keywords="qualitative analysis", keywords="process evaluation", abstract="Background: The ``Strengthen Your Ankle'' neuromuscular training program has been thoroughly studied over the past 8 years. This process evaluation is a part of a randomized controlled trial that examined both the short- and long-term effectiveness of this particular program. Although it was shown previously that the program, available both in a printed booklet and as a mobile app, is able to effectively reduce the number of recurrent ankle sprains, participants' compliance with the program is an ongoing challenge. Objective: This process evaluation explored participants' opinions regarding both the methods of delivery, using RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) Framework to identify barriers and challenges to program compliance. Although Reach, Effectiveness, and Adaptation were the focus of a previous study, this paper focuses on the implementation and maintenance phases. Methods: Semistructured interviews and online questionnaires were analyzed using qualitative content analysis. Fisher exact, chi-square, and t tests assessed between-group differences in quantitative survey responses. Interviews were assessed by thematic analysis to identify key themes. Results: While there were no significant differences in the perceived simplicity, usefulness, and liking of the exercise during the 8 weeks of the neuromuscular training program, semistructured interviews showed that 14 of 16 participants agreed that an app would be of additional benefits over a booklet. After the 12-month follow-up, when asked how they evaluated the overall use of the app or the booklet, the users of the app gave a mean score of 7.7 (SD 0.99) versus a mean score 7.1 (SD 1.23) for the users of the booklet. This difference in mean score was significant (P=.006). Conclusions: Although both the app and booklet showed a high user satisfaction, the users of the app were significantly more satisfied. Semistructured questionnaires allowed users to address issues they would like to improve in future updates. Including a possibility for feedback and postponement of exercises, an explanation of the use of specific exercises and possibly music were identified as features that might further improve the contentment of the program, probably leading to increased compliance. Trial Registration: Netherlands Trial Register NTR4027; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4027 (Archived by Webcite at http://www.webcitation.org/70MTo9dMV) ", doi="10.2196/rehab.8638", url="http://rehab.jmir.org/2018/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/29980497" } @Article{info:doi/10.2196/rehab.8335, author="Rodr{\'i}guez-Molinero, Alejandro and P{\'e}rez-L{\'o}pez, Carlos and Sam{\`a}, Albert and de Mingo, Eva and Rodr{\'i}guez-Mart{\'i}n, Daniel and Hern{\'a}ndez-Vara, Jorge and Bay{\'e}s, {\`A}ngels and Moral, Alfons and {\'A}lvarez, Ramiro and P{\'e}rez-Mart{\'i}nez, A. David and Catal{\`a}, Andreu", title="A Kinematic Sensor and Algorithm to Detect Motor Fluctuations in Parkinson Disease: Validation Study Under Real Conditions of Use", journal="JMIR Rehabil Assist Technol", year="2018", month="Apr", day="25", volume="5", number="1", pages="e8", keywords="Parkinson disease", keywords="movement disorders", keywords="movement", keywords="gait", abstract="Background: A new algorithm has been developed, which combines information on gait bradykinesia and dyskinesia provided by a single kinematic sensor located on the waist of Parkinson disease (PD) patients to detect motor fluctuations (On- and Off-periods). Objective: The goal of this study was to analyze the accuracy of this algorithm under real conditions of use. Methods: This validation study of a motor-fluctuation detection algorithm was conducted on a sample of 23 patients with advanced PD. Patients were asked to wear the kinematic sensor for 1 to 3 days at home, while simultaneously keeping a diary of their On- and Off-periods. During this testing, researchers were not present, and patients continued to carry on their usual daily activities in their natural environment. The algorithm's outputs were compared with the patients' records, which were used as the gold standard. Results: The algorithm produced 37\% more results than the patients' records (671 vs 489). The positive predictive value of the algorithm to detect Off-periods, as compared with the patients' records, was 92\% (95\% CI 87.33\%-97.3\%) and the negative predictive value was 94\% (95\% CI 90.71\%-97.1\%); the overall classification accuracy was 92.20\%. Conclusions: The kinematic sensor and the algorithm for detection of motor-fluctuations validated in this study are an accurate and useful tool for monitoring PD patients with difficult-to-control motor fluctuations in the outpatient setting. ", doi="10.2196/rehab.8335", url="http://rehab.jmir.org/2018/1/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/29695377" } @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/rehab.9247, author="Teixeira Neto, Cavalcante Nestor and Lima, Lopes Yuri and Almeida, Le{\~a}o Gabriel Peixoto and Bezerra, Almeida M{\'a}rcio and Lima, Paula Pedro Olavo De and de Oliveira, Ribeiro Rodrigo", title="Physiotherapy Questionnaires App to Deliver Main Musculoskeletal Assessment Questionnaires: Development and Validation Study", journal="JMIR Rehabil Assist Technol", year="2018", month="Feb", day="23", volume="5", number="1", pages="e1", keywords="mobile phone", keywords="Foot and Ankle Outcome Score", keywords="American Orthopaedic Foot and Ankle Society", keywords="musculoskeletal assessment questionnaires", keywords="health survey", abstract="Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. Objective: This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. Methods: In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study's outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. Results: The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients' data. In regards to validity, the mean of the total scores of the FAOS were 91.54\% (SD 8.86\%) for the paper version and 91.74\% (SD 9.20\%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95\% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95\% CI 0.98-0.99). For compliance, 72\% (36/50) of the participants in the FAOS group and 94\% (47/50) in the AOFAS group preferred the app version. Conclusions: The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice. ", doi="10.2196/rehab.9247", url="http://rehab.jmir.org/2018/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/29475827" } @Article{info:doi/10.2196/mhealth.8074, author="Col{\'o}n-Semenza, Cristina and Latham, K. Nancy and Quintiliani, M. Lisa and Ellis, D. Terry", title="Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study", journal="JMIR Mhealth Uhealth", year="2018", month="Feb", day="15", volume="6", number="2", pages="e42", keywords="Parkinson disease", keywords="exercise", keywords="telemedicine", keywords="social support", keywords="fitness tracker", abstract="Background: Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. Objective: The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. Methods: A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Results: Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were ``satisfied'' or ``very satisfied'' with the training program, and all participants were ``satisfied'' or ``very satisfied'' with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Conclusions: Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach. ", doi="10.2196/mhealth.8074", url="http://mhealth.jmir.org/2018/2/e42/", url="http://www.ncbi.nlm.nih.gov/pubmed/29449201" } @Article{info:doi/10.2196/mhealth.8815, author="Manor, Brad and Yu, Wanting and Zhu, Hao and Harrison, Rachel and Lo, On-Yee and Lipsitz, Lewis and Travison, Thomas and Pascual-Leone, Alvaro and Zhou, Junhong", title="Smartphone App--Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="30", volume="6", number="1", pages="e36", keywords="smartphone", keywords="gait assessment", keywords="pocket", keywords="dual task", keywords="validity", keywords="reliability", keywords="mobile applications", abstract="Background: Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and ``dual-task'' walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings. Objective: The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings. Methods: We created an iPhone app that used the phone's motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user's pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard--instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times---a clinically meaningful metric of locomotor control---from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses. Results: Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r2=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r2=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94). Conclusions: The iPhone app we created enabled valid and reliable assessment of stride timing---with the smartphone in the pocket---during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations. ", doi="10.2196/mhealth.8815", url="http://mhealth.jmir.org/2018/1/e36/", url="http://www.ncbi.nlm.nih.gov/pubmed/29382625" } @Article{info:doi/10.2196/humanfactors.8017, author="Beatty, L. Alexis and Magnusson, L. Sara and Fortney, C. John and Sayre, G. George and Whooley, A. Mary", title="VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study", journal="JMIR Hum Factors", year="2018", month="Jan", day="15", volume="5", number="1", pages="e3", keywords="cardiac rehabilitation", keywords="mobile applications", keywords="exercise therapy", keywords="exercise", keywords="rehabilitation research", keywords="telemedicine", keywords="habits", keywords="qualitative research", abstract="Background: Cardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR. Objective: The aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability. Methods: We recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users. Results: We conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44\% (11/25 tasks) to 78\% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (``I think it'll be good to track my exercise and to see what I'm doing''), a desire for introductory training (``Initially, training with a technical person, instead of me relying on myself''), and an expectation for sharing data with providers (``It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor''). Conclusions: With participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology. ", doi="10.2196/humanfactors.8017", url="http://humanfactors.jmir.org/2018/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/29335235" } @Article{info:doi/10.2196/humanfactors.8096, author="Lau, YS Annie and Piper, Kalman and Bokor, Desmond and Martin, Paige and Lau, SL Victor and Coiera, Enrico", title="Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study", journal="JMIR Hum Factors", year="2017", month="Dec", day="07", volume="4", number="4", pages="e31", keywords="mobile application", keywords="mobile health", keywords="personal health record", keywords="patients", keywords="health services", keywords="medical informatics", keywords="surgery", keywords="orthopedics", keywords="shoulder", keywords="rotator cuff", keywords="rehabilitation", abstract="Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective: The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47\%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians. ", doi="10.2196/humanfactors.8096", url="http://humanfactors.jmir.org/2017/4/e31/", url="http://www.ncbi.nlm.nih.gov/pubmed/29217504" } @Article{info:doi/10.2196/rehab.9032, author="Huber, Stephan and Priebe, A. Janosch and Baumann, Kaja-Maria and Plidschun, Anne and Schiessl, Christine and T{\"o}lle, R. Thomas", title="Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results", journal="JMIR Rehabil Assist Technol", year="2017", month="Dec", day="04", volume="4", number="2", pages="e11", keywords="lower back pain", keywords="app", keywords="mHealth", keywords="retrospective study", keywords="self-management", abstract="Background: Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. Objective: The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Methods: Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Results: Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects. ", doi="10.2196/rehab.9032", url="http://rehab.jmir.org/2017/2/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/29203460" } @Article{info:doi/10.2196/mhealth.8656, author="Adusumilli, Gautam and Joseph, Eben Solomon and Samaan, A. Michael and Schultz, Brooke and Popovic, Tijana and Souza, B. Richard and Majumdar, Sharmila", title="iPhone Sensors in Tracking Outcome Variables of the 30-Second Chair Stand Test and Stair Climb Test to Evaluate Disability: Cross-Sectional Pilot Study", journal="JMIR Mhealth Uhealth", year="2017", month="Oct", day="27", volume="5", number="10", pages="e166", keywords="osteoarthritis", keywords="telemedicine", keywords="mobile phone", keywords="mobile apps", keywords="algorithms", keywords="medical informatics", abstract="Background: Performance tests are important to characterize patient disabilities and functional changes. The Osteoarthritis Research Society International and others recommend the 30-second Chair Stand Test and Stair Climb Test, among others, as core tests that capture two distinct types of disability during activities of daily living. However, these two tests are limited by current protocols of testing in clinics. There is a need for an alternative that allows remote testing of functional capabilities during these tests in the osteoarthritis patient population. Objective: Objectives are to (1) develop an app for testing the functionality of an iPhone's accelerometer and gravity sensor and (2) conduct a pilot study objectively evaluating the criterion validity and test-retest reliability of outcome variables obtained from these sensors during the 30-second Chair Stand Test and Stair Climb Test. Methods: An iOS app was developed with data collection capabilities from the built-in iPhone accelerometer and gravity sensor tools and linked to Google Firebase. A total of 24 subjects performed the 30-second Chair Stand Test with an iPhone accelerometer collecting data and an external rater manually counting sit-to-stand repetitions. A total of 21 subjects performed the Stair Climb Test with an iPhone gravity sensor turned on and an external rater timing the duration of the test on a stopwatch. App data from Firebase were converted into graphical data and exported into MATLAB for data filtering. Multiple iterations of a data processing algorithm were used to increase robustness and accuracy. MATLAB-generated outcome variables were compared to the manually determined outcome variables of each test. Pearson's correlation coefficients (PCCs), Bland-Altman plots, intraclass correlation coefficients (ICCs), standard errors of measurement, and repeatability coefficients were generated to evaluate criterion validity, agreement, and test-retest reliability of iPhone sensor data against gold-standard manual measurements. Results: App accelerometer data during the 30-second Chair Stand Test (PCC=.890) and gravity sensor data during the Stair Climb Test (PCC=.865) were highly correlated to gold-standard manual measurements. Greater than 95\% of values on Bland-Altman plots comparing the manual data to the app data fell within the 95\% limits of agreement. Strong intraclass correlation was found for trials of the 30-second Chair Stand Test (ICC=.968) and Stair Climb Test (ICC=.902). Standard errors of measurement for both tests were found to be within acceptable thresholds for MATLAB. Repeatability coefficients for the 30-second Chair Stand Test and Stair Climb Test were 0.629 and 1.20, respectively. Conclusions: App-based performance testing of the 30-second Chair Stand Test and Stair Climb Test is valid and reliable, suggesting its applicability to future, larger-scale studies in the osteoarthritis patient population. ", doi="10.2196/mhealth.8656", url="http://mhealth.jmir.org/2017/10/e166/", url="http://www.ncbi.nlm.nih.gov/pubmed/29079549" } @Article{info:doi/10.2196/mhealth.7136, author="Bendixen, M. Roxanna and Fairman, D. Andrea and Karavolis, Meredith and Sullivan, Carly and Parmanto, Bambang", title="A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management", journal="JMIR Mhealth Uhealth", year="2017", month="Sep", day="26", volume="5", number="9", pages="e141", keywords="mobile health", keywords="telemedicine", keywords="self-care", keywords="adolescence", keywords="spina bifida", keywords="cerebral palsy", keywords="spinal cord injury", abstract="Background: Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. Objective: Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. Methods: Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. Results: A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. Conclusions: Our findings suggest that most individuals keep their mobile phones with them at all times and typically use a mobile phone for social media, music, photos, and texting. Our qualitative analysis indicates that youth and young adults with BSA, as well as their caregivers, acknowledge the importance of being actively engaged in developing and using mHealth apps that monitor and manage their health care needs. Information gleaned from these focus group sessions and surveys have provided data to refine the iMHere 2.0 mHealth prototype platform that we have developed. ", doi="10.2196/mhealth.7136", url="http://mhealth.jmir.org/2017/9/e141/", url="http://www.ncbi.nlm.nih.gov/pubmed/28951378" } @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/mhealth.7335, author="Dicianno, Edward Brad and Henderson, Geoffrey and Parmanto, Bambang", title="Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks", journal="JMIR Mhealth Uhealth", year="2017", month="Jul", day="24", volume="5", number="7", pages="e103", keywords="goals", keywords="self-care", keywords="mobile health", keywords="rehabilitation", keywords="smartphone", keywords="spinal cord injury", keywords="spinal dysraphism", abstract="Background: Goal-setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to (1) qualitatively analyze data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module to support their complex goal-setting routines, (2) design a prototype of a goal-setting module within an existing mobile health (mHealth) system, and (3) identify what educational content might be necessary to integrate into the system. Methods: A total of 750 goals were analyzed from patients with SB and SCI enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for an mHealth goal-setting module and identify important educational content. Results: Those of male sex (P=.02) and with SCI diagnosis (P<.001) were more likely to achieve goals than females or those with SB. Temporality (P<.001) and type (P<.001) of goal were associated with likelihood that the goal would be achieved. Nearly all (210/213; 98.6\%) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated. Conclusions: Innovative mHealth tools can be developed to support commonly set goals by individuals with disabilities. ", doi="10.2196/mhealth.7335", url="http://mhealth.jmir.org/2017/7/e103/", url="http://www.ncbi.nlm.nih.gov/pubmed/28739558" } @Article{info:doi/10.2196/rehab.7085, author="St{\"u}tz, Thomas and Emsenhuber, Gerlinde and Huber, Daniela and Domhardt, Michael and Tiefengrabner, Martin and Oostingh, Janneke Gertie and F{\"o}tschl, Ulrike and Matis, Nicholas and Ginzinger, Simon", title="Mobile Phone--Supported Physiotherapy for Frozen Shoulder: Feasibility Assessment Based on a Usability Study", journal="JMIR Rehabil Assist Technol", year="2017", month="Jul", day="20", volume="4", number="2", pages="e6", keywords="telemedicine", keywords="mobile health", keywords="mHealth", keywords="frozen shoulder", keywords="adhesive capsulitis", keywords="physiotherapy (techniques)", keywords="home health aides", keywords="mobile phone", abstract="Background: Patients with frozen shoulder show limited shoulder mobility often accompanied by pain. Common treatment methods include physiotherapy, pain medication, administration of corticosteroids, and surgical capsulotomy. Frozen shoulder often lasts from months to years and mostly affects persons in the age group of 40 to 70 years. It severely reduces the quality of life and the ability to work. Objective: The objective of this study was to evaluate the feasibility of a mobile health (mHealth) intervention that supports patients affected by ``stage two'' frozen shoulder. Patients were supported with app-based exercise instructions and tools to monitor their training compliance and progress. These training compliance and progress data supplement the patients' oral reports to the physiotherapists and physicians and can assist them in therapy adjustment. Methods: In order to assess the feasibility of the mHealth intervention, a pilot study of a newly developed app for frozen shoulder patients was conducted with 5 patients for 3 weeks. The main function of the app was the instruction for exercising at home. Standardized questionnaires on usability such as System Usability Scale (SUS) and USE (Usefulness, Satisfaction, and Ease of use), and Technology Acceptance Model-2 (TAM-2) were completed by the study participants at the end of the study. Additionally, a nonstandardized questionnaire was completed by all patients. The correctness of the exercises as conducted by the patients was assessed by a physiotherapist at the end of the study. The mobility of the shoulder and pain in shoulder movement was assessed by a physiotherapist at the start and the end of the study. Results: The pilot study was successfully conducted, and the app was evaluated by the patients after 3 weeks. The results of the standardized questionnaires showed high acceptance (TAM-2) and high usability (SUS) of the developed app. The overall usability of the system as assessed by the SUS questionnaire was very good (an average score of 88 out of 100). The average score of the TAM-2 questionnaire on the intention to further use the app was 4.2 out of 5, which indicated that most patients would use the app if further available. The results of the USE questionnaires highlighted that the patients learned how to use the app easily (an average score of 4.2 out of 5) and were satisfied with the app (an average score of 4.7 out of 5). The frequency of app usage and training was very high based on patient reports and verified by analysis of the usage data. The patients conducted the exercises almost flawlessly. Conclusions: Our results indicate the feasibility of the mHealth intervention, as the app was easy to use and frequently used by the patients. The app supported the patients' physiotherapy by providing clear exercising instructions. ", doi="10.2196/rehab.7085", url="http://rehab.jmir.org/2017/2/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28729234" } @Article{info:doi/10.2196/mhealth.7863, author="Li, C. Linda and Sayre, C. Eric and Xie, Hui and Clayton, Cam and Feehan, M. Lynne", title="A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study", journal="JMIR Mhealth Uhealth", year="2017", month="Jun", day="26", volume="5", number="6", pages="e86", keywords="osteoarthritis", keywords="physical activity", keywords="sedentary behavior", keywords="sedentary lifestyle", keywords="wearables", keywords="digital technology", keywords="fitness trackers", keywords="exercise", abstract="Background: Physical activity can improve health outcomes in people with knee osteoarthritis (OA); however, participation in physical activity is very low in this population. Objective: The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables (Fitbit Flex) and telephone counselling by a physical therapist (PT) for improving physical activity in people with a physician-confirmed diagnosis of knee OA, or who have passed 2 validated criteria for early OA. Methods: We conducted a community-based feasibility randomized controlled trial. The immediate group (n=17) received a brief education session by a physical therapist, a Fitbit Flex activity tracker, and a weekly telephone call for activity counselling with the physical therapist. The delayed group (n=17) received the same intervention 1 month later. All participants were assessed at baseline (T0), and the end of 1 month (T1) and 2 months (T2). Outcomes were (1) mean moderate to vigorous physical activity time, (2) mean time spent on sedentary behavior, (3) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (4) Partners in Health Scale. Feasibility data were summarized with descriptive statistics. We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2, after adjusting for blocking and T0. We assessed planned contrasts of changes in outcome measures over measurement periods. Results: We identified 46 eligible individuals; of those, 34 (74\%) enrolled and no one dropped out. All but 1 participant adhered to the intervention protocol. We found a significant effect, with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group. The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale, favoring the delayed group. Conclusions: This study demonstrated the feasibility of a behavioral intervention, supported by the use of a wearable device, to promote physical activity among people with knee OA. Trial Registration: ClinicalTrials.gov NCT02313506; https://clinicaltrials.gov/ct2/show/NCT02313506 (Archived by WebCite at http://www.webcitation.org/6r4P3Bub0) ", doi="10.2196/mhealth.7863", url="http://mhealth.jmir.org/2017/6/e86/", url="http://www.ncbi.nlm.nih.gov/pubmed/28652228" } @Article{info:doi/10.2196/resprot.7280, author="Best, L. Krista and Routhier, Fran{\c{c}}ois and Sweet, N. Shane and Arbour-Nicitopoulos, P. Kelly and Borisoff, F. Jaimie and Noreau, Luc and Martin Ginis, A. Kathleen", title="The Smartphone Peer Physical Activity Counseling (SPPAC) Program for Manual Wheelchair Users: Protocol of a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2017", month="Apr", day="26", volume="6", number="4", pages="e69", keywords="Manual wheelchair", keywords="Physical activity", keywords="Peer training", keywords="Smartphone", keywords="Randomized controlled trial", abstract="Background: Physical activity (PA) must be performed regularly to accrue health benefits. However, the majority of manual wheelchair users do not meet PA recommendations. Existing community-based PA programs for manual wheelchair users appear to work, but effect sizes are small and retention is low. Existing PA programs may not fully implement some psychosocial factors that are strongly linked with PA (eg, autonomy). The use of peers and mobile phone technology in the Smartphone Peer PA Counseling (SPPAC) program represents a novel approach to cultivating a PA-supportive environment for manual wheelchair users. Objective: The primary objective is to compare change in objective PA between the experimental (SPPAC) and control groups from baseline to postintervention (10 weeks) and follow-up (3 months). Changes in and relationships between subjective PA, wheelchair skills, motivation, self-efficacy (for overcoming barriers to PA for manual wheelchair use), satisfaction of psychological needs for PA, and satisfaction with PA participation will be explored (secondary outcome). Program implementation will be explored (tertiary objective). Methods: A total of 38 community-living manual wheelchair users (?18 years) will be recruited in a randomized controlled trial (RCT). Participants in both the control and experimental groups will receive existing PA guidelines. Participants in the experimental group will also receive the SPPAC program: 14 sessions ({\textasciitilde}30 min) over a 10-week period delivered by a peer trainer using a mobile phone. PA activities will be based on individuals' preferences and goals. Implementation of important theoretical variables will be enforced through a peer-trainer checklist. Outcomes for objective PA (primary) and subjective PA, wheelchair skills, motivation, self-efficacy, satisfaction of psychological needs, and satisfaction with participation will be collected at three time points (baseline, postintervention, follow-up). Multiple imputations will be used to treat missing data. A mixed-model ANCOVA will be conducted, controlling for covariates (primary and secondary objectives). The strength and direction of the relationships between the primary and secondary outcomes will be explored (secondary objective). Descriptive and content analysis will be used to appraise program implementation (tertiary objective). Results: Funding has been obtained from the Craig Neilsen Foundation and the Canadian Disability Participation Project, with additional funds being sought from the Canadian Institute for Health Research and Fonds de Recherche du Qu{\'e}bec-Sant{\'e}. Pilot evaluation of intervention implementation is currently underway, with enrollment anticipated to begin early 2018. Conclusions: There may be substantial benefits for the SPPAC program including limited burden on health care professionals, decreased barriers (eg. accessibility, transportation), development of peer social supports, and potential cost savings related to physical inactivity. Before conducting a large and expensive multisite RCT within a small heterogeneous population of manual wheelchair users, a pilot study affords a prudent step to establishing an adequate study protocol and implementation strategies. Trial Registration: ClinicalTrials.gov NCT02826707; https://clinicaltrials.gov/ct2/show/NCT02826707 (Archived by WebCite at http://www.webcitation.org/6pqIc14dU) ", doi="10.2196/resprot.7280", url="http://www.researchprotocols.org/2017/4/e69/", url="http://www.ncbi.nlm.nih.gov/pubmed/28446419" } @Article{info:doi/10.2196/mhealth.7184, author="Lilje, Charlotta Stina and Olander, Ewy and Berglund, Johan and Skillgate, Eva and Anderberg, Peter", title="Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study", journal="JMIR Mhealth Uhealth", year="2017", month="Mar", day="30", volume="5", number="3", pages="e39", keywords="text messages", keywords="older adults", keywords="recurrent low back pain", keywords="manual therapy", abstract="Background: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients' experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. Objectives: The aim of this study was to explore older persons' common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. Methods: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi's principles of psychological phenomenological analysis. Results: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. Conclusions: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed. ", doi="10.2196/mhealth.7184", url="http://mhealth.jmir.org/2017/3/e39/", url="http://www.ncbi.nlm.nih.gov/pubmed/28360026" } @Article{info:doi/10.2196/rehab.6074, author="Bright, Tess and Pallawela, Danuk", title="Validated Smartphone-Based Apps for Ear and Hearing Assessments: A Review", journal="JMIR Rehabil Assist Technol", year="2016", month="Dec", day="23", volume="3", number="2", pages="e13", keywords="hearing", keywords="testing", keywords="mobile", keywords="audiometry", keywords="smartphone", keywords="applications", keywords="app", keywords="hearing loss", keywords="hearing impairment", keywords="surveys", keywords="prevalence", abstract="Background: An estimated 360 million people have a disabling hearing impairment globally, the vast majority of whom live in low- and middle-income countries (LMICs). Early identification through screening is important to negate the negative effects of untreated hearing impairment. Substantial barriers exist in screening for hearing impairment in LMICs, such as the requirement for skilled hearing health care professionals and prohibitively expensive specialist equipment to measure hearing. These challenges may be overcome through utilization of increasingly available smartphone app technologies for ear and hearing assessments that are easy to use by unskilled professionals. Objective: Our objective was to identify and compare available apps for ear and hearing assessments and consider the incorporation of such apps into hearing screening programs Methods: In July 2015, the commercial app stores Google Play and Apple App Store were searched to identify apps for ear and hearing assessments. Thereafter, six databases (EMBASE, MEDLINE, Global Health, Web of Science, CINAHL, and mHealth Evidence) were searched to assess which of the apps identified in the commercial review had been validated against gold standard measures. A comparison was made between validated apps. Results: App store search queries returned 30 apps that could be used for ear and hearing assessments, the majority of which are for performing audiometry. The literature search identified 11 eligible validity studies that examined 6 different apps. uHear, an app for self-administered audiometry, was validated in the highest number of peer reviewed studies against gold standard pure tone audiometry (n=5). However, the accuracy of uHear varied across these studies. Conclusions: Very few of the available apps have been validated in peer-reviewed studies. Of the apps that have been validated, further independent research is required to fully understand their accuracy at detecting ear and hearing conditions. ", doi="10.2196/rehab.6074", url="http://rehab.jmir.org/2016/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582261" } @Article{info:doi/10.2196/resprot.5940, author="Jones, Donald and Skrepnik, Nebojsa and Toselli, M. Richard and Leroy, Bruno", title="Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2016", month="Aug", day="09", volume="5", number="3", pages="e164", keywords="mHealth", keywords="osteoarthritis", keywords="pain", keywords="physical therapy", abstract="Background: Osteoarthritis (OA) of the knee is one of the leading causes of disability in the United States. One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies, as they can be used to increase physical activity and promote exercise, which are key components of knee OA management. Objective: Currently, no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available, and similarly, no data on whether mHealth technologies can impact outcomes are available. Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored, comprehensive management strategy for patients with knee OA. Methods: The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor (thereby both encouraging changes in mobility as well as tracking them) combined with education about the benefits of walking on patient mobility. The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors. Activity monitors will capture step count estimates and will compare those with patients' step goals, calories burned, and distance walked. Patients using the novel smartphone app will be able to enter information on their daily pain, mood, and sleep quality. The relationships among activity and pain, activity and mood, and sleep will be assessed, as will patient satisfaction with and adherence to the mobile app. Results: We present information on an upcoming trial that will prospectively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid. Conclusions: We anticipate the results of this study will support the concept that mHealth technologies provide continuous, real-time feedback to patients with OA on their overall level of activity for a more proactive, personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders. ", doi="10.2196/resprot.5940", url="http://www.researchprotocols.org/2016/3/e164/", url="http://www.ncbi.nlm.nih.gov/pubmed/27506148" } @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/mhealth.5501, author="Rawstorn, C. Jonathan and Gant, Nicholas and Meads, Andrew and Warren, Ian and Maddison, Ralph", title="Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform", journal="JMIR mHealth uHealth", year="2016", month="Jun", day="24", volume="4", number="2", pages="e57", keywords="telemedicine", keywords="telerehabilitation", keywords="wireless technology", keywords="remote sensing technology", keywords="behavioral medicine", keywords="myocardial ischemia", abstract="Background: Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on. Objective: We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location. Methods: An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support. Results: The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients' exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription. Conclusions: The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial. ", doi="10.2196/mhealth.5501", url="http://mhealth.jmir.org/2016/2/e57/", url="http://www.ncbi.nlm.nih.gov/pubmed/27342791" } @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/rehab.4511, author="Shah, Nirtal and Aleong, Rosanne and So, Ivan", title="Novel Use of a Smartphone to Measure Standing Balance", journal="JMIR Rehabil Assist Technol", year="2016", month="Mar", day="29", volume="3", number="1", pages="e4", keywords="mobile application", keywords="telemedicine", keywords="postural balance", keywords="sports medicine", keywords="mobile phone", abstract="Background: Balance assessment and training is utilized by clinicians and their patients to measure and improve balance. There is, however, little consistency in terms of how clinicians, researchers, and patients measure standing balance. Utilizing the inherent sensors in every smartphone, a mobile application was developed to provide a method of objectively measuring standing balance. Objective: We aimed to determine if a mobile phone application, which utilizes the phone's accelerometer, can quantify standing balance. Methods: Three smartphones were positioned simultaneously above the participants' malleolus and patella and at the level of the umbilicus. Once secured, the myAnkle application was initiated to measure acceleration. Forty-eight participants completed 8 different balance exercises separately for the right and left legs. Accelerometer readings were obtained from each mobile phone and mean acceleration was calculated for each exercise at each ankle and knee and the torso. Results: Mean acceleration vector magnitude was reciprocally transformed to address skewness in the data distribution. Repeated measures ANOVAs were completed using the transformed data. A significant 2-way interaction was revealed between exercise condition and the body position of the phone (P<.001). Post-hoc tests indicated higher acceleration vector magnitude for exercises of greater difficulty. ANOVAs at each body position were conducted to examine the effect of exercise. The results revealed the knee as the location most sensitive for the detection of differences in acceleration between exercises. The accelerometer ranking of exercise difficulty showed high agreement with expert clinical rater rankings (kappa statistic>0.9). Conclusions: The myAnkle application revealed significantly greater acceleration magnitude for exercises of greater difficulty. Positioning of the mobile phone at the knee proved to be the most sensitive to changes in accelerometer values due to exercise difficulty. Application validity was shown through comparison with clinical raters. As such, the myAnkle app has utility as a measurement tool for standing balance. ", doi="10.2196/rehab.4511", url="http://rehab.jmir.org/2016/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582247" } @Article{info:doi/10.2196/rehab.5079, author="Mawson, Susan and Nasr, Nasrin and Parker, Jack and Davies, Richard and Zheng, Huiru and Mountain, Gail", title="A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation", journal="JMIR Rehabil Assist Technol", year="2016", month="Jan", day="07", volume="3", number="1", pages="e1", keywords="stroke", keywords="self-management", keywords="design", keywords="realist evaluation", keywords="sensor technology", keywords="equipment design", keywords="telehealth", keywords="self-care", abstract="Background: In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology--enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an ``intelligent shoe.''. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. Objective: To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities. ", doi="10.2196/rehab.5079", url="http://rehab.jmir.org/2016/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582250" } @Article{info:doi/10.2196/mhealth.4269, author="Tacchino, Andrea and Pedull{\`a}, Ludovico and Bonzano, Laura and Vassallo, Claudio and Battaglia, Alberto Mario and Mancardi, Gianluigi and Bove, Marco and Brichetto, Giampaolo", title="A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis", journal="JMIR mHealth uHealth", year="2015", month="Aug", day="31", volume="3", number="3", pages="e85", keywords="tablet", keywords="mobile phone", keywords="mobile device", keywords="cognitive rehabilitation", keywords="cognitive impairment", keywords="working memory", keywords="self-management", keywords="adaptive working load algorithms", keywords="usability", abstract="Background: Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. Objective: The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). Methods: COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C\# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. Results: The adherence to the treatment was 84\% (33.4/40). Of the patients with MS, 94\% (15/16) understood the instructions given, 100\% (16/16) felt independent to use COGNI-TRAcK at home, 75\% (12/16) found the exercises interesting, and 81\% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). Conclusions: As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention. ", doi="10.2196/mhealth.4269", url="http://mhealth.jmir.org/2015/3/e85/", url="http://www.ncbi.nlm.nih.gov/pubmed/26323749" } @Article{info:doi/10.2196/rehab.4120, author="Mateos-Angulo, Alvaro and Gal{\'a}n-Mercant, Alejandro and Cuesta-Vargas, Antonio", title="Mobile Jump Assessment (mJump): A Descriptive and Inferential Study", journal="JMIR Rehabil Assist Technol", year="2015", month="Aug", day="26", volume="2", number="2", pages="e7", keywords="squat jump", keywords="countermovement jump", keywords="inertial sensor", keywords="smartphone", abstract="Background: Vertical jump tests are used in athletics and rehabilitation to measure physical performance in people of different age ranges and fitness. Jumping ability can be analyzed through different variables, and the most commonly used are fly time and jump height. They can be obtained by a variety of measuring devices, but most are limited to laboratory use only. The current generation of smartphones contains inertial sensors that are able to record kinematic variables for human motion analysis, since they are tools for easy access and portability for clinical use. Objective: The aim of this study was to describe and analyze the kinematics characteristics using the inertial sensor incorporated in the iPhone 4S, the lower limbs strength through a manual dynamometer, and the jump variables obtained with a contact mat in the squat jump and countermovement jump tests (fly time and jump height) from a cohort of healthy people. Methods: A cross sectional study was conducted on a population of healthy young adults. Twenty-seven participants performed three trials (n=81 jumps) of squat jump and countermovement jump tests. Acceleration variables were measured through a smartphone's inertial sensor. Additionally, jump variables from a contact mat and lower limbs dynamometry were collected. Results: In the present study, the kinematic variables derived from acceleration through the inertial sensor of a smartphone iPhone 4S, dynamometry of lower limbs with a handheld dynamometer, and the height and flight time with a contact mat have been described in vertical jump tests from a cohort of young healthy subjects. The development of the execution has been described, examined and identified in a squat jump test and countermovement jump test under acceleration variables that were obtained with the smartphone. Conclusions: The built-in iPhone 4S inertial sensor is able to measure acceleration variables while performing vertical jump tests for the squat jump and countermovement jump in healthy young adults. The acceleration kinematics variables derived from the smartphone's inertial sensor are higher in the countermovement jump test than the squat jump test. ", doi="10.2196/rehab.4120", url="http://rehab.jmir.org/2015/2/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582259" } @Article{info:doi/10.2196/mhealth.3785, author="Appelboom, Geoff and Taylor, E. Blake and Bruce, Eliza and Bassile, C. Clare and Malakidis, Corinna and Yang, Annie and Youngerman, Brett and D'Amico, Randy and Bruce, Sam and Bruy{\`e}re, Olivier and Reginster, Jean-Yves and Dumont, PL Emmanuel and Connolly Jr, Sander E.", title="Mobile Phone-Connected Wearable Motion Sensors to Assess Postoperative Mobilization", journal="JMIR mHealth uHealth", year="2015", month="Jul", day="28", volume="3", number="3", pages="e78", keywords="mobilization", keywords="activity tracking", keywords="postoperative", keywords="physiotherapy", keywords="functional recovery", keywords="physical therapy", keywords="gait", keywords="neurorehabilitation", abstract="Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation. Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility. Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on four activity sensors positioned at different body locations. Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recorded by the devices and were remotely available for the researchers to analyze. The sensor accuracy was significantly greater when placed over the ankles than over the hips (P<.001). Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (r=.640, r2=.397) that reached statistical significance on the multivariate model (P=.03). Increased gait speed also correlated with increased ankle sensor accuracy, although less strongly (r=.444, r2=.197). We did not note an effect of unilateral weakness on the accuracy of left- versus right-sided sensors. Accuracy was also affected by several specific measures of a patient's level of physical assistance, for which we generated a model to mathematically adjust for systematic underestimation as well as disease severity. Conclusions: We provide one of the first assessments of the accuracy and utility of widely available and wirelessly connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient's mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients. ", doi="10.2196/mhealth.3785", url="http://mhealth.jmir.org/2015/3/e78/", url="http://www.ncbi.nlm.nih.gov/pubmed/26220691" } @Article{info:doi/10.2196/rehab.4102, author="Merch{\'a}n-Baeza, Antonio Jose and Gonz{\'a}lez-S{\'a}nchez, Manuel and Cuesta-Vargas, Antonio", title="Mobile Functional Reach Test in People Who Suffer Stroke: A Pilot Study", journal="JMIR Rehabil Assist Technol", year="2015", month="Jun", day="11", volume="2", number="1", pages="e6", keywords="mobile health", keywords="reliability and validity", keywords="elderly", keywords="stroke", keywords="postural balance", abstract="Background: Postural instability is one of the major complications found in people who survive a stroke. Parameterizing the Functional Reach Test (FRT) could be useful in clinical practice and basic research, as this test is a clinically accepted tool (for its simplicity, reliability, economy, and portability) to measure the semistatic balance of a subject. Objective: The aim of this study is to analyze the reliability in the FRT parameterization using inertial sensor within mobile phones (mobile sensors) for recording kinematic variables in patients who have suffered a stroke. Our hypothesis is that the sensors in mobile phones will be reliable instruments for kinematic study of the FRT. Methods: This is a cross-sectional study of 7 subjects over 65 years of age who suffered a stroke. During the execution of FRT, the subjects carried two mobile phones: one placed in the lumbar region and the other one on the trunk. After analyzing the data obtained in the kinematic registration by the mobile sensors, a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the mobile sensors were distance, maximum angular lumbosacral/thoracic displacement, time for maximum angular lumbosacral/thoracic displacement, time of return to the initial position, and total time. Using these data, we calculated speed and acceleration of each. A descriptive analysis of all kinematic outcomes recorded by the two mobile sensors (trunk and lumbar) was developed and the average range achieved in the FRT. Reliability measures were calculated by analyzing the internal consistency of the measures with 95\% confidence interval of each outcome variable. We calculated the reliability of mobile sensors in the measurement of the kinematic variables during the execution of the FRT. Results: The values in the FRT obtained in this study (2.49 cm, SD 13.15) are similar to those found in other studies with this population and with the same age range. Intrasubject reliability values observed in the use of mobile phones are all located above 0.831, ranging from 0.831 (time B\_C trunk area) and 0.894 (displacement A\_B trunk area). Likewise, the observed intersubject values range from 0.835 (time B\_C trunk area) and 0.882 (displacement A\_C trunk area). On the other hand, the reliability of the FRT was 0.989 (0.981-0.996) and 0.978 (0.970-0.985), intrasubject and intersubject respectively. Conclusions: We found that mobile sensors in mobile phones could be reliable tools in the parameterization of the Functional Reach Test in people who have had a stroke. ", doi="10.2196/rehab.4102", url="http://rehab.jmir.org/2015/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582239" } @Article{info:doi/10.2196/rehab.4101, author="Roldan-Jimenez, Cristina and Cuesta-Vargas, Antonio and Bennett, Paul", title="Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones", journal="JMIR Rehabil Assist Technol", year="2015", month="May", day="20", volume="2", number="1", pages="e4", keywords="patient outcome assessment", keywords="shoulder", keywords="upper extremity", keywords="kinematics", abstract="Background: In recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration. Objective: The aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space. Methods: This cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated. Results: Descriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860). Conclusions: The use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient. ", doi="10.2196/rehab.4101", url="http://rehab.jmir.org/2015/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582241" } @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/mhealth.3956, author="Pan, Di and Dhall, Rohit and Lieberman, Abraham and Petitti, B. Diana", title="A Mobile Cloud-Based Parkinson's Disease Assessment System for Home-Based Monitoring", journal="JMIR mHealth uHealth", year="2015", month="Mar", day="26", volume="3", number="1", pages="e29", keywords="mHealth", keywords="Smartphone", keywords="Mobile App", keywords="Cloud application", keywords="Parkinson's Disease", keywords="Home based monitoring", keywords="Telemedicine", keywords="Decision marking", keywords="Tremor", keywords="Gait difficulty", abstract="Background: Parkinson's disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients' motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson's is subjective and mostly conducted by brief observations made during patient visits. Changes in patients' motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families. Objective: In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, ``PD Dr'', which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms. Methods: We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts' rating on standardized rating scales. Results: The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89 and accuracy was .81. In PD severity estimation, the captured motion features also demonstrated strong correlation with PD severity stage, hand resting tremor severity, and gait difficulty. The system is simple to use, user friendly, and economically affordable. Conclusions: The key contribution of this study was building a mobile PD assessment and monitoring system to extend current PD assessment based in the clinic setting to the home-based environment. The results of this study proved feasibility and a promising future for utilizing mobile technology in PD management. ", doi="10.2196/mhealth.3956", url="http://mhealth.jmir.org/2015/1/e29/", url="http://www.ncbi.nlm.nih.gov/pubmed/25830687" } @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/mhealth.3929, author="Semple, L. John and Sharpe, Sarah and Murnaghan, Lucas M. and Theodoropoulos, John and Metcalfe, A. Kelly", title="Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study", journal="JMIR mHealth uHealth", year="2015", month="Feb", day="12", volume="3", number="1", pages="e18", keywords="outpatient", keywords="recovery", keywords="care", keywords="post-operative", keywords="smartphone", keywords="technology", keywords="mobile", abstract="Background: Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications. Objective: The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting. Methods: We enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device. Results: All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency. Conclusions: The use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required. ", doi="10.2196/mhealth.3929", url="http://mhealth.jmir.org/2015/1/e18/", url="http://www.ncbi.nlm.nih.gov/pubmed/25679749" } @Article{info:doi/10.2196/mhealth.3321, author="Rodr{\'i}guez-Molinero, Alejandro and Sam{\`a}, Albert and P{\'e}rez-Mart{\'i}nez, A. David and P{\'e}rez L{\'o}pez, Carlos and Romagosa, Jaume and Bay{\'e}s, {\`A}ngels and Sanz, Pilar and Calopa, Matilde and G{\'a}lvez-Barr{\'o}n, C{\'e}sar and de Mingo, Eva and Rodr{\'i}guez Mart{\'i}n, Daniel and Gonzalo, Natalia and Formiga, Francesc and Cabestany, Joan and Catal{\'a}, Andreu", title="Validation of a Portable Device for Mapping Motor and Gait Disturbances in Parkinson's Disease", journal="JMIR mHealth uHealth", year="2015", month="Feb", day="02", volume="3", number="1", pages="e9", keywords="accelerometer", keywords="kinematic sensor", keywords="motor fluctuations", abstract="Background: Patients with severe idiopathic Parkinson's disease experience motor fluctuations, which are often difficult to control. Accurate mapping of such motor fluctuations could help improve patients' treatment. Objective: The objective of the study was to focus on developing and validating an automatic detector of motor fluctuations. The device is small, wearable, and detects the motor phase while the patients walk in their daily activities. Methods: Algorithms for detection of motor fluctuations were developed on the basis of experimental data from 20 patients who were asked to wear the detector while performing different daily life activities, both in controlled (laboratory) and noncontrolled environments. Patients with motor fluctuations completed the experimental protocol twice: (1) once in the ON, and (2) once in the OFF phase. The validity of the algorithms was tested on 15 different patients who were asked to wear the detector for several hours while performing daily activities in their habitual environments. In order to assess the validity of detector measurements, the results of the algorithms were compared with data collected by trained observers who were accompanying the patients all the time. Results: The motor fluctuation detector showed a mean sensitivity of 0.96 (median 1; interquartile range, IQR, 0.93-1) and specificity of 0.94 (median 0.96; IQR, 0.90-1). Conclusions: ON/OFF motor fluctuations in Parkinson's patients can be detected with a single sensor, which can be worn in everyday life. ", doi="10.2196/mhealth.3321", url="http://mhealth.jmir.org/2015/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/25648406" }