@Article{info:doi/10.2196/19608,
author="Stamm, Oskar
and Heimann-Steinert, Anika",
title="Accuracy of Monocular Two-Dimensional Pose Estimation Compared With a Reference Standard for Kinematic Multiview Analysis: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="21",
volume="8",
number="12",
pages="e19608",
keywords="2D human pose estimation",
keywords="motion capturing",
keywords="kinematics",
keywords="clinical practice",
keywords="mobility",
keywords="smartphone app",
keywords="analysis",
abstract="Background: Expensive optoelectronic systems, considered the gold standard, require a laboratory environment and the attachment of markers, and they are therefore rarely used in everyday clinical practice. Two-dimensional (2D) human pose estimations for clinical purposes allow kinematic analyses to be carried out via a camera-based smartphone app. Since clinical specialists highly depend on the validity of information, there is a need to evaluate the accuracy of 2D pose estimation apps. Objective: The aim of the study was to investigate the accuracy of the 2D pose estimation of a mobility analysis app (Lindera-v2), using the PanopticStudio Toolbox data set as a reference standard. The study aimed to assess the differences in joint angles obtained by 2D video information generated with the Lindera-v2 algorithm and the reference standard. The results can provide an important assessment of the adequacy of the app for clinical use. Methods: To evaluate the accuracy of the Lindera-v2 algorithm, 10 video sequences were analyzed. Accuracy was evaluated by assessing a total of 30,000 data pairs for each joint (10 joints in total), comparing the angle data obtained from the Lindera-v2 algorithm with those of the reference standard. The mean differences of the angles were calculated for each joint, and a comparison was made between the estimated values and the reference standard values. Furthermore, the mean absolute error (MAE), root mean square error, and symmetric mean absolute percentage error of the 2D angles were calculated. Agreement between the 2 measurement methods was calculated using the intraclass correlation coefficient (ICC[A,2]). A cross-correlation was calculated for the time series to verify whether there was a temporal shift in the data. Results: The mean difference of the Lindera-v2 data in the right hip was the closest to the reference standard, with a mean value difference of --0.05{\textdegree} (SD 6.06{\textdegree}). The greatest difference in comparison with the baseline was found in the neck, with a measurement of --3.07{\textdegree} (SD 6.43{\textdegree}). The MAE of the angle measurement closest to the baseline was observed in the pelvis (1.40{\textdegree}, SD 1.48{\textdegree}). In contrast, the largest MAE was observed in the right shoulder (6.48{\textdegree}, SD 8.43{\textdegree}). The medians of all acquired joints ranged in difference from 0.19{\textdegree} to 3.17{\textdegree} compared with the reference standard. The ICC values ranged from 0.951 (95\% CI 0.914-0.969) in the neck to 0.997 (95\% CI 0.997-0.997) in the left elbow joint. The cross-correlation showed that the Lindera-v2 algorithm had no temporal lag. Conclusions: The results of the study indicate that a 2D pose estimation by means of a smartphone app can have excellent agreement compared with a validated reference standard. An assessment of kinematic variables can be performed with the analyzed algorithm, showing only minimal deviations compared with data from a massive multiview system. ",
doi="10.2196/19608",
url="http://mhealth.jmir.org/2020/12/e19608/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33346739"
}


@Article{info:doi/10.2196/21576,
author="Baeza-Barrag{\'a}n, Rosa Maria
and Labajos Manzanares, Teresa Maria
and Ruiz Vergara, Carmen
and Casuso-Holgado, Jes{\'u}s Mar{\'i}a
and Mart{\'i}n-Valero, Roc{\'i}o",
title="The Use of Virtual Reality Technologies in the Treatment of Duchenne Muscular Dystrophy: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="8",
volume="8",
number="12",
pages="e21576",
keywords="Duchenne muscular dystrophy",
keywords="virtual reality",
keywords="upper limb",
keywords="physical therapy",
keywords="muscular dystrophy",
keywords="mutation",
keywords="muscle",
keywords="degeneration",
abstract="Background: Duchenne muscular dystrophy is a serious and progressive disease affecting one in 3500-6000 live male births. The use of new virtual reality technologies has revolutionized the world of youth rehabilitation. Objective: We performed a systematic review to study the effectiveness of the use of virtual reality systems applied in the rehabilitation of the upper limbs of individuals with Duchenne muscular dystrophy. Methods: Between June 2018 and September 2019, we carried out a series of searches in 5 scientific databases: (1) PubMed, (2) Web of Science, (3) Scopus, (4) The Cochrane Library, and (5) MEDLINE via EBSCO. Two evaluators independently conducted the searches following the PRISMA recommendations for systematic reviews for articles. Two independent evaluators collated the results. Article quality was determined using the PEDro scale. Results: A total of 7 clinical trials were included in the final review. These studies used new technologies as tools for physiotherapeutic rehabilitation of the upper limbs of patients with Duchenne muscular dystrophy. Collectively, the studies showed improvement in functionality, quality of life, and motivation with the use of virtual reality technologies in the rehabilitation of upper limbs of individuals with Duchenne muscular dystrophy. Conclusions: The treatment of neuromuscular diseases has changed in recent years, from palliative symptom management to preventive methods for capacity building. The use of virtual reality is beginning to be necessary in the treatment of progressive diseases involving movement difficulties, as it provides freedom and facilitates the improvement of results in capacity training. Given that new technologies are increasingly accessible, rehabilitation and physiotherapy programs can use these technologies more frequently, and virtual reality environments can be used to improve task performance, which is essential for people with disabilities. Ultimately, virtual reality can be a great tool for physiotherapy and can be used for Duchenne muscular dystrophy rehabilitation programs to improve patient performance during training. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018102548; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=102548 ",
doi="10.2196/21576",
url="http://mhealth.jmir.org/2020/12/e21576/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289679"
}


@Article{info:doi/10.2196/18858,
author="Vaezipour, Atiyeh
and Campbell, Jessica
and Theodoros, Deborah
and Russell, Trevor",
title="Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="29",
volume="8",
number="10",
pages="e18858",
keywords="communication disorders",
keywords="speech therapy",
keywords="language therapy",
keywords="ergonomics",
keywords="rehabilitation",
keywords="mobile health",
keywords="mHealth",
abstract="Background: Worldwide, more than 75\% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective: The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods: Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results: From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61\% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61\% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20\% (14/70) on the Android platform, and 19\% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice,  and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions: To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use. ",
doi="10.2196/18858",
url="http://mhealth.jmir.org/2020/10/e18858/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118953"
}


@Article{info:doi/10.2196/17986,
author="Czech, Matthew
and Demanuele, Charmaine
and Erb, Kelley Michael
and Ramos, Vesper
and Zhang, Hao
and Ho, Bryan
and Patel, Shyamal",
title="The Impact of Reducing the Number of Wearable Devices on Measuring Gait in Parkinson Disease: Noninterventional Exploratory Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Oct",
day="21",
volume="7",
number="2",
pages="e17986",
keywords="gait",
keywords="Parkinson disease",
keywords="wearable sensors",
keywords="digital medicine",
abstract="Background: Measuring free-living gait using wearable devices may offer higher granularity and temporal resolution than the current clinical assessments for patients with Parkinson disease (PD). However, increasing the number of devices worn on the body adds to the patient burden and impacts the compliance. Objective: This study aimed to investigate the impact of reducing the number of wearable devices on the ability to assess gait impairments in patients with PD. Methods: A total of 35 volunteers with PD and 60 healthy volunteers performed a gait task during 2 clinic visits. Participants with PD were assessed in the On and Off medication state using the Movement Disorder Society version of the Unified Parkinson Disease Rating Scale (MDS-UPDRS). Gait features derived from a single lumbar-mounted accelerometer were compared with those derived using 3 and 6 wearable devices for both participants with PD and healthy participants. Results: A comparable performance was observed for predicting the MDS-UPDRS gait score using longitudinal mixed-effects model fit with gait features derived from a single (root mean square error [RMSE]=0.64; R2=0.53), 3 (RMSE=0.64; R2=0.54), and 6 devices (RMSE=0.54; R2=0.65). In addition, MDS-UPDRS gait scores predicted using all 3 models differed significantly between On and Off motor states (single device, P=.004; 3 devices, P=.004; 6 devices, P=.045). Conclusions: We observed a marginal benefit in using multiple devices for assessing gait impairments in patients with PD when compared with gait features derived using a single lumbar-mounted accelerometer. The wearability burden associated with the use of multiple devices may offset gains in accuracy for monitoring gait under free-living conditions. ",
doi="10.2196/17986",
url="http://rehab.jmir.org/2020/2/e17986/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33084585"
}


@Article{info:doi/10.2196/17036,
author="Signal, June Nada Elizabeth
and McLaren, Ruth
and Rashid, Usman
and Vandal, Alain
and King, Marcus
and Almesfer, Faisal
and Henderson, Jeanette
and Taylor, Denise",
title="Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="29",
volume="8",
number="7",
pages="e17036",
keywords="stroke",
keywords="rehabilitation",
keywords="physical activity",
keywords="movement",
keywords="disability",
keywords="technology",
keywords="upper limb",
keywords="wearable",
keywords="haptic",
keywords="nudge",
abstract="Background: As many as 80\% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective: This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods: A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a ``Planned Nudge'' to the odds of affected limb movement during the observation period following ``No Nudge.'' Results: The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95\% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95\% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95\% CI 0.99-1.29, P=.07). Conclusions: Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration: Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687\&isReview=true ",
doi="10.2196/17036",
url="https://mhealth.jmir.org/2020/7/e17036",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723718"
}


@Article{info:doi/10.2196/17032,
author="Chen, Yu-Pin
and Lin, Chung-Ying
and Tsai, Ming-Jr
and Chuang, Tai-Yuan
and Lee, Kuang-Sheng Oscar",
title="Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="23",
volume="22",
number="7",
pages="e17032",
keywords="motion sensor",
keywords="adhesive capsulitis",
keywords="rehabilitation",
keywords="home-based exercise",
keywords="telerehabilitation",
keywords="telehealth, telemonitoring",
abstract="Background: Adhesive capsulitis (AC) of the shoulder is a common disorder that painfully reduces the shoulder range of motion (ROM) among middle-aged individuals. Although physical therapy with home-based exercises is widely advised to restore ROM in the treatment of AC, clinical results vary owing to inconsistent patient compliance. Objective: In this study, we aimed to verify the feasibility of a treatment model that involves applying a wearable motion sensor device to assist patients conduct home-based exercises to improve training compliance and the accuracy of exercises, with the ultimate goal of improving the functional recovery of patients with AC. Methods: The motion sensor device was comprised of inertial measurement unit--based sensors and mobile apps for patients and physicians, offering shoulder mobility tracing, home-based exercise support, and progress monitoring. The interrater reliability of shoulder mobility measurement using the motion sensor device on 10 healthy participants and 15 patients with AC was obtained using an intraclass correlation coefficient analysis and compared with the assessments performed by two highly experienced physicians. A pilot prospective control trial was then carried out to allocate the 15 patients with AC to two groups: home-based exercise group and motion sensor--assisted rehabilitation group. Changes in active and passive shoulder ROM, pain and functional scores, and exercise completion rates were compared between the groups during a treatment period of 3 months. Results: Shoulder ROM, as measured using the motion sensor device, exhibited good to excellent reliability based on the comparison with the measurements of two physicians (intraclass correlation coefficient range, 0.771 to 0.979). Compared with patients with AC in the home-based exercise group, those in the motion sensor--assisted rehabilitation group exhibited better shoulder mobility and functional recovery and a higher exercise completion rate during and after 3 months of rehabilitation. Conclusions: Motion sensor device--assisted home-based rehabilitation for the treatment of AC is a useful treatment model for telerehabilitation that enhances the compliance of patients through training, thus improving functional recovery. This helps overcome important obstacles in physiotherapy at home by providing comprehensible and easily accessible exercise instructions, enhancing compliance, ensuring the correctness of exercise, and monitoring the progress of patients. ",
doi="10.2196/17032",
url="http://www.jmir.org/2020/7/e17032/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32457026"
}


@Article{info:doi/10.2196/14178,
author="Jung, Timothy
and Moorhouse, Natasha
and Shi, Xin
and Amin, Farhan Muhammad",
title="A Virtual Reality--Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="7",
volume="22",
number="7",
pages="e14178",
keywords="virtual reality",
keywords="COPD",
keywords="rehabilitation",
abstract="Background: The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. Objective: This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. Methods: This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. Results: In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. Conclusions: Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale. ",
doi="10.2196/14178",
url="https://www.jmir.org/2020/7/e14178",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673224"
}


@Article{info:doi/10.2196/19116,
author="Li, C. Linda
and Feehan, M. Lynne
and Xie, Hui
and Lu, Na
and Shaw, D. Christopher
and Gromala, Diane
and Zhu, Siyi
and Avi{\~n}a-Zubieta, Antonio J.
and Hoens, M. Alison
and Koehn, Cheryl
and Tam, Johnathan
and Therrien, Stephanie
and Townsend, F. Anne
and Noonan, Gregory
and Backman, L. Catherine",
title="Effects of a 12-Week Multifaceted Wearable-Based Program for People With Knee Osteoarthritis: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="3",
volume="8",
number="7",
pages="e19116",
keywords="physical activity",
keywords="counseling",
keywords="knee osteoarthritis",
keywords="physiotherapy",
keywords="wearables",
abstract="Background: Current guidelines emphasize an active lifestyle in the management of knee osteoarthritis (OA), but up to 90\% of patients with OA are inactive. In a previous study, we demonstrated that an 8-week physiotherapist (PT)-led counseling intervention, with the use of a Fitbit, improved step count and quality of life in patients with knee OA, compared with a control. Objective: This study aimed to examine the effect of a 12-week, multifaceted wearable-based program on physical activity and patient outcomes in patients with knee OA. Methods: This was a randomized controlled trial with a delay-control design. The immediate group (IG) received group education, a Fitbit, access to FitViz (a Fitbit-compatible app), and 4 biweekly phone calls from a PT over 8 weeks. Participants then continued using Fitbit and FitViz independently up to week 12. The delay group (DG) received a monthly electronic newsletter in weeks 1 to 12 and started the same intervention in week 14. Participants were assessed in weeks 13, 26, and 39. The primary outcome was time spent in daily moderate-to-vigorous physical activity (MVPA; in bouts ?10 min) measured with a SenseWear Mini. Secondary outcomes included daily steps, time spent in purposeful activity and sedentary behavior, Knee Injury and OA Outcome Score, Patient Health Questionnaire-9, Partners in Health Scale, Theory of Planned Behavior Questionnaire, and Self-Reported Habit Index. Results: We enrolled 51 participants (IG: n=26 and DG: n=25). Compared with the IG, the DG accumulated significantly more MVPA time at baseline. The adjusted mean difference in MVPA was 13.1 min per day (95\% CI 1.6 to 24.5). A significant effect was also found in the adjusted mean difference in perceived sitting habit at work (0.7; 95\% CI 0.2 to 1.2) and during leisure activities (0.7; 95\% CI 0.2 to 1.2). No significant effect was found in the remaining secondary outcomes. Conclusions: A 12-week multifaceted program with the use of a wearable device, an app, and PT counseling improved physical activity in people with knee OA. Trial Registration: ClinicalTrials.gov NCT02585323; https://clinicaltrials.gov/ct2/show/NCT02585323 ",
doi="10.2196/19116",
url="https://mhealth.jmir.org/2020/7/e19116",
url="http://www.ncbi.nlm.nih.gov/pubmed/32618578"
}


@Article{info:doi/10.2196/17804,
author="Held, Oskar Jeremia Philipp
and Yu, Kevin
and Pyles, Connor
and Veerbeek, Marieke Janne
and Bork, Felix
and Heining, Sandro-Michael
and Navab, Nassir
and Luft, R{\"u}diger Andreas",
title="Augmented Reality--Based Rehabilitation of Gait Impairments: Case Report",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="26",
volume="8",
number="5",
pages="e17804",
keywords="HoloLens 2",
keywords="gait",
keywords="rehabilitation",
keywords="stroke",
keywords="augmented reality",
keywords="sensors",
abstract="Background: Gait and balance impairments are common in neurological diseases, including stroke, and negatively affect patients' quality of life. Improving balance and gait are among the main goals of rehabilitation. Rehabilitation is mainly performed in clinics, which lack context specificity; therefore, training in the patient's home environment is preferable. In the last decade, developed rehabilitation technologies such as virtual reality and augmented reality (AR) have enabled gait and balance training outside clinics. Here, we propose a new method for gait rehabilitation in persons who have had a stroke in which mobile AR technology and a sensor-based motion capture system are combined to provide fine-grained feedback on gait performance in real time. Objective: The aims of this study were (1) to investigate manipulation of the gait pattern of persons who have had a stroke based on virtual augmentation during overground walking compared to walking without AR performance feedback and (2) to investigate the usability of the AR system. Methods: We developed the ARISE (Augmented Reality for gait Impairments after StrokE) system, in which we combined a development version of HoloLens 2 smart glasses (Microsoft Corporation) with a sensor-based motion capture system. One patient with chronic minor gait impairment poststroke completed clinical gait assessments and an AR parkour course with patient-centered performance gait feedback. The movement kinematics during gait as well as the usability and safety of the system were evaluated. Results: The patient changed his gait pattern during AR parkour compared to the pattern observed during the clinical gait assessments. He recognized the virtual objects and ranked the usability of the ARISE system as excellent. In addition, the patient stated that the system would complement his standard gait therapy. Except for the symptom of exhilaration, no adverse events occurred. Conclusions: This project provided the first evidence of gait adaptation during overground walking based on real-time feedback through visual and auditory augmentation. The system has potential to provide gait and balance rehabilitation outside the clinic. This initial investigation of AR rehabilitation may aid the development and investigation of new gait and balance therapies. ",
doi="10.2196/17804",
url="http://mhealth.jmir.org/2020/5/e17804/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452815"
}


@Article{info:doi/10.2196/17326,
author="De Canni{\`e}re, H{\'e}l{\`e}ne
and Smeets, P. Christophe J.
and Schoutteten, Melanie
and Varon, Carolina
and Van Hoof, Chris
and Van Huffel, Sabine
and Groenendaal, Willemijn
and Vandervoort, Pieter",
title="Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="20",
volume="22",
number="5",
pages="e17326",
keywords="wearables",
keywords="sensor",
keywords="6MWT",
keywords="rehabilitation",
keywords="cardiovascular",
abstract="Background: Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. Objective: The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. Methods: A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. Results: All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HRpeak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HRrec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HRrec1: P<.001, HRrec2: P<.001, HRrec3: P<.001, HRrec4: P<.001, and HRrec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses. Conclusions: This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome. ",
doi="10.2196/17326",
url="http://www.jmir.org/2020/5/e17326/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32432552"
}


@Article{info:doi/10.2196/14465,
author="Nguyen, Thi An
and Somerville, Kling Emily
and Esp{\'i}n-Tello, Martina Sandra
and Keglovits, Marian
and Stark, Lynn Susan",
title="A Mobile App Directory of Occupational Therapists Who Provide Home Modifications: Development and Preliminary Usability Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Mar",
day="30",
volume="7",
number="1",
pages="e14465",
keywords="mHealth",
keywords="mobile app",
keywords="occupational therapist",
keywords="occupational therapy",
keywords="older adult",
keywords="user-computer interface",
abstract="Background: Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications. Objective: This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States. Methods: In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach. Results: In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information. Conclusions: Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults' perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults' access to home modifications. ",
doi="10.2196/14465",
url="http://rehab.jmir.org/2020/1/e14465/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224486"
}


@Article{info:doi/10.2196/14059,
author="Lai, Byron
and Sasaki, E. Jeffer
and Jeng, Brenda
and Cederberg, L. Katie
and Bamman, M. Marcas
and Motl, W. Robert",
title="Accuracy and Precision of Three Consumer-Grade Motion Sensors During Overground and Treadmill Walking in People With Parkinson Disease: Cross-Sectional Comparative Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Jan",
day="16",
volume="7",
number="1",
pages="e14059",
keywords="wearable electronic devices",
keywords="wearable",
keywords="fitness tracker",
keywords="accelerometer",
keywords="reproducibility",
keywords="Parkinson disease",
keywords="disabled persons",
keywords="exercise",
abstract="Background: Wearable motion sensors are gaining popularity for monitoring free-living physical activity among people with Parkinson disease (PD), but more evidence supporting the accuracy and precision of motion sensors for capturing step counts is required in people with PD. Objective: This study aimed to examine the accuracy and precision of 3 common consumer-grade motion sensors for measuring actual steps taken during prolonged periods of overground and treadmill walking in people with PD. Methods: A total of 31 ambulatory participants with PD underwent 6-min bouts of overground and treadmill walking at a comfortable speed. Participants wore 3 devices (Garmin Vivosmart 3, Fitbit One, and Fitbit Charge 2 HR), and a single researcher manually counted the actual steps taken. Accuracy and precision were based on absolute and relative metrics, including intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: Participants walked 628 steps over ground based on manual counting, and Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR devices had absolute (relative) error values of 6 (6/628, 1.0\%), 8 (8/628, 1.3\%), and 30 (30/628, 4.8\%) steps, respectively. ICC values demonstrated excellent agreement between manually counted steps and steps counted by both Garmin Vivosmart (0.97) and Fitbit One (0.98) but poor agreement for Fitbit Charge 2 HR (0.47). The absolute (relative) precision values for Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR were 11.1 (11.1/625, 1.8\%), 14.7 (14.7/620, 2.4\%), and 74.4 (74.4/598, 12.4\%) steps, respectively. ICC confidence intervals demonstrated low variability for Garmin Vivosmart (0.96 to 0.99) and Fitbit One (0.93 to 0.99) but high variability for Fitbit Charge 2 HR (--0.57 to 0.74). The Fitbit One device maintained high accuracy and precision values for treadmill walking, but both Garmin Vivosmart and Fitbit Charge 2 HR (the wrist-worn devices) had worse accuracy and precision for treadmill walking. Conclusions: The waist-worn sensor (Fitbit One) was accurate and precise in measuring steps with overground and treadmill walking. The wrist-worn sensors were accurate and precise only during overground walking. Similar research should inform the application of these devices in clinical research and practice involving patients with PD. ",
doi="10.2196/14059",
url="https://rehab.jmir.org/2020/1/e14059",
url="http://www.ncbi.nlm.nih.gov/pubmed/31944182"
}


@Article{info:doi/10.2196/15981,
author="Parker, Jack
and Powell, Lauren
and Mawson, Susan",
title="Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="8",
volume="22",
number="1",
pages="e15981",
keywords="wearable electronic devices",
keywords="stroke",
keywords="rehabilitation",
keywords="upper extremity",
abstract="Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77\% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. Objective: This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. Results: In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P?.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. Trial Registration: PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=57715 ",
doi="10.2196/15981",
url="https://www.jmir.org/2020/1/e15981",
url="http://www.ncbi.nlm.nih.gov/pubmed/31913131"
}


@Article{info:doi/10.2196/14468,
author="Larriv{\'e}e, Samuel
and Balg, Fr{\'e}d{\'e}ric
and L{\'e}onard, Guillaume
and B{\'e}dard, Sonia
and Tousignant, Michel
and Boissy, Patrick",
title="Wrist-Based Accelerometers and Visual Analog Scales as Outcome Measures for Shoulder Activity During Daily Living in Patients With Rotator Cuff Tendinopathy: Instrument Validation Study",
journal="JMIR Rehabil Assist Technol",
year="2019",
month="Dec",
day="3",
volume="6",
number="2",
pages="e14468",
keywords="shoulder",
keywords="wearable sensors",
keywords="activity count",
keywords="validation",
keywords="test-retest",
keywords="sensitivity to change",
abstract="Background: Shoulder pain secondary to rotator cuff tendinopathy affects a large proportion of patients in orthopedic surgery practices. Corticosteroid injections are a common intervention proposed for these patients. The clinical evaluation of a response to corticosteroid injections is usually based only on the patient's self-evaluation of his function, activity, and pain by multiple questionnaires with varying metrological qualities. Objective measures of upper extremity functions are lacking, but wearable sensors are emerging as potential tools to assess upper extremity function and activity. Objective: This study aimed (1) to evaluate and compare test-retest reliability and sensitivity to change of known clinical assessments of shoulder function to wrist-based accelerometer measures and visual analog scales (VAS) of shoulder activity during daily living in patients with rotator cuff tendinopathy convergent validity and (2) to determine the acceptability and compliance of using wrist-based wearable sensors. Methods: A total of 38 patients affected by rotator cuff tendinopathy wore wrist accelerometers on the affected side for a total of 5 weeks. Western Ontario Rotator Cuff (WORC) index; Short version of the Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH); and clinical examination (range of motion and strength) were performed the week before the corticosteroid injections, the day of the corticosteroid injections, and 2 and 4 weeks after the corticosteroid injections. Daily Single Assessment Numeric Evaluation (SANE) and VAS were filled by participants to record shoulder pain and activity. Accelerometer data were processed to extract daily upper extremity activity in the form of active time; activity counts; and ratio of low-intensity activities, medium-intensity activities, and high-intensity activities. Results: Daily pain measured using VAS and SANE correlated well with the WORC and QuickDASH questionnaires (r=0.564-0.815) but not with accelerometry measures, amplitude, and strength. Daily activity measured with VAS had good correlation with active time (r=0.484, P=.02). All questionnaires had excellent test-retest reliability at 1 week before corticosteroid injections (intraclass correlation coefficient [ICC]=0.883-0.950). Acceptable reliability was observed with accelerometry (ICC=0.621-0.724), apart from low-intensity activities (ICC=0.104). Sensitivity to change was excellent at 2 and 4 weeks for all questionnaires (standardized response mean=1.039-2.094) except for activity VAS (standardized response mean=0.50). Accelerometry measures had low sensitivity to change at 2 weeks, but excellent sensitivity at 4 weeks (standardized response mean=0.803-1.032). Conclusions: Daily pain VAS and SANE had good correlation with the validated questionnaires, excellent reliability at 1 week, and excellent sensitivity to change at 2 and 4 weeks. Daily activity VAS and accelerometry-derived active time correlated well together. Activity VAS had excellent reliability, but moderate sensitivity to change. Accelerometry measures had moderate reliability and acceptable sensitivity to change at 4 weeks. ",
doi="10.2196/14468",
url="http://rehab.jmir.org/2019/2/e14468/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31793896"
}


@Article{info:doi/10.2196/13640,
author="Rold{\'a}n-Jim{\'e}nez, Cristina
and Martin-Martin, Jaime
and Cuesta-Vargas, I. Antonio",
title="Reliability of a Smartphone Compared With an Inertial Sensor to Measure Shoulder Mobility: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="06",
volume="7",
number="9",
pages="e13640",
keywords="shoulder",
keywords="kinematics",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: The shoulder is one of the joints with the greatest mobility within the human body and its evaluation is complex. An assessment can be conducted using questionnaires or functional tests, and goniometry can complement the information obtained in this assessment. However, there are now validated devices that can provide more information on the realization of movement, such as inertial sensors. The cost of these devices is usually high and they are not available to all clinicians, but there are also inertial sensors that are implemented in mobile phones which are cheaper and widely available. Results from the inertial sensors integrated into mobile devices can have the same reliability as those from dedicated sensors. Objective: This study aimed to validate the use of the Nexus 4 smartphone as a measuring tool for the mobility of the humerus during shoulder movement compared with a dedicated InertiaCube3 (Intersense) sensor. Methods: A total of 43 subjects, 27 affected by shoulder pathologies and 16 asymptomatic, participated in the study. Shoulder flexion, abduction, and scaption were measured using an InertiaCube3 and a Nexus 4 smartphone, which were attached to the participants to record the results simultaneously. The interclass correlation coefficient (ICC) was calculated based on the 3 movements performed. Results: The smartphone reliably recorded the velocity values and simultaneously recorded them alongside the inertial sensor. The ICCs of the 3 gestures and for each of the axes of movement were analyzed with a 95\% CI. In the abduction movement, the devices demonstrated excellent interclass reliability for the abduction humeral movement axis (Cronbach alpha=.98). The axis of abduction of the humeral showed excellent reliability for the movements of flexion (Cronbach alpha=.93) and scaption (Cronbach alpha=.98). Conclusions: Compared with the InertiaCube3, the Nexus 4 smartphone is a reliable and valid tool for recording the velocity produced in the shoulder. ",
doi="10.2196/13640",
url="http://mhealth.jmir.org/2019/9/e13640/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31493320"
}


@Article{info:doi/10.2196/14523,
author="Dias Correia, Fernando
and Nogueira, Andr{\'e}
and Magalh{\~a}es, Ivo
and Guimar{\~a}es, Joana
and Moreira, Maria
and Barradas, Isabel
and Molinos, Maria
and Teixeira, Laetitia
and Pires, Joaquim
and Seabra, Rosmaninho
and Lains, Jorge
and Bento, Virg{\'i}lio",
title="Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study",
journal="JMIR Rehabil Assist Technol",
year="2019",
month="Jun",
day="21",
volume="6",
number="1",
pages="e14523",
keywords="THA",
keywords="THR",
keywords="digital physiotherapy",
keywords="telerehabilitation",
keywords="biofeedback",
keywords="motion trackers",
keywords="AI-powered rehabilitation",
abstract="Background: The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. Objective: The aim of this study was to assess the feasibility of a novel artificial intelligence--powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. Methods: This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). Results: A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86\% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of ?4.79 seconds (95\% CI ?7.24 to ?1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. Conclusions: This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Trial Registration: ClinicalTrials.gov NCT03045549; https://clinicaltrials.gov/ct2/show/NCT03045549 ",
doi="10.2196/14523",
url="http://rehab.jmir.org/2019/1/e14523/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31228176"
}


@Article{info:doi/10.2196/13019,
author="LeBeau, Kelsea
and Huey, G. Lauren
and Hart, Mark",
title="Assessing the Quality of Mobile Apps Used by Occupational Therapists: Evaluation Using the User Version of the Mobile Application Rating Scale",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="1",
volume="7",
number="5",
pages="e13019",
keywords="occupational therapy",
keywords="occupational therapists",
keywords="mobile apps",
keywords="mobile applications",
keywords="technology",
keywords="computers, handheld",
keywords="mHealth",
keywords="mobile health",
abstract="Background: The continuous development of mobile apps has led to many health care professionals using them in clinical settings; however, little research is available to guide occupational therapists (OTs) in choosing quality apps for use in their respective clinical settings. Objective: The purpose of this study was to use the user version of the Mobile Application Rating Scale (uMARS) to evaluate the quality of the most frequently noted mobile health (mHealth) apps used by OTs and to demonstrate the utility of the uMARS to assess the quality of mHealth apps. Methods: A previous study surveying OTs' use of apps in therapy compiled a list of apps frequently noted. A total of 25 of these apps were evaluated individually by 2 trained researchers using the uMARS, a simple, multidimensional analysis tool that can be reliably used to evaluate the quality of mHealth apps. Results: The top 10 apps had a total quality score of 4.3, or higher, out of 5 based on the mean scores of engagement, functionality, and aesthetics. Apps scored highest in functionality and lowest in engagement. Apps noted most frequently were not always high-quality apps; apps noted least frequently were not always low-quality apps. Conclusions: Determining the effectiveness of using apps in clinical settings must be built upon a foundation of the implementation of high-quality apps. Mobile apps should not be incorporated into clinical settings solely based on frequency of use. The uMARS should be considered as a useful tool for OTs, and other professionals, to determine app quality. ",
doi="10.2196/13019",
url="https://mhealth.jmir.org/2019/5/e13019/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066712"
}


@Article{info:doi/10.2196/11099,
author="Coswig, Victor
and Silva, E. Anselmo De Athayde Costa
and Barbalho, Matheus
and Faria, De Fernando Rosch
and Nogueira, D. Claudio
and Borges, Mariane
and Buratti, R. J{\'e}ssica
and Vieira, B. Ivaldo
and Rom{\'a}n, L{\'o}pez Francisco Javier
and Gorla, I. Jos{\'e}",
title="Assessing the Validity of the MyJump2 App for Measuring Different Jumps in Professional Cerebral Palsy Football Players: An Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="30",
volume="7",
number="1",
pages="e11099",
keywords="cerebral palsy football",
keywords="jump performance",
keywords="mobile apps",
keywords="mobile phone",
keywords="paralympic sports",
abstract="Background: Vertical jumps can be used to assess neuromuscular status in sports performance. This is particularly important in Cerebral Palsy Football (CP Football) because players are exposed to high injury risk, but it may be complicated because the gold standard for assessing jump performance is scarce in field evaluation. Thus, field techniques, such as mobile apps, have been proposed as an alternative method for solving this problem. Objective: This study aims to evaluate the reliability of the measures of the MyJump2 app to assess vertical jump performance in professional CP Football. Methods: We assessed 40 male CP Football athletes (age 28.1 [SD 1.4] years, weight 72.5 [SD 6.2] kg, and height 176 [SD 4.2] cm) through the countermovement jump (CMJ) and squat jump (SJ) using a contact mat. At the same time, we assessed the athletes using the MyJump2 app. Results: There were no significant differences between the instruments in SJ height (P=.12) and flight time (P=.15). Additionally, there were no significant differences between the instruments for CMJ in jump height (P=.16) and flight time (P=.13). In addition, it was observed that there were significant and strong intraclass correlations in all SJ variables varying from 0.86 to 0.89 (both P<.001), which was classified as ``almost perfect.'' Similar results were observed in all variables from the CMJ, varying from 0.92 to 0.96 (both P ?.001). Conclusions: We conclude that the MyJump2 app presents high validity and reliability for measuring jump height and flight time of the SJ and CMJ in CP Football athletes. ",
doi="10.2196/11099",
url="http://mhealth.jmir.org/2019/1/e11099/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30698529"
}


@Article{info:doi/10.2196/mhealth.9931,
author="Yu, Daihua
and Parmanto, Bambang
and Dicianno, Brad",
title="An mHealth App for Users with Dexterity Impairments: Accessibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="08",
volume="7",
number="1",
pages="e202",
keywords="accessibility",
keywords="dexterity impairments",
keywords="disability",
keywords="mHealth",
keywords="self-management",
keywords="smartphone apps",
keywords="spina bifida",
keywords="spinal cord injury",
keywords="wellness",
keywords="mobile phone",
abstract="Background: A mobile health (mHealth) system called iMHere (interactive mobile health and rehabilitation) was developed to support individuals with chronic conditions and disability in their self-management regimens. The initial design of iMHere, however, lacked sufficient accessibility for users with a myriad of dexterity impairments. The accessibility of self-management apps is essential in ensuring usability. Objective: This study aims to increase the usability of the iMHere system for users with dexterity impairments by increasing the app's accessibility. Methods: We targeted the accessibility redesign by focusing on the physical presentation and the navigability of the iMHere apps. Six participants presenting with dexterity impairments were included in the usability study of the original and redesigned apps. Results: We observed a lower number of touches needed to complete tasks (P=.09) and time to complete individual tasks (P=.06) with the redesigned app than with the original app; a significantly lower time for users to complete all tasks (P=.006); and a significantly lower error rate (P=.01) with the redesigned app than with the original app. In fact, no errors occurred with use of the redesigned app. Participant-reported overall average usability of the redesigned app (P=.007) and usability of individual modules (P<.001) were significantly higher than that of the original app due mostly to better ease of use and learnability, interface quality, and reliability. Conclusions: Improved usability was achieved using a redesigned app. This study offers insight into the importance of personalization in enhancing the accessibility and also identifies strategies for improving usability in app development. ",
doi="10.2196/mhealth.9931",
url="https://mhealth.jmir.org/2019/1/e202/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30622096"
}


@Article{info:doi/10.2196/11748,
author="Barbareschi, Giulia
and Holloway, Catherine
and Bianchi-Berthouze, Nadia
and Sonenblum, Sharon
and Sprigle, Stephen",
title="Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Dec",
day="20",
volume="5",
number="2",
pages="e11748",
keywords="wheelchair transfers",
keywords="movement evaluation",
keywords="machine learning",
keywords="activity monitoring",
keywords="accelerometer",
abstract="Background: Transfers are an important skill for many wheelchair users (WU). However, they have also been related to the risk of falling or developing upper limb injuries. Transfer abilities are usually evaluated in clinical settings or biomechanics laboratories, and these methods of assessment are poorly suited to evaluation in real and unconstrained world settings where transfers take place. Objective: The objective of this paper is to test the feasibility of a system based on a wearable low-cost sensor to monitor transfer skills in real-world settings. Methods: We collected data from 9 WU wearing triaxial accelerometer on their chest while performing transfers to and from car seats and home furniture. We then extracted significant features from accelerometer data based on biomechanical considerations and previous relevant literature and used machine learning algorithms to evaluate the performance of wheelchair transfers and detect their occurrence from a continuous time series of data. Results: Results show a good predictive accuracy of support vector machine classifiers when determining the use of head-hip relationship (75.9\%) and smoothness of landing (79.6\%) when the starting and ending of the transfer are known. Automatic transfer detection reaches performances that are similar to state of the art in this context (multinomial logistic regression accuracy 87.8\%). However, we achieve these results using only a single sensor and collecting data in a more ecological manner. Conclusions: The use of a single chest-placed accelerometer shows good predictive accuracy for algorithms applied independently to both transfer evaluation and monitoring. This points to the opportunity for designing ubiquitous-technology based personalized skill development interventions for WU. However, monitoring transfers still require the use of external inputs or extra sensors to identify the start and end of the transfer, which is needed to perform an accurate evaluation. ",
doi="10.2196/11748",
url="http://rehab.jmir.org/2018/2/e11748/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30573447"
}


@Article{info:doi/10.2196/11315,
author="Agarwal, Vibhu
and Smuck, Matthew
and Tomkins-Lane, Christy
and Shah, H. Nigam",
title="Inferring Physical Function From Wearable Activity Monitors: Analysis of Free-Living Activity Data From Patients With Knee Osteoarthritis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="18",
volume="6",
number="12",
pages="e11315",
keywords="physical function",
keywords="passive monitoring",
keywords="physical function profile",
keywords="wearable activity data",
keywords="statistical learning",
abstract="Background: Clinical assessments for physical function do not objectively quantify routine daily activities. Wearable activity monitors (WAMs) enable objective measurement of daily activities, but it remains unclear how these map to clinically measured physical function measures. Objective: This study aims to derive a representation of physical function from daily measurements of free-living activity obtained through a WAM. In addition, we evaluate our derived measure against objectively measured function using an ordinal classification setup. Methods: We defined function profiles representing average time spent in a set of pattern classes over consecutive days. We constructed a function profile using minute-level activity data from a WAM available from the Osteoarthritis Initiative. Using the function profile as input, we trained statistical models that classified subjects into quartiles of objective measurements of physical function as measured through the 400-m walk test, 20-m walk test, and 5 times sit-stand test. Furthermore, we evaluated model performance on held-out data. Results: The function profile derived from minute-level activity data can accurately predict physical performance as measured through clinical assessments. Using held-out data, the Goodman-Kruskal Gamma statistic obtained in classifying performance values in the first quartile, interquartile range, and the fourth quartile was 0.62, 0.53, and 0.51 for the 400-m walk, 20-m walk, and 5 times sit-stand tests, respectively. Conclusions: Function profiles accurately represent physical function, as demonstrated by the relationship between the profiles and clinically measured physical performance. The estimation of physical performance through function profiles derived from free-living activity data may enable remote functional monitoring of patients. ",
doi="10.2196/11315",
url="http://mhealth.jmir.org/2018/12/e11315/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30394876"
}


@Article{info:doi/10.2196/10307,
author="Levac, Danielle
and Dumas, M. Helene
and Meleis, Waleed",
title="A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Nov",
day="26",
volume="5",
number="2",
pages="e10307",
keywords="equipment design",
keywords="rehabilitation",
keywords="pediatrics",
keywords="tablets",
keywords="software",
abstract="Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69\% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. ",
doi="10.2196/10307",
url="http://rehab.jmir.org/2018/2/e10307/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30478025"
}


@Article{info:doi/10.2196/mhealth.8127,
author="Lo, Ambrose Wai Leung
and Lei, Di
and Li, Le
and Huang, Feng Dong
and Tong, Kin-Fai",
title="The Perceived Benefits of an Artificial Intelligence--Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and Back Pain: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="26",
volume="6",
number="11",
pages="e198",
keywords="low back pain",
keywords="neck pain",
keywords="mobile app",
keywords="exercise therapy",
keywords="mHealth",
abstract="Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technology has been suggested as an alternative way to increase adherence to exercise therapy, which may improve clinical outcomes. Objective: The aim was to investigate the self-perceived benefits of an artificial intelligence (AI)--embedded mobile app to self-manage chronic neck and back pain. Methods: A total of 161 participants responded to the invitation. The evaluation questionnaire included 14 questions that were intended to explore if using the AI rehabilitation system may (1) increase time spent on therapeutic exercise, (2) affect pain level (assessed by the 0-10 Numerical Pain Rating Scale), and (3) reduce the need for other interventions. Results: An increase in time spent on therapeutic exercise per day was observed. The median Numerical Pain Rating Scale scores were 6 (interquartile range [IQR] 5-8) before and 4 (IQR 3-6) after using the AI-embedded mobile app (95\% CI 1.18-1.81). A 3-point reduction was reported by the participants who used the AI-embedded mobile app for more than 6 months. Reduction in the usage of other interventions while using the AI-embedded mobile app was also reported. Conclusions: This study demonstrated the positive self-perceived beneficiary effect of using the AI-embedded mobile app to provide a personalized therapeutic exercise program. The positive results suggest that it at least warrants further study to investigate the physiological effect of the AI-embedded mobile app and how it compares with routine clinical care. ",
doi="10.2196/mhealth.8127",
url="http://mhealth.jmir.org/2018/11/e198/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30478019"
}


@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"
}