@Article{info:doi/10.2196/23386,
author="Lawford, Joan Belinda
and Bennell, L. Kim
and Campbell, K. Penny
and Kasza, Jessica
and Hinman, S. Rana",
title="Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Jan",
day="18",
volume="8",
number="1",
pages="e23386",
keywords="osteoarthritis",
keywords="physiotherapy",
keywords="physical therapy",
keywords="tele-rehabilitation",
keywords="telephone",
keywords="therapeutic alliance",
keywords="exercise",
keywords="knee",
keywords="pain",
abstract="Background: The therapeutic alliance between patients and physical therapists has been shown to influence clinical outcomes in patients with chronic low back pain when consulting in-person. However, no studies have examined whether the therapeutic alliance developed between patients with knee osteoarthritis and physical therapists during telephonic consultations influences clinical outcomes. Objective: This study aims to investigate whether the therapeutic alliance between patients with knee osteoarthritis and physical therapists measured after the second consultation is associated with outcomes following telephone-delivered exercise and advice. Methods: Secondary analysis of 87 patients in the intervention arm of a randomized controlled trial allocated to receive 5 to 10 telephone consultations with one of 8 physical therapists over a period of 6 months, involving education and prescription of a strengthening and physical activity program. Separate regression models investigated the association between patient and therapist ratings of therapeutic alliance (measured after the second consultation using the Working Alliance Inventory Short Form) and outcomes (pain, function, self-efficacy, quality of life, global change, adherence to prescribed exercise, physical activity) at 6 and 12 months, with relevant covariates included. Results: There was some evidence of a weak association between patient ratings of the alliance and some outcomes at 6 months (improvements in average knee pain: regression coefficient ?0.10, 95\% CI ?0.16 to ?0.03; self-efficacy: 0.16, 0.04-0.28; global improvement in function: odds ratio 1.26, 95\% CI 1.04-1.39, and overall improvement: odds ratio 1.26, 95\% CI 1.06-1.51; but also with worsening in fear of movement: regression coefficient ?0.13, 95\% CI ?0.23 to ?0.04). In addition, there was some evidence of a weak association between patient ratings of the alliance and some outcomes at 12 months (improvements in self-efficacy: regression coefficient 0.15, 95\% CI 0.03-0.27; global improvement in both function, odds ratio 1.19, 95\% CI 0.03-1.37; and pain, odds ratio 1.14, 95\% CI 1.01-1.30; and overall improvement: odds ratio 1.21, 95\% CI 1.02-1.42). The data suggest that associations between therapist ratings of therapeutic alliance and outcomes were not strong, except for improved quality of life at 12 months (regression coefficient 0.01, 95\% CI 0.0003-0.01). Conclusions: Higher patient ratings, but not higher therapist ratings, of the therapeutic alliance were weakly associated with improvements in some clinical outcomes and with worsening in one outcome. Although the findings suggest that patients who perceive a stronger alliance with their therapist may achieve better clinical outcomes, the observed relationships were generally weak and unlikely to be clinically significant. The limitations include the fact that measures of therapeutic alliance have not been validated for use in musculoskeletal physical therapy settings. There was a risk of type 1 error; however, findings were interpreted on the basis of clinical significance rather than statistical significance alone. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000054415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369204 ",
doi="10.2196/23386",
url="http://rehab.jmir.org/2021/1/e23386/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33459601"
}


@Article{info:doi/10.2196/19747,
author="Doherty, Cailbhe
and Joorabchi, Arash
and Megyesi, Peter
and Flynn, Aileen
and Caulfield, Brian",
title="Physiotherapists' Use of Web-Based Information Resources to Fulfill Their Information Needs During a Theoretical Examination: Randomized Crossover Trial",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="17",
volume="22",
number="12",
pages="e19747",
keywords="evidence-based medicine",
keywords="knowledge discovery",
keywords="information seeking behavior",
keywords="information dissemination",
keywords="information literacy",
keywords="online systems",
keywords="point-of-care systems",
keywords="mobile phone",
abstract="Background: The widespread availability of internet-connected smart devices in the health care setting has the potential to improve the delivery of research evidence to the care pathway and fulfill health care professionals' information needs. Objective: This study aims to evaluate the frequency with which physiotherapists experience information needs, the capacity of digital information resources to fulfill these needs, and the specific types of resources they use to do so. Methods: A total of 38 participants (all practicing physiotherapists; 19 females, 19 males) were randomly assigned to complete three 20-question multiple-choice questionnaire (MCQ) examinations under 3 conditions in a randomized crossover study design: assisted by a web browser, assisted by a federated search portal system, and unassisted. MCQ scores, times, and frequencies of information needs were recorded for overall examination-level and individual question-level analyses. Generalized estimating equations were used to assess differences between conditions for the primary outcomes. A log file analysis was conducted to evaluate participants' web search and retrieval behaviors. Results: Participants experienced an information need in 55.59\% (845/1520) MCQs (assisted conditions only) and exhibited a mean improvement of 10\% and 16\% in overall examination scores for the federated search and web browser conditions, respectively, compared with the unassisted condition (P<.001). In the web browser condition, Google was the most popular resource and the only search engine used, accounting for 1273 (64\%) of hits, followed by PubMed (195 hits; 10\% of total). In the federated search condition, Wikipedia and PubMed were the most popular resources with 1518 (46\% of total) and 1273 (39\% of total) hits, respectively. Conclusions: In agreement with the findings of previous research studies among medical physicians, the results of this study demonstrate that physiotherapists frequently experience information needs. This study provides new insights into the preferred digital information resources used by physiotherapists to fulfill these needs. Future research should clarify the implications of physiotherapists' apparent high reliance on Google, whether these results reflect the authentic clinical environment, and whether fulfilling clinical information needs alters practice behaviors or improves patient outcomes. ",
doi="10.2196/19747",
url="http://www.jmir.org/2020/12/e19747/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33331826"
}


@Article{info:doi/10.2196/21704,
author="Biebl, Theresia Johanna
and Huber, Stephan
and Rykala, Marzena
and Kraft, Eduard
and Lorenz, Andreas",
title="Attitudes and Expectations of Health Care Professionals Toward App-Based Therapy in Patients with Osteoarthritis of the Hip or Knee: Questionnaire Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="28",
volume="8",
number="10",
pages="e21704",
keywords="mobile health",
keywords="digital health",
keywords="self-management",
keywords="osteoarthritis",
keywords="smartphone",
keywords="patient education",
keywords="exercise therapy",
abstract="Background: The use of mobile health (mHealth) apps is becoming increasingly widespread. However, little is known about the attitudes, expectations, and basic acceptance of health care professionals toward such treatment options. As physical activity and behavior modification are crucial in osteoarthritis management, app-based therapy could be particularly useful for the self-management of this condition. Objective: The objective of the study was to determine the expectations and attitudes of medical professionals toward app-based therapy for osteoarthritis of the hip or knee. Methods: Health care professionals attending a rehabilitation congress and employees of a university hospital were asked to fill out a questionnaire consisting of 16 items. A total of 240 questionnaires were distributed. Results: A total of 127 participants completed the questionnaire. At 95.3\% (121/127), the approval rate for app-based therapy for patients with osteoarthritis of the hip or knee was very high. Regarding possible concerns, aspects related to data protection and privacy were primarily mentioned (41/127, 32.3\%). Regarding potential content, educational units, physiotherapeutic exercise modules, and practices based on motivation psychology were all met with broad approval. Conclusions: The study showed a high acceptance of app-based therapy for osteoarthritis, indicating a huge potential of this form of treatment to be applied, prescribed, and recommended by medical professionals. It was widely accepted that the content should reflect a multimodal therapy approach. ",
doi="10.2196/21704",
url="http://mhealth.jmir.org/2020/10/e21704/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112255"
}


@Article{info:doi/10.2196/18233,
author="Durst, Jennifer
and Roesel, Inka
and Sudeck, Gorden
and Sassenberg, Kai
and Krauss, Inga",
title="Effectiveness of Human Versus Computer-Based Instructions for Exercise on Physical Activity--Related Health Competence in Patients with Hip Osteoarthritis: Randomized Noninferiority Crossover Trial",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="28",
volume="22",
number="9",
pages="e18233",
keywords="digital app",
keywords="exercise",
keywords="movement control",
keywords="self-efficacy",
keywords="control competence",
keywords="mHealth",
keywords="osteoarthritis",
keywords="tablet",
abstract="Background: Hip and knee osteoarthritis is ranked as the 11th highest contributor to global disability. Exercise is a core treatment in osteoarthritis. The model for physical activity--related health competence describes possibilities to empower patients to perform physical exercises in the best possible health-promoting manner while taking into account their own physical condition. Face-to-face supervision is the gold standard for exercise guidance. Objective: The aim of this study was to evaluate whether instruction and guidance via a digital app is not inferior to supervision by a physiotherapist with regard to movement quality, control competence for physical training, and exercise-specific self-efficacy. Methods: Patients with clinically diagnosed hip osteoarthritis were recruited via print advertisements, emails and flyers. The intervention consisted of two identical training sessions with one exercise for mobility, two for strength, and one for balance.  One session was guided by a physiotherapist and the other was guided by a fully automated tablet computer-based app. Both interventions took place at a university hospital. Outcomes were assessor-rated movement quality, and self-reported questionnaires on exercise-specific self-efficacy and control competence for physical training. Participants were randomly assigned to one of two treatment sequences. One sequence started with the app in the first session followed by the physiotherapist in the second session after a minimum washout phase of 27 days (AP group) and the other sequence occurred in the reverse order (PA group). Noninferiority was defined as a between-treatment effect (gIG)<0.2 in favor of the physiotherapist-guided training, including the upper confidence interval. Participants, assessors, and the statistician were neither blinded to the treatment nor to the treatment sequence. Results: A total of 54 participants started the first training session (32 women, 22 men; mean age 62.4, SD 8.2 years). The treatment sequence groups were similar in size (PA: n=26; AP: n=28). Seven subjects did not attend the second training session (PA: n=3; AP: n=4). The app was found to be inferior to the physiotherapist in all outcomes considered, except for movement quality of the mobility exercise (gIG --0.13, 95\% CI --0.41-0.16). In contrast to the two strengthening exercises in different positions (supine gIG 0.76, 95\% CI 0.39-1.13; table gIG 1.19, 95\% CI 0.84-1.55), movement quality of the balance exercise was close to noninferiority (gIG 0.15, 95\% CI --0.17-0.48). Exercise-specific self-efficacy showed a strong effect in favor of the physiotherapist (gIG 0.84, 95\% CI 0.46-1.22). In terms of control competence for physical training, the app was only slightly inferior to the physiotherapist (gIG 0.18, 95\% CI --0.14-0.50). Conclusions: Despite its inferiority in almost all measures of interest, exercise-specific self-efficacy and control competence for physical training did improve in patients who used the digital app. Movement quality was acceptable for exercises that are easy to conduct and instruct. The digital app opens up possibilities as a supplementary tool to support patients in independent home training for less complex exercises; however, it cannot replace a physiotherapist. Trial Registration: German Clinical Trial Register: DRKS00015759; http://www.drks.de/DRKS00015759 ",
doi="10.2196/18233",
url="http://www.jmir.org/2020/9/e18233/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985991"
}


@Article{info:doi/10.2196/19296,
author="Dunphy, Emma
and Gardner, C. Elizabeth",
title="Telerehabilitation to Address the Rehabilitation Gap in Anterior Cruciate Ligament Care: Survey of Patients",
journal="JMIR Form Res",
year="2020",
month="Sep",
day="18",
volume="4",
number="9",
pages="e19296",
keywords="anterior cruciate ligament",
keywords="telerehabilitation",
keywords="rehabilitation",
keywords="eHealth",
keywords="knee",
keywords="survey",
keywords="telehealth",
keywords="patient experience",
abstract="Background: Evidence shows that after anterior cruciate ligament (ACL) reconstruction, patients may have varied access to physical therapy. In particular, physical therapy input may end many months before patients reach full recovery. Telerehabilitation may provide an opportunity to address this rehabilitation gap and improve access to evidence-based rehabilitation alongside physical therapy at all stages of care. Objective: This study aims to understand the opinions of patients who have undergone ACL surgery and rehabilitation on the use of telerehabilitation as part of ACL care and define the population and explore their experiences and views on the acceptability of telerehabilitation after ACL reconstruction. Methods: This study was a cross-sectional, voluntary, web-based survey combining both closed and open questions. Ethical approval was obtained from the Yale School of Medicine Institutional Review Board. Participants were aged 16 years or older at the time of recruitment and had undergone ACL reconstruction within the past 5 years. A 26-item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary, and qualitative. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure the quality of reporting of surveys in the medical literature. Data were analyzed using Stata version 15. Qualitative data were analyzed using NVivo 11. The theoretical framework for this analysis is based on the Capability, Opportunity, and Motivation-Behavior model of behavior change. Results: A total of 100 participants opened the survey. All completers were unique. The participation and completion rates were each 96\% (96/100). Patients reported their physical therapy care ended at an average of 6.4 months and that they felt fully recovered at an average of 13.2 months. Only 26\% (25/96) of patients felt fully recovered at the end of physical therapy. Of these 96 patients, 54 (60\%) were younger than 30 years, 71 (74\%) were recreational athletes, 24 (24\%) were competitive athletes, 72 (75\%) had private insurance, 74 (77\%) were not familiar at all with telerehabilitation, and 89\% (85/96) felt capable. They preferred to use telerehabilitation at different stages of care. Reported benefits included resource saving, improved access to care, improved learning, and greater engagement. Concerns included incorrect performance of exercises or unmanaged pain being missed and less access to manual therapy, motivation, and opportunities to ask questions. Participants' priorities for a future telerehabilitation intervention included its use as an adjunct to physical therapy rather than a replacement, with content available for each stage of care, especially return to sports. Participants stressed that the intervention should be personalized to them and include measures of progress. Conclusions: These findings helped understand and define the ACL reconstruction population. Participants found telerehabilitation acceptable in principle and highlighted the key user requirements and scope of future interventions. ",
doi="10.2196/19296",
url="http://formative.jmir.org/2020/9/e19296/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32945776"
}


@Article{info:doi/10.2196/18508,
author="Korhonen, Olli
and V{\"a}yrynen, Karin
and Krautwald, Tino
and Bilby, Glenn
and Broers, Theresia Hedwig Anna
and Giunti, Guido
and Isomursu, Minna",
title="Data-Driven Personalization of a Physiotherapy Care Pathway: Case Study of Posture Scanning",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Sep",
day="15",
volume="7",
number="2",
pages="e18508",
keywords="digital health services",
keywords="information systems",
keywords="case reports",
keywords="qualitative research",
keywords="physiotherapy",
keywords="posture",
abstract="Background: Advanced sensor, measurement, and analytics technologies are enabling entirely new ways to deliver health care. The increased availability of digital data can be used for data-driven personalization of care. Data-driven personalization can complement expert-driven personalization by providing support for decision making or even by automating some parts of decision making in relation to the care process. Objective: The aim of this study was to analyze how digital data acquired from posture scanning can enhance physiotherapy services and enable more personalized delivery of physiotherapy. Methods: A case study was conducted with a company that designed a posture scan recording system (PSRS), which is an information system that can digitally record, measure, and report human movement for use in physiotherapy. Data were collected through interviews with different stakeholders, such as health care professionals, health care users, and the information system provider, and were analyzed thematically. Results: Based on the results of our thematic analysis, we propose three different types of support that posture scanning data can provide to enhance and enable more personalized delivery of physiotherapy: 1) modeling the condition, in which the posture scanning data are used to detect and understand the health care user's condition and the root cause of the possible pain; 2) visualization for shared understanding, in which the posture scanning data are used to provide information to the health care user and involve them in more collaborative decision-making regarding their care; and 3) evaluating the impact of the intervention, in which the posture scanning data are used to evaluate the care progress and impact of the intervention. Conclusions: The adoption of digital tools in physiotherapy has remained low. Physiotherapy has also lacked digital tools and means to inform and involve the health care user in their care in a person-centered manner. In this study, we gathered insights from different stakeholders to provide understanding of how the availability of digital posture scanning data can enhance and enable personalized physiotherapy services. ",
doi="10.2196/18508",
url="http://rehab.jmir.org/2020/2/e18508/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32930667"
}


@Article{info:doi/10.2196/18589,
author="Georgiou, Theodoros
and Islam, Riasat
and Holland, Simon
and van der Linden, Janet
and Price, Blaine
and Mulholland, Paul
and Perry, Allan",
title="Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Sep",
day="14",
volume="7",
number="2",
pages="e18589",
keywords="physiotherapy",
keywords="rhythm",
keywords="haptic",
keywords="tactile",
keywords="wearable",
keywords="cueing",
keywords="Huntington",
keywords="gait",
abstract="Background: Huntington disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities; they then degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external, usually auditory, rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (ie, tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking. An added benefit is that less intrusive, more private cues are delivered by a wearable device that leaves the ears free for conversation, situation awareness, and safety. This paper presents a case study where rhythmic haptic cueing (RHC) was applied to one person with HD. The case study has two elements:  the gait data we collected from our wearable devices and the comments we received from a group of highly trained expert physiotherapists and specialists in HD. Objective: The objective of this case study was to investigate whether RHC can be applied to improve gait coordination and limb control in people living with HD. While not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life. Methods: The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated-measures design with three conditions: before haptic rhythm (ie, baseline), with haptic rhythm, and after exposure to haptic rhythm. The second element is an in-depth interview with physiotherapists observing the session. Results: In comparison to the baseline, the physiotherapists noted a number of improvements to the participant's kinematics during her walk with the haptic cues. These improvements continued in the after-cue condition, indicating some lasting effects. The quantitative data obtained support the physiotherapists' observations. Conclusions: The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate, potentially therapeutic benefits for the walking kinematics of people living with HD and warrants further investigation. ",
doi="10.2196/18589",
url="http://rehab.jmir.org/2020/2/e18589/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924955"
}


@Article{info:doi/10.2196/19914,
author="Steiner, Bianca
and Elgert, Lena
and Saalfeld, Birgit
and Wolf, Klaus-Hendrik",
title="Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="25",
volume="8",
number="3",
pages="e19914",
keywords="shoulder",
keywords="upper extremity",
keywords="musculoskeletal diseases",
keywords="rehabilitation",
keywords="gamification",
keywords="serious games",
keywords="exergames",
keywords="scoping review",
abstract="Background: Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. Objective: This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. Methods: We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. Results: A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. Conclusions: There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics. ",
doi="10.2196/19914",
url="http://games.jmir.org/2020/3/e19914/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32840488"
}


@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/10.2196/16380,
author="Mehra, Sumit
and van den Helder, Jantine
and Visser, Bart
and Engelbert, H. Raoul H.
and Weijs, M. Peter J.
and Kr{\"o}se, A. Ben J.",
title="Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="23",
volume="22",
number="7",
pages="e16380",
keywords="frail elderly",
keywords="aged",
keywords="activities of daily living",
keywords="exercise",
keywords="health behavior",
keywords="telemedicine",
keywords="mobile devices",
keywords="tablet computers",
keywords="usability testing",
keywords="evaluation",
abstract="Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29\% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36\% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17\% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. ",
doi="10.2196/16380",
url="http://www.jmir.org/2020/7/e16380/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459652"
}


@Article{info:doi/10.2196/17841,
author="Burns, David
and Razmjou, Helen
and Shaw, James
and Richards, Robin
and McLachlin, Stewart
and Hardisty, Michael
and Henry, Patrick
and Whyne, Cari",
title="Adherence Tracking With Smart Watches for Shoulder Physiotherapy in Rotator Cuff Pathology: Protocol for a Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="5",
volume="9",
number="7",
pages="e17841",
keywords="rehabilitation",
keywords="treatment adherence and compliance",
keywords="wearable electronic devices",
keywords="machine learning",
keywords="rotator cuff",
abstract="Background: Physiotherapy is essential for the successful rehabilitation of common shoulder injuries and following shoulder surgery. Patients may receive some training and supervision for shoulder physiotherapy through private pay or private insurance, but they are typically responsible for performing most of their physiotherapy independently at home. It is unknown how often patients perform their home exercises and if these exercises are performed correctly without supervision. There are no established tools for measuring this. It is, therefore, unclear if the full benefit of shoulder physiotherapy treatments is being realized. Objective: The proposed research will (1) validate a smartwatch and machine learning (ML) approach for evaluating adherence to shoulder exercise participation and technique in a clinical patient population with rotator cuff pathology; (2) quantify the rate of home physiotherapy adherence, determine the effects of adherence on recovery, and identify barriers to successful adherence; and (3) develop and pilot test an ethically conscious adherence-driven rehabilitation program that individualizes patient care based on their capacity to effectively participate in their home physiotherapy. Methods: This research will be conducted in 2 phases. The first phase is a prospective longitudinal cohort study, involving 120 patients undergoing physiotherapy for rotator cuff pathology. Patients will be issued a smartwatch that will record 9-axis inertial sensor data while they perform physiotherapy exercises both in the clinic and in the home setting. The data collected in the clinic under supervision will be used to train and validate our ML algorithms that classify shoulder physiotherapy exercise. The validated algorithms will then be used to assess home physiotherapy adherence from the inertial data collected at home. Validated outcome measures, including the Disabilities of the Arm, Shoulder, and Hand questionnaire; Numeric Pain Rating Scale; range of motion; shoulder strength; and work status, will be collected pretreatment, monthly through treatment, and at a final follow-up of 12 months. We will then relate improvement in patient outcomes to measured physiotherapy adherence and patient baseline variables in univariate and multivariate analyses. The second phase of this research will involve the evaluation of a novel rehabilitation program in a cohort of 20 patients. The program will promote patient physiotherapy engagement via the developed technology and support adherence-driven care decisions. Results: As of December 2019, 71 patients were screened for enrollment in the noninterventional validation phase of this study; 65 patients met the inclusion and exclusion criteria. Of these, 46 patients consented and 19 declined to participate in the study. Only 2 patients de-enrolled from the study and data collection is ongoing for the remaining 44. Conclusions: This study will provide new and important insights into shoulder physiotherapy adherence, the relationship between adherence and recovery, barriers to better adherence, and methods for addressing them. International Registered Report Identifier (IRRID): DERR1-10.2196/17841 ",
doi="10.2196/17841",
url="https://www.researchprotocols.org/2020/7/e17841",
url="http://www.ncbi.nlm.nih.gov/pubmed/32623366"
}


@Article{info:doi/10.2196/16631,
author="Timmer, A. Merel
and Kloek, J. Corelien J.
and de Kleijn, Piet
and Kuijlaars, R. Isolde A.
and Schutgens, G. Roger E.
and Veenhof, Cindy
and Pisters, F. Martijn",
title="A Blended Physiotherapy Intervention for Persons With Hemophilic Arthropathy: Development Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="19",
volume="22",
number="6",
pages="e16631",
keywords="hemophilia",
keywords="physiotherapy",
keywords="exercise",
keywords="eHealth",
keywords="blended care",
keywords="mobile phone",
abstract="Background: Joint bleeds are the hallmark of hemophilia, leading to a painful arthritic condition called as hemophilic arthropathy (HA). Exercise programs are frequently used to improve the physical functioning in persons with HA. As hemophilia is a rare disease, there are not many physiotherapists who are experienced in the field of hemophilia, and regular physiotherapy sessions with an experienced physiotherapist in the field of hemophilia are not feasible for persons with HA. Blended care is an innovative intervention that can support persons with HA at home to perform the advised physical activities and exercises and provide self-management information. Objective: The aim of this study was to develop a blended physiotherapy intervention for persons with HA. Methods: The blended physiotherapy intervention, namely, e-Exercise HA was developed by cocreation with physiotherapists, persons with HA, software developers, and researchers. The content of e-Exercise HA was compiled using the first 3 steps of the Center for eHealth Research roadmap model (ie, contextual inquiry, value specification, and design), including people with experience in the development of previous blended physiotherapy interventions, a literature search, and focus groups. Results: A 12-week blended intervention was developed, integrating face-to-face physiotherapy sessions with a web-based app. The intervention consists of information modules for persons with HA and information modules for physiotherapists, a graded activity program using a self-chosen activity, and personalized video-supported exercises. The information modules consist of text blocks, videos, and reflective questions. The patients can receive pop-ups as reminders and give feedback on the performance of the prescribed activities. Conclusions: In this study, we developed a blended physiotherapy intervention for persons with HA, which consists of information modules, a graded activity program, and personalized video-supported exercises. ",
doi="10.2196/16631",
url="http://www.jmir.org/2020/6/e16631/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32558654"
}


@Article{info:doi/10.2196/17872,
author="Islam, Riasat
and Bennasar, Mohamed
and Nicholas, Kevin
and Button, Kate
and Holland, Simon
and Mulholland, Paul
and Price, Blaine
and Al-Amri, Mohammad",
title="A Nonproprietary Movement Analysis System (MoJoXlab) Based on Wearable Inertial Measurement Units Applicable to Healthy Participants and Those With Anterior Cruciate Ligament Reconstruction Across a Range of Complex Tasks: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="16",
volume="8",
number="6",
pages="e17872",
keywords="gait",
keywords="algorithms",
keywords="motion trackers",
keywords="lower extremity",
keywords="wearable electronic devices",
keywords="exercise therapy",
keywords="digital physiotherapy",
keywords="kinematics",
keywords="wearables",
keywords="range of motion",
keywords="anterior cruciate ligament",
abstract="Background: Movement analysis in a clinical setting is frequently restricted to observational methods to inform clinical decision making, which has limited accuracy. Fixed-site, optical, expensive movement analysis laboratories provide gold standard kinematic measurements; however, they are rarely accessed for routine clinical use. Wearable inertial measurement units (IMUs) have been demonstrated as comparable, inexpensive, and portable movement analysis toolkits. MoJoXlab has therefore been developed to work with generic wearable IMUs. However, before using MoJoXlab in clinical practice, there is a need to establish its validity in participants with and without knee conditions across a range of tasks with varying complexity. Objective: This paper aimed to present the validation of MoJoXlab software for using generic wearable IMUs for calculating hip, knee, and ankle joint angle measurements in the sagittal, frontal, and transverse planes for walking, squatting, and jumping in healthy participants and those with anterior cruciate ligament (ACL) reconstruction. Methods: Movement data were collected from 27 healthy participants and 20 participants with ACL reconstruction. In each case, the participants wore seven MTw2 IMUs (Xsens Technologies) to monitor their movement in walking, jumping, and squatting tasks. The hip, knee, and ankle joint angles were calculated in the sagittal, frontal, and transverse planes using two different software packages: Xsens' validated proprietary MVN Analyze and MoJoXlab. The results were validated by comparing the generated waveforms, cross-correlation (CC), and normalized root mean square error (NRMSE) values. Results: Across all joints and activities, for data of both healthy and ACL reconstruction participants, the CC and NRMSE values for the sagittal plane are 0.99 (SD 0.01) and 0.042 (SD 0.025); 0.88 (SD 0.048) and 0.18 (SD 0.078) for the frontal plane; and 0.85 (SD 0.027) and 0.23 (SD 0.065) for the transverse plane (hip and knee joints only). On comparing the results from the two different software systems, the sagittal plane was very highly correlated, with frontal and transverse planes showing strong correlation. Conclusions: This study demonstrates that nonproprietary software such as MoJoXlab can accurately calculate joint angles for movement analysis applications comparable with proprietary software for walking, squatting, and jumping in healthy individuals and those following ACL reconstruction. MoJoXlab can be used with generic wearable IMUs that can provide clinicians accurate objective data when assessing patients' movement, even when changes are too small to be observed visually. The availability of easy-to-setup, nonproprietary software for calibration, data collection, and joint angle calculation has the potential to increase the adoption of wearable IMU sensors in clinical practice, as well as in free living conditions, and may provide wider access to accurate, objective assessment of patients' progress over time. ",
doi="10.2196/17872",
url="http://mhealth.jmir.org/2020/6/e17872/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32543446"
}


@Article{info:doi/10.2196/16056,
author="van Egmond, A. Maarten
and Engelbert, H. Raoul H.
and Klinkenbijl, G. Jean H.
and van Berge Henegouwen, I. Mark
and van der Schaaf, Marike",
title="Physiotherapy With Telerehabilitation in Patients With Complicated Postoperative Recovery After Esophageal Cancer Surgery: Feasibility Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="9",
volume="22",
number="6",
pages="e16056",
keywords="physical therapy modalities",
keywords="telerehabilitation",
keywords="telemedicine",
keywords="esophageal neoplasms",
keywords="surgical oncology",
abstract="Background: Improvement of functional status with physiotherapy is an important goal for patients with postoperative complications and an increased length of hospital stay (LoS) after esophagectomy. Supervised physiotherapy with telerehabilitation instead of conventional face-to-face care could be an alternative to treat these patients in their home environment after hospital discharge (T0), but its feasibility has not yet been investigated in detail. Objective: The aim of this study was to investigate the feasibility of a 12-week supervised postoperative physiotherapy intervention with telerehabilitation for patients with esophageal cancer who underwent esophagectomy and had postoperative complications or who had an increased LoS. The secondary objective was to investigate the preliminary effectiveness of telerehabilitation on functional recovery compared with usual care. Methods: A prospective feasibility study with a matched historical comparison group was performed. Feasibility outcomes included willingness and adherence to participate, refusal rate, treatment duration, occurrence of adverse events, and patient satisfaction. Secondary outcome measures were measurements of musculoskeletal and cardiovascular functions and activities according to the domains of the International Classification of Functioning, Disability and Health. Results: A total of 22 patients with esophageal cancer who underwent esophagectomy and had postoperative complications or an increased LoS were included. The mean age at surgery was 64.55 (SD 6.72) years, and 77\% (17/22) of patients were male. Moreover, 15 patients completed the intervention. Patient adherence was 99.8\% in the first 6 weeks and dropped to 75.6\% in the following 6 weeks, with a mean difference of ?24.3\% (95\% CI 1.3 to 47.2; P=.04). At 3 months post operation, no differences in functional status were found between the intervention group and the matched historical comparison group. Conclusions: This study showed that a postoperative physiotherapeutic intervention with telerehabilitation is feasible for patients with postoperative complications or an increased LoS after esophageal cancer surgery up to 6 weeks after T0. ",
doi="10.2196/16056",
url="http://www.jmir.org/2020/6/e16056/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32515742"
}


@Article{info:doi/10.2196/16605,
author="Stevens, Timothy
and McGinnis, S. Ryan
and Hewgill, Blake
and Choquette, H. Rebecca
and Tourville, W. Timothy
and Harvey, Jean
and Lachapelle, Richard
and Beynnon, D. Bruce
and Toth, J. Michael
and Skalka, Christian",
title="A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile--Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation",
journal="JMIR Hum Factors",
year="2020",
month="May",
day="11",
volume="7",
number="2",
pages="e16605",
keywords="device use tracking",
keywords="internet of things",
keywords="neuromuscular electrical stimulation",
keywords="exercise",
keywords="smart devices",
keywords="mHealth",
keywords="rehabilitation",
keywords="mobile health",
keywords="digital health",
abstract="Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System--based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software--tracked device use, the RehabTracker system recorded 83\% (40/48) of the rehabilitation sessions, with 100\% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100\% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. ",
doi="10.2196/16605",
url="http://humanfactors.jmir.org/2020/2/e16605/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32384052"
}


@Article{info:doi/10.2196/19462,
author="Sheehy, Mary Lisa",
title="Considerations for Postacute Rehabilitation for Survivors of COVID-19",
journal="JMIR Public Health Surveill",
year="2020",
month="May",
day="8",
volume="6",
number="2",
pages="e19462",
keywords="covid-19",
keywords="rehabilitation",
keywords="subacute care",
keywords="inpatient rehabilitation",
keywords="public health",
keywords="infectious disease",
keywords="virus",
keywords="patient outcome",
keywords="geriatric",
keywords="treatment",
keywords="recovery",
doi="10.2196/19462",
url="http://publichealth.jmir.org/2020/2/e19462/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32369030"
}


@Article{info:doi/10.2196/14139,
author="Wijnen, Annet
and Hoogland, Jildou
and Munsterman, Tjerk
and Gerritsma, LE Carina
and Dijkstra, Baukje
and Zijlstra, P. Wierd
and Dekker, S. Johan
and Annegarn, Janneke
and Ibarra, Francisco
and Slager, EC Geranda
and Zijlstra, Wiebren
and Stevens, Martin",
title="Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Apr",
day="27",
volume="7",
number="1",
pages="e14139",
keywords="remote coaching",
keywords="internet",
keywords="osteoarthritis",
keywords="total hip arthroplasty",
keywords="home-based rehabilitation program",
keywords="physiotherapy",
keywords="usual care",
keywords="tablet app",
keywords="total hip replacement",
keywords="rehabilitation",
abstract="Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up \& Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales ``function in sport and recreational activities'' and ``hip-related quality of life'' of HOOS, and on the subscale ``physical role limitations'' of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2),  endorsed by effect sizes on the self-reported outcomes. Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. Trial Registration: ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo ",
doi="10.2196/14139",
url="http://rehab.jmir.org/2020/1/e14139/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338621"
}


@Article{info:doi/10.2196/15428,
author="Almeida, Jo{\~a}o
and Nunes, Francisco",
title="The Practical Work of Ensuring the Effective Use of Serious Games in a Rehabilitation Clinic: Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Feb",
day="28",
volume="7",
number="1",
pages="e15428",
keywords="serious games",
keywords="exergames",
keywords="physiotherapy rehabilitation",
keywords="practical rehabilitation work",
keywords="qualitative research",
abstract="Background: Many rehabilitation clinics adopted serious games to support their physiotherapy sessions. Serious games can monitor and provide feedback on exercises and are expected to improve therapy and help professionals deal with more patients. However, there is little understanding of the impacts of serious games on the actual work of physiotherapists. Objective: This study aimed to understand the impact of an electromyography-based serious game on the practical work of physiotherapists. Methods: This study used observation sessions in an outpatient rehabilitation clinic that recently started using a serious game based on electromyography sensors. In total, 44 observation sessions were performed, involving 3 physiotherapists and 22 patients. Observation sessions were documented by audio recordings or fieldnotes and were analyzed for themes using thematic analysis. Results: The findings of this study showed that physiotherapists played an important role in enabling the serious game to work. Physiotherapists briefed patients, calibrated the system, prescribed exercises, and supported patients while they played the serious game, all of which amounted to relevant labor. Conclusions: The results of this work challenge the idea that serious games reduce the work of physiotherapists and call for an overall analysis of the different impacts a serious game can have. Adopting a serious game that creates more work can be entirely acceptable, provided the clinical outcomes or other advantages enabled by the serious game are strong; however, those impacts will have to be assessed on a case-by-case basis. Moreover, this work motivates the technology development community to better investigate physiotherapists and their context, offering implications for technology design. ",
doi="10.2196/15428",
url="http://rehab.jmir.org/2020/1/e15428/"
}


@Article{info:doi/10.2196/14619,
author="Nelligan, K. Rachel
and Hinman, S. Rana
and Atkins, Lou
and Bennell, L. Kim",
title="A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="18",
volume="7",
number="10",
pages="e14619",
keywords="text messaging",
keywords="mobile phone",
keywords="knee osteoarthritis",
keywords="exercise",
abstract="Background: Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. Objective: The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. Methods: The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. Results: The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ?3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported \&lt;3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. Conclusions: This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise. ",
doi="10.2196/14619",
url="https://mhealth.jmir.org/2019/10/e14619",
url="http://www.ncbi.nlm.nih.gov/pubmed/31628786"
}


@Article{info:doi/10.2196/11617,
author="Welbie, Marlies
and Wittink, Harriet
and Westerman, J. Marjan
and Topper, Ilse
and Snoei, Josca
and Devill{\'e}, M. Walter L. J.",
title="A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment",
journal="JMIR Form Res",
year="2019",
month="Sep",
day="27",
volume="3",
number="3",
pages="e11617",
keywords="mHealth",
keywords="eHealth",
keywords="surveys and questionnaires",
keywords="physical therapy specialty",
keywords="qualitative research",
abstract="Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies. ",
doi="10.2196/11617",
url="https://formative.jmir.org/2019/3/e11617",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573909"
}


@Article{info:doi/10.2196/12293,
author="Chung, Hung-Yuan
and Chung, Yao-Liang
and Liang, Chih-Yen",
title="Design and Implementation of a Novel System for Correcting Posture Through the Use of a Wearable Necklace Sensor",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="28",
volume="7",
number="5",
pages="e12293",
keywords="wearable sensing technology",
keywords="necklace",
keywords="posture correction",
keywords="image recognition",
keywords="internet of things",
abstract="Background: To our knowledge, few studies have examined the use of wearable sensing devices to effectively integrate information communication technologies and apply them to health care issues (particularly those pertaining to posture correction). Objective: A novel system for posture correction involving the application of wearable sensing technology was developed in this study. The system was created with the aim of preventing the unconscious development of bad postures (as well as potential spinal diseases over the long term). Methods: The newly developed system consists of a combination of 3 subsystems, namely, a smart necklace, notebook computer, and smartphone. The notebook computer is enabled to use a depth camera to read the relevant data, to identify the skeletal structure and joint reference points of a user, and to compute calculations relating to those reference points, after which the computer then sends signals to the smart necklace to enable calibration of the smart necklace's standard values (base values for posture assessment). The gravitational acceleration data of the user are collected and analyzed by a microprocessor unit-6050 sensor housed in the smart necklace when the smart necklace is worn, with those data being used by the smart necklace to determine the user's body posture. When poor posture is detected by the smart necklace, the smart necklace sends the user's smartphone a reminder to correct his or her posture; a mobile app that was also developed as part of the study allows the smart necklace to transmit such messages to the smartphone. Results: The system effectively enables a user to monitor and correct his or her own posture, which in turn will assist the user in preventing spine-related diseases and, consequently, in living a healthier life. Conclusions: The proposed system makes it possible for (1) the user to self-correct his or her posture without resorting to the use of heavy, thick, or uncomfortable corrective clothing; (2) the smart necklace's standard values to be quickly calibrated via the use of posture imaging; and (3) the need for complex wiring to be eliminated through the effective application of the Internet of Things as well as by implementing wireless communication between the smart necklace, notebook computer, and smartphone. ",
doi="10.2196/12293",
url="https://mhealth.jmir.org/2019/5/e12293/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31140439"
}


@Article{info:doi/10.2196/12708,
author="Barak Ventura, Roni
and Nakayama, Shinnosuke
and Raghavan, Preeti
and Nov, Oded
and Porfiri, Maurizio",
title="The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation",
journal="J Med Internet Res",
year="2019",
month="May",
day="15",
volume="21",
number="5",
pages="e12708",
keywords="citizen science",
keywords="social interactions",
keywords="telerehabilitation",
keywords="physical therapy",
abstract="Background: Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. Objective: Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. Methods: We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. Results: We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). Conclusions: Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively. ",
doi="10.2196/12708",
url="http://www.jmir.org/2019/5/e12708/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094338"
}


@Article{info:doi/10.2196/10970,
author="Fitze, P. Daniel
and Franchi, Martino
and Popp, L. Werner
and Ruoss, Severin
and Catuogno, Silvio
and Camenisch, Karin
and Lehmann, Debora
and Schmied, M. Christian
and Niederseer, David
and Frey, O. Walter
and Fl{\"u}ck, Martin",
title="Concentric and Eccentric Pedaling-Type Interval Exercise on a Soft Robot for Stable Coronary Artery Disease Patients: Toward a Personalized Protocol",
journal="JMIR Res Protoc",
year="2019",
month="Mar",
day="27",
volume="8",
number="3",
pages="e10970",
keywords="cardiovascular rehabilitation",
keywords="concentric and eccentric exercise",
keywords="high-intensity interval training",
keywords="muscle oxygen saturation",
keywords="near-infrared spectroscopy",
keywords="peak oxygen uptake",
keywords="ramp test",
keywords="skeletal muscle power",
keywords="soft robot",
abstract="Background: Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. Objective: We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO2peak), peak aerobic power output (Ppeak), and parameters of muscle oxygen saturation (SmO2) during exercise, and anaerobic muscle power. Methods: We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO2. Moreover, the aerobic skeletal muscle power (Ppeak) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. Results: The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO2peak (+26\% vs ?6\%), and Ppeak (+20\% vs 0\%), and exaggerated muscle deoxygenation during the ramp test (248\% vs 49\%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (?9\% vs +20\%) and peak SmO2 (+7\% vs ?7\%). Anaerobic muscle power only improved after the CON protocol (+18\% vs ?15\%). Conclusions: This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the Ppeak. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. Trial Registration: ClinicalTrials.gov NCT02845063;?https://clinicaltrials.gov/ct2/show/NCT02845063 ",
doi="10.2196/10970",
url="https://www.researchprotocols.org/2019/3/e10970/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30916659"
}


@Article{info:doi/10.2196/10798,
author="Best, L. Krista
and Routhier, Fran{\c{c}}ois
and Sweet, N. Shane
and Lacroix, Emilie
and Arbour-Nicitopoulos, P. Kelly
and Borisoff, F. Jaimie",
title="Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation",
journal="JMIR Res Protoc",
year="2019",
month="Mar",
day="22",
volume="8",
number="3",
pages="e10798",
keywords="smartphone",
keywords="mobile phone",
keywords="behavior change",
keywords="digital peer training",
keywords="leisure-time physical activity",
keywords="spinal cord injury",
keywords="Medical Research Council framework",
abstract="Background: Leisure-time physical activity (LTPA) is a critical component of a healthy lifestyle for individuals with spinal cord injury (SCI). However, most individuals are not sufficiently active to accrue health benefits. The Active Living Lifestyles program for individuals with SCI who use manual wheelchairs (ALLWheel) targets important psychological factors that are associated with LTPA uptake and adherence while overcoming some barriers associated with participation restrictions. Objective: The goal of the paper is to describe the protocol for the development and evaluation of the ALLWheel program for individuals with SCI who use manual wheelchairs. Methods: The first three stages of the Medical Research Council framework for developing and evaluating complex interventions (ie, preclinical, modeling, exploratory) are described. The preclinical phase will consist of scoping and systematic reviews and review of theory. The intervention will be modeled by expert opinions and consensus through focus groups and Delphi surveys with individuals with SCI, clinicians, and community partners. Finally, the feasibility and potential influence of the ALLWheel program on LTPA and psychological outcomes will be evaluated. Results: This project is funded by the Craig H Neilsen Foundation, the Fonds de Recherche du Qu{\'e}bec--Sant{\'e}, and the Canadian Disability Participation Project and is currently underway. Conclusions: Using peer trainers and mobile phone technology may help to cultivate autonomy-supportive environments that also enhance self-efficacy. Following a framework for developing and evaluating a novel intervention that includes input from stakeholders at all stages will ensure the final product (ie, a replicable intervention) is desirable to knowledge users and ready for evaluation in a randomized controlled trial. If effective, the ALLWheel program has the potential to reach a large number of individuals with SCI to promote LTPA uptake and adherence. International Registered Report Identifier (IRRID): DERR1-10.2196/10798 ",
doi="10.2196/10798",
url="http://www.researchprotocols.org/2019/3/e10798/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30901001"
}


@Article{info:doi/10.2196/11123,
author="Hurley, A. Deirdre
and Keogh, Alison
and Mc Ardle, Danielle
and Hall, M. Amanda
and Richmond, Helen
and Guerin, Suzanne
and Magdalinski, Tara
and Matthews, James",
title="Evaluation of an E-Learning Training Program to Support Implementation of a Group-Based, Theory-Driven, Self-Management Intervention For Osteoarthritis and Low-Back Pain: Pre-Post Study",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="07",
volume="21",
number="3",
pages="e11123",
keywords="technology-enhanced learning",
keywords="evaluation",
keywords="e-learning",
keywords="digital learning",
keywords="program evaluation",
keywords="effectiveness",
keywords="physiotherapy",
keywords="implementation",
keywords="osteoarthritis",
keywords="low-back pain",
abstract="Background: By adaptation of the face-to-face physiotherapist-training program previously used in the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) feasibility trial, an asynchronous, interactive, Web-based, e-learning training program (E-SOLAS) underpinned by behavior and learning theories was developed. Objective: This study investigated the effect of the E-SOLAS training program on relevant outcomes of effective training and implementation. Methods: Thirteen physiotherapists from across Ireland were trained via E-SOLAS by using mixed methods, and seven physiotherapists progressed to implementation of the 6-week group-based SOLAS intervention. The effectiveness of E-SOLAS was evaluated using the Kirkpatrick model at the levels of reaction (physiotherapist engagement and satisfaction with E-SOLAS training methods and content), learning (pre- to posttraining changes in physiotherapists' confidence and knowledge in delivering SOLAS content and self-determination theory-based communication strategies, administered via a SurveyMonkey questionnaire), and behavior (fidelity to delivery of SOLAS content using physiotherapist-completed weekly checklists). During implementation, five physiotherapists audio recorded delivery of one class, and the communication between physiotherapists and clients was assessed using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behaviour Scale (CCBS), and an intervention-specific measure (ISM; 7-point Likert scale). A range of implementation outcomes were evaluated during training and delivery (ie, acceptability, appropriateness, feasibility, fidelity, and sustainability of E-SOLAS) using a posttraining feedback questionnaire and individual semistructured telephone interviews. Results: With regard to their reaction, physiotherapists (n=13) were very satisfied with E-SOLAS posttraining (median 5.0; interquartile range 1.0; min-max 4.0-5.0) and completed training within 3-4 weeks. With regard to learning, there were significant increases in physiotherapists' confidence and knowledge in delivery of all SOLAS intervention components (P<.05). Physiotherapists' confidence in 7 of 10 self-determination theory-based communication strategies increased (P<.05), whereas physiotherapists' knowledge of self-determination theory-based strategies remained high posttraining (P>.05). In terms of behavior, physiotherapists delivered SOLAS in a needs supportive manner (HCCQ: median 5.2, interquartile range 1.3, min-max 3.7-5.8; CCBS: median 6.6, interquartile range 1.0, min-max 5.6-7.0; ISM: median 4.5, interquartile range 1.2, min-max 2.8-4.8). Fidelity scores were high for SOLAS content delivery (total \%mean fidelity score 93.5\%; SD 4.9\%). The posttraining questionnaire and postdelivery qualitative interviews showed that physiotherapists found E-SOLAS acceptable, appropriate, feasible, and sustainable within primary care services to support the implementation of the SOLAS intervention. Conclusions: This study provides preliminary evidence of the effectiveness, acceptability, and feasibility of an e-learning program to train physiotherapists to deliver a group-based self-management complex intervention in primary care settings, which is equivalent to face-to-face training outcomes and would support inclusion of physiotherapists in a definitive trial of SOLAS. ",
doi="10.2196/11123",
url="https://www.jmir.org/2019/3/e11123/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30843863"
}


@Article{info:doi/10.2196/10342,
author="Hoogland, Jildou
and Wijnen, Annet
and Munsterman, Tjerk
and Gerritsma, LE Carina
and Dijkstra, Baukje
and Zijlstra, P. Wierd
and Annegarn, Janneke
and Ibarra, Francisco
and Zijlstra, Wiebren
and Stevens, Martin",
title="Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="31",
volume="7",
number="1",
pages="e10342",
keywords="home-based rehabilitation",
keywords="mobile phone",
keywords="osteoarthritis",
keywords="physiotherapy",
keywords="total hip arthroplasty",
abstract="Background: Recent developments in technology are promising for providing home-based exercise programs. Objective: The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. Methods: We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). Results: Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92\%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25\% (33/134) and work 15\% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale ``coaching'' and the lowest for the subscale ``sensor.'' Conclusions: A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed. ",
doi="10.2196/10342",
url="http://mhealth.jmir.org/2019/1/e10342/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30702438"
}


@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/10.2196/10307,
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/10.2196/10099,
author="Meyer, Robert
and Spittel, Susanne
and Steinfurth, Laura
and Funke, Andreas
and Kettemann, Dagmar
and M{\"u}nch, Christoph
and Meyer, Thomas
and Maier, Andr{\'e}",
title="Patient-Reported Outcome of Physical Therapy in Amyotrophic Lateral Sclerosis: Observational Online Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Nov",
day="12",
volume="5",
number="2",
pages="e10099",
keywords="ALS",
keywords="amyotrophic lateral sclerosis",
keywords="physical therapy",
keywords="MYMOP",
keywords="net promoter score",
keywords="NPS",
keywords="online self-assessment",
abstract="Background: Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular strength and functional maintenance is not fully understood. Objective: The purpose of this study was to examine patients' perception of physical therapy during symptom progression using an internet assessment approach. Methods: A prospective, longitudinal, observational study was performed. Recruitment took place in an ALS center in Berlin, Germany. Online self-assessment was established on a case management platform over 6 months. Participants self-assessed the progression of the disease with the ALS Functional Rating Scale-Revised (ALSFRS-R) and tracked the efficacy of targeted physical therapy using Measure Yourself Medical Outcome Profile (MYMOP). We used the net promoter score (NPS) to inquire into recommendation levels of physical therapy. Results: Forty-five participants with ALS were included in the study. Twenty-seven (60.0\%) started the online assessment. The mean duration of physical therapy sessions per week was 142.7 minutes (SD 60.4) with a mean frequency of 2.9 (SD 1.2) per week. As defined by MYMOP input, the most concerning symptoms were reported in the legs (62.2\%), arms (31.1\%), and less frequently in the torso (6.7\%). As expected for a progressive disease, there was a functional decline of 3 points in the ALSFRS-R at the end of the observation period (n=20). Furthermore, the MYMOP showed a significant loss of 0.8 in the composite score, 0.9 in the activity score and 0.8 in the targeted symptom. In spite of functional decline, the recommendation for physical therapy jumped from a baseline value of 20 NPS points to a very high 50 points at the end of study (P=.05). Conclusions: Physical therapy is perceived as an important treatment method by patients with ALS. Despite functional deterioration, patients are satisfied with physical therapy and recommend this intervention. The results also underline how the meaning of physical therapy changes throughout the disease. Physical therapy in ALS has to be regarded as a supportive and palliative health care intervention beyond functional outcome parameters. ",
doi="10.2196/10099",
url="http://rehab.jmir.org/2018/2/e10099/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30425026"
}


@Article{info:doi/10.2196/10522,
author="Applegate, E. Megan
and France, R. Christopher
and Russ, W. David
and Leitkam, T. Samuel
and Thomas, S. James",
title="Determining Physiological and Psychological Predictors of Time to Task Failure on a Virtual Reality S{\o}rensen Test in Participants With and Without Recurrent Low Back Pain: Exploratory Study",
journal="JMIR Serious Games",
year="2018",
month="Sep",
day="10",
volume="6",
number="3",
pages="e10522",
keywords="fatigue",
keywords="low back pain",
keywords="S{\o}rensen test",
keywords="trunk mass",
keywords="virtual reality",
abstract="Background: S{\o}rensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the S{\o}rensen test performance. Objective: The objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality S{\o}rensen test in participants with and without a history of recurrent low back pain. Methods: We recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index--matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality S{\o}rensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials. Results: A two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality S{\o}rensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=?.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=?.67, P<.001), Tampa Scale for Kinesiophobia (beta=?.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF. Conclusions: Trunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain. ",
doi="10.2196/10522",
url="http://games.jmir.org/2018/3/e10522/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30201604"
}


@Article{info:doi/10.2196/rehab.9219,
author="Kerr, Andrew
and Smith, Mark
and Reid, Lynn
and Baillie, Lynne",
title="Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Aug",
day="17",
volume="5",
number="2",
pages="e15",
keywords="stroke",
keywords="rehabilitation",
keywords="technology",
keywords="priorities",
abstract="Background: Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation. Objective: This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption. Methods: We invited stakeholders (n=60), comprising stroke survivors (20/60, 33\%), therapists (20/60, 33\%), caregivers, and technology developers (including researchers; 20/60, 33\%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions to enhance adoption. Results: A total of 25 priorities were generated from the survey; these were reduced to 10 nonranked priorities through discussion, consensus activities, and voting at Workshop 1: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff, and performance feedback. The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies. Conclusions: The key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence-based stroke rehabilitation. ",
doi="10.2196/rehab.9219",
url="http://rehab.jmir.org/2018/2/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30120086"
}


@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/games.7969,
author="Ling, Yun
and Ter Meer, P. Louis
and Yumak, Zerrin
and Veltkamp, C. Remco",
title="Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study",
journal="JMIR Serious Games",
year="2017",
month="Oct",
day="12",
volume="5",
number="4",
pages="e19",
keywords="rehabilitation exercise",
keywords="computer games",
keywords="hip replacement",
keywords="elderly",
keywords="physical therapists",
abstract="Background: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. Objective: The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient's personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient's medical status. Methods: This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. Results: The results showed that after successfully playing the games, 75\% to 100\% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43\%) due to interference with the Kinect v2 from support chairs. All the patients (100\%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed. Conclusions: The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time. ",
doi="10.2196/games.7969",
url="http://games.jmir.org/2017/4/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29025696"
}


@Article{info:doi/10.2196/rehab.6182,
author="Ploderer, Bernd
and Fong, Justin
and Klaic, Marlena
and Nair, Siddharth
and Vetere, Frank
and Cofr{\'e} Lizama, Eduardo L.
and Galea, Pauline Mary",
title="How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information",
journal="JMIR Rehabil Assist Technol",
year="2016",
month="Oct",
day="05",
volume="3",
number="2",
pages="e9",
keywords="stroke",
keywords="upper-limb rehabilitation",
keywords="therapy",
keywords="information visualization",
keywords="dashboard",
keywords="wearable technology",
abstract="Background: Stroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30\% to 60\% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients' adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient's arm movement and a Web-based dashboard to visualize this information for therapists. Objective: The aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process. Methods: An interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis. Results: Therapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients' activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and (3) to engage with other clinicians and researchers based on objective data. A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living. Conclusions: Upper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and visualization of contextual information to provide meaningful insights into patient engagement in activities of daily living. These findings open the door for further work to develop a fully functioning system and to trial it with patients and clinicians during therapy. ",
doi="10.2196/rehab.6182",
url="http://rehab.jmir.org/2016/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582257"
}


@Article{info:doi/10.2196/rehab.5524,
author="Lai, Byron
and Rimmer, James
and Barstow, Beth
and Jovanov, Emil
and Bickel, Scott C.",
title="Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series",
journal="JMIR Rehabil Assist Technol",
year="2016",
month="Jul",
day="14",
volume="3",
number="2",
pages="e8",
keywords="exercise",
keywords="physical activity",
keywords="telehealth",
keywords="spinal cord injury",
keywords="persons with disabilities",
abstract="Background: Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. Objective: To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. Methods: Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. Results: Participants completed all 24 intervention sessions with 100\% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8\%) were makeup sessions. The teleexercise system successfully recorded 85\% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. Conclusion: A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample. ",
doi="10.2196/rehab.5524",
url="http://rehab.jmir.org/2016/2/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582252"
}


@Article{info:doi/10.2196/resprot.4091,
author="Spasi{\'c}, Irena
and Button, Kate
and Divoli, Anna
and Gupta, Satyam
and Pataky, Tamas
and Pizzocaro, Diego
and Preece, Alun
and van Deursen, Robert
and Wilson, Chris",
title="TRAK App Suite: A Web-Based Intervention for Delivering Standard Care for the Rehabilitation of Knee Conditions",
journal="JMIR Res Protoc",
year="2015",
month="Oct",
day="16",
volume="4",
number="4",
pages="e122",
keywords="internet",
keywords="social media",
keywords="web applications",
keywords="mobile applications",
keywords="usability testing",
keywords="knee",
keywords="rehabilitation",
keywords="exercise",
keywords="self-management",
abstract="Background: Standard care for the rehabilitation of knee conditions involves exercise programs and information provision. Current methods of rehabilitation delivery struggle to keep up with large volumes of patients and the length of treatment required to maximize the recovery. Therefore, the development of novel interventions to support self-management is strongly recommended. Such interventions need to include information provision, goal setting, monitoring, feedback, and support groups, but the most effective methods of their delivery are poorly understood. The Internet provides a medium for intervention delivery with considerable potential for meeting these needs. Objective: The objective of this study was to demonstrate the feasibility of a Web-based app and to conduct a preliminary review of its practicability as part of a complex medical intervention in the rehabilitation of knee disorders. This paper describes the development, implementation, and usability of such an app. Methods: An interdisciplinary team of health care professionals and researchers, computer scientists, and app developers developed the TRAK app suite. The key functionality of the app includes information provision, a three-step exercise program based on a standard care for the rehabilitation of knee conditions, self-monitoring with visual feedback, and a virtual support group. There were two types of stakeholders (patients and physiotherapists) that were recruited for the usability study. The usability questionnaire was used to collect both qualitative and quantitative information on computer and Internet usage, task completion, and subjective user preferences. Results: A total of 16 patients and 15 physiotherapists participated in the usability study. Based on the System Usability Scale, the TRAK app has higher perceived usability than 70\% of systems. Both patients and physiotherapists agreed that the given Web-based approach would facilitate communication, provide information, help recall information, improve understanding, enable exercise progression, and support self-management in general. The Web app was found to be easy to use and user satisfaction was very high. The TRAK app suite can be accessed at http://apps.facebook.com/kneetrak/. Conclusions: The usability study suggests that a Web-based intervention is feasible and acceptable in supporting self-management of knee conditions. ",
doi="10.2196/resprot.4091",
url="http://www.researchprotocols.org/2015/4/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26474643"
}


@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/games.3401,
author="Tatla, K. Sandy
and Shirzad, Navid
and Lohse, R. Keith
and Virji-Babul, Naznin
and Hoens, M. Alison
and Holsti, Liisa
and Li, C. Linda
and Miller, J. Kimberly
and Lam, Y. Melanie
and Van der Loos, Machiel H. F.",
title="Therapists' Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation",
journal="JMIR Serious Games",
year="2015",
month="Mar",
day="10",
volume="3",
number="1",
pages="e2",
keywords="virtual reality",
keywords="technology adoption",
keywords="rehabilitation",
keywords="therapy",
keywords="social media",
keywords="gaming",
keywords="stroke",
keywords="cerebral palsy",
keywords="hemiplegia",
abstract="Background: The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians' perspectives regarding technology adoption by their clients. Objective: The objective of our study was to explore therapists' perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation. Methods: We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes. Results: Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media. Conclusions: This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that clinicians will adopt innovative technologies. ",
doi="10.2196/games.3401",
url="http://games.jmir.org/2015/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25759148"
}


@Article{info:doi/10.2196/rehab.3484,
author="Lam, Y. Melanie
and Tatla, K. Sandy
and Lohse, R. Keith
and Shirzad, Navid
and Hoens, M. Alison
and Miller, J. Kimberly
and Holsti, Liisa
and Virji-Babul, Naznin
and Van der Loos, Machiel H. F.",
title="Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups",
journal="JMIR Rehabil Assist Technol",
year="2015",
month="Feb",
day="10",
volume="2",
number="1",
pages="e1",
keywords="cerebral palsy",
keywords="stroke",
keywords="hemiplegia",
keywords="rehabilitation",
keywords="gaming",
keywords="social media",
keywords="technology adoption",
keywords="qualitative research",
abstract="Background: Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients' technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs. Objective: This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use. Methods: We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data. Results: We identified three key themes: (1) clients' use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups. Conclusions: Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games. ",
doi="10.2196/rehab.3484",
url="http://rehab.jmir.org/2015/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582236"
}


@Article{info:doi/10.2196/jmir.3154,
author="Garrido Navarro, Enrique Juan
and Ruiz Penichet, Manuel Victor
and Lozano P{\'e}rez, Dolores Mar{\'i}a",
title="Movement-Based Interaction Applied to Physical Rehabilitation Therapies",
journal="J Med Internet Res",
year="2014",
month="Dec",
day="09",
volume="16",
number="12",
pages="e281",
keywords="exercise movement techniques",
keywords="human--computer interaction",
keywords="interaction devices",
keywords="movement-based interaction",
keywords="rehabilitation therapies",
abstract="Background: Health care environments are continuously improving conditions, especially regarding the use of current technology. In the field of rehabilitation, the use of video games and related technology has helped to develop new rehabilitation procedures. Patients are able to work on their disabilities through new processes that are more motivating and entertaining. However, these patients are required to leave their home environment to complete their rehabilitation programs. Objective: The focus of our research interests is on finding a solution to eliminate the need for patients to interrupt their daily routines to attend rehabilitation therapy. We have developed an innovative  system that allows patients with a balance disorder to perform a specific rehabilitation exercise at home. Additionally, the system features an assistive tool to complement the work of physiotherapists. Medical staff are thus provided with a system that avoids the need for them to be present during the exercise in specific cases in which patients are under suitable supervision. Methods: A movement-based interaction device was used to achieve a reliable system for monitoring rehabilitation exercises performed at home. The system accurately utilizes parameters previously defined by the specialist for correct performance of the exercise. Accordingly, the system gives instructions and corrects the patient's actions. The data generated during the session are collected for assessment by the specialist to adapt the difficulty of the exercise to the patient's progress. Results: The evaluation of the system was conducted by two experts in balance disorder rehabilitation.  They were required to verify the effectiveness of the system, and they also facilitated the simulation of real patient behavior. They used the system freely for a period of time and provided interesting and optimistic feedback. First, they evaluated the system as a tool for real-life rehabilitation therapy. Second, their interaction with the system allowed us to obtain important feedback needed to improve the system. Conclusions: The system improves the rehabilitation conditions of people with balance disorder. The main contribution comes from the fact that it allows patients to carry out the rehabilitation process at home under the supervision of physiotherapists. As a result, patients avoid having to attend medical centers. Additionally, medical staff have access to an assistant, which means their presence is not required in many exercises that involve constant repetition. ",
doi="10.2196/jmir.3154",
url="http://www.jmir.org/2014/12/e281/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25491148"
}


@Article{info:doi/10.2196/games.2933,
author="Lozano-Quilis, Jose-Antonio
and Gil-G{\'o}mez, Hermenegildo
and Gil-G{\'o}mez, Jose-Antonio
and Albiol-P{\'e}rez, Sergio
and Palacios-Navarro, Guillermo
and Fardoun, M. Habib
and Mashat, S. Abdulfattah",
title="Virtual Rehabilitation for Multiple Sclerosis Using a Kinect-Based System: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2014",
month="Nov",
day="12",
volume="2",
number="2",
pages="e12",
keywords="multiple sclerosis",
keywords="motor rehabilitation",
keywords="virtual reality",
keywords="natural interfaces",
keywords="augmented reality",
abstract="Background: The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients' motivation and adherence to treatment. Objective: We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient's progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. Methods: A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Results: Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. Conclusions: The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed. ",
doi="10.2196/games.2933",
url="http://games.jmir.org/2014/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25654242"
}